Anemia of chronic diseases: connection with cardiovascular pathology

Background. In the XXI century, there is a rapid increase of chronic non-communicable diseases, leading to population disability and mortality. Anaemia is one of the most frequent comorbidities in cardiac patients and is associated with increased risks of adverse outcomes. The incidence of anaemia, as well as cardiovascular disease, increases with age. According to the World Health Organization (WHO), one of four patients with a chronic disease has concomitant anemia. A special place in chronic pathology is occupied by anemia of chronic diseases, which is in second place after iron deficiency anemia in terms of frequency of spread. In the development of anemia of chronic diseases, activation of immunocomponent cells and proinflammatory cytokines is noted, which in turn have biological effects on iron metabolism and hematopoiesis regulation, reducing the life expectancy of circulating red blood cells. It is assumed that hemorheological disorders and remodeling of the cardiovascular system occur under the influence of enhanced erythrophagocytosis by macrophages. Anemia aggravates the course of concomitant pathology and contributes to a decrease in performance, cognitive function and survival. Anemia is a predictor and risk factor for cardiovascular remodeling.

Materials and methods. The analysis of literature sources in the database "Scopus", "Web of Science", "PubMed/MedLine", "eLibrary" were carried out. The literature search was conducted using the following keywords in Russian and English: "anemia", "anemia of chronic diseases", "coronary heart disease", "myocardial infarction".

Conclusion. We have analyzed publications from 2013 to 2024. It is a literature review of cardiovascular changes in anemia of chronic diseases, examines the possible negative effects of anemia on the coronary heart disease development, presents the results of modern research and their importance in practical healthcare.

1. Roth G. A., Mensah G. A., Johnson C. O., et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020; 76: 2982-3021. DOI: 10.1016/j.jacc.2020.11.010.

2. Tsao C. W., Aday A. W., Almarzooq Z. I., et al. Heart disease and stroke statistics-2022 update: a report from the American Heart Association. Circulation. 2022; 145: e153-e639. DOI: 10.1161/cir.0000000000001052.

3. Gan T., Hu J., Liu W., Li C., et al. Causal Association Between Anemia and Cardiovascular Disease: A 2-Sample Bidirectional Mendelian Randomization Study. J Am Heart Assoc. 2023; 12 (12): e029689. DOI: 10.1161/JAHA.123.029689.

4. Safiri S., Kolahi A. A., Noori M., et al. Burden of anemia and its underlying causes in 204 countries and territories, 1990-2019: results from the global burden of disease study 2019. J Hematol Oncol. 2021; 14: 185. DOI: 10.1186/s13045-021-01202-2.

5. Gorokhovskaya G. N., Martynov A. I., Yun B. L., et al. The modern view of the therapist on the problem of iron deficiency anemia in patients with cardiovascular pathology. Meditsinskii sovet. 2020; (14): 70-78. (In Russ.) DOI:10.21518/2079-701X-2020-14-70-78.

6. Khastieva D. R., Khasanov N. R. Iron deficiency in patients with coronary heart disease. Rossiyskii kardiologicheskii zhurnal. 2022; 27 (4S): 49-62. (In Russ.) DOI: 10.15829/1560-4071-2022-4962.

7. Orlov Yu. P., Govorova N. V., Nochnaya Yu. A., et al. Anemia of inflammation: features, necessity and possibility of correction. Literature review. Vestnik intensivnoi terapii imeni A. I. Saltanova. 2019; (1): 20-35. (In Russ.) DOI:10.21320/1818-474X-2019-1-20-35.

8. Ying, Y., Ye, J., Yuan, Z., et al. Association of anaemia on heart failure and left ventricular function: A bidirectional Mendelian randomization study. ESC Heart Failure, 2024; 11: 299-305. https://doi.org/10.1002/ehf2.14579.

9. Valitova A. D., Kadyrova Z. M., Oslopov V. N., et al. Anemia of chronic diseases: a verdict or a protective reaction of the body? Kazanskii meditsinskii zhurnal. 2023; 104 (3): 393-401. (In Russ.) DOI: 10.17816/KMJ114869.

10. Nedomolkina S. A., Zuykova A. A., Nedomolkin S. V. Features of cytokine secretion in anemia of chronic diseases. Prakticheskaya meditsina. 2022; 5 (20): 19-21. (In Russ.)

11. Sakhin V. T., Kryukov E. V., Rukavitsin O. A. Anemia of chronic diseases . Under the general editorship of E. V. Kryukov. M.: GEOTAR-Media, 2020. 160 p. (In Russ.)

12. Bondarchuk S. V., Golovko K. P., Ovchinnikov D. V. Anemia of chronic diseases as an interdisciplinary problem. Izvestiya Rossiyskoy voenno-meditsinskoi akademii. 2021; 40 (2): 55-61. (In Russ.) DOI: 10.17816/rmmar81177.

13. Ponikowski P., Kirwan B. A., Anker S. D., et al. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet. 2020; 396 (10266): 1895-1904. DOI: 10.1016/S0140-6736(20)32339-4.

14. McDonagh T. A., Metra M., Adamo M., et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42 (36): 3599-3726. DOI: 10.1093/eurheartj/ehab368.

15. Russian Society of Cardiology (RCS). Chronic heart failure. Clinical Guidelines 2020. Rossiyskii kardiologicheskii zhurnal. 2020; 25 (11): 4083. (In Russ.) DOI: 10.15829/1560-4071-2020-4083.

16. Vinogradova N. G., Chesnikova A. I. Iron deficiency conditions in cardiovascular diseases: influence on prognosis and correction features. Yuzhno-Rossiyskii zhurnal terapevticheskoi praktiki. 2023; 4 (1): 7-18. (In Russ.) DOI: 10.21886/2712-8156-2023-4-1-7-18.

