Threshold haemoglobin levels and the prognosis of stable coronary disease: two new cohorts and a systematic review and meta-analysis.
Cast your vote
You can rate an item by clicking the amount of stars they wish to award to this item.
When enough users have cast their vote on this item, the average rating will also be shown.
Your vote was cast
Thank you for your feedback
Thank you for your feedback
AuthorsShah, Anoop D
Timmis, Adam D
Hingorani, Aroon D
MetadataShow full item record
AbstractLow haemoglobin concentration has been associated with adverse prognosis in patients with angina and myocardial infarction (MI), but the strength and shape of the association and the presence of any threshold has not been precisely evaluated. A retrospective cohort study was carried out using the UK General Practice Research Database. 20,131 people with a new diagnosis of stable angina and no previous acute coronary syndrome, and 14,171 people with first MI who survived for at least 7 days were followed up for a mean of 3.2 years. Using semi-parametric Cox regression and multiple adjustment, there was evidence of threshold haemoglobin values below which mortality increased in a graded continuous fashion. For men with MI, the threshold value was 13.5 g/dl (95% confidence interval [CI] 13.2-13.9); the 29.5% of patients with haemoglobin below this threshold had an associated hazard ratio for mortality of 2.00 (95% CI 1.76-2.29) compared to those with haemoglobin values in the lowest risk range. Women tended to have lower threshold haemoglobin values (e.g, for MI 12.8 g/dl; 95% CI 12.1-13.5) but the shape and strength of association did not differ between the genders, nor between patients with angina and MI. We did a systematic review and meta-analysis that identified ten previously published studies, reporting a total of only 1,127 endpoints, but none evaluated thresholds of risk. There is an association between low haemoglobin concentration and increased mortality. A large proportion of patients with coronary disease have haemoglobin concentrations below the thresholds of risk defined here. Intervention trials would clarify whether increasing the haemoglobin concentration reduces mortality.
PublisherPublic Library of Science
The following licence applies to the copyright and re-use of this item:
- Creative Commons
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by-nc-nd/4.0/
- Exercise-based cardiac rehabilitation for coronary heart disease.
- Authors: Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, Taylor RS
- Issue date: 2016 Jan 5
- Healthcare disparities for women hospitalized with myocardial infarction and angina.
- Authors: Jackson AM, Zhang R, Findlay I, Robertson K, Lindsay M, Morris T, Forbes B, Papworth R, McConnachie A, Mangion K, Jhund PS, McCowan C, Berry C
- Issue date: 2020 Apr 1
- Natural history of myocardial infarction and angina pectoris in a general population sample of middle-aged men: a 16-year follow-up of the Primary Prevention Study, Göteborg, Sweden.
- Authors: Rosengren A, Wilhelmsen L, Hagman M, Wedel H
- Issue date: 1998 Dec
- Cardiovascular disease incidence and mortality in older men with diabetes and in men with coronary heart disease.
- Authors: Wannamethee SG, Shaper AG, Lennon L
- Issue date: 2004 Dec
- Mortality in South Asians and Caucasians after percutaneous coronary intervention in the United Kingdom: an observational cohort study of 279,256 patients from the BCIS (British Cardiovascular Intervention Society) National Database.
- Authors: Jones DA, Gallagher S, Rathod KS, Redwood S, de Belder MA, Mathur A, Timmis AD, Ludman PF, Townend JN, Wragg A, NICOR (National Institute for Cardiovascular Outcomes Research)
- Issue date: 2014 Apr