title: A review of anemia as a cardiovascular risk factor in patients with myelodysplastic syndromes.
abstract: BACKGROUND
  Anemia is an important cause of morbidity in MDS patients, principally through increased cardiovascular disease. Transfusion status has been seen to be a significant prognostic factor for disease progression and mortality, yet the relationship between anemia levels and cardiovascular disease is not well understood.
  
  
  OBJECTIVE
  This study aimed to review the published literature on the effect of anemia on cardiovascular outcomes in patients with MDS.
  
  
  METHODS
  A systematic literature review was undertaken to identify studies that investigated the relationship between anemia (as defined by hemoglobin levels) and cardiovascular outcomes in patients with MDS (all subtypes).
  
  
  RESULTS
  Three studies were identified that explicitly evaluated the relationship between anemia and cardiovascular outcomes in MDS, and another study reported the relationship between hemoglobin levels and survival. The four studies consistently showed a strong relationship between lower hemoglobin levels and worse cardiovascular outcomes, including cardiac remodeling, congestive heart failure, coronary artery disease, myocardial infarction, arrhythmia, heart valve disease, and cardiovascular mortality. Anemia was seen to be an independent predictor of cardiovascular disease outcomes in patients with MDS, beyond transfusion status and IPSS.
  
  
  CONCLUSIONS
  Based upon a relatively small body of evidence, there appears to be a strong and clinically significant association between anemia and cardiovascular morbidity and mortality in MDS. While further research is needed, clinicians should seek to actively manage hemoglobin levels in MDS patients before the point of transfusion dependency is reached.
authors.forename: Esther N
authors.initials: EN
authors.lastname: Oliva
authors.forename: Carina
authors.initials: C
authors.lastname: Schey
authors.forename: Adam S
authors.initials: AS
authors.lastname: Hutchings