STATE-OF-THE-ART PAPER
Anemia as a risk factor and therapeutic target in heart failure
G.Michael Felker, MD*,*,
Kirkwood F. Adams, Jr, MD, FACC ,
Wendy A. Gattis, PharmD* and
Christopher M. O'Connor, MD, FACC*
* Duke Clinical Research Institute, Durham, North Carolina, USA
University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
Manuscript received March 24, 2004;
revised manuscript received April 18, 2004,
accepted May 19, 2004.
* Reprint requests and correspondence: Dr. G. Michael Felker, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27715 (Email: felke001{at}mc.duke.edu).
Anemia has recently been recognized as an important comorbid condition and potentially novel therapeutic target in patients with heart failure (HF). Anemia is common in HF patients, with a prevalence ranging from 4% to 55% depending on the population studied. Multiple potential mechanisms of interaction exist between anemia and the clinical syndrome of HF, including hemodilution, inflammatory activation, renal insufficiency, and malnutrition. A growing body of literature from observational databases and clinical trials suggests that anemia is an independent risk factor for adverse outcomes in patients with HF. Although preliminary data suggest that treatment of anemia may result in significant symptomatic improvement in HF, aggressive treatment of anemia may also be associated with increased risk of hypertension or thrombosis. Multiple ongoing studies will provide definitive data on the balance of risks and benefits of anemia treatment in chronic HF.
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Abbreviations and Acronyms
| | ACE = angiotensin-converting enzyme | | ESRD = end-stage renal disease | | Hb = hemoglobin | | HF = heart failure | | NYHA = New York Heart Association | | rHuEPO = recombinant human erythropoietin | | TNF = tumor necrosis factor |
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