Key result
Severe anemia is linked to ~30 g/m² higher LVMI compared to normal hemoglobin.
Why the study?
The growing burden of CVD in low- and middle-income countries is not fully explained by traditional risk factors like hypertension. This study evaluated whether highly prevalent anemia is associated with preclinical CVD and echocardiographic measures such as LVH in two diverse LMIC settings.
Is anemia independently associated with increased left ventricular mass index, left ventricular hypertrophy, and echocardiographic features of high-output cardiac hypertrophy in adults living in Tanzania and Haiti?
Cross-Sectional (n=4,004)
Yes
Is anemia independently associated with increased left ventricular mass index, left ventricular hypertrophy, and echocardiographic features of high-output cardiac hypertrophy in adults living in Tanzania and Haiti?
Moderate and severe anemia are independently associated with high-output left ventricular hypertrophy despite lower blood pressure in Tanzanian and Haitian adults, highlighting anemia as an important, potentially modifiable non-traditional cardiovascular risk factor in low- and middle-income countries.
Low- and middle-income countries (LMICs) face a growing burden of cardiovascular disease (CVD) that is not fully explained by traditional risk factors like hypertension. Anemia is highly prevalent in LMICs and may be an important non-traditional CVD risk factor. We evaluated the association between anemia and preclinical CVD, including left ventricular hypertrophy (LVH) and other echocardiographic measures, in two diverse LMIC settings. This was a cross-sectional analysis of data from two separate cohorts of adults in Mwanza, Tanzania ( n = 999; data collected 2022–2023) and Port-au-Prince, Haiti ( n = 3,005; data collected 2019–2021). Participants underwent clinical examinations, laboratory testing, and echocardiography. Models assessing the relationship between anemia and echocardiographic outcomes were adjusted for age, sex, HIV status, blood pressure, and body mass index. Anemia prevalence was 23% in Tanzania and 32% in Haiti. Despite lower blood pressure and BMI among anemic participants, moderate/severe anemia were strongly associated with higher LVMI and LVH in both cohorts. In combined analyses, moderate/severe anemia were associated with LVMI increases of 8.4 g/m² and 29.7 g/m², respectively. Anemia was also associated with echocardiographic changes characteristic of a high-output cardiac state, including increased cardiac and stroke volume indices. Moderate/severe anemia was associated with18.2% of LVH cases in Tanzania and 9.1% in Haiti, and 34.4% among people with HIV. Anemia was independently associated with high-output cardiac hypertrophy in two distinct LMIC populations, underscoring anemia as a potentially modifiable CVD risk factor. Enhanced anemia screening and management could serve as a vital strategy to mitigate the rising burden of CVD in these regions.
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Rouzier et al. (2026) conducted a cross-sectional in Anemia and preclinical cardiovascular disease (left ventricular hypertrophy) (n=4,004). Severe anemia (Hb <8 g/dL) and moderate anemia (Hb 8-11 g/dL) vs. Normal hemoglobin (females >=12 g/dL, males >=13 g/dL) was evaluated on Left ventricular mass index (LVMI, g/m²) in combined cohort analysis (MD 29.7 g/m² for severe anemia; MD 8.4 g/m² for moderate anemia, 95% CI 19.6-39.8, p=<0.001). Moderate and severe anemia were independently associated with left ventricular mass index increases of 8.4 g/m² and 29.7 g/m² (both p<0.001) compared to normal hemoglobin in Tanzania and Haiti.
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