Anemia, Cardiovascular Disease, and Frailty in the Older Adult

Anemia, defined by the World Health Organization (WHO) as hemoglobin ≤ 130 g/L in men and ≤ 120 g/L in women, is a common clinical condition in older adults, with a reported prevalence of 10% to 20%, and has multiple potential hemodynamic and nonhemodynamic impacts on cardiovascular disease (CVD). 1 World Health OrganisationHaemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011. http://www.who.int/vmnis/indicators/haemoglobin.pdfDate: 2011 Date accessed: January 31, 2022 Google Scholar ,2 Guralnik J.M. Eisenstaedt R.S. Ferrucci L. et al. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004; : 2263-2268 Crossref PubMed Scopus (1066) Google Scholar Anemia is independently associated with worsening New York Heart Association (NYHA) functional class, heart failure readmission, and a graded mortality risk, with a relative risk (RR) of 1.13 (95% confidence interval [CI] 1.05-1.22) for each 1 g/dL decrease of hemoglobin. 3 Horwich T.B. Fonarow G.C. Hamilton M.A. MacLellan R. Borenstein J. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in paitents with advanced heart failure. J Am Coll Cardiol. 2002; 39: 1780-1786 Crossref PubMed Scopus (618) Google Scholar Anemia is also known to be a marker of increased risk of major adverse cardiovascular events (MACE) outside of the heart failure population. For example, in a substudy of the Trial of Invasive vs Medical Therapy in Elderly Patients (TIME) trial, every 1 g/dL decrease of hemoglobin was associated with an increased risk of cardiovascular (CV) death (adjusted RR 1.28; P = 0.02) and MACE (adjusted RR 1.23; P = 0.01). 4 Muzzarelli S. Pfisterer M. Investigators T.I.M.E. Anemia as independent predictor of major events in elderly patients with chronic angina. Am Heart J. 2006; 152: 991-996 Crossref PubMed Scopus (73) Google Scholar Hemoglobin, Frailty, and Long-term Cardiovascular Events in Community-Dwelling Older Men Aged ≥ 70 YearsCanadian Journal of CardiologyVol. 38Issue 6PreviewAnemia 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. Full-Text PDF