title: Anaemia, independent of chronic kidney disease, predicts all-cause and cardiovascular mortality in type 2 diabetic patients.
abstract: OBJECTIVE
  There is limited and controversial information on whether anaemia is a risk factor for cardiovascular mortality in type 2 diabetes, and whether this risk is modified by the presence of chronic kidney disease (CKD). We assessed the predictive role of lower hemoglobin concentrations on all-cause and cardiovascular mortality in a cohort of type 2 diabetic individuals.
  
  
  METHODS
  The cohort included 1153 type 2 diabetic outpatients, who were followed for a mean period of 4.9 years. The independent association of anaemia (i.e., hemoglobin <120 g/l in women and <130 g/l in men) with all-cause and cardiovascular mortality was evaluated by Cox proportional hazards regression models and adjusted for several potential confounders, including kidney function measures.
  
  
  RESULTS
  During follow-up, 166 (14.4%) patients died, 42.2% (n=70) of them from cardiovascular causes. In univariate analysis, anaemia was associated with increased risk of all-cause (hazard ratio HR 2.62, 95% confidence intervals 1.90-3.60, p<0.001) and cardiovascular mortality (HR 2.70, 1.67-4.37, p<0.001). After adjustment for age, sex, body mass index, smoking, hypertension, dyslipidemia, diabetes duration, hemoglobin A1c, medication use (hypoglycemic, anti-hypertensive, lipid-lowering and anti-platelet drugs) and kidney function measures, the association of anaemia with all-cause (adjusted HR 2.11, 1.32-3.35, p=0.002) and cardiovascular mortality (adjusted HR 2.23, 1.12-4.39, p=0.020) remained statistically significant.
  
  
  CONCLUSIONS
  Anaemia is associated with increased risk of all-cause and cardiovascular mortality in type 2 diabetic individuals, independently of the presence of CKD and other potential confounders. The advantage to treat anaemia in type 2 diabetes for reducing the risk of adverse cardiovascular outcomes remains to be demonstrated.
authors.affiliation: Section of Endocrinology, Department of Biomedical and Surgical Sciences, University of Verona, Ospedale Civile Maggiore, Piazzale Stefani, 1, 37126 Verona, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zoppini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
authors.forename: Michel
authors.initials: M
authors.lastname: Chonchol
authors.forename: Carlo
authors.initials: C
authors.lastname: Negri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Stoico
authors.forename: Isabella
authors.initials: I
authors.lastname: Pichiri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
authors.forename: Michele
authors.initials: M
authors.lastname: Muggeo
authors.forename: Enzo
authors.initials: E
authors.lastname: Bonora
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000401:mortality*; D015331:Cohort Studies; D048909:Diabetes Complications; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D005260:Female; D006454:Hemoglobins / Q000096:biosynthesis / Q000378:metabolism; D006801:Humans; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D006454:Hemoglobins