Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Biomedical Sciences, Seoul National University Hospital, Seoul, Korea.
J Am Heart Assoc. 2018 Jan 29;7(3):e007723. doi: 10.1161/JAHA.117.007723.
Anemia is thought to increase mortality risks, but the effects of high hemoglobin concentration on survival are unclear. The effect of change in hemoglobin concentrations on survival in the general population is also unknown. This study aimed to examine the effect of hemoglobin concentrations and their changes on cardiovascular and all-cause mortality risks.
We retrospectively analyzed a cohort from the NHIS-HEALS (National Health Insurance Service-National Health Screening Cohort) database, including 170 078 men and 122 116 women without cardiovascular diseases, aged >40 years at baseline, with hemoglobin concentrations available for both first and second health examinations. We assessed 2 independent variables: "One-time" hemoglobin concentrations and changes in hemoglobin from first to second examination. Participants were followed up for a median of 8 years to determine mortality related to myocardial infarction, stroke, all cardiovascular diseases, and all causes. Hemoglobin concentrations showed a U- or J-shaped association with cardiovascular and all-cause mortality after adjusting for cardiovascular risk factors. When anemic men achieved normal hemoglobin concentrations, the all-cause mortality risk decreased, with an adjusted hazard ratio of 0.67 (95% confidence interval, 0.59-0.77), in comparison with those whose anemia persisted. Both increases and decreases of hemoglobin concentration outside the normal range elevated all-cause mortality risk (adjusted hazard ratio: 1.39 [95% confidence interval, 1.28-1.49] and 1.10 [95% confidence interval, 1.01-1.20], respectively), compared with persistent normal hemoglobin concentrations. The trend was similar in women but was less significant.
Low or high hemoglobin concentrations were associated with elevated cardiovascular and all-cause mortality. Reaching and maintaining hemoglobin concentrations within the normal range correlated with decreased all-cause mortality.
贫血被认为会增加死亡风险，但血红蛋白浓度升高对生存的影响尚不清楚。人群中血红蛋白浓度变化对生存的影响也不清楚。本研究旨在探讨血红蛋白浓度及其变化对心血管和全因死亡风险的影响。
我们回顾性分析了 NHIS-HEALS（国家健康保险服务-国家健康筛查队列）数据库中的一个队列，包括 170078 名男性和 122116 名无心血管疾病、基线时年龄>40 岁且两次体检均有血红蛋白浓度的女性。我们评估了 2 个独立变量：“一次性”血红蛋白浓度和从第一次到第二次检查的血红蛋白变化。参与者的中位随访时间为 8 年，以确定与心肌梗死、中风、所有心血管疾病和所有原因相关的死亡率。在调整心血管危险因素后，血红蛋白浓度与心血管和全因死亡率呈 U 形或 J 形关联。与贫血持续的男性相比，贫血男性达到正常血红蛋白浓度时，全因死亡率降低，调整后的危险比为 0.67（95%置信区间，0.59-0.77）。血红蛋白浓度超出正常范围的升高和降低均会增加全因死亡率风险（调整后的危险比分别为 1.39（95%置信区间，1.28-1.49）和 1.10（95%置信区间，1.01-1.20）），与持续正常的血红蛋白浓度相比。这种趋势在女性中相似，但不那么显著。
低或高血红蛋白浓度与心血管和全因死亡率升高相关。达到并维持正常范围内的血红蛋白浓度与全因死亡率降低相关。
