Author + information
- Received September 30, 2003
- Revision received December 23, 2003
- Accepted January 19, 2004
- Published online June 2, 2004.
- Christopher B Arant, MD*,2 (, )
- Timothy R Wessel, MD*,
- Marian B Olson, MS‡,
- C.Noel Bairey Merz, MD, FACC¶,
- George Sopko, MD#,
- William J Rogers, MD, FACC∥,
- Barry L Sharaf, MD, FACC§,
- Steven E Reis, MD, FACC‡,
- Karen M Smith, MD, FACC*,
- B.Delia Johnson, PhD‡,
- Eileen Handberg, PhD*,
- Sunil Mankad, MD, FACC† and
- Carl J Pepine, MD, MACC*,1 ()
Dr. Christopher B. Arant, University of Florida Medicine, 1600 SW Archer Road, P.O. Box 100277, Gainesville, Florida 32610-0277, USA.
- ↵1Reprint requests:
Dr. Carl J. Pepine, University of Florida College of Medicine, Division of Cardiovascular Medicine, P.O. Box 100277, Gainesville, Florida 32610-0277.
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.
☆ This work was supported by NHLBI contracts NO1-HV-68161, NO1-HV-68162, NO1-HV-68163, and NO1-HV-68164, and grants UO1-HL64829-01, UO1-HL64914-01, and UO1-HL65924-01.
- Received September 30, 2003.
- Revision received December 23, 2003.
- Accepted January 19, 2004.
- American College of Cardiology Foundation