Untreated anemia can affect cardiovascular health; understand how – 03/19/2023

Anemia is the generic name for a series of conditions characterized by a deficiency in the levels of hemoglobin, a protein found in red blood cells (also called red blood cells), responsible for the red color of blood. It is also the function of transporting and distributing oxygen throughout the body. And therein lies the danger.

Due to the lack of hemoglobin in the body, tissues and organs suffer from low oxygenation, causing various symptoms, complications and damage.

Untreated anemia can lead to progressive fatigue, minimal exertion, heart and even neurological problems.

Although it is the most common cause, those who believe that anemia is only related to a lack of iron are mistaken. In reality, the problem arises, in particular, as a result of an underlying disease, a health condition or a nutritional deficiency.

What causes anemia?

The WHO defines anemia as a hemoglobin level below 13.0 g/dL for men and 12.0 g/dL for women.

An anemic condition can be driven by different reasons which lead to lack of production or high rates of destruction of red blood cells or even severe blood loss. The condition can be temporary or long-term, and its severity usually varies depending on what caused it.

Factors that can lead to anemia include:

  • accidents
  • gastrointestinal surgeries and bleeding (which cause severe and accelerated blood loss)
  • heavy periods
  • pregnancy
  • ulcers
  • polyps or colon cancer
  • hereditary disorders
  • blood and metabolic disorders
  • autoimmune diseases
  • deficiency of one or more nutrients – in addition to iron, we can also highlight vitamin B9 (folic acid) and B12

Untreated anemia can affect the heart

Take the example of the most common anemia, that caused by a lack of iron, called iron deficiency – it is estimated that 90% of anemias are caused by a lack of the mineral due to conditions that prevent its absorption or a bad nutrition.

Iron is present in many foods and is absorbed by the body through the stomach. The body needs it to produce hemoglobin.

Without hemoglobin, there is no adequate oxygen transport in the blood, one of our most important biological mechanisms. And it is the function of the heart to pump and distribute blood. When there are problems with oxygenation, the organ begins to work faster to meet this need and ensure the supply of all the cells of the body. In other words, it becomes more demanding.

This increased effort, in the medium and long term, can affect its functioning, trigger more serious problems and lead to even worse results in people who already have heart problems.

The body’s response to anemia can lead to:

  • increased heart muscle thickness
  • heart dilation
  • abnormal and rapid heartbeat (tachycardia)
  • and, therefore, in heart failure – a condition in which the heart is unable to pump enough blood to the body

Anemia and heart failure

Anemia and heart failure are therefore linked: people with heart failure are more at risk of anemia and vice versa. Research indicates that an anemic condition is commonly seen in patients with heart failure.

According to a study published in the journal Traffic (2018), anemia, especially due to iron deficiency, is quite common in these patients, with incidence rates ranging from 30% in stable individuals to 50% in the group comprising people hospitalized for heart failure . And one of the explanations comes from what happens in the heart and kidney functions.

The kidney is also affected

When the heart is not able to pump blood as it should, the organs of the body do not receive enough oxygen, which leads to adverse consequences. One of them is kidney failure or chronic kidney disease, a scenario in which the kidneys cannot filter the blood properly.

Weakened kidney function then leads to a decrease in erythropoietin (EPO), a hormone synthesized in the kidneys responsible for the creation of red blood cells.

Therefore, heart failure leads to kidney dysfunction and kidney dysfunction leads to low levels of EPO, which can cause anemia.

And this relationship does not end there. There are other ways heart failure leads to anemia. Evidence suggests, for example, that severe heart failure leads to activation of pro-inflammatory cytokines (activation of inflammatory molecules that trigger the immune system).

A situation that could lead to the development of anemia due to a chronic disease with defective iron utilization, decreased erythropoietin production, and bone marrow disease, which in turn also causes severe anemia .

Risks of heart attack

In a study published in the scientific journal Frontiers in Cardiovascular Medicine (2021), researchers looked at 960 patients with coronary heart disease to study how anemia affects the cases of those with the heart problem: results showed that 17% had anemia and it was associated with greater disease severity, poorer heart function and more adverse events, such as heart attacks and strokes.

Another survey, conducted among 193 men, by SUNY Downstate Medical Center (New York/USA) pointed out that people with anemia have a higher risk of myocardial infarction two years after the onset of an acute coronary syndrome. The study — published in American Journal of Cardiology– also found that patients with coronary heart disease were 86% more likely to die within two years, compared to men who did not have anemia.

What are the most common signs?

At first, the anemia may be so mild that the person is not even aware of it, however, the symptoms worsen as the condition worsens.

The most important signs of acute anemia (sudden drop in hemoglobin in the circulation) are caused by a reduction in circulating blood volume. The main one is the drop in blood pressure.

In chronic anemias (i.e. those of longer duration), the decrease in hemoglobin production also leads to:

  • pale skin and mucous membranes
  • general weakness
  • tiredness and weariness
  • drowsiness
  • shortness of breath and difficulty catching breath
  • chest pain or discomfort
  • rapid or abnormal heartbeat
  • feeling cold (especially in the hands and feet)
  • memory and concentration problems
  • lack of appetite
  • headache
  • dizziness


As these signs are common to several other health problems, only a clinical evaluation and more detailed laboratory tests can give the accurate diagnosis of an anemic condition.

Treatment can vary depending on what caused the condition and the severity of the problem – and ranges from dietary changes and iron or B vitamin supplementation to medical procedures, such as bone marrow transplantation.

Genetic inheritance, growing children and adolescents, pregnant women, the elderly, women with heavy menstrual flow, people on restrictive or nutrient-poor diets, patients with chronic diseases, autoimmune or hemorrhagic are among the group most at risk and should have Pay close attention to signs of anemia.

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