Can Iron Play a Crucial Role in Maintaining Cardiovascular Health in the 21st Century?

Round 1

Reviewer 1 Report

In this manuscript, Szklarz and colleagues reviewed regulations of iron metabolism and discussed the impact of iron metabolism on heart diseases, treatment of heart failure, diabetes and obesity. They also found that iron deficiency potentiated tissue sensitivity to heavy metals and chemical particles, which may led to a range of cardiovascular disorders. It also impaired body’s reactions to stress, and this led to the sympathetic nervous system hyperactivity and accelerated the progress of atherosclerosis. Finally, it could impair immune response to viral infections, including COVID-19, and reduced the effectiveness of vaccinations. Overall, this is a comprehensive review. However, further improvement is needed in the logical sorting of the text.

 

Major points:

1、Since it is mentioned in the article that both heart failure and iron deficiency are related to social and economic conditions, immigration, etc., in the subsequent description of the correlation between heart failure and iron deficiency, whether the role of common influencing factors in the correlation is considered, and whether there is data support of relevant attribution analysis?

2、The correlation between heart failure, iron deficiency and anemia is confusing, lacking in order and forming a relationship network. It is suggested to adjust the order of exposition to make the article more logical.

3、The title suggests that this review is more about iron and heart beating, but the link between heart failure and iron deficiency is only partial, and the link does not seem to be as severe as the title suggests. After reading the full text, I feel that the theme and focus are not consistent enough. It may be necessary to further clarify the wording.

4、According to the introduction in the abstract, it may be better to advance the content related to iron metabolism to the beginning of the text. So as to avoid the feeling of disorder in the structure of disease-iron metabolism-disease.

Author Response

Responses are sent in the attachment.

Author Response File: Author Response.doc

Reviewer 2 Report

Dear Authors, 

I carefully went through the entire review and it is very difficult to follow. Although it appears that you have done a thorough research of the literature, the information is far too dense and lacks proper organisation. If your intention is to highlight the importance of iron in chronic heart failure, this is hardly noticed by a reader.

My recommendations for improving this paper are as follows:

- adequate structuring of the work into chapters and subchapters;

- the inclusion of a methodology chapter in which you detail the research algorithm, article selection, criteria, research period etc and also a chapter detailing the objectives of this review;

- the introduction of a table containing the main studies you have chosen following the research algorithm;

- i would reduce the extensive descriptions of the involvement of iron in other pathologies and focus more on those directly related to chronic heart failure;

- the conclusion chapter should be reformulated in a concrete idea that resulted from this review, avoiding the introduction of new information, let alone epidemiological data;

- from my point of view, the bibliography should be also reduced.

Author Response

Responses are sent in the attachment.

Author Response File: Author Response.doc

Round 2

Reviewer 1 Report

The manuscript has been much improved.

Reviewer 2 Report

Dear Authors,

I have read carefully the revised version of the manuscript and from my point of view there are no further changes required.