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Association of anemia with clinical outcomes in stable coronary artery disease.
Coron Artery Dis. 2008 Feb; 19(1):21-6.CA

Abstract

BACKGROUND

Although anemia is pathophysiologically associated with myocardial ischemia, there are scarce data on its clinical impact in patients with stable coronary artery disease on contemporary treatment. This study aims to describe the prevalence of anemia, and its association with symptoms and outcomes in this population.

METHODS

We conducted a prospective cohort study in stable documented coronary artery disease patients. Anemia criteria was hemoglobin (Hb) <12 g/dl in women and <13 g/dl in men. Hemoglobin levels were divided in quartiles (Q) adjusted for sex. Major events included acute coronary syndromes, stroke and cardiovascular deaths. Secondary outcomes were presence of angina and chronic use of nitrates. Cox regression models were used to evaluate the independent effect of anemia on clinical outcomes.

RESULTS

Among 310 patients, 71 (23%) met criteria for anemia. After a mean follow-up of 44+/-23 months, hemoglobin levels had a marked association with occurrence of major events (27% in Q1, 7% in Q2, 8% in Q3 and 12% in Q4; P<0.01). In multivariate analysis, anemia was independently associated with an increased risk of death [hazard ratio (HR) 6.5, 95% confidence interval (1.7-24.2)], major events [HR 3.3 (1.7-6.5)] and revascularization procedures [HR 2.3 (1.3-4.1)]. Persistent of angina symptoms (32 vs. 18%, P=0.01) and chronic use of nitrates (35 vs. 21%, P=0.02) were also more frequent among patients with anemia at baseline.

CONCLUSIONS

In patients with stable ischemic heart disease, presence of anemia, even mild, is associated with a worse prognosis. Strategies aiming at identifying reversible causes of anemia or new treatments should be evaluated in prospective clinical trials.

Authors+Show Affiliations

Postgraduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Cardiology Division of Clinic Hospital of Porto Alegre, Brazil.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18281811

Citation

da Silveira, Anderson D., et al. "Association of Anemia With Clinical Outcomes in Stable Coronary Artery Disease." Coronary Artery Disease, vol. 19, no. 1, 2008, pp. 21-6.
da Silveira AD, Ribeiro RA, Rossini AP, et al. Association of anemia with clinical outcomes in stable coronary artery disease. Coron Artery Dis. 2008;19(1):21-6.
da Silveira, A. D., Ribeiro, R. A., Rossini, A. P., Stella, S. F., Ritta, H. A., Stein, R., & Polanczyk, C. A. (2008). Association of anemia with clinical outcomes in stable coronary artery disease. Coronary Artery Disease, 19(1), 21-6. https://doi.org/10.1097/MCA.0b013e3282f27c0a
da Silveira AD, et al. Association of Anemia With Clinical Outcomes in Stable Coronary Artery Disease. Coron Artery Dis. 2008;19(1):21-6. PubMed PMID: 18281811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of anemia with clinical outcomes in stable coronary artery disease. AU - da Silveira,Anderson D, AU - Ribeiro,Rodrigo A, AU - Rossini,Ana Paula W, AU - Stella,Steffan F, AU - Ritta,Henry A R, AU - Stein,Ricardo, AU - Polanczyk,Carisi A, PY - 2008/2/19/pubmed PY - 2008/3/26/medline PY - 2008/2/19/entrez SP - 21 EP - 6 JF - Coronary artery disease JO - Coron Artery Dis VL - 19 IS - 1 N2 - BACKGROUND: Although anemia is pathophysiologically associated with myocardial ischemia, there are scarce data on its clinical impact in patients with stable coronary artery disease on contemporary treatment. This study aims to describe the prevalence of anemia, and its association with symptoms and outcomes in this population. METHODS: We conducted a prospective cohort study in stable documented coronary artery disease patients. Anemia criteria was hemoglobin (Hb) <12 g/dl in women and <13 g/dl in men. Hemoglobin levels were divided in quartiles (Q) adjusted for sex. Major events included acute coronary syndromes, stroke and cardiovascular deaths. Secondary outcomes were presence of angina and chronic use of nitrates. Cox regression models were used to evaluate the independent effect of anemia on clinical outcomes. RESULTS: Among 310 patients, 71 (23%) met criteria for anemia. After a mean follow-up of 44+/-23 months, hemoglobin levels had a marked association with occurrence of major events (27% in Q1, 7% in Q2, 8% in Q3 and 12% in Q4; P<0.01). In multivariate analysis, anemia was independently associated with an increased risk of death [hazard ratio (HR) 6.5, 95% confidence interval (1.7-24.2)], major events [HR 3.3 (1.7-6.5)] and revascularization procedures [HR 2.3 (1.3-4.1)]. Persistent of angina symptoms (32 vs. 18%, P=0.01) and chronic use of nitrates (35 vs. 21%, P=0.02) were also more frequent among patients with anemia at baseline. CONCLUSIONS: In patients with stable ischemic heart disease, presence of anemia, even mild, is associated with a worse prognosis. Strategies aiming at identifying reversible causes of anemia or new treatments should be evaluated in prospective clinical trials. SN - 0954-6928 UR - https://www.unboundmedicine.com/medline/citation/18281811/Association_of_anemia_with_clinical_outcomes_in_stable_coronary_artery_disease_ L2 - https://doi.org/10.1097/MCA.0b013e3282f27c0a DB - PRIME DP - Unbound Medicine ER -