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Journal ArticleDOI

Anemia and mortality in acute coronary syndromes: A systematic review and meta-analysis

01 Feb 2013-American Heart Journal (Am Heart J)-Vol. 165, Iss: 2, pp 143-153
TL;DR: Clinically and statistically significant increases in mortality were observed as early as at 30 days post-ACS and persisted at 1 year and anemia in patients with ACS is independently associated with a significantly increased risk of early and late mortality.
About: This article is published in American Heart Journal.The article was published on 2013-02-01. It has received 132 citations till now. The article focuses on the topics: Anemia & Relative risk.
Citations
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Journal ArticleDOI
TL;DR: This work discusses how regulatory cues (e.g., iron, inflammation, or hypoxia) affect the hepcidin response and how impairment of the hePCidin/ferroportin regulatory system causes disorders of iron metabolism.
Abstract: Iron is an essential element in our daily diet. Most iron is required for the de novo synthesis of red blood cells, where it plays a critical role in oxygen binding to hemoglobin. Thus, iron deficiency causes anemia, a major public health burden worldwide. On the other extreme, iron accumulation in critical organs such as liver, heart, and pancreas causes organ dysfunction due to the generation of oxidative stress. Therefore, systemic iron levels must be tightly balanced. Here we focus on the regulatory role of the hepcidin/ferroportin circuitry as the major regulator of systemic iron homeostasis. We discuss how regulatory cues (e.g., iron, inflammation, or hypoxia) affect the hepcidin response and how impairment of the hepcidin/ferroportin regulatory system causes disorders of iron metabolism.

144 citations


Cites background from "Anemia and mortality in acute coron..."

  • ...) is frequently observed in people with an increased risk to develop ACS and myocardial infarction [150]....

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Journal ArticleDOI
09 Dec 2013-PLOS ONE
TL;DR: There is a significant association between prior IDA and ischemic stroke and no significant relationship betweenIDA and subarachnoid/intracerebral hemorrhage even adjusting for other confounding factors.
Abstract: Background Very little is known about the relationship between non-sickle cell anemia and stroke. The purpose of this study is to evaluate the association of iron-deficiency anemia (IDA) with stroke based on a nationwide coverage database in Taiwan.

101 citations


Cites background from "Anemia and mortality in acute coron..."

  • ...Several reports have already indirectly suggested IDA as a risk factor for ischemic stroke [29,34,3,5]....

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  • ...Some researchers have stated that iron deficiency status is considered a risk factor for thrombocytosis and should, wherever possible, be avoided [4,5]....

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  • ...Anemia is the most common disorder of the blood and had been proved to be highly related to the cardiovascular diseases as well as cerebrovascular accidents [5-9]....

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  • ...Due to the fact that most patients with anemia are asymptomatic, the true incidence of the IDA might be potentially higher than previously reported [2,5]....

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  • ...Anemia was known to be an important risk factor in the development of many cardiovascular diseases [5-8]....

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Journal ArticleDOI
TL;DR: The analysis of 422 855 patients with ACS showed that 27.7% of patients presenting with ACS are anemic and that these patients are older, have a greater prevalence of renal disease, peripheral vascular disease, diabetes mellitus, and previous acute myocardial infarction, and are less likely to receive evidence‐based therapies shown to improve clinical outcomes.
Abstract: BackgroundWe aim to determine the prevalence of anemia in acute coronary syndrome (ACS) patients and compare their clinical characteristics, management, and clinical outcomes to those without anemi...

57 citations


Cites result from "Anemia and mortality in acute coron..."

  • ...Previous reports have suggested that ACS patients with anemia have significantly worse in-hospital and longer-term total and cardiac mortality outcomes,(5-7,16,17) heart failure,(18) and risk of major bleeding(6) and of reinfarction.(6,8,19) Some studies have reported that, once differences in age or comorbidity burden between anemic/nonanemic ACS cohorts are adjusted for, anemia is no longer an independent predictor of adverse mortality(20) or cardiovascular mortality,(21) although other studies report that the relationship persists....

