The current profile of heart failure patients (advanced age, multiple comorbidities) has generated interest in emerging comorbidities, like iron deficiency, as potential therapeutic targets. The first part of this thesis investigates the prevalence, clinical predictors and prognosis of iron deficiency in chronic heart failure. Using a wide range of chronic heart failure patients from several countries with different cultural characteristics and geographic environments, we conclude that iron deficiency is frequently observed and strongly relates to disease severity. Furthermore, our results show that iron deficiency has detrimental effects on survival in chronic heart failure, regardless of hemoglobin concentration or renal function. In the second part of this thesis we examine the role of hemoglobin and markers of iron homeostasis in terms of risk prediction for new onset heart failure or cardiovascular events in the general population. The association between levels of hemoglobin and new onset heart failure appears to be “U-shaped”. Interestingly, hemoglobin levels, already within the high-normal range, are associated with an increased heart failure incidence. This was in contrast to anemia, where a higher annual HF incidence was only observed for severe anemia. Increasing ferritin levels independently amplify the risk for new onset heart failure in apparently healthy women from the general population and might be directly or indirectly involved in the pathogenesis of heart failure. Finally, we provide an overview of our current understanding on pathophysiology, epidemiology, clinical and prognostic consequences and contemporary and possible future therapeutic approaches for the treatment of iron deficiency in heart failure.
|Qualification||Doctor of Philosophy|
|Place of Publication||[Groningen]|
|Publication status||Published - 2016|