Gender differences in the impact of anemia on subclinical myocardial damage and cardiovascular mortality in the general population: The Yamagata (Takahata) study.

Abstract

Anemia has been shown to worsen cardiovascular diseases. However, it is unclear whether there is a gender difference in the impact of anemia on subclinical myocardial damage and cardiovascular mortality in the general population. A prospective cohort study was conducted in a community based on annual health checks. Serum heart-type fatty acid binding protein (H-FABP) levels, which is a marker for myocardial damage, and blood counts were measured at baseline in subjects without previous cardiovascular diseases (n=3111). There were 343 subjects (11.0%) with anemia at baseline. H-FABP levels were inversely correlated with hemoglobin concentrations in male subjects, whereas there was no such correlation in female subjects, irrespective of the status of menopause. Prevalence of myocardial damage (H-FABP ≥4.3ng/ml) was significantly higher in male subjects with anemia than those without, irrespective of the type of anemia (microcytic, normocytic, and macrocytic). Multivariate logistic regression analysis revealed that anemia was an independent predictor of myocardial damage after adjusting for confounders. During 10years of follow-up, there were 204 all-cause deaths including 57 cardiovascular deaths. Kaplan-Meier analysis demonstrated that cardiovascular mortality was higher in male subjects with anemia than in those without. However, anemia was not associated with cardiovascular mortality in female subjects. Multivariate Cox proportional hazard analysis revealed that anemia was an independent predictor of all-cause and cardiovascular mortalities after adjusting for confounders. Anemia was an independent predictor of all-cause and cardiovascular mortalities, and subclinical myocardial damage in male subjects, but not in female subjects.