title: Anemia is associated with the progression of white matter disease in older adults with high blood pressure: the cardiovascular health study.
abstract: OBJECTIVE
  To investigate whether anemia predicts worsening white matter hyperintensities (WMHs) in older community-dwellers.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Older community-dwellers.
  
  
  METHODS
  One thousand eight hundred forty-six Cardiovascular Health Study (CHS) participants (mean age 73.7 +/- 4.4, 41% male, 15.6% African American).
  
  
  METHODS
  Participants had hemoglobin measured and brain magnetic resonance imaging (MRI) in 1992/93 and a second brain MRI in 1997/98. Anemia was defined according to World Health Organization criteria (hemoglobin <12 g/dL in women and <13 g/dL in men). Worsening WMHs were determined according to standardized side-by-side readings.
  
  
  RESULTS
  After 5 years, WMHs worsened in 517 participants (28%). Progression was not associated with anemia in the whole sample, in sex or race strata, or in other prespecified subgroups (participants with renal dysfunction or diabetes mellitus), except in participants with high blood pressure (>or=140/90 mmHg). Of the 678 participants with high blood pressure, those with anemia (10.5%) had a 1.79 times greater risk of WMHs worsening (95% confidence interval=1.06-2.98; P for interaction between anemia and high blood pressure=.01) independent of demographics, baseline WMHs, cardiovascular risk factors and comorbidities, medications, renal function, inflammation, and incident stroke (logistic regression models). There was no greater risk in participants with anemia with normal blood pressure.
  
  
  CONCLUSIONS
  Anemia may contribute to worsening of WMHs in older adults with high blood pressure.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. inzitarim@edc.pitt.edu
authors.forename: Marco
authors.initials: M
authors.lastname: Inzitari
authors.forename: Stephanie
authors.initials: S
authors.lastname: Studenski
authors.forename: Caterina
authors.initials: C
authors.lastname: Rosano
authors.forename: Neil A
authors.initials: NA
authors.lastname: Zakai
authors.forename: William T
authors.initials: WT
authors.lastname: Longstreth
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications*; D001921:Brain / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000150:complications; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D049292:Leukoaraiosis / Q000150:complications / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male