Abstract
Background: Anemia is an independent risk factor for morbidity and mortality in patients with cardiovascular disease. However, the impact of anemia on pre-clinical cardiac damage has not yet fully determined in apparently healthy subjects. The aim of the present study was to investigate whether anemia is associated with pre-clinical cardiac damage and cardiovascular mortality in general population. Methods and Results: A cohort study was conducted with subjects who participated in a community-based annual health check in Takahata, Japan, from 2004 through 2006. We examined blood count, serum levels of brain-type natriuretic peptide (BNP) and heart-type fatty acid binding protein (H-FABP) in participants and prospectively followed them (n = 3,509). Anemia was defined as hemoglobin < 13 g/dl for men; < 12 g/dl for women. Four hundred subjects (11.4%) had anemia. In both gender, BNP levels were higher in subjects with anemia than in those without. H-FABP levels were also higher in male subjects with anemia than in those without, while anemia was not associated with H-FABP levels in female subjects. During follow-up period of 7 years, 40 subjects died of cardiovascular diseases. Kaplan-Meier analysis demonstrated that subjects with anemia had higher cardiovascular mortality than those without. Further, subjects those with macrocytic anemia, defined as anemia with mean corpuscular volume (MCV) ≥ 100 fl, had the highest levels of BNP and H-FABP and the highest event rate among subjects with anemia. Multivariate Cox proportional hazard analysis revealed that anemia was an independent predictor of cardiovascular diseases after adjusting age, gender, smoking index, estimated glomerular filtration rate, and BNP (HR: 2.307; 95% CI, 1.032 - 4.808). Conclusions: Anemia, especially macrocytic anemia, was associated with pre-clinical myocardial damage and cardiovascular mortality in general population.
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