Iron Deficiency and Heart Failure


Research shows around 30% of the world’s population is deficient in iron. Iron is an essential nutrient, but deficiency isn’t just a nutritional issue. It’s of critical concern for heart health–especially in middle age. 

Read on to discover the link between iron deficiency and heart disease, and actionable strategies to enhance your cardiovascular wellness, naturally.

Can low iron cause heart issues? 

Most people associate iron deficiency with symptoms like fatigue and anemia–but a growing number of medical experts say it can also play a role in the development of heart disease. 

Recent research from the University Heart and Vasculature Centre Hamburg, Germany suggests that correcting iron deficiency could prevent up to 10% of coronary heart disease cases among middle-aged adults.

According to study author Dr. Benedikt Schrage, this research was observational in nature (as opposed to experimental, in which researchers introduce an intervention to participants to assess its effects). “However,” Dr. Schrage says, “Evidence is growing that there is a link, and these findings provide the basis for further research to confirm the results.” 

The study involved over 12,000 participants, and identified those with either absolute or functional iron deficiency as more prone to heart disease. 

Absolute deficiency is characterized by a lack of stored iron, which is easily addressed with supplementation. Functional iron deficiency, on the other hand, means the body has sufficient iron stores but struggles to utilize this iron–which presents a complex challenge for maintaining a healthy heart.

The study found that absolute deficiency raised heart disease risk by 20%, but wasn’t associated with higher rates of death. More concerningly, researchers linked functional deficiency to a:

  • 24% higher risk of coronary heart disease
  • 26% higher risk of death due to cardiovascular issues
  • 12% higher risk of death due to any cause

This is a serious problem, given the fact that nearly two-thirds of participants and one-third of the global population have low levels of this vital nutrient. 

The role of iron in heart health

Iron is critical for the production of hemoglobin, which helps transport oxygen to the heart and throughout the body. For this reason, low iron levels can strain the heart, making it work harder to oxygenate the body–thereby increasing heart disease risk.

Iron is also essential for the production of mitochondria. Mitochondria are structures within cells that perform specific functions and generate energy for cellular activities. In heart muscle cells, mitochondria allow the production of energy necessary for the heart to keep pumping.

Iron’s role also extends to reducing oxidative stress (damage to cells from harmful compounds called free radicals) and inflammation, which are both known contributors to heart disease. 

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Researchers have also linked iron deficiency to impaired endothelial function (the inner lining of blood vessels), which is critical for vascular health and blood pressure regulation.

Preventing iron deficiency to reduce heart disease risk

Preventing and managing iron deficiency is crucial in reducing heart disease risk–especially during middle age, when the body becomes more susceptible to cardiovascular issues. 

A comprehensive approach to prevention and management is key, involving not just the replenishment of iron stores but also ensuring the iron is effectively utilized by the body.

Here are some tips to prevent iron deficiency and boost your heart health.

Eat iron-rich foods.

There are two types of iron sources: heme (animal-based) and non-heme (plant-based.) Heme is more readily absorbed by the body. In fact, over 95% of functional iron in the body is in the form of heme, according to one study. 

But it’s best to consume a mix of both kinds. Research shows that pairing non-heme sources with vitamin C-rich foods helps with iron absorption.

Heme iron sources:

  • Meat (beef, pork, lamb)
  • Poultry (chicken, turkey, eggs)
  • Seafood (salmon, sardines, tuna)
  • Organ meats (liver, kidney)

Non-heme iron sources:

  • Nuts and seeds (almonds, pistachios, sunflower seeds)
  • Dried fruit (raisins)
  • Legumes (beans, lentils, chickpeas)
  • Leafy green vegetables (spinach, kale, broccoli)
  • Tofu
  • Iron-fortified foods (whole grain bread, pasta, breakfast cereals)

Excellent sources of vitamin C:

  • Citrus fruits (oranges, grapefruit, lemons)
  • Bell peppers
  • Strawberries
  • Broccoli
  • Brussels sprouts

Consider an iron supplement.

If you find it challenging to get enough iron through foods (if, for example, you follow a plant-based diet), supplementation might be necessary. Consult your healthcare provider for the appropriate type and dosage to prevent overload. 

Alternatively, if you have a functional iron deficiency, experience side effects from oral supplements (such as gastrointestinal discomfort), or take medications that interact poorly with iron supplements, your doctor might suggest intravenous iron therapy. 

This treatment directly boosts available iron, bypassing the digestive system. Check with your healthcare provider for the best treatment options for your unique situation.

Manage underlying health conditions.

Certain chronic conditions (such as inflammatory autoimmune diseases) can inhibit iron absorption or utilization. Consult with your doctor to determine the best route to manage any conditions you may have that could affect your iron levels and, therefore, heart health.

Regularly monitor your levels.

Check your iron levels with blood tests regularly. Your healthcare provider will look at ferritin and transferrin saturation to recommend prevention and treatment options.

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Ferritin is a protein that measures the iron stored in your blood. Low ferritin means your iron reserves are low. Although doctors often see levels under 30 as a sign of iron deficiency, other health issues can also affect these levels.

Transferrin saturation (TSAT) is a calculation that shows what percentage of your blood’s iron is being carried by a protein called transferrin, compared to how much it could potentially carry. 

TSAT helps decide whether you need iron supplements, and whether your deficiency is due to low iron stores or your body’s inability to use its iron properly (functional deficiency).

It’s especially useful for spotting iron deficiency when you have other health conditions that might make ferritin levels less reliable. A TSAT below 20% usually indicates deficiency. 

If both your ferritin and TSAT are low, you’re certainly deficient in iron. 

Adopt other healthy lifestyle habits.

Other lifestyle habits play a critical role in preventing iron deficiency and heart disease. Here are some tips:

  • Exercise regularly. Moderate exercise increases red blood cell and hemoglobin production, boosting iron levels and energy. Get your heart pumping for around 30 minutes each day.
  • Watch your caffeine intake. Caffeinated beverages like coffee contain polyphenols that can make it harder for your body to absorb plant-based iron. So, if you don’t eat meat, it may be best to limit your caffeine consumption–or avoid it altogether. 
  • Avoid excessive alcohol. Similar to caffeine, drinking too much alcohol can disrupt the way your body handles iron–either leading to a deficiency or an overload–which can harm your liver and other organs.
  • Limit dairy products. Research shows that dairy’s calcium and protein content can interfere with iron absorption. Enjoy small to moderate amounts only.
  • Quit smoking. Smoking indirectly affects iron by increasing inflammation and oxidative stress, while lowering vitamin C levels–two key factors in iron storage. Quitting smoking can improve your iron levels and overall health.

Understanding the link between iron deficiency and heart health can help protect you from developing cardiovascular issues. 

By eating well, considering supplements as needed, managing any underlying health conditions and living an active, healthy lifestyle, you can keep your iron levels and whole body in great shape, paving the way for a longer, healthier life.


Iron deficiency in middle age is linked with higher risk of developing heart disease

Association of iron deficiency with incident cardiovascular diseases and mortality in the general population

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Carrie Solomon

Carrie Solomon is a freelance health writer, copywriter, and passionate wellness enthusiast. She’s on a mission to help wellness-focused companies educate, engage, and inspire their audiences to make the world a healthier, happier place. Learn more about her at or on LinkedIn.

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