1. Iron Deficiency in Heart Failure and Effect of Dapagliflozin
- Author
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Docherty, Kieran F., Welsh, Paul, Verma, Subodh, De Boer, Rudolf A., O'Meara, Eileen, Bengtsson, Olof, Køber, Lars, Kosiborod, Mikhail N., Hammarstedt, Ann, Langkilde, Anna Maria, Lindholm, Daniel, Little, Dustin J., Sjöstrand, Mikaela, Martinez, Felipe A., Ponikowski, Piotr, Sabatine, Marc S., Morrow, David A., Schou, Morten, Solomon, Scott D., Sattar, Naveed, Jhund, Pardeep S., McMurray, John J.V., and Cardiovascular Centre (CVC)
- Subjects
ferritin ,heart failure ,Stroke Volume ,Iron Deficiencies ,sodium-glucose cotransporter 2 inhibitor ,anemia ,iron ,Glucosides ,Hepcidins ,Physiology (medical) ,Ferritins ,Receptors, Transferrin ,Receptors, Erythropoietin ,Humans ,Transferrins ,transferrin ,hepcidin ,Benzhydryl Compounds ,Cardiology and Cardiovascular Medicine ,Biomarkers ,erythropoiesis - Abstract
Background: Iron deficiency is common in heart failure and associated with worse outcomes. We examined the prevalence and consequences of iron deficiency in the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure) and the effect of dapagliflozin on markers of iron metabolism. We also analyzed the effect of dapagliflozin on outcomes, according to iron status at baseline. Methods: Iron deficiency was defined as a ferritin level Results: Of the 4744 patients randomized in DAPA-HF, 3009 had ferritin and transferrin saturation measurements available at baseline, and 1314 of these participants (43.7%) were iron deficient. The rate of the primary outcome was higher in patients with iron deficiency (16.6 per 100 person-years) compared with those without (10.4 per 100 person-years; P P -interaction=0.59). Similar findings were observed for cardiovascular death, heart failure hospitalization, and all-cause mortality. Transferrin saturation, ferritin, and hepcidin were reduced and total iron-binding capacity and soluble transferrin receptor increased with dapagliflozin compared with placebo. Conclusions: Iron deficiency was common in DAPA-HF and associated with worse outcomes. Dapagliflozin appeared to increase iron use but improved outcomes, irrespective of iron status at baseline. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03036124.
- Published
- 2022