Impact of Hemoglobin Levels and Their Dynamic Changes on the Risk of Atrial Fibrillation: A Nationwide Population-Based Study

[Gianluca]

Abstract​

Anemia is a risk factor for cardiovascular disease, but its impact on new-onset atrial fibrillation (AF) is unclear. In this study, we investigated the effect of hemoglobin (Hb) levels and their changes on the risk of AF development in the general population of Korea. We retrospectively analyzed a cohort from the Korean National Health Insurance Service database and identified 9,686,314 subjects (49.8% male) without a history of AF, aged ≥40 years, and with Hb levels available for both first (2009–2010) and second (2011–2012) health checkups. These subjects were followed up until 2017 to determine AF development. The presence of anemia (Hb level <13 g/dL in men and <12 g/dL in women) was a significant risk factor for AF development. However, Hb levels showed a U-shaped association with incident AF after adjustment for cardiovascular risk factors. AF incidence was lowest at Hb levels of 14–14.9 g/dL in men and 12–12.9 g/dL in women. Among individuals with Hb levels within normal ranges (13–15.9 g/dL in men and 12–14.9 g/dL in women), both decrease and increase in Hb levels at the second measurement outside the normal ranges showed an elevation of AF risk by 11% and 21% for men and 3% and 36% for women, respectively, compared with those who maintained normal Hb levels. In conclusion, low or high Hb levels are associated with an increased risk of incident AF. This study suggests that maintaining Hb levels within the normal ranges confers a low risk of AF development.

Impact of Hemoglobin Levels and Their Dynamic Changes on the Risk of Atrial Fibrillation: A Nationwide Population-Based Study - Scientific Reports

Anemia is a risk factor for cardiovascular disease, but its impact on new-onset atrial fibrillation (AF) is unclear. In this study, we investigated the effect of hemoglobin (Hb) levels and their changes on the risk of AF development in the general population of Korea. We retrospectively analyzed...

www.nature.com

 

[Gianluca]

Increased Hb Levels Are Associated with the Incidence of Atrial Fibrillation: But Is It Related to the Occurrence of Stroke

Anemia has been known to increase the incidence of atrial fibrillation (AF) in general practice. However, it is known that patients with polycythemia also increase the incidence of AF. Various mechanisms are known for this. It is thought that the inflammatory response of the vascular endothelial cell, the increase in viscosity, and the expansion of the left atrium due to an increase in atrial pressure cause AF.1-3) However, it is not easy to carry out a study on this through a large-scale heterogeneous group. Therefore, it can be said that analytical research through the population of the whole country has great significance. Hemoglobin (Hb) levels are generally known to be higher in men than in women. In addition, it is known that the incidence of AF is also higher in men than in women. However, the occurrence of AF was caused from a combination of several reasons including genetic and environmental factors.4)5) The most common causes are age, high blood pressure, and diabetes, and heart failure and coronary artery disease. In this issue of the Korean Circulation Journal, Kim et al,6) Figure 2 of this study shows how Hb levels influence the occurrence of AF. Similarly, the higher the body mass index (BMI), the higher the incidence of cardiovascular disease (CVD). And the U-shape pattern that the incidence of CVD increases even in patients with a relatively low BMI is also similarly applied in this study.7) There is a difference in cut off value for men and women,8) but this is thought to be due to a physiological difference depending on gender. And it shows a U shape pattern in common. In the case of anemia, it varies according to the cause of the disease, but the more severe it is, the higher the incidence of CVDs including AF can be expected. However, it is interesting to note that in the case of polycythemia, the incidence of AF increases as the level of Hb increases. The mechanism of the disease has not been revealed, but it is generally thought that the increased viscosity of the blood, shear stress, hypoxia and inflammation, etc. affect the incidence of AF.2)3)7)9)10) Since this study was analyzed through retrospective claim data, there is a limitation in that it cannot take into account both the patient's drug prescription and the included confounding bias. Therefore, it seems that the basic animal and cell level experiments should be conducted along with prospective studies for each factor. And with the occurrence of AF, the part that we should be interested in is the occurrence of stroke. The reason why the occurrence of AF is important is the effect of subsequent strokes. It is well known that the incidence of ischemic events is high in patients with polycythemia,

Korean Circ J. 2020 Dec;50(12):1111-1112 KCJ Korean Circulation Journal 대한심장학회지 pISSN 1738-5520·eISSN 1738-5555 Editorial Received: Nov 17, 2020 Accepted: Nov 18, 2020 Correspondence to Junbeom Park, MD, PhD Department of Cardiology, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea. E-mail: [email protected] Copyright © 2020. The Korean Society of Cardiology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https:// creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ORCID iDs Junbeom Park ORCID Conflict of Interest The author has no financial conflicts of interest. The contents of the report are the author's own views and do not necessarily reflect the views of the Korean Circulation Journal. Junbeom Park , MD, PhD Department of Cardiology, College of Medicine, Ewha Womans University, Seoul, Korea Increased Hb Levels Are Associated with the Incidence of Atrial Fibrillation: But Is It Related to the Occurrence of Stroke? ► See the article “Sex-based Approach for the Clinical Impact of the Increased Hemoglobin on Incident AF in the General Population” in volume 50 on page 1095. and anti-platelets have been used to prevent this. However, if AF occurs in patients with Hb more than the cut off value shown in this study, it is not known whether the risk of stroke is increased compared to patients who do not. This is because all patients are already using anticoagulation or antiplatelet according to the CHA2DS2-VASc score. Therefore, it is believed that a more systematic study based on prospective data is necessary. This study is meaningful in predicting the risk of AF through Hb data that can be easily obtained in clinical practice. However, in patients taking anticoagulation, changes in Hb cannot have a significant meaning with only one test, and changes often occur according to the occurrence of events such as bleeding. Therefore, it is considered that a prospective study is also needed to determine how changes of Hb level according to sequential measurements affect the occurrence of AF and stroke

 

[Nelson Vergel]

Interesting! Thanks for sharing.

