Decreasing hemoglobin independently predicted adverse cardiovascular outcomes in women with suspected ischemia (HR 1.20, p=0.002); anemic women had higher total adverse outcomes (26% vs 16%, p<0.01).
Cohort (n=864)
Does lower hemoglobin level predict adverse cardiovascular outcomes in women undergoing evaluation for suspected ischemia?
Lower hemoglobin levels are an independent predictor of adverse cardiovascular outcomes and all-cause mortality in women evaluated for suspected ischemia.
Hazard Ratio: 1.2
Absolute Event Rate: 26% vs 16%
p-value: p=0.002
OBJECTIVES: This study was designed to investigate the relationship between hemoglobin level (Hgb) and adverse cardiovascular outcomes in women with suspected ischemia. BACKGROUND: Low Hgb levels correlate with increased cardiovascular morbidity and mortality in patients presenting with acute myocardial infarction (MI) or congestive heart failure (CHF). However, the prognostic significance of Hgb in women with suspected ischemia is unclear. METHODS: As part of the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE), we prospectively studied 936 women referred for coronary angiography to evaluate suspected ischemia. We compared Hgb levels with cardiovascular risk factors, core lab interpreted angiograms, inflammatory markers, and adverse cardiovascular outcomes. RESULTS: Of women enrolled, 864 (mean age 58.4 +/-11.6 years) had complete Hgb, angiogram, and follow-up (mean 3.3 +/- 1.7 years) data. The mean Hgb was 12.9 g/dl (range 7.7 to 16.4 g/dl) and 184 women (21%) were anemic (Hgb <12 g/dl). Anemic women had higher creatinine and were more likely to be nonwhite and have a history of diabetes, hypertension, and CHF (p < 0.05). However, we found no difference in EF or severity of coronary artery disease. Anemic women had a higher risk of death from any cause (10.3% vs. 5.4%; p = 0.02) and total adverse outcomes (26% vs. 16%, p < 0.01). In a multivariable model, decreasing Hgb was associated with significantly higher risk of adverse outcomes (hazard ratio = 1.20, p = 0.002). Also, anemic women had shorter survival time free of adverse outcome (p < 0.001). CONCLUSIONS: Our findings extend previous reports, linking lower hemoglobin levels with higher risk for adverse cardiovascular outcomes, to women evaluated for suspected ischemia in the absence of acute MI or CHF.
“There were several surprises from the study. First, women with low hemoglobin levels had a higher rate of death and cardiovascular events over a relatively intermediate length of follow up, averaging just over three years. In addition, the hemoglobin levels where these adverse events occurred are by standard definitions only mildly to moderately low. And a low hemoglobin level was a better predictor of adverse cardiovascular events than most traditional cardiovascular risk factors such as smoking, hypertension, age, or family history of heart disease.”
Arant et al. (2004) conducted a cohort in suspected ischemia (n=864). Anemia (Hgb <12 g/dl) or decreasing hemoglobin vs. Non-anemic women (Hgb ≥12 g/dl) was evaluated on total adverse outcomes (HR 1.20, p=0.002). Decreasing hemoglobin independently predicted adverse cardiovascular outcomes in women with suspected ischemia (HR 1.20, p=0.002); anemic women had higher total adverse outcomes (26% vs 16%, p<0.01).