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Canadian Journal of Cardiology

Anemia, Cardiovascular Disease, and Frailty in the Older Adult

Published:March 05, 2022DOI:https://doi.org/10.1016/j.cjca.2022.03.001
      Anemia, defined by the World Health Organization (WHO) as hemoglobin ≤ 130 g/L in men and ≤ 120 g/L in women, is a common clinical condition in older adults, with a reported prevalence of 10% to 20%, and has multiple potential hemodynamic and nonhemodynamic impacts on cardiovascular disease (CVD).
      World Health Organisation
      Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011.
      ,
      • Guralnik J.M.
      • Eisenstaedt R.S.
      • Ferrucci L.
      • et al.
      Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia.
      Anemia is independently associated with worsening New York Heart Association (NYHA) functional class, heart failure readmission, and a graded mortality risk, with a relative risk (RR) of 1.13 (95% confidence interval [CI] 1.05-1.22) for each 1 g/dL decrease of hemoglobin.
      • Horwich T.B.
      • Fonarow G.C.
      • Hamilton M.A.
      • MacLellan R.
      • Borenstein J.
      Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in paitents with advanced heart failure.
      Anemia is also known to be a marker of increased risk of major adverse cardiovascular events (MACE) outside of the heart failure population. For example, in a substudy of the Trial of Invasive vs Medical Therapy in Elderly Patients (TIME) trial, every 1 g/dL decrease of hemoglobin was associated with an increased risk of cardiovascular (CV) death (adjusted RR 1.28; P = 0.02) and MACE (adjusted RR 1.23; P = 0.01).
      • Muzzarelli S.
      • Pfisterer M.
      • Investigators T.I.M.E.
      Anemia as independent predictor of major events in elderly patients with chronic angina.
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