17. Joosten E., Lioen P. Iron deficiency anemia and anemia of chronic disease in geriatric hospitalized patients: How frequent are comorbidities as an additional explanation for the anemia? Geriatr Gerontol Int. 2015; 15 (8): 931-935. DOI: 10.1111/ggi.12371.

18. Chang J. Y., Lee J. S., Kim B. J., et al. Influence of hemoglobin concentration on stroke recurrence and composite vascular events. Stroke. 2020; 51: 1309-1312. DOI: 10.1161/strokeaha.119.028058.

19. Vallurupalli M., MacFadyen J. G., Glynn R. J., et al. Effects of interleukin1beta Inhibition on incident anemia: exploratory analyses from a randomized trial. Ann Intern Med. 2020; 172: 523-532. DOI: 10.7326/M19-2945.

20. Akhunbaev O. A. The effect of anemia on the course of cardiovascular diseases. JKMP (Fergana). 2023; 1 (1): 16-19. (In Russ.)

21. Tim Goodnough L., Comin-Colet J., Leal-Noval S., et al. Management of anemia in patients with congestive heart failure. Am J Hematol. 2017; 92 (1): 88-93. DOI:10.1002/ajh.24595.

22. Mironova O. Yu., Panferov A. S. Anemia of chronic diseases: current state of the problem and prospects. Terapevticheskii arkhiv. 2022; 94 (12): 1349-1354. (In Russ.) DOI: 10.26442/00403660.2022.12.201984.

23. Ioana Mozos. Mechanisms Linking Red Blood Cell Disorders and Cardiovascular Diseases. BioMed Research International. 2015. 12 p. DOI: 10.1155/2015/682054.

24. Tarasova N. A., Khasanov N. R. Iron deficiency in patients with cardiovascular diseases. Prakticheskaya meditsina. 2023; 2 (21): 15-20. (In Russ.)

25. Kalyuta T. Yu., Glushakova V. D., Glushakov I. A., et al. Anemia and acute coronary syndromes: epidemiology, etiology, prognostic value and risks of bleeding. Aktualnye problemy meditsiny. 2022; 45 (4): 325-342. (In Russ.) DOI: 10.52575/2687-0940-2022-45-4-325-342.

26. Ohana-Sarna-Cahan L., Atar S. Clinical outcomes of patients with acute coronary syndrome and moderate or severe chronic anaemia undergoing coronary angiography or intervention. Eur. Heart. J. Acute. Cardiovasc. Care. 7 (7): 646-651. DOI: 10.1177/2048872617707959.

27. Badimon L., Vilahur G., Rocca B., et.al. The key contribution of platelet and vascular arachidonic acid metabolism to the pathophysiology of atherothrombosis. Cardiovasc Res. 2021; 17 (9): 2001-2015. DOI: 10.1093/cvr/cvab003.

28. Lattuca B., Cayla G., Silvain J., et al. ACTION Study Group. Bleeding in the Elderly: Risk Factors and Impact on Clinical Outcomes After an Acute Coronary Syndrome, a Sub-study of the Randomized ANTARCTIC Trial. Am. J. Cardiovasc. Drugs. 2021; 21 (6): 681-691. DOI:10.1007/s40256-021-00468-8.

29. Wester A., Attar R., Mohammad M. A., et al. Impact of Baseline Anemia in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: A Prespecified Analysis From the VALIDATE- SWEDEHEART Trial. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease. 2019; 16 (8): e012741.

30. Kanic V., Kompara G., Vollrath M., et.al. Age-specific sex-based differences in anemia in patients with myocardial infarction. J Womens Health (Larchmt). 2019; 28: 1004-1010. DOI: 10.1089/jwh.2018.7211.

31. Collet J. P., Thiele H., Barbato E., et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021; 42 (14): 1289-1367. DOI: 10.1093/eurheartj/ehaa575.

32. Lanser L., Fuchs D., Scharnagl H., et.al. Anemia of Chronic Disease in Patients With Cardiovascular Disease. Front. Cardiovasc. Med. 2021; 8: 666638. DOI: 10.3389/fcvm.2021.666638.

33. Moghaddam N., Graham C. W., John A. C., et al. Association of Anemia With Outcomes Among ST-Segment-Elevation Myocardial Infarction Patients Receiving Primary Percutaneous Coronary Intervention. Circulation. Cardiovascular Interventions. 2018; 12 (11): e007175.

34. Kanic V., Kompara G., Suran D. Differential impact of anemia in relation to sexin patients with myocardial infarction. Front. Cardiovasc. Med. 2023; 10: 1108710. DOI: 10.3389/fcvm.2023.1108710.

35. Khamadullina I. F., Khusainova A. A., Ivantsov E. N., et. al. Anemia of varying severity in patients with ST-segment elevation myocardial infarction. Vestnik sovremennoi klinicheskoi meditsiny. 2023; 16 (6): 78-81. (In Russ.) DOI: 10.20969/VSKM.2023.16(6).78-81.

36. Chiwhane A., Burchundi S., Manakshe G., et. al. Incremental Prognostic Value of Anemia in Acute Coronary Syndrome from A Rural Hospital in India. Global Heart. 2020; 15 (1): 16. DOI: https://doi.org/10.5334/gh.527.

37. Brown D. W., Giles W. H., Croft J. B. Hematocrit and the risk of coronary heart disease mortality. Am Heart J. 2001; 142: 657-663. DOI: 10.1067/mhj.2001.118467.

38. Ducrocq G., Gonzalez-Juanatey J. R., Puymirat E., et al. Effect of a Restrictive vs Liberal Blood Transfusion Strategyon Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Clinical Trial . JAMA. 2021; 6 (325): 552-560.