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. 2011;1(2):160-6.
Epub 2011 Sep 10.

A review of anemia as a cardiovascular risk factor in patients with myelodysplastic syndromes

Esther N Oliva, Carina Schey, Adam S Hutchings

A review of anemia as a cardiovascular risk factor in patients with myelodysplastic syndromes

Esther N Oliva et al. Am J Blood Res. 2011.

Abstract

Background: Anemia is an important cause of morbidity in MDS patients, principally through increased cardiovascular disease. Transfusion status has been seen to be a significant prognostic factor for disease progression and mortality, yet the relationship between anemia levels and cardiovascular disease is not well understood.

Objective: This study aimed to review the published literature on the effect of anemia on cardiovascular outcomes in patients with MDS.

Methods: A systematic literature review was undertaken to identify studies that investigated the relationship between anemia (as defined by hemoglobin levels) and cardiovascular outcomes in patients with MDS (all subtypes).

Results: Three studies were identified that explicitly evaluated the relationship between anemia and cardiovascular outcomes in MDS, and another study reported the relationship between hemoglobin levels and survival. The four studies consistently showed a strong relationship between lower hemoglobin levels and worse cardiovascular outcomes, including cardiac remodeling, congestive heart failure, coronary artery disease, myocardial infarction, arrhythmia, heart valve disease, and cardiovascular mortality. Anemia was seen to be an independent predictor of cardiovascular disease outcomes in patients with MDS, beyond transfusion status and IPSS.

Conclusion: Based upon a relatively small body of evidence, there appears to be a strong and clinically significant association between anemia and cardiovascular morbidity and mortality in MDS. While further research is needed, clinicians should seek to actively manage hemoglobin levels in MDS patients before the point of transfusion dependency is reached.

Keywords: MDS; anemia; Myelodysplastic syndromes; cardiovascular disease; hemoglobin; mortality; quality of life; transfusion.

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Figures

Figure 1
Figure 1
Cumulative probability of cardiac complications in MDS patients without cardiac disease at presentation, according to the presence or absence of severe anemia (HR 3.85, P<0.001) [25].
Figure 2
Figure 2
Overall survival (OS) of patients with MDS in the Intermediate IPSS categories (Int-1 and Int-2) relative to baseline levels of hemoglobin (Kaplan Meier curves) [13].
See this image and copyright information in PMC

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