Is There a Link Between Anemia and Heart Disease?

Anemia is prevalent among people with heart disease and is associated with worse outcomes.

Medically reviewed in November 2020

Anemia occurs when your blood does not have enough hemoglobin, the protein found in red blood cells. Red blood cells transport oxygen from the lungs to cells throughout the body. Red blood cells also take carbon dioxide produced by cells and deliver it to the lungs for removal from the body.

The most common type of anemia is iron-deficiency anemia. This type occurs when your body doesn't have enough iron to build healthy red blood cells. Low iron levels can have multiple causes, including blood loss, pregnancy, poor diet, or an inability to absorb enough iron from food.

Anemia is prevalent among people with cardiovascular disease, including people with heart failure and coronary artery disease, though the relationship between the conditions is not fully understood.

Hemoglobin and the heart
When a person has low levels of hemoglobin, it results in lower levels of oxygen available in the body. This can make the heart work harder to supply the cells with oxygen. This can put the heart at greater risk for problems such as murmurs, arrythmias, enlarged heart, and heart failure.

Anemia is associated with worse outcomes in patients with heart disease. People who have heart disease and anemia are more likely to experience poorer outcomes, including poorer quality of life, an increased risk of hospitalization, and an increased risk of death.

Treatment for anemia
If you have anemia, it is important to work with a healthcare provider to get treatment. If you think you might have anemia, it is important to see a healthcare provider who can diagnose what’s causing your symptoms. Some of the symptoms of anemia include:

  • Fatigue
  • Pale skin
  • Jaundice
  • Fast or irregular heartbeat
  • Shortness of breath
  • Chest pain
  • Dizziness, feeling faint, or fainting
  • Confusion, or problems thinking clearly
  • Cold hands and feet
  • Headache
  • Brittle nails
  • Cracks at the side of the mouth
  • Swollen or sore tongue

Treatment for anemia will depend on how severe the anemia is and the underlying cause of anemia. A healthcare provider may prescribe iron supplements and changes to diet to improve iron levels. Some people with anemia may also need intravenous iron infusions or infusions of red blood cells.

Anemia can also be caused by other health conditions and injuries, such as some types of cancer, rheumatoid arthritis, inflammatory bowel disease, chronic kidney disease, and injuries that cause internal bleeding. Identifying, ruling out, and addressing these causes will also be a focus of diagnosis and treatment.

Preventing heart disease
There are a number of steps you can take to keep your heart as healthy as possible. These include:

  • Maintain a healthy weight.
  • Get 150 minutes of moderate exercise, 75 minutes of vigorous exercise, or a combination of the two each week.
  • Eat a balanced diet that focuses on fruits, vegetables, whole grains, lean proteins (like fish and poultry), and healthy fats. Dark leafy green vegetables, seafood, and enriched grains are good sources of iron.
  • Avoid alcohol, smoking, sugar-sweetened foods and beverages, fried foods, processed foods, and red meat.
  • Manage any existing health conditions you have.

Appointments with your healthcare provider are also essential to taking care of your heart and monitoring for the warning signs of heart disease and other conditions. Also discuss the topics above. If you need to lose weight, talk to your healthcare provider about safe and sustainable ways to approach weight loss. Discuss the best ways for you to exercise safely. Ask what foods you should be eating and what habits you should be avoiding.

Sources:
American Academy of Family Physicians. "Patient Education: Anemia."
Merck Manual Consumer Version. "Overview of Anemia."
Tamrat Befekadu Abebe, Eyob Alemayehu Gebreyohannes, et al. "Anemia in severe heart failure patients: does it predict prognosis?" BMC Cardiovascular Disorder, 2017. Vol. 17.
Inder S. Anand and Pankaj Gupta. "Anemia and Iron Deficiency in Heart Failure: Current Concepts and Emerging Therapies." Circulation, 2018. Vol. 138, No. 1.
Amir Qaseem, Linda L. Humphrey, et al. "Treatment of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians." Annals of Internal Medicine, 2013. Vol. 159, No. 11.
Mayo Clinic. "Anemia."
Zhou Liu, Rong Sun, et al. "Relations of Anemia With the All-Cause Mortality and Cardiovascular Mortality in General Population: A Meta-Analysis." American Journal of the Medical Sciences, 2019. Vol. 358, No. 3.
Elsevier Patient Education. "Patient Education: Anemia."
Premier Health. "Anemia: When Your Blood Doesn’t Deliver Enough Oxygen."
National Heart, Lung, and Blood Institute. "Iron-Deficiency Anemia."
Cleveland Clinic. "Anemia: Management and Treatment."
National Institute of Diabetes and Digestive and Kidney Disease. "Anemia of Inflammation or Chronic Disease."
American Heart Association. "The American Heart Association Diet and Lifestyle Recommendations."

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