Cardiology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Cardiology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Can J Cardiol. 2022 Jun;38(6):745-753. doi: 10.1016/j.cjca.2022.01.024. Epub 2022 Jan 29.
Anemia is associated with increased risk of all-cause mortality in older populations. However, the relationship between hemoglobin and major adverse cardiovascular events (MACE), and whether this is modulated by frailty, is unclear.
CHAMP (Concord Health and Ageing in Men Project) is a prospective study of community-dwelling men aged ≥ 70 years. The relationship between hemoglobin and 7-year MACE was analysed by means of Cox regression. The Youden index was used to determine the optimal hemoglobin cutoff point in predicting MACE. Frailty was assessed with the use of the Fried criteria.
The cohort comprised 1604 men (mean ± SD age 76.9 ± 5.5 years). Decreasing hemoglobin was associated with increased comorbidity, frailty, and MACE (P < 0.001), with 140 g/L the optimal cutoff point for predicting MACE. Hemoglobin, age, and frailty independently predicted MACE (all P < 0.001). Each 10 g/L decrement in hemoglobin level was associated with increased risk of MACE (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.06-1.20; P < 0.001), all-cause mortality (HR 1.20, 95% CI 1.12-1.29; P < 0.001), cardiovascular mortality (HR 1.07, 95% CI 1.01-1.14; P = 0.025), myocardial infarction (HR 1.17, 95% CI 1.09-1.25; P < 0.001), and heart failure (HR 1.17, 95% CI 1.09-1.25; P < 0.001). When stratified into hemoglobin quintiles, men in the lowest 2 quintiles (Hb 133-140 g/L and < 132g/L, respectively) were at increased risk of MACE, cardiovascular mortality, myocardial infarction, and heart failure (all P < 0.05). This relationship for MACE was independent from frailty status, with the test for interaction between frailty and hemoglobin not reaching significance (P = 0.24).
Low hemoglobin was associated with increased MACE in community-dwelling older men independently from frailty. A hemoglobin cutoff point of 140 g/L, a level that is above contemporary definitions of anemia, predicted long-term MACE.
贫血与老年人群的全因死亡率增加相关。然而，血红蛋白与主要不良心血管事件（MACE）之间的关系，以及这种关系是否受到衰弱的影响，尚不清楚。
CHAMP（男性健康与衰老研究项目）是一项对年龄≥70 岁的社区居住男性进行的前瞻性研究。采用 Cox 回归分析血红蛋白与 7 年 MACE 的关系。使用约登指数确定预测 MACE 的最佳血红蛋白截断点。使用 Fried 标准评估衰弱情况。
该队列包括 1604 名男性（平均年龄 76.9±5.5 岁）。血红蛋白降低与合并症、衰弱和 MACE 增加相关（均 P<0.001），140g/L 是预测 MACE 的最佳截断点。血红蛋白、年龄和衰弱独立预测 MACE（均 P<0.001）。血红蛋白水平每降低 10g/L，MACE 风险增加（风险比 [HR]1.13，95%置信区间 [CI]1.06-1.20；P<0.001），全因死亡率（HR 1.20，95%CI 1.12-1.29；P<0.001），心血管死亡率（HR 1.07，95%CI 1.01-1.14；P=0.025），心肌梗死（HR 1.17，95%CI 1.09-1.25；P<0.001）和心力衰竭（HR 1.17，95%CI 1.09-1.25；P<0.001）。按血红蛋白五分位分层时，血红蛋白处于最低 2 个五分位（分别为 133-140g/L 和<132g/L）的男性发生 MACE、心血管死亡率、心肌梗死和心力衰竭的风险增加（均 P<0.05）。这种 MACE 相关性与衰弱状态无关，衰弱和血红蛋白之间的交互检验无统计学意义（P=0.24）。
在社区居住的老年男性中，血红蛋白水平低与 MACE 增加相关，与衰弱无关。血红蛋白截断点为 140g/L，高于当代贫血定义，可预测长期 MACE。
