Iron deficiency, affecting over a quarter of the global population, is particularly concerning in conditions like iron deficiency anemia (IDA) and hemoglobinopathies. While dietary intake generally maintains iron balance, certain factors like vegetarian diets or chronic medication use can disrupt this balance. In particular, low-dose aspirin use has been linked to iron deficiency in elderly individuals, even in the absence of gastrointestinal bleeding.

Recent studies suggest that aspirin’s iron-chelating metabolites, such as salicylic acid and its derivatives, might act similarly to combination iron chelation therapy, incrementally increasing iron excretion over time. This could explain the observed cases of IDA in long-term, low-dose aspirin users. The risk may be heightened in individuals with low dietary iron intake, such as vegetarians, or those with increased iron demands due to physical activity. However, in non-vegetarians, normal dietary iron intake may offset the increased excretion, maintaining iron balance. Further research is needed to fully understand the impact of these aspirin metabolites on iron metabolism and their broader implications in conditions like cancer, neurodegeneration, and diseases involving oxidative stress and ferroptosis.

Reference: Kontoghiorghes GJ. The Puzzle of Aspirin and Iron Deficiency: The Vital Missing Link of the Iron-Chelating Metabolites. Int J Mol Sci. 2024 May 9;25(10):5150. doi: 10.3390/ijms25105150. PMID: 38791185; PMCID: PMC11121054.