Non-anaemic iron deficiency (NAID) is a strategic target in cardiovascular medicine because of its association with a range of adverse effects in various conditions. Endeavours to tackle NAID in heart failure have yielded mixed results, exposing knowledge gaps in how best to define ‘iron deficiency’ and the handling of iron therapies by the body. To address these gaps, we harness the latest understanding of the mechanisms of iron homeostasis outside the erythron and integrate clinical and preclinical lines of evidence. The emerging picture is that current definitions of iron deficiency do not assimilate the multiple influences at play in patients with heart failure and, consequently, fail to identify those with a truly unmet need for iron. Additionally, current iron supplementation therapies benefit only certain patients with heart failure, reflecting differences in the nature of the unmet need for iron and the modifying effects of anaemia and inflammation on the handling of iron therapies by the body. Building on these insights, we identify untapped opportunities in the management of NAID, including the refinement of current approaches and the development of novel strategies. Lessons learned from NAID in cardiovascular disease could ultimately translate into benefits for patients with other chronic conditions such as chronic kidney disease, chronic obstructive pulmonary disease and cancer.

非贫血性缺铁（NAID）是心血管医学的一个战略目标，因为它与各种情况下的一系列不良反应有关。解决心力衰竭中 NAID 问题的努力取得了好坏参半的结果，暴露了如何最好地定义“缺铁”以及身体如何处理铁疗法方面的知识差距。为了解决这些差距，我们利用对红细胞外铁稳态机制的最新理解，并整合临床和临床前证据。目前的情况是，目前对铁缺乏的定义并没有考虑到心力衰竭患者的多重影响，因此无法识别那些真正对铁的需求未得到满足的患者。此外，目前的补铁疗法仅对某些心力衰竭患者有益，这反映了铁需求未满足的性质以及贫血和炎症对身体处理铁疗法的改变作用的差异。基于这些见解，我们发现了 NAID 管理中尚未开发的机会，包括改进当前方法和制定新策略。从 NAID 在心血管疾病方面获得的经验教训最终可能会转化为患有其他慢性疾病（如慢性肾病、慢性阻塞性肺病和癌症）的患者的益处。