This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Arant, C. B. Articles by Pepine, C. J. Search for Related Content PubMed PubMed Citation Articles by Arant, C. B. Articles by Pepine, C. J.

CLINICAL RESEARCH: MYOCARDIAL ISCHEMIA AND INFARCTION

Hemoglobin level is an independent predictor for adverse cardiovascular outcomes in women undergoing evaluation for chest pain

Results from the National Heart, Lung, and Blood Institute women's ischemia syndrome evaluation study

Christopher B. Arant, MD^*,2, Timothy R. Wessel, MD^*, Marian B. Olson, MS, C. Noel Bairey Merz, MD, FACC^¶, George Sopko, MD^#, William J. Rogers, MD, FACC^||, Barry L. Sharaf, MD, FACC, Steven E. Reis, MD, FACC, Karen M. Smith, MD, FACC^*, B. Delia Johnson, PhD, Eileen Handberg, PhD^*, Sunil Mankad, MD, FACC and Carl J. Pepine, MD, MACC^*,1

^* University of Florida College of Medicine, Division of Cardiovascular Medicine, Gainesville, Florida, USA
Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Division of Medicine, Department of Cardiology, Rhode Island Hospital, Providence, Rhode Island, USA
^|| Division of Cardiology, University of Alabama Birmingham, Birmingham, Alabama, USA
^¶ Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
^# Division of Heart and Vascular Disease, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA

Manuscript received September 30, 2003; revised manuscript received December 23, 2003, accepted January 19, 2004.

² Correspondence: Dr. Christopher B. Arant, University of Florida Medicine, 1600 SW Archer Road, P.O. Box 100277, Gainesville, Florida 32610-0277, USA.
chrsarant{at}aol.com

¹ Reprint requests: Dr. Carl J. Pepine, University of Florida College of Medicine, Division of Cardiovascular Medicine, P.O. Box 100277, Gainesville, Florida 32610-0277.
pepincj{at}medicine.ufl.edu

OBJECTIVES: This study was designed to investigate the relationship between hemoglobin level (Hgb) and adverse cardiovascular outcomes in women with suspected ischemia.

BACKGROUND: Low Hgb levels correlate with increased cardiovascular morbidity and mortality in patients presenting with acute myocardial infarction (MI) or congestive heart failure (CHF). However, the prognostic significance of Hgb in women with suspected ischemia is unclear.

METHODS: As part of the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE), we prospectively studied 936 women referred for coronary angiography to evaluate suspected ischemia. We compared Hgb levels with cardiovascular risk factors, core lab interpreted angiograms, inflammatory markers, and adverse cardiovascular outcomes.

RESULTS: Of women enrolled, 864 (mean age 58.4 ±11.6 years) had complete Hgb, angiogram, and follow-up (mean 3.3 ± 1.7 years) data. The mean Hgb was 12.9 g/dl (range 7.7 to 16.4 g/dl) and 184 women (21%) were anemic (Hgb <12 g/dl). Anemic women had higher creatinine and were more likely to be nonwhite and have a history of diabetes, hypertension, and CHF (p < 0.05). However, we found no difference in EF or severity of coronary artery disease. Anemic women had a higher risk of death from any cause (10.3% vs. 5.4%; p = 0.02) and total adverse outcomes (26% vs. 16%, p < 0.01). In a multivariable model, decreasing Hgb was associated with significantly higher risk of adverse outcomes (hazard ratio = 1.20, p = 0.002). Also, anemic women had shorter survival time free of adverse outcome (p < 0.001).

CONCLUSIONS: Our findings extend previous reports, linking lower hemoglobin levels with higher risk for adverse cardiovascular outcomes, to women evaluated for suspected ischemia in the absence of acute MI or CHF.

Abbreviations and Acronyms   CAD = coronary artery disease   CHF = congestive heart failure   EF = ejection fraction   HF = heart failure   Hgb = hemoglobin   hs-CRP = high sensitivity C-reactive protein   IL = interleukin   MI = myocardial infarction   TNF = tumor necrosis factor   WISE = Women's Ischemia Syndrome Evaluation study

This article has been cited by other articles:

				W. Shu, W. Lei, and S. Peng Recent development of ischaemic heart disease in sex difference Postgrad. Med. J., April 1, 2007; 83(978): 240 - 243. [Abstract] [Full Text] [PDF]

				K. Bindra, C. Berry, J. Rogers, N. Stewart, M. Watts, J. Christie, S.M. Cobbe, and H. Eteiba Abnormal haemoglobin levels in acute coronary syndromes. QJM, December 1, 2006; 99(12): 851 - 862. [Abstract] [Full Text] [PDF]

				L. J. Shaw, C. N. Bairey Merz, C. J. Pepine, S. E. Reis, V. Bittner, S. F. Kelsey, M. Olson, B. D. Johnson, S. Mankad, B. L. Sharaf, et al. Insights From the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part I: Gender Differences in Traditional and Novel Risk Factors, Symptom Evaluation, and Gender-Optimized Diagnostic Strategies J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S4 - S20. [Abstract] [Full Text] [PDF]

				E. Handberg, B. D. Johnson, C. B. Arant, T. R. Wessel, R. A. Kerensky, G. von Mering, M. B. Olson, S. E. Reis, L. Shaw, C. N. Bairey Merz, et al. Impaired Coronary Vascular Reactivity and Functional Capacity in Women: Results From the NHLBI Women's Ischemia Syndrome Evaluation (WISE) Study J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S44 - S49. [Abstract] [Full Text] [PDF]

				A. Lerman and G. Sopko Women and Cardiovascular Heart Disease: Clinical Implications From the Women's Ischemia Syndrome Evaluation (WISE) Study: Are We Smarter? J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S59 - S62. [Abstract] [Full Text] [PDF]

				A. K. Jacobs Women, Ischemic Heart Disease, Revascularization, and the Gender Gap: What Are We Missing? J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S63 - S65. [Abstract] [Full Text] [PDF]

				A. A. Quyyumi Women and Ischemic Heart Disease: Pathophysiologic Implications From the Women's Ischemia Syndrome Evaluation (WISE) Study and Future Research Steps J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S66 - S71. [Abstract] [Full Text] [PDF]

				M. S. Sabatine, D. A. Morrow, R. P. Giugliano, P. B.J. Burton, S. A. Murphy, C. H. McCabe, C. M. Gibson, and E. Braunwald Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes Circulation, April 26, 2005; 111(16): 2042 - 2049. [Abstract] [Full Text] [PDF]

				Low Hemoglobin Predicts Cardiovascular Events in Women Journal Watch Women's Health, July 20, 2004; 2004(720): 5 - 5. [Full Text]