Nutritional Landscape of Iron in Cardiovascular Disease

Xinyi Shen; Meijuan Zhong; Zhiting Lin; Yingjie Wang; Xuexian Fang; Junxia Min; Fudi Wang

doi:10.1016/j.tjnut.2025.06.016

Nutritional Landscape of Iron in Cardiovascular Disease

J Nutr. 2025 Jun 30:S0022-3166(25)00401-8. doi: 10.1016/j.tjnut.2025.06.016. Online ahead of print.

Authors

Xinyi Shen¹, Meijuan Zhong¹, Zhiting Lin¹, Yingjie Wang¹, Xuexian Fang², Junxia Min³, Fudi Wang⁴

Affiliations

¹ School of Public Health, Hengyang Medical School, University of South China, Hengyang, 421001, China.
² Department of Nutrition and Toxicology, School of Public Health and Nursing, Hangzhou Normal University, Hangzhou, 311121, China. Electronic address: xfang@hznu.edu.cn.
³ The First Affiliated Hospital, Institute of Translational Medicine, Zhejiang Key Laboratory of Frontier Medical Research on Cancer Metabolism, Zhejiang University School of Medicine, Hangzhou 310058, China. Electronic address: junxiamin@zju.edu.cn.
⁴ School of Public Health, Hengyang Medical School, University of South China, Hengyang, 421001, China; The Second Affiliated Hospital, School of Public Health, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou 310058, China; School of Public Health, School of Basic Medical Sciences, Henan Medical University, Xinxiang 453003, China. Electronic address: fwang@zju.edu.cn.

PMID: 40602724
DOI: 10.1016/j.tjnut.2025.06.016

Abstract

Both iron deficiency and iron overload are highly prevalent worldwide, along with cardiovascular disease (CVD) and associated risk factors; moreover, iron imbalance and CVD, can occur simultaneously. Iron plays important roles in hematopoiesis, the composition and function of various enzymes, and a wide range of physiological and biochemical reactions. Here, we summarize our current knowledge regarding the association between altered iron homeostasis and various forms of CVD, including atherosclerosis, heart failure, pulmonary arterial hypertension, and myocardial infarction. In addition, we outline the latest data from observational and interventional studies regarding the effects of iron deficiency and iron overload on CVD. The pathogenicity between CVD and both iron deficiency and iron overload has been revealed thanks to several decades of research, and we discuss whether data obtained from randomized controlled trials (RCT) regarding iron deficiency and/or overload can be exploited to improve cardiovascular outcome. Although both iron deficiency and iron overload can be harmful to the heart, whether iron-targeted therapies can improve outcome in CVD remains an open question that warrants future study. The emergence of Ferrology as a distinct discipline focused on ecosystemic iron regulatory networks offers promising avenues for advancing cardiovascular care. We believe that targeted maintenance of iron homeostasis may catalyze paradigm-shifting approaches in CVD management, potentially unveiling novel therapeutic strategies that address previously unrecognized pathophysiological mechanisms.

Keywords: Cardiovascular disease; Dietary iron; Ferrology; Ferroptosis; Heart disease; Iron metabolism; Iron supplementation.