1887
Volume 2022, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Cardiovascular disease is the leading cause of death worldwide. Multiple risk factors, including low hemoglobin levels, have been associated with poor outcomes in patients with cardiovascular disease. However, the long-term impact of anemia on death has not been investigated in high-risk patients in the United Arab Emirates. Therefore, this study evaluated whether anemia is a significant predictor of mortality in United Arab Emirates nationals with cardiovascular disease over 10 years.

Methods: A retrospective cohort study was conducted in an adult population of United Arab Emirates nationals with a history of cardiovascular disease, recruited from a tertiary healthcare facility. Electronic medical records between April 2008 and December 2008 were reviewed, and follow-up was conducted until December 2019. The survival functions for all-cause mortality in the presence and absence of anemia were compared using univariate Kaplan–Meier analysis with a log-rank test. The association between anemia and all-cause mortality was evaluated using a multivariable Cox regression model.

Results: A total of 224 patients were included in the follow-up for 10.5 years. At baseline, 46% of the patients had anemia, with a mean Hgb level of 105.5 ± 28.0 g/L. Patients with anemia were older (68 vs. 63 years, p = 0.001) and had a higher rate of chronic kidney disease (37.5% vs. 17.5%, p = 0.001) than those without anemia. A total of 77 (34.4%) deaths were recorded by the end of the follow-up period. Risk of all-cause mortality was significantly higher in patients with anemia than in those without (hazard ratio = 2.03, 95% confidence interval = 1.22–3.40, p = 0.006). Age and chronic kidney disease were also statistically significant predictors of death (p < 0.001 and p = 0.001, respectively).

Conclusion: Anemia is an independent predictor of all-cause mortality in United Arab Emirates nationals with underlying cardiovascular disease. Early intervention and treatment for anemia may improve clinical outcomes in this population.

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2022-03-12
2022-09-30
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References

