According to a review on the prevalence of anemia in HF, 6 the most widely used cutoff point is hemoglobin 9 For example, in the Euro-Heart Failure Study, 16 the estimate of the prevalence of anemia increased by 33 with the cutoff point of 12 gdL.The journal, published since 1947, is the official publication of the Spanish Society of Cardiology and founder of the REC Publications journal family.
![]() Inflammatory mechanisms in chronic anemia: critical role of interleukin 6 (IL-6) and hepcidin. CRP indicates C-reactive protein. TABLE 2. Possible Anemia-Inducing Mechanisms of Angiotensin-Converting Enzyme Antagonists and Angiotensin I Antagonists TABLE 3. ![]() Anemia is highly prevalent in patients with heart failure and is of great clinical significance. However, the treatment targets for anemia in patients with heart failure have still not been accurately defined. The present article reviews of the clinical and pathophysiological characteristics of anemia in this context. Particular emphasis has been placed on cellular and molecular regulatory mechanisms, and their implications for treatment. Palabras clave: Insuficiencia cardiaca Anemia Enfermedad renal crnica Eritropoyetina Hierro Inflamacin Interleucinas Hepcidina. ![]() This situation has recently taken a notable turn and anemia has come to occupy a more relevant position in the understanding of the pathogenesis of heart failure. In an illustrative example, while the clinical guidelines for the management of HF issued by the American College of Cardiology and the American Heart Association between 1999 and 2001 2 did not mention anemia, in those of 2005, 3 it is recognized as a frequent finding that is associated with the rates of morbidity and mortality. From that time on, the data has become increasingly extensive, and a recent review of new aspects of HF 4 acknowledges an even more relevant pathogenic role of anemia than that mentioned in the European guidelines for HF. This recognition has generated a high level of expectation with respect to the possible beneficial role of the treatment of anemia in the natural history of HF. This expectation, however, has not been accompanied by the systematization of its study and treatment. In contrast, there has been a progressive increase in the application of therapeutic measures, not always sufficiently individualized and systematized. All in all, anemia in patients with heart failure is still enveloped in unknowns, especially with respect to its pathogenesis and the importance of its course in HF, constituting a terrain in which opinion still predominates over scientific evidence. EPIDEMIOLOGY AND MAGNITUDE OF THE PROBLEM The Prevalence Depends on the Population Being Studied and the Comorbidity In published series, the percentage of patients in which HF is accompanied by anemia differs widely, 6,7 ranging between 9.9 8 and over 50. This variability depends in part on the differences between the populations analyzed (comorbidity, New York Heart Association NYHA class), but, above all, on the cutoff point used to define anemia. Patients with anemia and HF tend to be of more advanced age, in NYHA functional class III-IV, with more drug treatment and more comorbidity (diabetes mellitus, chronic renal disease CRD, and hypertension), as well as longer and more frequent hospital stays, 6,10 but these individuals are not usually included in drug trials. As an example, in an analysis of older patients, more than half had a hemoglobin level 12 A large body of data supports the concept that the prevalence of anemia increases with more severe HF, but they do not explain the mechanisms involved in this relationship. The Estimation of the Prevalence Depends on the Definition of Anemia A major drawback when assessing population-based data is the fact that uniform cutoff points have not been employed to define anemia. At the present time, the situation remains unstable in terms of definition. In individuals with CRD, the National Kidney Foundation (NKF), in its 2000 guidelines, defined anemia as a hemoglobin level 14 In a new version of these guidelines (2006), the limits were raised to 15 However, the publication of new works in the months following the appearance of these modified guidelines (see section on Current perspectives) has led to their immediate revision, and a third version is now being drafted in which lower target hemoglobin values are again being proposed (Adeer Levin, personal communication, 2007). As a whole, the instability of this issue is a clear invitation to act with caution when establishing objectives in the anemia of HF.
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