eprintid: 1319730 rev_number: 47 eprint_status: archive userid: 608 dir: disk0/01/31/97/30 datestamp: 2011-09-08 08:50:47 lastmod: 2021-12-13 01:32:24 status_changed: 2011-09-08 08:50:47 type: article metadata_visibility: show item_issues_count: 0 creators_name: Shah, AD creators_name: Nicholas, O creators_name: Timmis, AD creators_name: Feder, G creators_name: Abrams, KR creators_name: Chen, RL creators_name: Hingorani, AD creators_name: Hemingway, H title: Threshold Haemoglobin Levels and the Prognosis of Stable Coronary Disease: Two New Cohorts and a Systematic Review and Meta-Analysis ispublished: pub divisions: UCL divisions: B02 divisions: D14 divisions: DD4 divisions: B04 divisions: C06 divisions: F61 keywords: CHRONIC KIDNEY-DISEASE, PRACTICE RESEARCH DATABASE, LONG-TERM MORTALITY, HEART-FAILURE, MYOCARDIAL-INFARCTION, GENERAL-PRACTICE, INDEPENDENT PREDICTOR, CLINICAL-OUTCOMES, OLDER MEN, ANEMIA note: © 2011 Shah et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. abstract: Background: Low haemoglobin concentration has been associated with adverse prognosis in patients with angina and myocardial infarction (MI), but the strength and shape of the association and the presence of any threshold has not been precisely evaluated.Methods and findings: A retrospective cohort study was carried out using the UK General Practice Research Database. 20,131 people with a new diagnosis of stable angina and no previous acute coronary syndrome, and 14,171 people with first MI who survived for at least 7 days were followed up for a mean of 3.2 years. Using semi-parametric Cox regression and multiple adjustment, there was evidence of threshold haemoglobin values below which mortality increased in a graded continuous fashion. For men with MI, the threshold value was 13.5 g/dl (95% confidence interval [CI] 13.2-13.9); the 29.5% of patients with haemoglobin below this threshold had an associated hazard ratio for mortality of 2.00 (95% CI 1.76-2.29) compared to those with haemoglobin values in the lowest risk range. Women tended to have lower threshold haemoglobin values (e. g, for MI 12.8 g/dl; 95% CI 12.1-13.5) but the shape and strength of association did not differ between the genders, nor between patients with angina and MI. We did a systematic review and meta-analysis that identified ten previously published studies, reporting a total of only 1,127 endpoints, but none evaluated thresholds of risk.Conclusions: There is an association between low haemoglobin concentration and increased mortality. A large proportion of patients with coronary disease have haemoglobin concentrations below the thresholds of risk defined here. Intervention trials would clarify whether increasing the haemoglobin concentration reduces mortality. date: 2011-05-31 publisher: PUBLIC LIBRARY SCIENCE official_url: http://dx.doi.org/10.1371/journal.pmed.1000439 vfaculties: VFPHS vfaculties: VFPHS vfaculties: VFPHS oa_status: green pmcid: PMC3104976 language: eng primo: open primo_central: open_green article_type_text: Review verified: verified_manual elements_source: Web of Science elements_id: 318897 doi: 10.1371/journal.pmed.1000439 language_elements: EN lyricists_name: Hemingway, Harry lyricists_name: Hingorani, Aroon lyricists_name: Nicholas, Owen lyricists_name: Shah, Anoop lyricists_id: HHEMI65 lyricists_id: AHING65 lyricists_id: ONICH93 lyricists_id: ASHAH69 full_text_status: public publication: PLoS Medicine volume: 8 number: 5 article_number: e1000439 pagerange: - issn: 1549-1277 citation: Shah, AD; Nicholas, O; Timmis, AD; Feder, G; Abrams, KR; Chen, RL; Hingorani, AD; Shah, AD; Nicholas, O; Timmis, AD; Feder, G; Abrams, KR; Chen, RL; Hingorani, AD; Hemingway, H; - view fewer <#> (2011) Threshold Haemoglobin Levels and the Prognosis of Stable Coronary Disease: Two New Cohorts and a Systematic Review and Meta-Analysis. PLoS Medicine , 8 (5) , Article e1000439. 10.1371/journal.pmed.1000439 <https://doi.org/10.1371/journal.pmed.1000439>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/1319730/1/1319730.pdf