Optimal ferritin levels
I've been reading about ferritin targets recently and came across an interesting study that got me thinking about what an "optimal" ferritin level actually is.
I was looking through the literature and came across this study:
https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1342686/full
The study looked at iron deficiency and mortality in both the general population and people with heart failure. What stood out to me was that ferritin <30 ng/mL was associated with increased long-term mortality, while TSAT <20% was associated with increased short-term mortality.
Now, I'm not suggesting that having a higher ferritin is better. But I do think it's interesting because we often hear arguments that ferritin should be driven as low as possible with hemachromatosis, whereas this study seems to suggest there may also be consequences to pushing iron stores too low.
It makes me wonder whether iron follows the same pattern as many other biomarkers:
- Too low = problems
- Too high = problems
- Somewhere in the middle = optimal
For those of you who have dug into the literature more than I have, is there actually any good evidence that a maintenance ferritin of 30 is healthier than 50? Or that 50 is healthier than 80?
A lot of the ferritin targets I see discussed online seem to be based on convention rather than hard outcome data.
A ferritin target around 50 ng/mL is commonly recommended for maintenance in hereditary hemochromatosis, but I'm curious whether that number is based on outcome data or whether it's primarily a practical target that has been adopted over time. Has anyone seen studies comparing different maintenance ferritin ranges (e.g., 30–50 vs 50–100) and looking at long-term outcomes?
Curious to hear what others think.