ADOLESCENT anaemia may represent an early marker of cardiometabolic vulnerability, according to a narrative review exploring its potential role in life-course preventive cardiology. However, researchers emphasised that evidence directly linking anaemia during adolescence to cardiovascular and metabolic disease in adulthood remains limited.
The review examined biological mechanisms, existing clinical evidence and potential implications for early cardiovascular risk assessment.
Researchers evaluated literature available through August 2026, examining whether adolescent anaemia could provide clinically useful information about future cardiometabolic health.
The review distinguished between anaemia, iron deficiency and iron deficiency anaemia, while separating direct evidence from adolescent populations from findings extrapolated from adult studies and mechanistic research.
Several biological pathways were identified as potentially connecting anaemia with cardiometabolic vulnerability.
These included impaired oxygen delivery, iron-dependent mitochondrial dysfunction, altered glucose metabolism, inflammation, endothelial dysfunction and reduced functional capacity.
However, much of the direct adolescent evidence concerned short-term functional outcomes rather than long-term cardiovascular disease.
The review highlighted the complexity of relationships between iron status and metabolic health.
Researchers noted that associations between iron and metabolic processes may be nonlinear and bidirectional, suggesting that iron status could influence metabolic function while also being affected by underlying metabolic conditions.
Importantly, iron deficiency anaemia may alter glycated haemoglobin measurements independently of actual glycaemic status, potentially complicating interpretation of metabolic assessments.
Evidence from adult heart failure trials also suggested that intravenous iron could provide selected clinical benefits.
However, contemporary outcome trials produced mixed findings, and any mortality benefit remained uncertain.
The researchers cautioned against directly applying findings from adult populations to adolescents without appropriate supporting evidence.
The review emphasised that nutritional deficiencies, inflammatory conditions and socioeconomic circumstances may contribute to both anaemia and cardiometabolic vulnerability.
Consequently, observed associations may reflect shared underlying determinants rather than a direct causal relationship.
Current clinical priorities include identifying and treating the underlying causes of adolescent anaemia, improving nutrition, evaluating menstrual health and promoting physical activity.
Cardiovascular risk assessment should continue to follow established age-based and risk-based indications rather than relying on anaemia as an independent screening marker.
Researchers called for prospective adolescent cohort studies to establish whether anaemia provides additional predictive value beyond recognised cardiovascular risk factors.
Intervention studies are also needed to determine whether treating specific causes of anaemia can improve long-term cardiometabolic outcomes.
Overall, the review positioned adolescent anaemia care within broader preventive health strategies while emphasising that its value as a future cardiovascular risk marker remains unproven.
Reference
Prasad DS et al. Adolescent anaemia as a candidate marker of cardiometabolic vulnerability: A life-course preventive cardiology perspective. Am Heart Journal. 2026.
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