Elevated Hemoglobin Levels and Risk of ST-Segment Elevation Myocardial Infarction in High-Altitude Acute Coronary
Jing Li1, Lin-Feng Liu2, Gusang Lamu1
1Cardiovascular Department of Mountain Diseases, People's Hospital of Tibet Autonomous Region, Lhasa, China.
Background:
High-altitude populations typically exhibit elevated hemoglobin (Hb) levels due to chronic hypoxic exposure; however, the impact of this elevation on the risk of ST-segment elevation myocardial infarction (STEMI) remains unclear. Existing evidence is primarily derived from low-altitude populations and cannot be directly extrapolated to high-altitude settings.
Aims:
This study aims to systematically evaluate the effect of elevated hemoglobin levels in high-altitude environments on the risk of ST-segment elevation myocardial infarction (STEMI) and to identify the altitude-specific inflection point at which hemoglobin becomes a significant risk factor.
Methods:
This study involved 1209 patients diagnosed with acute coronary syndrome (ACS). The patients were classified into four groups according to their Hb levels: < 120, 120-160, 160-200, and ≥ 200 g/L. Initially, logistic regression and restricted cubic splines (RCS) were employed to evaluate the relationship between Hb levels and the risk of STEMI. Subsequently, survival analysis was conducted to assess 28-day survival rates. RCS curves were then compared with data from low-altitude populations. Finally, subgroup analyses were performed to further validate the robustness of the findings.
Results:
The study population comprised 80.9% males (mean age 58.3 ± 12.5 years) and 19.1% females (mean age 66.0 ± 11.9 years). Elevated Hb levels (≥ 160 g/L) were significantly associated with an increased risk of STEMI. RCS analysis revealed a nonlinear relationship between Hb levels and STEMI risk (nonlinearity p < 0.05). After adjusting for multiple variables, the odds ratios (OR) for STEMI in patients with Hb levels of 160-200 and ≥ 200 g/L were 1.9 (95% CI: 1.1-3.1, p = 0.019) and 3.6 (95% CI: 1.8-7.3, p < 0.001), respectively.
Conclusions:
In high-altitude ACS patients, Hb levels ≥ 160 g/L significantly increase the risk of STEMI, underscoring the importance of Hb monitoring in this population.
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