The Association between Hemoglobin Concentrations and Cardiovascular Disease in Postmenopausal Women within the Women's Health Initiative

INTRODUCTION: Cardiovascular disease (CVD) is a leading cause of death in the United States. It can lead to hospitalization, disability, mortality and decreased quality of life. Abnormal hemoglobin concentration (anemia or higher than normal level) has been proposed as a potential risk factor for CV...

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Main Author: Wu, Guanglin
Other Authors: Zhao, Chen
Language:en
Published: The University of Arizona. 2012
Subjects:
Online Access:http://hdl.handle.net/10150/243115
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spelling ndltd-arizona.edu-oai-arizona.openrepository.com-10150-2431152015-10-23T04:56:50Z The Association between Hemoglobin Concentrations and Cardiovascular Disease in Postmenopausal Women within the Women's Health Initiative Wu, Guanglin Zhao, Chen Shahar, Eyal Ernst, Kacey Chen, Zhao Epidemiology INTRODUCTION: Cardiovascular disease (CVD) is a leading cause of death in the United States. It can lead to hospitalization, disability, mortality and decreased quality of life. Abnormal hemoglobin concentration (anemia or higher than normal level) has been proposed as a potential risk factor for CVD. However, it has not been tested in general postmenopausal women using large perspective study method. The overall objective of this dissertation is to examine the association between abnormal hemoglobin concentration, left ventricular hypertrophy (LVH), and cardiovascular outcomes in postmenopausal women. METHODS: This dissertation unitized data from the Women's Health Initiative (WHI) cohort. Hemoglobin concentrations were classified into several categories: normal (12g/dl ≤ hemoglobin ≤ 15g/dl), mild anemia (hemoglobin < 12g/dl), moderate anemia (hemoglobin < 11g/dl), severe anemia (hemoglobin < 10.5g/dl), and extremely high hemoglobin (EHH) (hemoglobin > 15g/dl). Three associations were assessed. Hemoglobin concentration and subsequent cardiovascular events were tested in the WHI participants without prior CVD (n=123,465). The association between hemoglobin concentration and cardiovascular death was tested in the WHI participants with prior CVD (n=26,929). The last study, testing the association between hemoglobin concentration and LVH, were assessed cross-sectionally in the WHI clinical trials which had electrocardiographic (ECG) data (n=57,551). RESULTS: In women without prior CVD, both anemia and EHH was associated with an increased risk of cardiovascular events. The association varied by age groups, and EHH associated cardiovascular risk decreased with age. In women with prior CVD, risk of cardiovascular death significantly increased by 48%, 90% and 32% in mild anemia, moderate/severe anemia, and EHH group respectively compared to normal group. In the WHI participants who had ECG data, odds ratios of LVH were 1.13 (95% CI: 0.90-1.41), 1.35 (95% CI: 0.76-2.40), and 1.32 (95% CI: 0.76-2.40) for mild anemia, moderate/severe anemia, and EHH group respectively compared to normal group. CONCLUSION: These studies constantly demonstrated a U-shaped association between hemoglobin concentration and cardiovascular risk in the postmenopausal women. It suggests that the association of hemoglobin concentration and incidence of CVD was modified by age. Additional research is needed to determine whether there is a cause-and-effect relationship between hemoglobin concentration and LVH. 2012 text Electronic Dissertation http://hdl.handle.net/10150/243115 en Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. The University of Arizona.
collection NDLTD
language en
sources NDLTD
topic Epidemiology
spellingShingle Epidemiology
Wu, Guanglin
The Association between Hemoglobin Concentrations and Cardiovascular Disease in Postmenopausal Women within the Women's Health Initiative
description INTRODUCTION: Cardiovascular disease (CVD) is a leading cause of death in the United States. It can lead to hospitalization, disability, mortality and decreased quality of life. Abnormal hemoglobin concentration (anemia or higher than normal level) has been proposed as a potential risk factor for CVD. However, it has not been tested in general postmenopausal women using large perspective study method. The overall objective of this dissertation is to examine the association between abnormal hemoglobin concentration, left ventricular hypertrophy (LVH), and cardiovascular outcomes in postmenopausal women. METHODS: This dissertation unitized data from the Women's Health Initiative (WHI) cohort. Hemoglobin concentrations were classified into several categories: normal (12g/dl ≤ hemoglobin ≤ 15g/dl), mild anemia (hemoglobin < 12g/dl), moderate anemia (hemoglobin < 11g/dl), severe anemia (hemoglobin < 10.5g/dl), and extremely high hemoglobin (EHH) (hemoglobin > 15g/dl). Three associations were assessed. Hemoglobin concentration and subsequent cardiovascular events were tested in the WHI participants without prior CVD (n=123,465). The association between hemoglobin concentration and cardiovascular death was tested in the WHI participants with prior CVD (n=26,929). The last study, testing the association between hemoglobin concentration and LVH, were assessed cross-sectionally in the WHI clinical trials which had electrocardiographic (ECG) data (n=57,551). RESULTS: In women without prior CVD, both anemia and EHH was associated with an increased risk of cardiovascular events. The association varied by age groups, and EHH associated cardiovascular risk decreased with age. In women with prior CVD, risk of cardiovascular death significantly increased by 48%, 90% and 32% in mild anemia, moderate/severe anemia, and EHH group respectively compared to normal group. In the WHI participants who had ECG data, odds ratios of LVH were 1.13 (95% CI: 0.90-1.41), 1.35 (95% CI: 0.76-2.40), and 1.32 (95% CI: 0.76-2.40) for mild anemia, moderate/severe anemia, and EHH group respectively compared to normal group. CONCLUSION: These studies constantly demonstrated a U-shaped association between hemoglobin concentration and cardiovascular risk in the postmenopausal women. It suggests that the association of hemoglobin concentration and incidence of CVD was modified by age. Additional research is needed to determine whether there is a cause-and-effect relationship between hemoglobin concentration and LVH.
author2 Zhao, Chen
author_facet Zhao, Chen
Wu, Guanglin
author Wu, Guanglin
author_sort Wu, Guanglin
title The Association between Hemoglobin Concentrations and Cardiovascular Disease in Postmenopausal Women within the Women's Health Initiative
title_short The Association between Hemoglobin Concentrations and Cardiovascular Disease in Postmenopausal Women within the Women's Health Initiative
title_full The Association between Hemoglobin Concentrations and Cardiovascular Disease in Postmenopausal Women within the Women's Health Initiative
title_fullStr The Association between Hemoglobin Concentrations and Cardiovascular Disease in Postmenopausal Women within the Women's Health Initiative
title_full_unstemmed The Association between Hemoglobin Concentrations and Cardiovascular Disease in Postmenopausal Women within the Women's Health Initiative
title_sort association between hemoglobin concentrations and cardiovascular disease in postmenopausal women within the women's health initiative
publisher The University of Arizona.
publishDate 2012
url http://hdl.handle.net/10150/243115
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