Department of Neurology & Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea.
Cardiovasc Drugs Ther. 2010 Apr;24(2):151-60. doi: 10.1007/s10557-010-6239-7.
To date, all major clinical trials for anemia correction using erythrocyte stimulating agents (ESAs) failed to show improved outcomes for cardiovascular disease (CVD), stroke, and vascular thrombosis. Even moderate elevations in hemoglobin (e.g., to 13 g/dL) using erythropoietin have been associated with significantly increased risk of thrombotic cardiovascular events and heart failure. This review presents a biophysical rationale for increased risk of CVD among certain patients treated with ESAs and suggests a risk management approach based on blood viscosity. Whole blood viscosity is a key determinant of the work of the heart, and elevated blood viscosity appears to be both a strong predictor of cardiovascular disease and an important pathophysiological factor in the development of atherothrombosis. Blood donation has been shown to reduce viscosity. Reflecting these findings, studies in male blood donors and in women of premenopausal age with regular menstruation have shown reduced incidence of cardiovascular events such as myocardial infarction, angina, stroke, and the requirement for procedures such as percutaneous transluminal coronary angioplasty and coronary artery bypass graft compared with non-donors and postmenopausal women, respectively. We propose that blood viscosity monitoring should be considered as part of a cardiovascular risk assessment, whenever an increased cardiovascular risk is detected and particularly in the context of anemia correction.
迄今为止，所有使用红细胞生成刺激剂（ESA）纠正贫血的主要临床试验都未能显示出对心血管疾病（CVD）、中风和血管血栓形成的改善结果。即使使用促红细胞生成素将血红蛋白适度升高（例如，升高至 13g/dL），也与血栓性心血管事件和心力衰竭的风险显著增加相关。这篇综述提出了使用 ESA 治疗的某些患者发生 CVD 风险增加的生物物理原理，并基于血液粘度提出了一种风险管理方法。全血粘度是心脏工作量的关键决定因素，血液粘度升高似乎既是心血管疾病的强烈预测因素，也是动脉血栓形成发展的重要病理生理因素。献血已被证明可以降低粘度。反映这些发现的是，在男性献血者和有规律月经的绝经前女性中的研究表明，与非献血者和绝经后女性相比，心血管事件（如心肌梗死、心绞痛、中风）的发生率降低，经皮腔内冠状动脉成形术和冠状动脉旁路移植术等治疗的需求也降低。我们提出，应考虑在检测到心血管风险增加时，特别是在纠正贫血时，将血液粘度监测作为心血管风险评估的一部分。
