Pulmonary Vascular Disease: PAH |

Relationship of Iron Deficiency and Serum Ferritin Levels With Pulmonary Hypertension: The Jackson Heart Study FREE TO VIEW

Matthew Jankowich, MD; Samuel Evans, MD; Elizabeth Elston; Wen-Chih Wu, MD; Gaurav Choudhary
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Providence VA Medical Center, Providence, RI

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1150A. doi:10.1016/j.chest.2016.08.1260
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 01:30 PM - 03:00 PM

PURPOSE: Iron deficiency has been associated with idiopathic pulmonary arterial hypertension (IPAH), but whether iron deficiency or ferritin levels are associated with pulmonary hypertension (PH) or pulmonary artery systolic pressures in the general population is unknown.

METHODS: We performed a cross-sectional analysis of data on iron deficiency (exposure), and PH (pulmonary artery systolic pressure>40mmHg on echocardiogram) (outcome) on subjects with complete data on exposures and outcomes as well as covariates (n=2,876) enrolled in the Jackson Heart Study, a longitudinal prospective observational cohort study of heart disease in African-Americans from Jackson, Mississippi. Iron deficiency was defined as a serum ferritin level < 15ηg/mL (females); < 30ηg/mL (males). We determined crude prevalence ratios (PRs) for PH in iron deficient versus non-iron deficient groups. We also analyzed the prevalence of PH by sex-specific quartiles of ferritin (Females ≤ 47ηg/mL; > 47ηg/mL - 95ηg/mL; > 95ηg/mL - 171ηg/mL; > 171ηg/mL; Males ≤ 110ηg/mL; > 110ηg/mL - 182ηg/mL; > 182ηg/mL - 294ηg/mL; > 294ηg/mL), with the lowest quartile as the referent.

RESULTS: Median pulmonary artery systolic pressure was 27mmHg (interquartile range 23-31mmHg) in the study cohort. 149 subjects (5.2%) had PH. Of the 149 subjects with PH, only 4 (2.7%) were also iron deficient; crude PH prevalence ratio 0.5 (95% CI 0.2-1.4) in iron-deficiency. In analysis by quartiles of ferritin, adjusting for age and sex, there was no evidence of association in prevalence ratios for PH in quartiles 2 (PR 1.1, 95% CI 0.7-1.7), 3 (PR 0.8, 95% CI 0.5-1.3), or 4 (PR 0.8, 95% CI 0.5-1.3) compared with quartile 1 (referent group, PR 1). Further analyses of the relationship between pulmonary hypertension and ferritin as a log-transformed continuous variable or by quartiles of serum iron showed a similar lack of evidence for association between pulmonary hypertension and these variables.

CONCLUSIONS: In the Jackson Heart Study, the prevalence of pulmonary hypertension was similar in iron-deficient and non-iron deficient subjects. There was no evidence of a dose-response relationship between ferritin (or iron) levels and pulmonary hypertension.

CLINICAL IMPLICATIONS: Iron deficiency has been associated with IPAH, a rare disorder. However, in a large community-based sample of African-Americans, there was no evidence that iron deficiency or low iron levels was associated with elevated pulmonary artery pressures.

DISCLOSURE: The following authors have nothing to disclose: Matthew Jankowich, Samuel Evans, Elizabeth Elston, Wen-Chih Wu, Gaurav Choudhary

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