Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Impact of β-thalassemia trait carrier state on cardiovascular risk factors and metabolic profile in patients with newly diagnosed hypertension

Abstract

Thalassemia minor (Tm), the β-thalassemia carrier state, is followed by favorable lipidemic profile and seems to protect against myocardial infarction mainly in men. However, the cardiovascular risk factor (CRF) and metabolic profile of these subjects has not been thoroughly addressed, although it is not known whether gender differences are involved. We evaluated CRFs, metabolic parameters and risk-prediction equations along with renal function and selected echocardiographic indices in 23 680 consecutive subjects, that is, 11 192 women and 12 488 men, with newly diagnosed hypertension according to the presence or absence of Tm. Of 23 680 patients, 548 (2.3%) had Tm. Compared with patients without Tm, Tm cases had similar gender distribution, age, body mass index and blood pressure. Besides having a better lipidemic profile, Tm patients were less frequently smokers (25% vs 32%, P<0.001), had a lower prevalence of metabolic syndrome (26% vs 39%, P<0.001) and lower HeartSCORE and INTERHEART scores (P<0.001). Tm patients also had lower levels of fibrinogen and plasminogen activator inhibitor-1 (P<0.001), lower serum creatinine and higher estimated glomerular filtration rate (P<0.001), lower prevalence of left ventricular hypertrophy (35% vs 48%, P<0.001) and higher total and mid-wall fractional shortening (P=0.03 and <0.001, respectively). Most of these differences were consistent in both genders, whereas the HeartSCORE and the echo indices were significantly better in Tm only in women. Among patients with newly diagnosed hypertension, those with Tm have a better overall CRF and metabolic profile, beyond the well-known differences in serum lipids. Compared with men, women seem to be at least equally protected.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Higgs DR, Engel JD, Stamatoyannopoulos G . Thalassaemia. Lancet 2012; 379: 373–383.

    Article  CAS  Google Scholar 

  2. Farmakis D, Aessopos A . Pulmonary hypertension associated with hemoglobinopathies: prevalent but overlooked. Circulation 2011; 123: 1227–1232.

    Article  Google Scholar 

  3. Kremastinos DT, Farmakis D . Iron overload cardiomyopathy in clinical practice. Circulation 2011; 124: 2253–2263.

    Article  Google Scholar 

  4. Loukopoulos D . Current status of thalassemia and the sickle cell syndromes in Greece. Semin Hematol 1996; 33: 76–86.

    CAS  PubMed  Google Scholar 

  5. Gallerani M, Scapldi C, Cicognani I, Ricci A, Martinelli L, Cappato R et al. Thalassemia trait and myocardial infarction: low infarction incidence in male subjects confirmed. J Intern Med 1991; 230: 109–111.

    Article  CAS  Google Scholar 

  6. Crowley JP, Sheth S, Capone RJ, Schilling RF . A paucity of thalassemia trait in Italian men with myocardial infarction. Acta Haematol 1987; 78: 249–251.

    Article  CAS  Google Scholar 

  7. Wang CH, Schilling RF . Myocardial infarction and thalassemia trait: an example ofheterozygote advantage. Am J Hematol 1995; 49: 73–75.

    Article  CAS  Google Scholar 

  8. Tassiopoulos T, Stamatelos G, Zakopoulos N, Fessas P, Eliopoulos GD . Low incidence of acute myocardial infarction in beta-thalassaemia trait carriers. Haematologia (Budap) 1995; 26: 199–203.

    CAS  Google Scholar 

  9. Namazi MR . Minor thalassemia as a protective factor against cerebrovascular accidents. Med Hypotheses 2002; 59: 361–362.

    Article  Google Scholar 

  10. Fessas P, Stamatoyannopoulous G, Keys A . Serum cholesterol and thalassemia trait. Lancet 1963; 1: 1182–1183.

    Article  CAS  Google Scholar 

  11. Maioli M, Pettinato S, Cherchi GM, Giraudi D, Pacifico A, Pupita G et al. Plasma lipids in b-thalassemia minor. Atherosclerosis 1989; 75: 245–248.

    Article  CAS  Google Scholar 

  12. Altamentova SM, Marva E, Shaklai N . Oxidative interaction of unpaired hemoglobin chains with lipids and proteins: a key for modified serum lipoproteins in thalassemia. Arch Biochem Biophys 1997; 345: 39–46.

    Article  CAS  Google Scholar 

  13. Calandra S, Bertolini S, Pes GM, Deiana L, Tarugi P, Pisciotta L et al. Beta-thalassemia is a modifying factor of the clinical expression of familial hypercholesterolemia. Semin Vasc Med 2004; 4: 271–278.

