Chonchol Michel, Nielson Christopher
University of Colorado Health Sciences Center, Division of Renal Diseases and Hypertension, Denver, CO 80262, USA.
Am Heart J. 2008 Mar;155(3):494-8. doi: 10.1016/j.ahj.2007.10.031.
Anemia is a risk factor for adverse cardiovascular disease outcomes. However, there is limited information concerning the association of hemoglobin concentration and new onset of clinically recognized coronary artery disease (CAD).
An historical cohort study was conducted with patients from Veterans Affairs medical centers. Baseline hemoglobin determinations were evaluated with respect to CAD using data from records of 25,622 subjects with no known heart disease. Coronary artery disease was identified from a new diagnosis based on the International Classification of Diseases, Ninth Edition, coding or a new prescription for nitroglycerin. Models were adjusted for age, sex, body mass index, smoking, systolic blood pressure, diastolic blood pressure, fasting glucose, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, creatinine clearance, and use of statin or beta-blocker.
Among the cohort, 5297 (20.7%) subjects developed CAD over 73,895 person-years of follow-up. Compared with control hemoglobin levels of 15.0 to 17.0 g/dL, the multivariable-adjusted risk of CAD increased with lower hemoglobin levels: an adjusted hazard ratio (HR) of 1.47 and 95% confidence interval (CI) of 1.18 to 1.84 for hemoglobin levels of 9.0 to 11.0 g/dL; an HR of 1.34 and 95% CI of 1.20 to 1.49 for 11.0 to 13.0 g/dL; and an HR of 1.07 and 95% CI of 1.01 to 1.13 for 13.0 to 15.0 g/dL. Hemoglobin levels > or = 17.0 g/dL were also associated with increased risk for CAD (adjusted HR 1.22, 95% CI 1.08-1.37).
Hemoglobin levels > or = 17 or < 15 g/dL are independently associated with increase risk for new cardiac events.
贫血是心血管疾病不良结局的一个风险因素。然而，关于血红蛋白浓度与临床确诊的冠状动脉疾病（CAD）新发之间关联的信息有限。
对来自退伍军人事务医疗中心的患者进行了一项历史性队列研究。利用25622名无已知心脏病患者的记录数据，评估基线血红蛋白测定与CAD的关系。根据《国际疾病分类》第九版编码中的新诊断或硝酸甘油新处方来确定冠状动脉疾病。模型针对年龄、性别、体重指数、吸烟、收缩压、舒张压、空腹血糖、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、肌酐清除率以及他汀类药物或β受体阻滞剂的使用情况进行了调整。
在该队列中，5297名（20.7%）受试者在73895人年的随访期间患上了CAD。与15.0至17.0 g/dL的对照血红蛋白水平相比，CAD的多变量调整风险随着血红蛋白水平降低而增加：血红蛋白水平为9.0至11.0 g/dL时，调整后的风险比（HR）为1.47，95%置信区间（CI）为1.18至1.84；11.0至13.0 g/dL时，HR为1.34，95%CI为1.20至1.49；13.0至15.0 g/dL时，HR为1.07，95%CI为1.01至1.13。血红蛋白水平≥17.0 g/dL也与CAD风险增加相关（调整后HR 1.22，95%CI 1.08 - 1.37）。
血红蛋白水平≥17 g/dL或<15 g/dL与新的心脏事件风险增加独立相关。
