European Heart Journal Advance Access originally published online on September 11, 2008
European Heart Journal 2008 29(21):2695-2696; doi:10.1093/eurheartj/ehn400
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Erythropoietin, haemoglobin, heart failure, and mortality: reply
Department of Cardiology
University Medical Center Groningen
The Netherlands
Division of Cardiology
Department of Medicine
Massachusetts General Hospital
Charles River Plaza
185 Cambridge Street
Harvard Medical School
Boston, MA 02114
USA
Tel: +1 617 643 3441
Email: pvandermeer{at}partners.org;
p_van_der_meer{at}hotmail.com
Division of Cardiology
Department of Medicine
Massachusetts General Hospital
Harvard Medical School
Boston, MA
USA
Department of Cardiology
University Medical Center Groningen
The Netherlands
We thank Dr Diskin for his valuable comments on our manuscript. We agree that the etiology of anaemia in patients with chronic heart failure (CHF) is indeed multi-factorial. Dr Diskin correctly points out that there is a direct effect of angiotensin II on erythroid proliferation. Previously we and others have also linked the use of angiotensin converting enzyme (ACE) inhibitors with the occurrence of anaemia.1,2 Since ACE-inhibitors are the cornerstone in CHF treatment, the role of the renin–angiotensin system in the etiology of anaemia may be of importance.
In a recent meta-analysis in which >150 000 patients were investigated, we showed that anaemia in CHF is clearly associated with an increased mortality.3 Therefore judicious correction of anaemia with erythropoiesis stimulating proteins (ESP) should continue to be investigated.4 So far, relatively small-scale clinical trials did not show an increase in adverse events associated with ESP treatment, i.e. thromboembolic events or hypertension.5 Currently a large phase III clinical trial is being performed [Reduction of Events with Darbepoetin alfa in Heart Failure (RED-HF)].6 This study will shed more light on the safety and efficacy of ESP treatment in anaemic CHF patients.
References
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[Abstract/Free Full Text] - van der Meer P, Voors AA, Lipsic E, van Gilst WH, van Veldhuisen DJ. Erythropoietin in cardiovascular diseases. Eur Heart J (2004) 25:285–291.
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[Abstract/Free Full Text] - van Veldhuisen DJ, McMurray JJ. Are erythropoietin stimulating proteins safe and efficacious in heart failure? Why we need an adequately powered randomised outcome trial. Eur J Heart Fail (2007) 9:110–112.
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