Show simple item record

dc.contributor.authorShah, Anoop D
dc.contributor.authorNicholas, Owen
dc.contributor.authorTimmis, Adam D
dc.contributor.authorFeder, Gene
dc.contributor.authorAbrams, Keith
dc.contributor.authorChen, Ruoling
dc.contributor.authorHingorani, Aroon D
dc.contributor.authorHemingway, Harry
dc.date.accessioned2018-08-30T09:27:37Z
dc.date.available2018-08-30T09:27:37Z
dc.date.issued2011-05-31
dc.identifier.issn1932-6203
dc.identifier.pmid21655315
dc.identifier.doi10.1371/journal.pmed.1000439
dc.identifier.urihttp://hdl.handle.net/2436/621654
dc.description.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.
dc.formatapplication/PDF
dc.language.isoen
dc.publisherPublic Library of Science
dc.relation.urlhttps://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000439
dc.titleThreshold haemoglobin levels and the prognosis of stable coronary disease: two new cohorts and a systematic review and meta-analysis.
dc.typeJournal article
dc.identifier.journalPLoS One
dc.date.accepted2011-04-19
rioxxterms.funderJisc
rioxxterms.identifier.projectUOW300818RC
rioxxterms.versionAM
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
rioxxterms.licenseref.startdate2011-05-31
dc.source.journaltitlePLoS medicine
refterms.dateFCD2018-08-30T09:27:38Z
refterms.versionFCDAM
refterms.dateFOA2018-08-30T09:27:38Z


Files in this item

Thumbnail
Name:
journal.pmed.1000439.PDF
Size:
570.3Kb
Format:
PDF

This item appears in the following Collection(s)

Show simple item record

https://creativecommons.org/licenses/by-nc-nd/4.0/
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by-nc-nd/4.0/