title: 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.
abstract: OBJECTIVE
  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.
authors.affiliation: University of Florida College of Medicine, Division of Cardiovascular Medicine, Gainesville, Florida 32610-0277, USA. chrsarant@aol.com
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Arant
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Wessel
authors.forename: Marian B
authors.initials: MB
authors.lastname: Olson
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: William J
authors.initials: WJ
authors.lastname: Rogers
authors.forename: Barry L
authors.initials: BL
authors.lastname: Sharaf
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reis
authors.forename: Karen M
authors.initials: KM
authors.lastname: Smith
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.forename: Eileen
authors.initials: E
authors.lastname: Handberg
authors.forename: Sunil
authors.initials: S
authors.lastname: Mankad
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris; D015415:Biomarkers; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D006454:Hemoglobins