Research Article: Threshold Haemoglobin Levels and the Prognosis of Stable Coronary Disease: Two New Cohorts and a Systematic Review and Meta-Analysis

Date Published: May 31, 2011

Publisher: Public Library of Science

Author(s): Anoop D. Shah, Owen Nicholas, Adam D. Timmis, Gene Feder, Keith R. Abrams, Ruoling Chen, Aroon D. Hingorani, Harry Hemingway, Anushka Patel

Abstract: Anoop Shah and colleagues performed a retrospective cohort study and a systematic review, and show evidence that in people with stable coronary disease there were threshold hemoglobin values below which mortality increased in a graded, continuous fashion.

Partial Text: Haemoglobin is a potentially useful prognostic biomarker among patients with stable coronary artery disease because of the pathological role of myocardial hypoxia in subsequent acute coronary events [1],[2] and the existence of interventions to increase haemoglobin concentration [3]–[5]. Measurement of haemoglobin is nearly universal in such patients, further underscoring the relevance of understanding its impact on prognosis. While previous studies suggest that low haemoglobin is associated with mortality in patients with coronary artery disease [6],[7], they have been limited in their ability to describe the shape of the relationship, to assess gender differences, and to compare patients with angina or prior myocardial infarction (MI). Furthermore there are concerns that the prognostic biomarker literature may be subject to reporting and other biases [8]. Thus several questions, relevant to clinical practice and the design of future trials, remain unanswered.



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