Hemoglobin and Change in Hemoglobin Status Predict Mortality, Cardiovascular Events, and Bleeding in Stable Coronary Artery Disease

Kalra, Paul R.; Greenlaw, Nicola; Ferrari, Roberto; Ford, Ian; Tardif, Jean‐Claude; Tendera, Michał; Reid, Christopher M.; Danchin, Nicolás; Stępińska, Janina; Steg, Philippe Gabriel; Fox, Kim

doi:10.1016/j.amjmed.2017.01.002

Cited by 40 publications

(34 citation statements)

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“…A few previous studies have examined the association between a change in Hb concentration and mortality. A prospective cohort study of patients with a mean age of 64 years from 45 countries with stable coronary artery disease reported after a 4‐year follow‐up that persistent anemia elevated the risk of mortality, although patients whose anemia normalized over time did not appear to have an increased mortality risk 7. More recently, we also reported the association between change in Hb and risks of cardiovascular diseases and mortality among individuals over 40 years, which revealed that reaching and maintaining Hb concentrations within the normal range were associated with decreased all‐cause mortality 8…”

Section: Discussionmentioning

confidence: 99%

“…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%

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

Lee

Choi

Kim

et al. 2018

JAHA

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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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Section: Discussionmentioning

confidence: 99%

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

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“…In addition, it was unclear whether these results applied for longer follow‐up durations, considering that adverse outcomes in anemic patients tended to aggregate over time. Furthermore, patients’ hemoglobin levels at follow‐up was not clear, since prior study demonstrated that patients whose anemia normalized over time did not seem to have an excess mortality risk …”

Section: Discussionmentioning

confidence: 99%

Impact of anemia on percutaneous coronary intervention in Chinese patients: A large single center data

Jiang

Gao

Song

et al. 2018

J Interven Cardiology

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Objectives: To investigate the impact of anemia on 2-year outcomes in patients undergoing contemporary percutaneous coronary intervention (PCI).Background: Whether anemia is an independent predictor of adverse outcomes after PCI is under debate.Methods: A total of 10 717 consecutive patients who underwent PCI with available hemoglobin values at Fuwai Hospital were collected. Clinical outcomes were compared between patients with and without anemia both before and after PCI procedure.Results: Totally, 1348 (12.5%) and 3111 (29.0%) patients presented with pre-and post-PCI anemia according to World Health Organization criteria (hemoglobin level <120 g/L for women or <130 g/L for men), respectively. Anemic patients presented with more baseline clinical risks and more extensive coronary disease than those without anemia. During 2-year follow-up, patients with pre-PCI anemia had higher incidence of bleeding and stroke than those without pre-PCI anemia. Patients with post-PCI anemia experienced higher incidence of all-cause death, myocardial infarction (MI), target vessel revascularization (TVR), bleeding, and major adverse cardiovascular events (MACE) than those without post-PCI anemia.Survival analyses were performed using multivariable Cox proportional hazards models both before and after propensity score matching. Pre-PCI anemia was not an independent risk factor of any adverse clinical events. Post-PCI anemia was not an independent risk factor of all-cause death, but was an independent risk factor of MI, TVR, and MACE.Conclusions: Pre-PCI anemia was not an independent risk factor of any adverse clinical events, while post-PCI anemia had a predictable value of MI, TVR, and MACE after PCI. K E Y W O R D S anemia, clinical outcomes, percutaneous coronary intervention

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“…It is known by Gandhi et al (2017) that in primary care offices higher prevalence of anemia is associated with advancing age and comorbidities, such as essential hypertension, hypothyroidism, chronic kidney disease, malignancy, rheumatologic disease, congestive heart failure, and coronary artery disease. In the large population with stable CAD, according to Nappi (2003) and Kalra et al (2017), low hemoglobin is an independent predictor of mortality, cardiovascular events, and major bleeds. Persisting or new-onset anemia is a powerful predictor of cardiovascular and non-cardiovascular mortality.…”

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confidence: 99%

The Incidence and Characteristic Features of Anemia in Older Patients With Coronary Artery Disease

James

Pavliukovych

2018

CBUP

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INTRODUCTION: Previous studies have shown that the presence of anemia is associated with increased short- and long-term outcomes in patients with cardio-vascular diseases, especially coronary artery disease. Decreased hemoglobin level is associated with increased mortality, increased frequency of hospitalization due to different reasons, decreased quality of life and worsening of the clinical course of the main and comorbid diseases. Knowledge about the origin of the patient’s anemia should result in its treatment and possible prevention of the rapid progression of the main cardio-vascular disease, particularly in elderly patients.OBJECTIVES: determination of the incidence and characteristic features of anemia in elderly and senile patients with chronic forms of coronary artery disease.METHODS: 1993 case reports of patients with chronic forms of coronary artery disease with comorbid anemia were analyzed retrospectively.RESULTS: Among all examined patients with coronary artery disease, anemia is found in nearly 70% of cases. In people after the age of 60, anemia is more common in men than in women. Only in less than a hundred case reports, the diagnosis of anemia was recorded in the final clinical diagnosis during patients’ discharge from the hospital. The incidence of anemia does not depend on the form of the chronic CAD (stable angina pectoris or cardiosclerosis). In most patients with CAD, comorbid anemia is of a normochromic and normocytic character. Along with the progression of the severity of the comorbid anemia, a statistically significant increase of the hospitalization period is observed. In patients with CAD and comorbid anemia the frequency of hospitalizations per year is also increased.CONCLUSIONS: Chronic forms of coronary artery disease in elderly and senile patients in 69,89% of cases are complicated by comorbid anemia of different degrees of severity. In older patients with CAD, anemic syndrome is most often caused by respiratory diseases, stomach and duodenal ulcers, and cancer of various localizations. In most patients with CAD, comorbid anemia is of a normochromic and normocytic character. Concomitant anemia in patients with CAD contributes to the prolongation of the patients’ in-hospital treatment and increases the frequency of hospitalizations due to the main disease throughout the year.

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Hemoglobin and Change in Hemoglobin Status Predict Mortality, Cardiovascular Events, and Bleeding in Stable Coronary Artery Disease

Abstract: Kalra, P. R. et al. (2017) Hemoglobin and change in hemoglobin status predict mortality, cardiovascular events and bleeding in stable coronary artery disease.

Cited by 40 publications

References 25 publications

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

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

Impact of anemia on percutaneous coronary intervention in Chinese patients: A large single center data

The Incidence and Characteristic Features of Anemia in Older Patients With Coronary Artery Disease

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