GENDER DISPARITIES IN CARDIO-RESPIRATORY FITNESS AMONG A COMORBIDITY FREE ANEMIC POPULATION
(Abstract release date: 05/19/16)
EHA Library. Shouval R. 06/09/16; 134962; PB2062
Dr. Roni Shouval
Contributions
Contributions
Abstract
Abstract: PB2062
Type: Publication Only
Background
Anemia is a common hematologic disorder characterized by reduced absolute number of circulating red blood cells. It has been established as a poor prognostic factor in a variety of medical disorders. Nonetheless, the functional impact of anemia on cardiorespiratory fitness (CRF) in healthy individuals has mostly been explored in small interventional studies, simulating acute rather than chronic states.
Aims
Using differing criteria for anemia diagnosis, while analyzing males and females separately, the primary and secondary objectives were to evaluate the effect of anemia on CRF and overall survival, respectively, in apparently healthy adults.
Methods
We retrospectively analyzed 16,332 self-referred subjects undergoing exercise stress testing as part of a routine screening program. Subjects were non-smoking, free of diabetes, ischemic heart disease, or chronic kidney disease. Anemia was defined by either the World Health Organization (WHO) criteria (Hemoglobin (Hb) less than 13 g/dl and 12 g/dl for males and females, respectively), or Beutler and Waalens’ (BW) criteria (Blood, 2006) (less than 13.7 g/dL and 13.2 g/dL for males younger and older than 60 years, respectively, and 12.2 for females). Fitness was categorized into age- and sex-specific quintiles according to Bruce protocol treadmill time. Multivariate logistic regression was used to evaluate the association between anemia and low CRF in the baseline visit as well as during multiple visits. A multivariate Cox proportional hazards regression model was constructed for survival analysis.
Results
The mean age of the cohort was 46 ± 10 years and 70% were men. Median follow-up was 10 years. Mean Hb levels were 13.09 ± 0.96 and 15.05 ± 0.96 among women and men, respectively (p<0.001), with higher proportion of anemia among women (10.8% versus 1.6% according to WHO criteria, and 15% versus 6.1% according to BW criteria, respectively; p<0.001 for both). Baseline visit anemia, according the WHO and BW criteria, was associated with a risk adjusted increase of 33% (1.06-1.66, 95% confidence interval (CI)) and 24% (1.01-1.52, 95% CI) for low CRF, respectively (p<0.05 for both). However, no association was observed in males, regardless of anemia threshold. These findings were corroborated in a repeated measures analysis of 71,200 sequential visits (Figure 1), where only in females, anemia resulted in a 38% (1.17-1.63, 95% CI) and 22% (1.05-1.40, 95% CI) increase in risk for low CRF (p<0.01 for both). Lack of regular physical activity, elevated body mass index, total cholesterol and fasting glucose levels were also independently associated with low CRF in the multivariate model, regardless of gender. With respect to survival, only anemia in men, as opposed to women, was associated with an increased risk for mortality, especially when adopting a more stringent criteria for diagnosis (hazard ratio of 3.06 (1.65-5.68, 95% CI) and 1.83 (1.06-3.17, 95% CI), using the WHO criteria and BW criteria respectively, p<0.05 for both).
Conclusion
Anemia’s functional and prognostic significance differs between genders in a cohort of comorbidity free subjects. Anemia, regardless of diagnostic criteria, was associated with low fitness only in females, while increased mortality was solely observed in males. Taken together our findings indicate differing anemia mechanisms and physiological responses between genders. Moreover, we suggest a functional and prognostic, rather than an epidemiologic approach, for setting anemia diagnosis thresholds.
Session topic: E-poster
Keyword(s): Anemia, Survival
Type: Publication Only
Background
Anemia is a common hematologic disorder characterized by reduced absolute number of circulating red blood cells. It has been established as a poor prognostic factor in a variety of medical disorders. Nonetheless, the functional impact of anemia on cardiorespiratory fitness (CRF) in healthy individuals has mostly been explored in small interventional studies, simulating acute rather than chronic states.
Aims
Using differing criteria for anemia diagnosis, while analyzing males and females separately, the primary and secondary objectives were to evaluate the effect of anemia on CRF and overall survival, respectively, in apparently healthy adults.
