Cardiology

Recent research has ascertained that, although iron deficiency is common in patients with chronic obstructive pulmonary disease (COPD), it is not routinely tested for or treated. It has also been shown that treating these patients with erythropoietin stimulating agents (ESAs) or intravenous iron not only corrects the iron deficiency but also improves symptoms of dyspnoea.

Stefan Anker is Professor of cardiology and cachexia research at Charité Universitätsmedizin Berlin, Germany. He is active in biomarker, anaemia, metabolic, immunological and nutrition research, with a particular focus on developing new therapies for heart failure and for cachexia. Professor Anker currently serves on the Board of the European Heart Failure Association (HFA) and is President of the HFA (2012–2014).

Traditionally, diabetes has been linked with iron overload and haemochromatosis. Our study, which was published recently in Diabetes Care, demonstrates that iron deficiency is prevalent in patients with stable coronary artery disease and type 2 diabetes, and that it may be linked with a poor prognosis for this patient group.

This retrospective study, presented at the Annual Cardiovascular Critical Care conference in Washington 2013, showed that anaemia significantly impacts cardiac surgery outcomes. Correcting preoperative anaemia (inclusive of iron deficiency), where feasible, could potentially help to improve cardiac surgery outcomes and reduce costs.

The phenomenon of ischaemic preconditioning (IPC) is clinically very important, being involved in the potential protection of myocardium during cardiac surgery or percutaneous invasive procedures. However, its precise mechanisms have not yet been established. It is commonly known that patients with either diabetes or heart failure do not benefit from IPC in a similar extent to subjects without these metabolic pathologies.

Intravenous iron therapy reduces symptoms for patients with chronic heart failure irrespective of anaemia, according to a subanalysis. The study indicates that iron status should be assessed in symptomatic patients with chronic heart failure both with and without anaemia, and that treatment of iron deficiency should be considered in both patient populations.

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