Elevated serum ferritin may serve as an independent prognostic biomarker for major adverse cardiovascular events (MACEs) in patients with Takayasu arteritis (TAK), according to a recent study published in Clinical Rheumatology. The findings suggest that serum ferritin could help identify patients with TAK who are at increased risk of adverse cardiovascular outcomes during follow-up.
Elevated serum ferritin levels have been associated with adverse outcomes in several autoimmune diseases and cardiovascular conditions. However, the clinical significance of ferritin in TAK has remained unclear. Ferritin is commonly used as a marker of body iron stores, but its concentration can also increase in response to systemic inflammation, making it potentially relevant to inflammatory diseases such as TAK.
Iron is an essential micronutrient involved in several physiological processes, including oxygen transport and storage, mitochondrial respiration, and redox reactions. Serum ferritin maintains excess iron in a safe and bioavailable form and generally correlates with total body iron stores. However, ferritin is also an acute-phase reactant that is significantly upregulated during inflammatory responses. Therefore, elevated serum ferritin may reflect systemic inflammation in addition to iron status.
This inflammatory component may be particularly relevant to cardiovascular outcomes. Patients with coronary artery disease and heart failure frequently exhibit chronic inflammatory responses, while previous studies have associated increased serum ferritin levels with progression of coronary artery disease and adverse cardiovascular outcomes. Inflammation may contribute to myocardial oxidative stress and tissue injury, potentially affecting cardiac function and prognosis.
To investigate the prognostic significance of ferritin in TAK, researchers conducted a two-center retrospective cohort study involving 189 treatment-naïve patients with TAK who underwent serum ferritin testing at baseline. The patients were followed longitudinally, and the association between baseline serum ferritin levels and adverse cardiovascular events was assessed using survival analyses.
During a median follow-up of 34.00 months (range, 20.00–55.00 months), 37 patients (19.6%) experienced MACEs. The researchers identified a serum ferritin cut-off value of 68.6 μg/L. Patients with serum ferritin levels above this threshold had significantly higher MACE rates at 12, 36, 60, and 96 months than those with lower ferritin levels. The differences were statistically significant at all four time points, with χ² values of 8.59 (P = 0.003), 15.23 (P < 0.001), 11.48 (P < 0.001), and 12.63 (P < 0.001), respectively.
Further analysis showed that serum ferritin was independently associated with the risk of MACEs at 96 months. When serum ferritin was analysed as a continuous variable, the hazard ratio was 1.003 (95% CI, 1.001–1.006; P = 0.007). When ferritin was analysed as a categorical variable using the identified cut-off, patients with higher serum ferritin levels had a significantly increased risk of MACEs (HR, 2.609; 95% CI, 1.280–5.320; P = 0.008).
The predictive association between serum ferritin and MACEs remained broadly consistent across most subgroups. The findings indicate that elevated baseline serum ferritin is associated with poorer cardiovascular outcomes in patients with TAK and may provide additional prognostic information beyond conventional clinical assessment. Patients with higher ferritin concentrations had a greater risk of adverse cardiovascular events during follow-up, suggesting that increased ferritin levels could help identify individuals who may benefit from closer monitoring.
The researchers noted that the prognostic value of serum ferritin may be related to its dual role as a marker of iron stores and systemic inflammation. However, the retrospective design, two-center setting, and relatively limited sample size warrant confirmation in larger prospective and multicenter studies. Further research is also needed to determine whether changes in ferritin levels over time provide additional prognostic information. The study identifies serum ferritin as an independent biomarker associated with MACE risk in TAK and highlights its potential role in cardiovascular risk assessment among patients with this large-vessel vasculitis.
References
- Ci W, Kong F, Du J, Zhang Y, Zhao Y, Pan L. Serum ferritin as a predictor of major adverse cardiovascular events in Takayasu arteritis: a two-center retrospective cohort study. Clin Rheumatol. 2026 Aug;45(8):4993-5004.
- Aisikeer N, Zhang J, Gao WT, Wen ZY, He XC, Chen HX, Li YX, Zheng YY, Ma YT. Effect of serum ferritin on the prognosis of patients with coronary heart disease combined with heart failure. BMC Cardiovasc Disord. 2025 Nov 24;25(1):886.