Hemoglobin, Frailty, and Long-term Cardiovascular Events in Community-Dwelling Older Men Aged ≥ 70 Years

Sonali R Gnanenthiran; Austin C C Ng; Robert G Cumming; David B Brieger; David G le Couteur; Louise M Waite; Markus Seibel; David J Handelsman; Vasi Naganathan; Leonard Kritharides; Fiona M Blyth

doi:10.1016/j.cjca.2022.01.024

Hemoglobin, Frailty, and Long-term Cardiovascular Events in Community-Dwelling Older Men Aged ≥ 70 Years

Can J Cardiol. 2022 Jun;38(6):745-753. doi: 10.1016/j.cjca.2022.01.024. Epub 2022 Jan 29.

Affiliations

¹ Cardiology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia. Electronic address: sgnanenthiran@georgeinstitute.org.au.
² Cardiology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
³ Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁴ Cardiology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia.
⁵ Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁶ Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
⁷ ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
⁸ ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Andrology Department, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
⁹ Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

PMID: 35101588
DOI: 10.1016/j.cjca.2022.01.024

Abstract

Background: Anemia is associated with increased risk of all-cause mortality in older populations. However, the relationship between hemoglobin and major adverse cardiovascular events (MACE), and whether this is modulated by frailty, is unclear.

Methods: CHAMP (Concord Health and Ageing in Men Project) is a prospective study of community-dwelling men aged ≥ 70 years. The relationship between hemoglobin and 7-year MACE was analysed by means of Cox regression. The Youden index was used to determine the optimal hemoglobin cutoff point in predicting MACE. Frailty was assessed with the use of the Fried criteria.

Results: The cohort comprised 1604 men (mean ± SD age 76.9 ± 5.5 years). Decreasing hemoglobin was associated with increased comorbidity, frailty, and MACE (P < 0.001), with 140 g/L the optimal cutoff point for predicting MACE. Hemoglobin, age, and frailty independently predicted MACE (all P < 0.001). Each 10 g/L decrement in hemoglobin level was associated with increased risk of MACE (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.06-1.20; P < 0.001), all-cause mortality (HR 1.20, 95% CI 1.12-1.29; P < 0.001), cardiovascular mortality (HR 1.07, 95% CI 1.01-1.14; P = 0.025), myocardial infarction (HR 1.17, 95% CI 1.09-1.25; P < 0.001), and heart failure (HR 1.17, 95% CI 1.09-1.25; P < 0.001). When stratified into hemoglobin quintiles, men in the lowest 2 quintiles (Hb 133-140 g/L and < 132g/L, respectively) were at increased risk of MACE, cardiovascular mortality, myocardial infarction, and heart failure (all P < 0.05). This relationship for MACE was independent from frailty status, with the test for interaction between frailty and hemoglobin not reaching significance (P = 0.24).

Conclusions: Low hemoglobin was associated with increased MACE in community-dwelling older men independently from frailty. A hemoglobin cutoff point of 140 g/L, a level that is above contemporary definitions of anemia, predicted long-term MACE.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Anemia* / complications
Anemia* / epidemiology
Frailty*
Heart Failure*
Hemoglobins / analysis
Humans
Independent Living
Male
Myocardial Infarction*
Prospective Studies

Substances

Hemoglobins