Iron-Deficiency Anemias Worsen Some Cardiovascular Diseases: The Role of Intravenous Ferric Carboxymaltose

Review Article

J Blood Disord. 2021; 8(1): 1065.

Iron-Deficiency Anemias Worsen Some Cardiovascular Diseases: The Role of Intravenous Ferric Carboxymaltose

Cacciapuoti F¹ and Cacciapuoti F²*

¹Department of Cardiology and ICU “V. Monaldi” Hospital, Italy

²Department of Internal Medicine, “L.Vanvitelli” Campania University, Italy

*Corresponding author: Federico Cacciapuoti, Internal Medicine Department, “L.Vanvitelli” Campania University, Piazza L. Miraglia, 2, Naples, Italy

Received: October 26, 2021; Accepted: November 18, 2021; Published: November 25, 2021


Background: Anemia induced by iron deficiency is a frequent co-morbidity of cardiovascular disease and is called as sideropenic anaemia. This is caused by low iron serum levels, with reduction of the hemoglobin value.

Methods: Iron-deficiency reduces the oxygen carry throughout the body. The reduction of oxygen supply to the cardiac and pulmonary systems can point out some clinical symptoms, such as precordial angor, dyspnea, tachycardia and edema at lower limbs. It also induces an increase of some hemodynamic data, such as pulmonary and capillary pressures and worsens the prognosis of patients subjected to cardiac surgery.

Results: Several data confirm that iron deficiency exerts detrimental effects in patients with coronary artery disease, heart failure, pulmonary hypertension and in those undergoing cardiac surgery.

Conclusions: Iron deficiency further worsen the outcome and the complications of some cardiovascular disease. In addition, the manner and the advantages of i.v. iron administration (ferric carboxymaltose especially) were displayed. This administration may be requested in some conditions of cardiovascular disease and in the coexistence of these with kidney failure.

Keywords: Anaemia; Iron; Coronary artery disease; Heart failure; Pulmonary hypertension; Cardiac surgery; Ferric carboxymaltose


Anemia is a very common disease worldwide. It is present in both sexes, particularly in middle aged and elderly subjects [1]. Several causes, such as reduced red blood cells, excessive loss of these (blood dripping), congenital diseases (thalassemia, falciform red blood cells, etc.), or unsatisfactory taking of iron and some B vitamins can induce anaemia [2]. Among these, sideropenic anaemia is the most common form of anaemia and is characterized by a reduction of iron-content in hemoglobin (< 13 gr/dl in men, <12 gr/dl in women) [3].

Anaemia induced by iron deficiency affects up to one-third of the world’s population. In many cases, it depends on some pathological/physiological conditions, such as hemorrhagic gastritis, intestinal polypus, bleeding hemorrhoids, chronic renal failure, plentiful menstruations, pregnancy, etc. Loss of the hemoglobin value is unable to supply an adequate amount of oxygen to different organs and systems, with a consequent functional inability of these. Iron metabolism involves two proteins, as transferrin and ferritin. Transferrin is a plasma-protein that transports iron through the blood. In the cytoplasm, iron is employed to synthetize heme-group, cytochromes and others. In contrast, the latter enables iron storage [4].

Sideropenic anaemia clinically shows with paleness, easy weariness, dyspnea for light efforts, coldness and paleness of upper and lower limbs. It also worsens the hemodynamics and symptoms.

Iron deficiency is particularly frequent in patients with some cardiovascular diseases, in whom it is associated with a poor outcome. Particularly, anaemia from iron deficiency can worsen and point out some symptoms induced by asymptomatic chronic Coronary Artery Disease (CAD), chronic heart failure, hypertension of pulmonary system and the prognosis of patients underwent to cardiac surgery [5].

Coronary Artery Disease

CAD happens because of a reduction of coronary lumen-width due to the atherosclerotic plaques, with consequent lowering of blood supply to the myocardial cells. This condition can be responsible of a myocardial ischemia, sometimes displaying abnormal cardiac beats (extrasystolic beats, tachy- or brady-arrhythmias, dyspnea for light efforts, etc.) with or without precordial pain. The contemporary presence of iron deficiency (with or without anaemia) favors a further reduction of coronary blood flow, with reduction of oxygen supply to the myocardial cells (Figure 1). The increase of pre-load (due to the reduced viscosity of the blood), the increase of heart beats and the reduction of stroke volume, further worsen the symptoms of myocardial ischemia when the iron deficiency is present at the same moment [6].