Anemia and Long-term cardiovascular outcomes in women with suspected ischemia – The Women's Ischemia Syndrome Evaluation (WISE)

Abstract

Background: Anemia is associated with adverse cardiovascular outcomes in patients with ischemic heart disease and is more prevalent in women as compared to men. Prior studies have evaluated short-term outcomes in women with stable angina and relatively low rates of obstructive coronary artery disease (CAD). We investigated the long-term clinical significance of baseline anemia in this cohort. Methods: We studied 885 women enrolled in the Women's Ischemia Syndrome Evaluation (WISE) undergoing clinically indicated coronary angiography for suspected ischemia. Anemia at enrollment was defined as hemoglobin (Hgb) level < 12 g/dL. Major adverse cardiovascular events (MACE) included cardiovascular death, non-fatal myocardial infarction, heart failure hospitalization, stroke, and vascular events. Cox regression models and Kaplan-Meier methods were used. Results: Overall, the women, mean age 58.4 ± 11.7 years, were followed for an average of seven years (range 0–11 years). Anemia was present in 21.1%. They had higher creatinine levels with more frequent history of diabetes mellitus, hypertension, and HF (p < 0.05) but similar obstructive coronary artery disease compared to non-anemic women. Anemic women had higher long-term all-cause mortality and MACE rate. In multivariable analysis, anemia was independently associated with increased MACE risk (hazard ratio (HR): 1.5, 95% confidence interval [1.117–2.017, p = 0.007]) but not all-cause mortality (HR:1.2 [0.841, 1.727, p = 0.309]). Conclusions: Among women evaluated for symptoms of ischemia, anemia is associated with and independently predicts long-term MACE. Further research targeting anemia management in women to mitigate these adverse outcomes is warranted.

Keywords

• Ischemia
• WISE
• Cardiovascular
• Anemia