Methods
We retrospectively analyzed 16,332 self-referred subjects undergoing exercise stress testing as part of a routine screening program. Subjects were non-smoking, free of diabetes, ischemic heart disease, or chronic kidney disease. Anemia was defined by either the World Health Organization (WHO) criteria (Hemoglobin (Hb) less than 13 g/dl and 12 g/dl for males and females, respectively), or Beutler and Waalens’ (BW) criteria (Blood, 2006) (less than 13.7 g/dL and 13.2 g/dL for males younger and older than 60 years, respectively, and 12.2 for females). Fitness was categorized into age- and sex-specific quintiles according to Bruce protocol treadmill time. Multivariate logistic regression was used to evaluate the association between anemia and low CRF in the baseline visit as well as during multiple visits. A multivariate Cox proportional hazards regression model was constructed for survival analysis.
Results
The mean age of the cohort was 46 ± 10 years and 70% were men. Median follow-up was 10 years. Mean Hb levels were 13.09 ± 0.96 and 15.05 ± 0.96 among women and men, respectively (p<0.001), with higher proportion of anemia among women (10.8% versus 1.6% according to WHO criteria, and 15% versus 6.1% according to BW criteria, respectively; p<0.001 for both). Baseline visit anemia, according the WHO and BW criteria, was associated with a risk adjusted increase of 33% (1.06-1.66, 95% confidence interval (CI)) and 24% (1.01-1.52, 95% CI) for low CRF, respectively (p<0.05 for both). However, no association was observed in males, regardless of anemia threshold. These findings were corroborated in a repeated measures analysis of 71,200 sequential visits (Figure 1), where only in females, anemia resulted in a 38% (1.17-1.63, 95% CI) and 22% (1.05-1.40, 95% CI) increase in risk for low CRF (p<0.01 for both). Lack of regular physical activity, elevated body mass index, total cholesterol and fasting glucose levels were also independently associated with low CRF in the multivariate model, regardless of gender. With respect to survival, only anemia in men, as opposed to women, was associated with an increased risk for mortality, especially when adopting a more stringent criteria for diagnosis (hazard ratio of 3.06 (1.65-5.68, 95% CI) and 1.83 (1.06-3.17, 95% CI), using the WHO criteria and BW criteria respectively, p<0.05 for both).
Conclusion
Anemia’s functional and prognostic significance differs between genders in a cohort of comorbidity free subjects. Anemia, regardless of diagnostic criteria, was associated with low fitness only in females, while increased mortality was solely observed in males. Taken together our findings indicate differing anemia mechanisms and physiological responses between genders. Moreover, we suggest a functional and prognostic, rather than an epidemiologic approach, for setting anemia diagnosis thresholds.
Session topic: E-poster
Keyword(s): Anemia, Survival
Abstract: PB2062
Type: Publication Only
Background
Anemia is a common hematologic disorder characterized by reduced absolute number of circulating red blood cells. It has been established as a poor prognostic factor in a variety of medical disorders. Nonetheless, the functional impact of anemia on cardiorespiratory fitness (CRF) in healthy individuals has mostly been explored in small interventional studies, simulating acute rather than chronic states.
Aims
Using differing criteria for anemia diagnosis, while analyzing males and females separately, the primary and secondary objectives were to evaluate the effect of anemia on CRF and overall survival, respectively, in apparently healthy adults.
Methods
We retrospectively analyzed 16,332 self-referred subjects undergoing exercise stress testing as part of a routine screening program. Subjects were non-smoking, free of diabetes, ischemic heart disease, or chronic kidney disease. Anemia was defined by either the World Health Organization (WHO) criteria (Hemoglobin (Hb) less than 13 g/dl and 12 g/dl for males and females, respectively), or Beutler and Waalens’ (BW) criteria (Blood, 2006) (less than 13.7 g/dL and 13.2 g/dL for males younger and older than 60 years, respectively, and 12.2 for females). Fitness was categorized into age- and sex-specific quintiles according to Bruce protocol treadmill time. Multivariate logistic regression was used to evaluate the association between anemia and low CRF in the baseline visit as well as during multiple visits. A multivariate Cox proportional hazards regression model was constructed for survival analysis.