  1. WHO. Cardiovascular diseases (CVDs). Available at https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Accessed on January 14, 2021.
    [Google Scholar]
  2. Sarnak MJ, Tighiouart H, Manjunath G, MacLeod B, Griffith J, Salem D, Levey AS. Anemia as a risk factor for cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study. J Am Coll Cardiol 2002; 40:27–33.
    [Google Scholar]
  3. Al-Shamsi S, Regmi D, Govender RD. Incidence of cardiovascular disease and its associated risk factors in at-risk men and women in the United Arab Emirates: a 9-year retrospective cohort study. BMC Cardiovasc Disord 2019; 19:148.
    [Google Scholar]
  4. Michalak SS, Rupa-Matysek J, Hus I, Gil L. Unexplained anemia in the elderly – a real life analysis of 981 patients. Arch Med Sci 2020; 16:834–41.
    [Google Scholar]
  5. Shavelle RM, MacKenzie R, Paculdo DR. Anemia and mortality in older persons: does the type of anemia affect survival? Int J Hematol 2012; 95:248–56.
    [Google Scholar]
  6. Lanser L, Fuchs D, Scharnagl H, Grammer T, Kleber ME, März W, et al. Anemia of chronic disease in patients with cardiovascular disease. Front Cardiovasc Med 2021; 8:666638.
    [Google Scholar]
  7. Son YJ, Kim BH. Prevalence of anemia and its influence on hospital readmissions and emergency department visits in outpatients with heart failure. Eur J Cardiovasc Nurs 2017; 16:687–95.
    [Google Scholar]
  8. Mamas MA, Kwok CS, Kontopantelis E, Fryer AA, Buchan I, Bachmann MO, et al. Relationship between anemia and mortality outcomes in a national acute coronary syndrome cohort: insights from the UK myocardial ischemia national audit project registry. J Am Heart Assoc 2016; 5:e003348.
    [Google Scholar]
  9. Jomaa W, Ben Ali I, Hamdi S, Azaiez MA, Hraïech AE, Ben Hamda K, Maatouk F. Prevalence and prognostic significance of anemia in patients presenting for ST-elevation myocardial infarction in a Tunisian center. J Saudi Heart Assoc 2017; 29:153–9.
    [Google Scholar]
  10. Vicente-Ibarra N, Marín F, Pernías-Escrig V, Sandín-Rollán M, Núñez-Martínez L, Lozano T, et al. Impact of anemia as risk factor for major bleeding and mortality in patients with acute coronary syndrome. Eur J Intern Med 2019; 61:48–53.
    [Google Scholar]
  11. Rayes HA, Vallabhajosyula S, Barsness GW, Anavekar NS, Go RS, Patnaik MS, et al. Association between anemia and hematological indices with mortality among cardiac intensive care unit patients. Clin Res Cardiol 2020; 109:616–27.
    [Google Scholar]
  12. Brown DW, Giles WH, Croft JB. Hematocrit and the risk of coronary heart disease mortality. Am Heart J 2001; 142:657–63.
    [Google Scholar]
  13. Shu DH, Ransom TPP, O'Connell CM, Cox JL, Kaiser SM, Gee SA, et al. Anemia is an independent risk for mortality after acute myocardial infarction in patients with and without diabetes. Cardiovasc Diabetol 2006; 5:8.
    [Google Scholar]
  14. Al Falluji N, Lawrence-Nelson J, Kostis JB, Lacy CR, Ranjan R, Wilson AC, Myocardial Infarction Data Acquisition system (MIDAS #8) Study Group. Effect of anemia on 1-year mortality in patients with acute myocardial infarction. Am Heart J 2002; 144:636–41.
    [Google Scholar]
  15. WHO. Noncommunicable diseases country profiles 2018. Available at https://www.who.int/nmh/countries/en/#U. Accessed on March 25, 2020.
    [Google Scholar]
  16. Al Sabbah H. Prevalence of overweight/obesity, anaemia and their associations among female university students in Dubai, United Arab Emirates: a cross-sectional study. J Nutr Sci 2020; 9:e26.
    [Google Scholar]
  17. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults–the evidence report. Obes Res 1998; 6:(Suppl 2):51S–209S.
    [Google Scholar]
  18. National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, detection, evaluation, and treatment of high blood pressure. Available at http://www.ncbi.nlm.nih.gov/books/NBK9630/. Accessed on June 9, 2020.
    [Google Scholar]
  19. WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Available at http://www.who.int/vmnis/indicators/haemoglobin/en/. Accessed on June 9, 2020.
    [Google Scholar]
  20. Expert Panel on Detection. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285:2486–97.
    [Google Scholar]
  21. Stevens PE, Levin A, Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013; 158:825–30.
    [Google Scholar]
