title: Ferritin levels and risk of heart failure-the Atherosclerosis Risk in Communities Study.
abstract: Severe iron overload is associated with cardiac damage, while iron deficiency has been related to worse outcomes in subjects with heart failure (HF). This study investigated the relationship between ferritin, a marker of iron status, and the incidence of HF in a community-based cohort.
  
  
  
  We examined 1063 participants who were free of heart failure from the Atherosclerosis Risk in Communities (ARIC) Study in whom ferritin serum levels were measured at baseline (1987-1989). The participants (mean age 52.7 ± 5.5 years, 62% women), were categorized in low (<30 ng/mL; n = 153), normal (30-200 ng/mL in women and 30-300 ng/mL in men; n = 663), and high (>200 ng/mL in women and >300 ng/mL in men; n = 247) ferritin levels. Multivariable Cox proportional hazards models were used to evaluate the relationship between ferritin and incident HF. After 21 ± 4.6 years of follow-up, HF occurred in 144 (13.5%) participants. When compared with participants with normal ferritin levels, participants with low ferritin levels had a higher risk of HF [hazard ratio (HR) = 2.24, 95% confidence interval (CI) 1.15-4.35; P = 0.02] as did those with high ferritin levels (HR = 1.81, 95% CI 1.01-3.25; P = 0.04), after adjusting for potential confounders. Notably, low ferritin levels remained associated with incident HF even after excluding subjects with anaemia (HR = 2.28, 95% CI 1.11-4.68; P = 0.03).
  
  
  
  Derangements in iron metabolism, either low or high ferritin serum levels, were associated with higher risk of incident HF in a general population, even without concurrent anaemia. These findings suggest that iron imbalance might play a role in the development of HF.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Odilson M
authors.initials: OM
authors.lastname: Silvestre
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.|University of Porto Medical School, Porto, Portugal.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gonçalves
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.|University of Campinas, Campinas, Brazil.
authors.forename: Wilson
authors.initials: W
authors.lastname: Nadruz
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.affiliation: University of North Carolina, NC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Couper
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Eckfeldt
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Pankow
authors.affiliation: Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Centre Göttingen (UMG), Göttingen, Germany.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005293:Ferritins / Q000097:blood*; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007501:Iron / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D005293:Ferritins; D007501:Iron
keywords: Ferritin; Heart failure; Iron deficiency; Iron overload