Results
The mean age of the cohort was 46 ± 10 years and 70% were men. Median follow-up was 10 years. Mean Hb levels were 13.09 ± 0.96 and 15.05 ± 0.96 among women and men, respectively (p<0.001), with higher proportion of anemia among women (10.8% versus 1.6% according to WHO criteria, and 15% versus 6.1% according to BW criteria, respectively; p<0.001 for both). Baseline visit anemia, according the WHO and BW criteria, was associated with a risk adjusted increase of 33% (1.06-1.66, 95% confidence interval (CI)) and 24% (1.01-1.52, 95% CI) for low CRF, respectively (p<0.05 for both). However, no association was observed in males, regardless of anemia threshold. These findings were corroborated in a repeated measures analysis of 71,200 sequential visits (Figure 1), where only in females, anemia resulted in a 38% (1.17-1.63, 95% CI) and 22% (1.05-1.40, 95% CI) increase in risk for low CRF (p<0.01 for both). Lack of regular physical activity, elevated body mass index, total cholesterol and fasting glucose levels were also independently associated with low CRF in the multivariate model, regardless of gender. With respect to survival, only anemia in men, as opposed to women, was associated with an increased risk for mortality, especially when adopting a more stringent criteria for diagnosis (hazard ratio of 3.06 (1.65-5.68, 95% CI) and 1.83 (1.06-3.17, 95% CI), using the WHO criteria and BW criteria respectively, p<0.05 for both).
Conclusion
Anemia’s functional and prognostic significance differs between genders in a cohort of comorbidity free subjects. Anemia, regardless of diagnostic criteria, was associated with low fitness only in females, while increased mortality was solely observed in males. Taken together our findings indicate differing anemia mechanisms and physiological responses between genders. Moreover, we suggest a functional and prognostic, rather than an epidemiologic approach, for setting anemia diagnosis thresholds.
Session topic: E-poster
Keyword(s): Anemia, Survival
Type: Publication Only
Background
Anemia is a common hematologic disorder characterized by reduced absolute number of circulating red blood cells. It has been established as a poor prognostic factor in a variety of medical disorders. Nonetheless, the functional impact of anemia on cardiorespiratory fitness (CRF) in healthy individuals has mostly been explored in small interventional studies, simulating acute rather than chronic states.
Aims
Using differing criteria for anemia diagnosis, while analyzing males and females separately, the primary and secondary objectives were to evaluate the effect of anemia on CRF and overall survival, respectively, in apparently healthy adults.
Methods
We retrospectively analyzed 16,332 self-referred subjects undergoing exercise stress testing as part of a routine screening program. Subjects were non-smoking, free of diabetes, ischemic heart disease, or chronic kidney disease. Anemia was defined by either the World Health Organization (WHO) criteria (Hemoglobin (Hb) less than 13 g/dl and 12 g/dl for males and females, respectively), or Beutler and Waalens’ (BW) criteria (Blood, 2006) (less than 13.7 g/dL and 13.2 g/dL for males younger and older than 60 years, respectively, and 12.2 for females). Fitness was categorized into age- and sex-specific quintiles according to Bruce protocol treadmill time. Multivariate logistic regression was used to evaluate the association between anemia and low CRF in the baseline visit as well as during multiple visits. A multivariate Cox proportional hazards regression model was constructed for survival analysis.
Results
The mean age of the cohort was 46 ± 10 years and 70% were men. Median follow-up was 10 years. Mean Hb levels were 13.09 ± 0.96 and 15.05 ± 0.96 among women and men, respectively (p<0.001), with higher proportion of anemia among women (10.8% versus 1.6% according to WHO criteria, and 15% versus 6.1% according to BW criteria, respectively; p<0.001 for both). Baseline visit anemia, according the WHO and BW criteria, was associated with a risk adjusted increase of 33% (1.06-1.66, 95% confidence interval (CI)) and 24% (1.01-1.52, 95% CI) for low CRF, respectively (p<0.05 for both). However, no association was observed in males, regardless of anemia threshold. These findings were corroborated in a repeated measures analysis of 71,200 sequential visits (Figure 1), where only in females, anemia resulted in a 38% (1.17-1.63, 95% CI) and 22% (1.05-1.40, 95% CI) increase in risk for low CRF (p<0.01 for both). Lack of regular physical activity, elevated body mass index, total cholesterol and fasting glucose levels were also independently associated with low CRF in the multivariate model, regardless of gender. With respect to survival, only anemia in men, as opposed to women, was associated with an increased risk for mortality, especially when adopting a more stringent criteria for diagnosis (hazard ratio of 3.06 (1.65-5.68, 95% CI) and 1.83 (1.06-3.17, 95% CI), using the WHO criteria and BW criteria respectively, p<0.05 for both).
Conclusion
Anemia’s functional and prognostic significance differs between genders in a cohort of comorbidity free subjects. Anemia, regardless of diagnostic criteria, was associated with low fitness only in females, while increased mortality was solely observed in males. Taken together our findings indicate differing anemia mechanisms and physiological responses between genders. Moreover, we suggest a functional and prognostic, rather than an epidemiologic approach, for setting anemia diagnosis thresholds.
Session topic: E-poster
Keyword(s): Anemia, Survival
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