title: Association of anemia with the risk of cardiovascular adverse events in overweight/obese patients.
abstract: OBJECTIVE
  Anemia is associated with increased cardiovascular risks. Obesity may cause anemia in several ways, for example, by low-grade inflammation and relative iron deficit. The outcomes associated with anemia in overweight/obese patients at high cardiovascular risk are however not known. Therefore, we investigated the cardiovascular prognosis in overweight/obese subjects with anemia.
  
  
  METHODS
  A total of 9,687 overweight/obese cardiovascular high-risk patients from the Sibutramine Cardiovascular OUTcomes trial were studied. Patients were stratified after baseline hemoglobin level and followed for the risks of primary event (comprising nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality. Risk estimates (hazard ratios (HR) with 95% confidence intervals (CI)) were calculated using Cox regression models.
  
  
  RESULTS
  Anemia was unadjusted associated with increased risk for the primary event, HR 1.73 (CI 1.37-2.18) and HR 2.02 (CI 1.34-3.06) for patients with mild or moderate-to-severe anemia, respectively, compared with patients without anemia. Adjusted for several confounders, anemia remained of prognostic importance. Increased risk of the primary events appeared to be driven by risk of cardiovascular death, adjusted HR 1.82 (CI 1.33-2.51) for mild anemia and adjusted HR 1.65 (CI 0.90-3.04) for moderate-to-severe anemia, and all-cause mortality, adjusted HR 1.50 (CI 1.17-1.93) for mild and adjusted HR 1.61 (CI 1.04-2.51) for moderate-to-severe anemia. While adding serum creatinine to the models, the increased risk of mild anemia was still a significant predictor for mortality (cardiovascular and all-cause), whereas moderate-to-severe anemia was not. For the primary events, anemia was no longer of independent prognostic importance when including serum creatinine.
  
  
  CONCLUSIONS
  Anemia is associated with an increased risk of long-term adverse cardiovascular events and deaths among overweight/obese cardiovascular high-risk patients. The increased risk appeared to be driven by the risk of cardiovascular death and all-cause mortality, and renal impairments seemed to have a role in the increased risk.
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: S A
authors.initials: SA
authors.lastname: Winther
authors.affiliation: Institute of Cardiovascular Science, University College London, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Finer
authors.affiliation: Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Sharma
authors.affiliation: Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: C
authors.identifier: 0000000328926131
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Andersson
mesh_terms: D000740:Anemia / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D001067:Appetite Depressants / Q000627:therapeutic use; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D003503:Cyclobutanes / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D012307:Risk Factors
chemical_list: D001067:Appetite Depressants; D003503:Cyclobutanes; C058254:sibutramine