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Published on: January 28, 2020
Hemoglobin levels and coronary artery disease
Michel Chonchol1, Christopher Nielson
1University of Colorado Health Sciences Center, Division of Renal Diseases and Hypertension, Denver, CO 80262, USA. michel.chonchol@uchsc.edu
Insights
Both low and high hemoglobin levels increase the risk of developing coronary artery disease (CAD). This study highlights the importance of monitoring hemoglobin levels for cardiovascular health.
Area of Science:
- Cardiology
- Hematology
- Epidemiology
Background:
- Anemia is a known risk factor for cardiovascular disease.
- Limited data exists on the association between hemoglobin levels and new coronary artery disease (CAD) onset.
Purpose of the Study:
- To investigate the relationship between baseline hemoglobin concentration and the incidence of new coronary artery disease (CAD).
Main Methods:
- A historical cohort study of 25,622 patients from Veterans Affairs medical centers.
- Hemoglobin levels were assessed at baseline, and CAD was identified via diagnosis codes or new nitroglycerin prescriptions.
- Analyses were adjusted for multiple cardiovascular risk factors.
Main Results:
- An increased risk of CAD was observed with hemoglobin levels below 15 g/dL and above 17 g/dL.
- Compared to 15.0-17.0 g/dL, hemoglobin levels of 9.0-11.0 g/dL showed a 1.47-fold increased risk (HR 1.47, 95% CI 1.18-1.84).
- Hemoglobin levels ≥17.0 g/dL were also associated with a 1.22-fold increased risk (HR 1.22, 95% CI 1.08-1.37).
Conclusions:
- Both lower (<15 g/dL) and higher (≥17 g/dL) hemoglobin levels are independently associated with an increased risk of new cardiac events.
- These findings suggest a U-shaped relationship between hemoglobin levels and CAD risk.
- Monitoring hemoglobin levels may be crucial for assessing cardiovascular risk.
Background:
Anemia is a risk factor for adverse cardiovascular disease outcomes. However, there is limited information concerning the association of hemoglobin concentration and new onset of clinically recognized coronary artery disease (CAD).
Methods:
An historical cohort study was conducted with patients from Veterans Affairs medical centers. Baseline hemoglobin determinations were evaluated with respect to CAD using data from records of 25,622 subjects with no known heart disease. Coronary artery disease was identified from a new diagnosis based on the International Classification of Diseases, Ninth Edition, coding or a new prescription for nitroglycerin. Models were adjusted for age, sex, body mass index, smoking, systolic blood pressure, diastolic blood pressure, fasting glucose, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, creatinine clearance, and use of statin or beta-blocker.
Results:
Among the cohort, 5297 (20.7%) subjects developed CAD over 73,895 person-years of follow-up. Compared with control hemoglobin levels of 15.0 to 17.0 g/dL, the multivariable-adjusted risk of CAD increased with lower hemoglobin levels: an adjusted hazard ratio (HR) of 1.47 and 95% confidence interval (CI) of 1.18 to 1.84 for hemoglobin levels of 9.0 to 11.0 g/dL; an HR of 1.34 and 95% CI of 1.20 to 1.49 for 11.0 to 13.0 g/dL; and an HR of 1.07 and 95% CI of 1.01 to 1.13 for 13.0 to 15.0 g/dL. Hemoglobin levels > or = 17.0 g/dL were also associated with increased risk for CAD (adjusted HR 1.22, 95% CI 1.08-1.37).
Conclusions:
Hemoglobin levels > or = 17 or < 15 g/dL are independently associated with increase risk for new cardiac events.
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