Association of Hemoglobin Concentration and Its Change With Cardiovascular and All-Cause Mortality.
Association of Hemoglobin Concentration and Its Change With Cardiovascular and All-Cause Mortality.
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DOI：
10.1161/jaha.117.007723
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发表时间：
2018-01-29
影响因子：
5.4
通讯作者：
Park SM
中科院分区：
文献类型：
--
作者：
Lee G;Choi S;Kim K;Yun JM;Son JS;Jeong SM;Kim SM;Park SM
贫血被认为会增加死亡风险，但高血红蛋白浓度对生存的影响尚不清楚。血红蛋白浓度变化对一般人群生存率的影响也是未知的。本研究旨在检查血红蛋白浓度及其变化对心血管和全因死亡风险的影响。我们回顾性分析了NHIS‐HEALS（国家健康保险服务-国家健康筛查队列）数据库中的一个队列，包括170 078名男性和122 116名女性，无心血管疾病，基线年龄>40岁，第一次和第二次健康检查的血红蛋白浓度可用。我们评估了2个独立变量：“一次性”血红蛋白浓度和第一次到第二次检查的血红蛋白变化。参与者接受了中位8年的随访，以确定与心肌梗死、中风、所有心血管疾病和所有原因相关的死亡率。在调整心血管风险因素后，血红蛋白浓度与心血管和全因死亡率呈U形或J形相关。当贫血男性达到正常血红蛋白浓度时，与贫血持续存在的患者相比，全因死亡风险降低，调整后的风险比为0.67（95%置信区间为0.59-0.77）。与持续正常血红蛋白浓度相比，血红蛋白浓度超出正常范围的升高和降低均增加了全因死亡风险（校正的风险比分别为：1.39 [95%置信区间，1.28-1.49]和1.10 [95%置信区间，1.01-1.20]）。这一趋势在女性中也类似，但不太明显。低或高血红蛋白浓度与心血管和全因死亡率升高相关。血红蛋白浓度达到并维持在正常范围内与全因死亡率降低相关。
Anemia is thought to increase mortality risks, but the effects of high hemoglobin concentration on survival are unclear. The effect of change in hemoglobin concentrations on survival in the general population is also unknown. This study aimed to examine the effect of hemoglobin concentrations and their changes on cardiovascular and all‐cause mortality risks. We retrospectively analyzed a cohort from the NHIS‐HEALS (National Health Insurance Service–National Health Screening Cohort) database, including 170 078 men and 122 116 women without cardiovascular diseases, aged >40 years at baseline, with hemoglobin concentrations available for both first and second health examinations. We assessed 2 independent variables: “One‐time” hemoglobin concentrations and changes in hemoglobin from first to second examination. Participants were followed up for a median of 8 years to determine mortality related to myocardial infarction, stroke, all cardiovascular diseases, and all causes. Hemoglobin concentrations showed a U‐ or J‐shaped association with cardiovascular and all‐cause mortality after adjusting for cardiovascular risk factors. When anemic men achieved normal hemoglobin concentrations, the all‐cause mortality risk decreased, with an adjusted hazard ratio of 0.67 (95% confidence interval, 0.59–0.77), in comparison with those whose anemia persisted. Both increases and decreases of hemoglobin concentration outside the normal range elevated all‐cause mortality risk (adjusted hazard ratio: 1.39 [95% confidence interval, 1.28–1.49] and 1.10 [95% confidence interval, 1.01–1.20], respectively), compared with persistent normal hemoglobin concentrations. The trend was similar in women but was less significant. Low or high hemoglobin concentrations were associated with elevated cardiovascular and all‐cause mortality. Reaching and maintaining hemoglobin concentrations within the normal range correlated with decreased all‐cause mortality.