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Understand the heart risks associated with anemia: anemia often co-exists with heart failure, and the search continues for a safe and effective treatment for the hemoglobin disorder.

By itself, heart failure is a formidable health challenge. It places burdens on all your organs, making it difficult to breathe easily, concentrate and have enough energy for a decent quality of life.

Advances in medications, heart pumps, and other cardiac devices are improving and extending the lives of heart failure patients. However, many individuals with heart failure also contend with anemia, a condition in which the body doesn't produce enough healthy red blood cells to carry oxygen throughout the body.

Cleveland Clinic cardiologist Joel Holland, MD, says about 20 percent of patients with significant heart failure also have significant anemia. And that combination can make life especially difficult for many patients.

"A lot of patients who have heart failure and anemia do worse than those who just have heart failure,"

Dr. Holland says. "Any condition will worsen if you have anemia."

Causes and treatment

It's not clear what causes anemia in so many heart failure patients. However, kidney function diminished by heart failure and associated conditions such as hypertension and diabetes may be one source of the problem, Dr. Holland says. Also, anemia can result from a variety of inflammatory conditions that affect red blood cell production.

Anemia is easy to diagnose. A hemoglobin test as part of your usual blood work can reveal whether your red blood cell levels are healthy or not. Hemoglobin is a protein in red blood cells that helps carry oxygen throughout the body. Once anemia is diagnosed, treatment options are limited. If you have iron-deficiency anemia, treatment usually includes iron and vitamin supplementation.

For serious cases of anemia, blood tranfusions may improve symptoms, but they don't necessarily improve survival rates, Dr. Holland says.

Researchers have been trying to develop a medication that duplicates the effects of erythropoietin, a hormone produced in the kidneys that helps increase red blood cell production. A Cleveland Clinic-led study of a drug called darbepoetin alfa showed that the medication did improve red blood cell levels, but didn't improve rates of hospitalization and mortality for anemic heart failure patients, according to the study results published in the New England Journal of Medicine.

"Unfortunately, the synthetic version of erythropoietin didn't pan out," Dr. Holland says, adding that the drug also appeared to raise the risk of blood clot formation.

Researchers, however, continue to look for anemia treatments that will benefit those with heart failure, too.


In general, a diet rich in iron, folate, vitamin B12 and vitamin C may help lower your risk of developing anemia. But many types of anemia can't be prevented. And conditions such as cancer or having an ulcer or polyp in your digestive system can also raise your risk of anemia.

If you're found to have anemia by your cardiologist, appropriate testing and possibly a referral to a blood specialist will be made to evaluate treatment options.

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Title Annotation:AWARENESS
Publication:Heart Advisor
Date:Nov 1, 2015
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