Anemia increases death risk in heart disease, stroke patients

Anemia has been linked to an increased risk of death in heart disease and stroke patients. Anemia – low blood cell count – is a condition commonly seen in heart disease patients, affecting nearly one-third of congestive heart failure patients and 10 to 20 percent of coronary heart disease patients.

There are many factors that contribute to anemia in heart disease patients, including iron deficiency, chronic kidney disease, blunted erythropoietin production, hemodilution, aspirin-induced gastrointestinal blood loss, use of renin–angiotensin–aldosterone system blockers, cytokine-mediated inflammation (anemia of chronic disease), and gut malabsorption with consequent nutritional deficiency.

Anemia can lead to worsened outcomes for heart disease patients by causing health complications and even increasing the risk of death.

Previous study links anemia with greater risk of death in heart disease patients

Previous research found a link between anemia and a risk of death in heart disease patients. Co-author of the study Dr. Lexin Wang said, “Health professionals may need to improve current practices to better treat anemia in patients with chronic heart failure.”

The rate of mortality in heart disease patients is quite high, even with advancements in medical treatment. Through a meta-analysis and systemic review of published literature, the research team uncovered an association between anemia and risk of death in heart disease patients.

The researchers suggest that in order to reduce mortality rates, proper treatment of anemia should be completed.

Being anemic could triple your risk of dying within a year after having a stroke

Other researchers found that being anemic could triple the risk of death within a year of having a stroke. Jason J. Sico, M.D., Assistant Professor of Neurology and Internal Medicine at the Yale School of Medicine, said, “Having a history of severe anemia is a potent predictor of dying anytime throughout the first year – more potent than having heart disease, and more potent than having cancer.”

The research team conducted a retrospective cohort study of data from over 3,800 patients with stroke. Patients with hematocrit levels between 32 and 37 percent were classified as being mildly anemic, those with levels between 27 and 32 percent were classified as moderately anemic, and those below 27 percent were severely anemic.

The findings revealed that anemia increases the risk of death post-stroke for up to a year. The link is because anemia reduces the amount of oxygenated blood to the brain, increases heart rate, and can contribute to high blood pressure. Dr. Sico added that anemia, “impairs the way the blood vessel to the brain can react to having a stroke.”

It is of good practice to pay close attention to hematocrit levels and improve anemia in order to reduce the risk of mortality.

Guidance for anemia in heart disease

Published in the Annals of Internal Medicine, guidelines for the treatment of anemia in heart disease patients was revised. Below are some of those guidelines.

The American College of Physicians (ACP) recommends that blood transfusions be used restrictively in treating anemia in heart disease patients. Furthermore, erythropoiesis-stimulating agents (ESAs) should never be used to treat anemia in heart disease patients.

In hospitalized patients with coronary heart disease, blood transfusions should only be used in severe anemia. Patients with congestive heart failure or coronary heart disease should not be treated with ESAs for mild-to-moderate anemia as there is lack of evidence to support the treatment.

The authors wrote, “The ACP does not support the use of ESAs for treating patients with mild-to-moderate anemia and heart disease because the harms outweigh the benefits for these patients. The recommendation for avoiding ESAs was considered a strong one based on moderate-quality evidence.”

Treatment options for anemia

Depending on the severity of the anemia, and if you have a heart condition or not, there are many treatment options available. A common cause for anemia is an iron deficiency, so supplementing iron could help with anemia. Iron can be obtained through diet and is commonly found in red meat, dark leafy greens and organ meats. Diet changes or pill supplements are a good start for treating an iron deficiency in anemia, but if anemia is severe, iron may need to be administered intravenously or through blood transfusions.

Being deficient in other vitamins, too, can contribute to anemia, so you may need to supplement those deficient vitamins in order to treat anemia. Additionally, chronic diseases can also lead to anemia, and treatment in those scenarios would involve treating the underlying illness.

Because anemia can have many causes, it is essential to identify the underlying cause and treat what can improve anemia. Your doctor will be able to determine your levels and severity and recommend proper treatment for your situation.