Abstract
OBJECTIVES:Previous studies have demonstrated that both low and high hemoglobin concentrations are predictive of adverse cardiovascular outcomes in various populations. However, an association of hemoglobin with the ankle-brachial index, which is widely used as a screening test for peripheral arterial disease, has not yet been identified.METHODS:We examined 786 subjects (236 women and 550 men) who received routine physical check-ups. The ankle-brachial index and several hematological parameters, including the hemoglobin level, hematocrit and red blood cell count and other demographic and biochemical characteristics were collected. Univariate and multivariate linear regression analyses were performed to assess the relationships between the ankle-brachial index and the independent determinants. Receiver operating characteristic curve analysis was conducted to calculate the cut-off level of hemoglobin for a relatively low ankle-brachial index (less than 20% of all subjects, which was 1.02).RESULTS:The hemoglobin level, hematocrit and red blood cell count were correlated with the ankle-brachial index in the males (r=-0.274, r=-0.224 and r=-0.273, respectively, p<0.001 for all), but these associations were not significant in the females. Multivariate linear regression analysis revealed that the independent determinants of the ankle-brachial index included age, total cholesterol, high-density lipoprotein cholesterol and the white blood cell count for the females and age, hypertension, total cholesterol and hemoglobin (β=-0.001, p<0.001) for the males after adjusting for confounding factors. Receiver operating characteristic curve analysis revealed that the cut-off level of hemoglobin for predicting a low ankle-brachial index was 156.5 g/L in the males.CONCLUSIONS:A high hemoglobin concentration was independently correlated with a low ankle-brachial index in the healthy males, indicating that an elevation in this level may be associated with an increased atherosclerosis risk.
Highlights
Previous epidemiologic studies have shown that the hemoglobin concentration is associated with unfavorable cardiovascular events in the general population and in patients with coronary arterial disease (CAD), hypertension and heart failure [1,2,3,4,5,6,7,8]
The hemoglobin level, hematocrit and red blood cell count were correlated with the ankle-brachial index in the males (r=-0.274, r=-0.224 and r=-0.273, respectively, po0.001 for all), but these associations were not significant in the females
A high hemoglobin concentration was independently correlated with a low ankle-brachial index in the healthy males, indicating that an elevation in this level may be associated with an increased atherosclerosis risk
Summary
Previous epidemiologic studies have shown that the hemoglobin concentration is associated with unfavorable cardiovascular events in the general population and in patients with coronary arterial disease (CAD), hypertension and heart failure [1,2,3,4,5,6,7,8]. Some investigations have revealed that a decreased hemoglobin concentration or anemia is predictive of adverse outcomes [1,2,3,4]; accumulating evidence demonstrates a J- or U-shaped curve for the relationship between hemoglobin and poor prognosis in patients with acute coronary syndrome or heart failure and in the elderly general population [5,6,7,8]. A low hemoglobin level or anemia, as well as an elevated hemoglobin level, should be taken into consideration in evaluation of the total risk of cardiovascular disease (CVD)
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