Association of Hemoglobin Concentration and Its Change With Cardiovascular and All‐Cause Mortality

Lee, Gyeongsil; Choi, Seulggie; Kim, Kyuwoong; Yun, Jae Moon; Son, Joung Sik; Jeong, Su Jin; Kim, Sung Min; Park, Sang Min

doi:10.1161/jaha.117.007723

Cited by 77 publications

(71 citation statements)

References 27 publications

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“…Having established a physiological drop of haemoglobin with increasing age, this leads to a conflict with results from several studies showing an association between anaemia and morbidity and mortality in the elderly (Culleton et al , ; Penninx et al , ; Lee et al , ; Wouters et al , ). According to these studies, anaemic elderly individuals have an increased risk of death in the following years even after correction of major confounding factors.…”

Section: Discussionmentioning

confidence: 98%

Blood counts in adult and elderly individuals: defining the norms over eight decades of life

Zierk

Krebs²,

Rauh

et al. 2020

Br J Haematol

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The blood count is one of the most common tests used for health assessment. In elderly individuals, selection of a 'healthy' reference population for laboratory assessment is difficult due to the high prevalence of chronic morbidities, leading to uncertainty regarding appropriate reference intervals. In particular, age-specific lower haemoglobin reference limits to define anaemia are controversial. Here, we applied a data mining approach to a large dataset of 3 029 904 clinical routine samples to establish blood count reference intervals. We excluded samples from units/specialists with a high proportion of abnormal blood counts, samples from patients with an unknown or decreased estimated glomerular filtration rate, and samples with abnormal test results in selected other analytes. After sample exclusion, 566 775-572 060 samples from different individuals aged 20-100 years were available for analysis. We then used an established statistical algorithm to determine the distribution of physiological test results and calculated age-and sex-specific reference intervals. Our results show substantial trends with age in haematology analytes' reference intervals. Most notably, haemoglobin and red cell counts decline in men with advanced age, accompanied by increases in red cell volume in both sexes. These findings were confirmed in an independent dataset, and suggest an at least partly physiologic cause.The blood count is one of the most common tests for health assessment with diagnostic and therapeutic implications for a multitude of common to rare and minor to life-threatening conditions. However, despite its frequent clinical use and importance and near-universal availability on the one hand, and an ageing population throughout the world on the other hand, uncertainty regarding appropriate reference intervals for older individuals still exists. In particular, age-specific lower reference limits for haemoglobin, which define anaemia, are controversial, despite substantial consequences for individual patients and considerable public health impact.A major challenge when establishing reference intervals for individuals >50 years is the increasing proportion of chronic morbidities and medication with age, which leads to exclusion of these subjects from conventional reference interval studies (Adeli et al., 2015;R€ ohrig et al., 2018). Based on these restrictions, data mining of age-specific reference intervals using laboratory test results collected from routine patient care can be considered a viable complement to conventional reference interval studies (Haeckel et al., 2017;Jones et al., 2018). In contrast to the highly selected population of conventional approaches, a reference interval data mining approach uses exactly the 'real world' population to which the reference intervals are ultimately applied, while still excluding outliers. In addition, the necessity to obtain a patient history and perform a clinical examination restricts the number of individuals who can be recruited for a conventional reference sample, while...

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Section: Discussionmentioning

confidence: 98%

Blood counts in adult and elderly individuals: defining the norms over eight decades of life

Zierk

Krebs²,

Rauh

et al. 2020

Br J Haematol

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“…The associations between hemoglobin (Hb) concentrations and cardiocerebrovascular diseases have been well investigated, primarily among high‐risk groups, including patients with chronic kidney disease or cardiovascular disease and older adults 1, 2, 3, 4, 5, 6, 7, 8. However, it is possible that an abnormal Hb concentration is a consequence of preclinical cardiocerebrovascular disease rather than a predisposing factor.…”

Section: Introductionmentioning

confidence: 99%

Association Between Changes in Hemoglobin Concentration and Cardiovascular Risks and All‐Cause Mortality Among Young Women