  22. Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 2001; 345:1230–6.
    [Google Scholar]
  23. Meneveau N, Schiele F, Seronde MF, Descotes-Genon V, Oettinger J, Chopard R, et al. Anemia for risk assessment of patients with acute coronary syndromes. Am J Cardiol 2009; 103:442–7.
    [Google Scholar]
  24. Sulaiman K, Prashanth P, Al-Zakwani I, Al-Mahmeed W, Al-Motarreb A, Al Suwaidi J, et al. Impact of anemia on in-hospital, one-month and one-year mortality in patients with acute coronary syndrome from the middle east. Clin Med Res 2012; 10:65–71.
    [Google Scholar]
  25. Yazji K, Abdul F, Elangovan S, Ul Haq MZ, Ossei-Gerning N, Morris K, et al. Baseline anemia in patients undergoing percutaneous coronary intervention after an acute coronary syndrome - a paradox of high bleeding risk, high ischemic risk, and complex coronary disease. J Interv Cardiol 2017; 30:491–9.
    [Google Scholar]
  26. AlHamdan NA, AlMazrou YY, AlSwaidi FM, Choudhry AJ. Premarital screening for thalassemia and sickle cell disease in Saudi Arabia. Genet Med 2007; 9:372–7.
    [Google Scholar]
  27. Rizzo C, Carbonara R, Ruggieri R, Passantino A, Scrutinio D. Iron deficiency: a new target for patients with heart failure. Front Cardiovasc Med 2021; 8:709872.
    [Google Scholar]
  28. Prentice AM, Mendoza YA, Pereira D, Cerami C, Wegmuller R, Constable A, Spieldenner J. Dietary strategies for improving iron status: balancing safety and efficacy. Nutr Rev 2017; 75:49–60.
    [Google Scholar]
  29. Jonsson A, Hallberg AC, Edner M, Lund LH, Dahlstrom U. A comprehensive assessment of the association between anemia, clinical covariates and outcomes in a population-wide heart failure registry. Int J Cardiol 2016; 211:124–31.
    [Google Scholar]
  30. Colombo MG, Kirchberger I, Amann U, Heier M, Thilo C, Kuch B, et al. Association between admission anemia and long-term mortality in patients with acute myocardial infarction: results from the Monica/KORA myocardial infarction registry. BMC Cardiovasc Disord 2018; 18:50.
    [Google Scholar]
  31. Xia H, Shen H, Cha W, Lu Q. The prognostic significance of anemia in patients with heart failure: a meta-analysis of studies from the last decade. Front Cardiovasc Med 2021; 8:632318.
    [Google Scholar]
  32. Anand IS, Gupta P. Anemia and iron deficiency in heart failure: current concepts and emerging therapies. Circulation 2018; 138:80–98.
    [Google Scholar]
  33. Papademetriou V, Stavropoulos K, Kokkinos P, Doumas M, Imprialos K, Thomopoulos C, et al. Left ventricular hypertrophy and mortality risk in male veteran patients at high cardiovascular risk. Am J Cardiol 2020; 125:887–93.
    [Google Scholar]
  34. Anderson J, Glynn LG, Newell J, Iglesias AA, Reddan D, Murphy AW. The impact of renal insufficiency and anaemia on survival in patients with cardiovascular disease: a cohort study. BMC Cardiovasc Disord 2009; 9:51.
    [Google Scholar]
  35. Kim CJ, Choi IJ, Park HJ, Kim TH, Kim PJ, Chang K, et al. Impact of cardiorenal anemia syndrome on short- and long-term clinical outcomes in patients hospitalized with heart failure. Cardiorenal Med 2016; 6:269–78.
    [Google Scholar]
  36. McCullough PA. Anemia of cardiorenal syndrome. Kidney Int Suppl (2011) 2021; 11:35–45.
    [Google Scholar]
  37. Stauder R, Thein SL. Anemia in the elderly: clinical implications and new therapeutic concepts. Haematologica 2014; 99:1127–30.
    [Google Scholar]
  38. Hata J, Nagai A, Hirata M, Kamatani Y, Tamakoshi A, Yamagata Z, et al. Risk prediction models for mortality in patients with cardiovascular disease: the biobank Japan project. J Epidemiol 2017; 27:S71–6.
    [Google Scholar]
  39. Taravatmanesh S, Khalili D, Khodakarim S, Asgari S, Hadaegh F, Azizi F, Sabour S. Determining the factors associated with cardiovascular disease recurrence: Tehran lipid and glucose study. J Tehran Heart Cent 2017; 12:107–13.
    [Google Scholar]
  40. van der Meer MG, Cramer MJ, van der Graaf Y, Doevendans PA, Nathoe HM, (on behalf of the SMART study group). Gender difference in long-term prognosis among patients with cardiovascular disease. Eur J Prev Cardiol 2014; 21:81–9.
    [Google Scholar]
  41. Walli-Attaei M, Joseph P, Rosengren A, Chow CK, Rangarajan S, Lear SA, et al. Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020; 396:97–109.
    [Google Scholar]
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