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Journal ArticleDOI
TL;DR: There was an association between IDA and VTEs based on a population-based coverage database and there was no significant difference in the adjusted OR of prior IDA between subjects with a pulmonary embolism and the controls.
Abstract: Although iron-deficiency anemia (IDA) as a rare cause of cerebral sinus thrombosis was supported by several studies, the relationship between IDA and venous thromboembolisms (VTEs) remains unclear. In this study, we evaluated the association between IDA and subsequent VTEs based on a population-based coverage database. We retrieved data for this case-control study from the Taiwan Longitudinal Health Insurance Database 2000. In total, 2522 cases with VTE and 12 610 randomly selected controls were included. A conditional logistic regression was used to examine the association of VTEs with previously diagnosed IDA. The χ test indicated that there was a significant difference in the prevalence of prior IDA between subjects with a VTE and the controls (3.41 vs. 2.06%, respectively, P < 0.001). The conditional logistic regression analysis showed that the odds ratio (OR) of previous IDA for subjects with a VTE was 1.43 [95% confidence interval (CI): 1.10-1.87] compared with the controls after adjusting for monthly income, geographic region, urbanization level, cancer, inflammatory bowel disease, heart failure, hypertension, diabetes, coronary heart disease, hyperlipidemia, renal disease, obesity, and whether or not a subject was hospitalized and whether or not a subject had suffered from a fracture within 1 year prior to the index date. The adjusted OR for prior IDA in subjects with deep-vein thrombosis was 1.43 (95% CI: 1.08-1.90) compared with the controls. However, there was no significant difference in the adjusted OR of prior IDA between subjects with a pulmonary embolism and the controls (OR: 1.10; 95% CI: 0.63-1.92). We concluded that there was an association between IDA and VTEs.

57 citations

Journal ArticleDOI
TL;DR: A Cardiologia Intervencionista tem experimentado extraordinario avanco nos ultimos anos, sendo atualmente o metodo de revascularizacao do miocardio mais empregado em todos os cenarios clinicos, incluindo a doenca arterial coronaria (DAC) estavel e as sindromes coronarias agudas (SCAs) as discussed by the authors.
Abstract: 1. Introducao A Cardiologia Intervencionista tem experimentado extraordinario avanco nos ultimos anos, sendo atualmente o metodo de revascularizacao do miocardio mais empregado em todos os cenarios clinicos, incluindo a doenca arterial coronaria (DAC) estavel e as sindromes coronarias agudas (SCAs). Isso se deve, entre outros fatores, ao grande desenvolvimento tecnologico dos dispositivos percutâneos, a evolucao das tecnicas de tratamento e, principalmente, a expansao das indicacoes, as quais permanecem substanciadas por uma serie de ensaios clinicos comparativos contemporâneos robustos que incluem [...]

55 citations

References
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Journal ArticleDOI
19 Apr 2000-JAMA
TL;DR: A checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion should improve the usefulness ofMeta-an analyses for authors, reviewers, editors, readers, and decision makers.
Abstract: ObjectiveBecause of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers.ParticipantsTwenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention.EvidenceWe conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods.Consensus ProcessFrom the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed.ConclusionsThe proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.

17,663 citations

01 Jan 2014
TL;DR: The Newcastle-Ottawa Scale (NOS) as discussed by the authors was developed to assess the quality of nonrandomised studies with its design, content and ease of use directed to the task of incorporating the quality assessments in the interpretation of meta-analytic results.
Abstract: Nonrandomised studies, including case-control and cohort studies, can be challenging to implement and conduct. Assessment of the quality of such studies is essential for a proper understanding of nonrandomised studies. The Newcastle-Ottawa Scale (NOS) is an ongoing collaboration between the Universities of Newcastle, Australia and Ottawa, Canada. It was developed to assess the quality of nonrandomised studies with its design, content and ease of use directed to the task of incorporating the quality assessments in the interpretation of meta-analytic results. A 'star system' has been developed in which a study is judged on three broad perspectives: the selection of the study groups; the comparability of the groups; and the ascertainment of either the exposure or outcome of interest for case-control or cohort studies respectively. The goal of this project is to develop an instrument providing an easy and convenient tool for quality assessment of nonrandomised studies to be used in a systematic review.