Lee

Choi

Kim

et al. 2018

JAHA

Self Cite

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BackgroundAnemia is considered to increase the risk of mortality in high‐risk populations, but its effect has not been examined among young populations. This study aimed to determine the effect of hemoglobin (Hb) concentration and its changes on the risk of acute myocardial infarction (AMI), stroke, cerebrovascular disease and all‐cause mortality among young women.Methods and ResultsWe analyzed data from the Korean National Health Information Database on 808 143 women aged 20 to 39 years without any cardiocerebrovascular disease. A 1‐time Hb concentration and changes in Hb over a 2‐year period were calculated as exposures. Participants were followed for a median of 10 years to determine the risk of AMI, stroke, cerebrovascular disease, and all‐cause mortality. There were U‐ or J‐shaped associations between Hb concentration or change in Hb and AMI, stroke, cerebrovascular disease, and all‐cause mortality. Increasing the Hb concentration from normal to high increased the risk for AMI (hazard ratio [95% confidence interval]: 1.49 [1.08‐2.04]). With regard to the risk for stroke, increasing the Hb concentration from a normal to a high range increased the risk (hazard ratio [95% confidence interval]: 1.10 [1.02‐1.35]), and decreasing the Hb concentration from a high to a normal range decreased this risk (hazard ratio [95% confidence interval]: 0.80 [0.60‐0.97]). Improving anemia to the normal Hb range decreased all‐cause mortality (hazard ratio [95% confidence interval]: 0.81 [0.69‐0.94]); however, overcorrection of Hb concentration (Hb≥14.0 g/dL) was not significant.ConclusionsThese findings suggest that regular Hb analysis may assist in identifying young women who are at risk of AMI, stroke, cerebrovascular disease, and all‐cause mortality.

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“…Third, we applied the PSM approach to facilitate the selection of controls with an almost equal rate of baseline characteristics. Lastly, we used a competing risk model to examine the association between anemia and stroke, considering that anemic patients may possess a higher mortality rate [ 43 ], which may shorten the observation period and underestimate the incidence of stroke.…”

Section: Discussionmentioning

confidence: 99%

Association between Anemia and Stroke in Females: A Nationwide, Population-Based Cohort Study in Taiwan

Yuan

Hong

Chien

et al. 2020

IJERPH

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Optimal stroke prevention strategies for women should take into account specific sex-related stroke risk factors. Anemia is a common medical condition in females, particularly in women of reproductive age. This study investigated whether anemia is an independent risk factor for stroke in females in a population-based cohort study. We investigated newly diagnosed anemic female patients with no history of central nervous system disease, psychiatric disorders, traumatic brain injury, major operations or hemorrhagic diseases identified from the Taiwan National Health Insurance Research Database. Non-anemic matched controls (1:1) were selected based on a propensity score estimated using a logistic regression model that included demographic characteristics and comorbidities. A competing risk analysis was applied to estimate the stroke risk in anemic patients compared to that of their matched controls. In our study, the adjusted sub-distribution hazard ratios (aSHRs) of overall, hemorrhagic and ischemic stroke in anemic female patients aged <50 years were 1.35 (95% confidence interval (CI): 1.19–1.52, p < 0.001), 1.31 (95% CI, 1.09-1.56, p < 0.003), and 1.35 (95% CI, 1.15–1.58, p < 0.001), respectively, compared to non-anemic female controls. However, a positive association between anemia and stroke was not found for those aged ≥50 years. Similar results were observed when the follow-up age was limited to 50 years to reduce the potential effects of menopause on stroke. In conclusion, the present population-based cohort study found that anemia is a potential risk factor for overall, hemorrhagic and ischemic stroke in females of reproductive age.

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Association of Hemoglobin Concentration and Its Change With Cardiovascular and All‐Cause Mortality

Cited by 77 publications

References 27 publications

Blood counts in adult and elderly individuals: defining the norms over eight decades of life

Blood counts in adult and elderly individuals: defining the norms over eight decades of life

Association Between Changes in Hemoglobin Concentration and Cardiovascular Risks and All‐Cause Mortality Among Young Women

Association between Anemia and Stroke in Females: A Nationwide, Population-Based Cohort Study in Taiwan

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