Another argument against those who say that hematocrit should not be monitored at all.

 

[tareload]

See latest TRAVERSE study results as well.

 

[Nelson Vergel]

Thanks, @readalot

P reached statistical significance for arrythmia and atrial fibrillation.

The "acute kidney injury" is puzzling to me. It may be due to increased blood pressure/water retention. Or probably increase creatinine, but I have never seen that in my 30+ years of experience.

Urinary retention makes sense as some older men tend to have increase BPH.

 

[tareload]

Thanks, @readalot

P reached statistical significance for arrythmia and atrial fibrillation.

This isn't getting much coverage. Obviously the other endpoints are reassuring but gotta look at the whole study. PE/DVT as well.

 

[tareload]

The Health Optimization Doctors RoundTable: High Hematocrit Not Important?

https://www.youtube.com/live/Wyu5GPDiXUg?feature=share

www.excelmale.com

 

[Nelson Vergel]

Not an uncommon complaint here on this forum:

palpitations

www.excelmale.com

PALPITATIONS ON TESTOSTERONE
OPEN ACCESS
Complex Clinical Cases

Elie Kozaily, Bhavana Bangalore, Parth Savsani, Humaira T. Khan, and Maya Guglin
J Am Coll Cardiol. 2022 Mar, 79 (9_Supplement) 3371

Background:
Palpitations is a common subjective complaint. It tends to be investigated in primary or specialty care clinics. Onset of palpitations after initiation of testosterone replacement therapy in specific patients should raise suspicion for certain conditions.

Case:
A 37-year-old Caucasian man was diagnosed with hypogonadism, with otherwise normal endocrine work-up, after an episode of epididymitis. He developed palpitations 6 months after starting testosterone gel. He was evaluated with echocardiography (ECHO), holter monitor and treadmill stress which were unremarkable. He also reported gray skin and right upper quadrant abdominal pain.He presented a year later with shortness of breath and palpitations that precluded him from working as a machinist in an iron factory. He was found to have atrial fibrillation with elevated troponin and brain natriuretic peptide. After conversion to sinus rhythm, electrocardiogram showed repolarization abnormalities in anterolateral leads. Left heart catheter showed normal coronary arteries. ECHO showed severely reduced right and left ventricular function (ejection fraction 19%). Right heart catheter showed right atrial pressure 19 mmHg, mean pulmonary artery pressure 26 mmHg and pulmonary capillary wedge pressure 18 mmHg. Fick cardiac index was 3.4 L/min/m2.

Decision-making:
Ferritin was elevated to 2,861 ng/mL and iron saturation was incalculable. Cardiac magnetic resonance showed significantly shortened myocardial T2 to 5 milliseconds suggestive of severe iron overload. Plus, hepatic but not splenic iron overload hinted to hereditary hemochromatosis. Genetic testing showed C282Y homozygous mutation for HFE.In addition to iron chelation, patient was initiated on intensive phlebotomy regimen despite hypotension. Symptoms improved notably after few sessions.

Conclusion:
Hypogonadism with concomitant anomalies in young men of Northern European descent should raise suspicion for hereditary hemochromatosis. Early screening and diagnosis before significant cardiac iron overload carries higher chances of reversal of cardiomyopathy.

 

[tareload]

What is Venous Thromboembolism? | CDC

Deep Vein Thrombosis and Pulmonary Embolism (DVT/PE) are often underdiagnosed and serious, but preventable medical conditions.

www.cdc.gov

DVT does not cause heart attack or stroke. There are two main types of blood clots.
How a clot affects the body depends on the type and location of the clot:
A blood clot in a deep vein of the leg, pelvis, and sometimes arm, is called deep vein thrombosis (DVT). This type of blood clot does not cause heart attack or stroke.
A blood clot in an artery, usually in the heart or brain, is called arterial thrombosis. This type of blood clot can cause heart attack or stroke.
Both types of clots can cause serious health problems, but the causes and steps you can take to protect yourself are different. To learn more about arterial thrombosis, visit CDC’s information about heart disease and stroke prevention.

 

[Gianluca]

See latest TRAVERSE study results as well.

Thanks for sharing this one as well.

I had now idea a debate was going on over here The Health Optimization Doctors RoundTable: High Hematocrit Not Important?

 

[tareload]

Thanks for sharing this one as well.

I had now idea a debate was going on over here The Health Optimization Doctors RoundTable: High Hematocrit Not Important?

"Robroy" and I do this every now and again. Call it my truth in advertising campaign every time he and his circle drop another video.

Thank you for sharing these studies! I have lived it so I appreciate the share.

 

[MacShark]

Thanks for all this great information guys!
I new to TRT and just joined this forum today. I started TRT a few months ago and started to have heart palpitations and/or Afib and crazy anxiety. My heart seemed to beat backwards for two nights….was very scary oh and hot flashes like crazy. I found the same article you showed above…by Elie Kozaily et all. So I had my ferritin checked it’s low 23…hemoglobin is 17.4 ,hematocrit 51.8 and total iron is 278. Needless to say I totally stoped trt and it’s now…..135 oh sorry its compounded cream by Empower Pharmacy.
Any ideas if the total iron might cause this and not ferritin?
Thanks