17,590 citations

Journal ArticleDOI
TL;DR: In this paper, a rank-based data augmentation technique is proposed for estimating the number of missing studies that might exist in a meta-analysis and the effect that these studies might have had on its outcome.
Abstract: We study recently developed nonparametric methods for estimating the number of missing studies that might exist in a meta-analysis and the effect that these studies might have had on its outcome. These are simple rank-based data augmentation techniques, which formalize the use of funnel plots. We show that they provide effective and relatively powerful tests for evaluating the existence of such publication bias. After adjusting for missing studies, we find that the point estimate of the overall effect size is approximately correct and coverage of the effect size confidence intervals is substantially improved, in many cases recovering the nominal confidence levels entirely. We illustrate the trim and fill method on existing meta-analyses of studies in clinical trials and psychometrics.

9,163 citations

Journal ArticleDOI
TL;DR: The present guidelines supersede the 1994 guidelines and summarize both the evidence and expert opinion and provide final recommendations for both patient evaluation and therapy.
Abstract: The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines was formed to make recommendations regarding the diagnosis and treatment of patients with known or suspected cardiovascular disease. Coronary artery disease (CAD) is the leading cause of death in the United States. Unstable angina (UA) and the closely related condition non–ST-segment elevation myocardial infarction (NSTEMI) are very common manifestations of this disease. These life-threatening disorders are a major cause of emergency medical care and hospitalizations in the United States. In 1996, the National Center for Health Statistics reported 1 433 000 hospitalizations for UA or NSTEMI. In recognition of the importance of the management of this common entity and of the rapid advances in the management of this condition, the need to revise guidelines published by the Agency for Health Care Policy and Research (AHCPR) and the National Heart, Lung and Blood Institute in 1994 was evident. This Task Force therefore formed the current committee to develop guidelines for the management of UA and NSTEMI. The present guidelines supersede the 1994 guidelines. The customary ACC/AHA classifications I, II, and III summarize both the evidence and expert opinion and provide final recommendations for both patient evaluation and therapy: Class I: Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective . Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment. Class IIa: Weight of evidence/opinion is in favor of usefulness/efficacy. Class IIb: Usefulness/efficacy is less well established by evidence/opinion. Class III: Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful. The weight of the evidence was ranked highest (A) if the data …

5,020 citations

Journal ArticleDOI
TL;DR: Elliott M. Antman, MD, FACC, FAHA, Co-Chair*†; Mary Hand, MSPH, RN,FAHA, co-Chair; Paul W. Armstrong,MD, F ACC, FAha‡§; Eric R. Bates, MD; Lakshmi K. Halasyamani, MD¶; Judith S. Lamas,MD; Charles J. Mullany, MB, MS, Facc.
Abstract: Elliott M. Antman, MD, FACC, FAHA, Co-Chair*†; Mary Hand, MSPH, RN, FAHA, Co-Chair; Paul W. Armstrong, MD, FACC, FAHA‡§; Eric R. Bates, MD, FACC, FAHA; Lee A. Green, MD, MPH ; Lakshmi K. Halasyamani, MD¶; Judith S. Hochman, MD, FACC, FAHA**; Harlan M. Krumholz, MD, FACC, FAHA††; Gervasio A. Lamas, MD, FACC**; Charles J. Mullany, MB, MS, FACC; David L. Pearle, MD, FACC, FAHA; Michael A. Sloan, MD, FACC; Sidney C. Smith, Jr, MD, FACC, FAHA§§

1,565 citations

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