    Article  Google Scholar 

  14. Karimi M, Marvasti VE, Motazedian S, Sharifian M . Is β-thalassemia trait a protective factor against hypertension in young adults? Ann hematol 2006; 85: 29–31.

    Article  Google Scholar 

  15. Vyssoulis G, Karpanou E, Kyvelou SM, Tzamou V, Triantafyllou A, Theodosiadis G et al. Ambulatory blood pressure profile in hypertensive patients with β-thalassemia minor. Hypertens Res 2011; 34: 253–256.

    Article  Google Scholar 

  16. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640–1645.

    Article  CAS  Google Scholar 

  17. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G et al SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24: 987–1003.

    Article  CAS  Google Scholar 

  18. McGorrian C, Yusuf S, Islam S, Jung H, Rangarajan S, Avezum A et al. Estimating modifiable coronary heart disease risk in multiple regions of the world: the INTERHEART Modifiable Risk Score. Eur Heart J 2011; 32: 581–589.

    Article  Google Scholar 

  19. Tassiopoulos S, Deftereos S, Konstantopoulos K, Farmakis D, Tsironi M, Kyriakidis M et al. Does heterozygous beta-thalassemia confer a protection against coronary artery disease? Ann N Y Acad Sci 2005; 1054: 467–470.

    Article  Google Scholar 

  20. Hashemi M, Shirzadi E, Talaei Z, Moghadas L, Shaygannia I, Yavari M et al. Effect of heterozygous beta-thalassaemia trait on coronary atherosclerosis via coronary artery disease risk factors: a preliminary study. Cardiovasc J Afr 2007; 18: 165–168.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Cheung YF, Chan GC, Ha SY . Arterial stiffness and endothelial function in patients with beta-thalassemia major. Circulation 2002; 106: 2561–2566.

    Article  CAS  Google Scholar 

  22. Aessopos A, Farmakis D, Tsironi M, Diamanti-Kandarakis E, Matzourani M, Fragodimiri C et al. Endothelial function and arterial stiffness in sickle-thalassemia patients. Atherosclerosis 2007; 191: 427–432.

    Article  CAS  Google Scholar 

  23. Aessopos A, Farmakis D, Loukopoulos D . Elastic tissue abnormalities resembling pseudoxanthoma elasticum in β thalassemia and the sickling syndromes. Blood 2002; 99: 30–35.

    Article  CAS  Google Scholar 

  24. Hillege HL, Girbes AR, de Kam PJ, Boomsma F, de Zeeuw D, Charlesworth A et al. Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation 2000; 102: 203–210.

    Article  CAS  Google Scholar 

  25. Miller AB . Aldosterone antagonism in heart failure. Vasc Health Risk Manag 2007; 3: 605–609.

    PubMed  PubMed Central  Google Scholar 

  26. Ghosh AK, Vaughan DE . PAI-1 in tissue fibrosis. J Cell Physiol 2012; 227: 493–507.

    Article  CAS  Google Scholar 

  27. Aessopos A, Farmakis D, Karagiorga M, Voskaridou E, Hatziliami A, Joussef J et al. Cardiac involvement in thalassemia intermedia: a multicenter study. Blood 2001; 97: 3411–3416.

    Article  CAS  Google Scholar 

  28. Aessopos A, Kati M, Farmakis D . Heart disease in thalassemia intermedia: a review of the underlying pathophysiology. Haematologica 2007; 92: 658–665.

    Article  Google Scholar 

  29. Aessopos A, Deftereos S, Farmakis D, Corovesis C, Tassiopoulos S, Tsironi M et al. Cardiovascular adaptation to chronic anemia in the elderly: an echocardiographic study. Clin Invest Med 2004; 27: 265–273.

    PubMed  Google Scholar 

  30. Stec JJ, Silbershatz H, Tofler GH, Matheney TH, Sutherland P, Lipinska I et al. Association of fibrinogen with cardiovascular risk factors and cardiovascular disease in the Framingham Offspring Population. Circulation 2000; 102: 1634–1638.

    Article  CAS  Google Scholar 

  31. Okwuosa TM, Klein O, Chan C, Jenny NS, Schreiner P, Green D et al. 13-year long-term associations between changes in traditional cardiovascular risk factors and changes in fibrinogen levels: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Atherosclerosis 2013; 226: 214–219.

    Article  CAS  Google Scholar 

  32. Ford ES . The metabolic syndrome and C-reactive protein, fibrinogen, and leukocyte count: findings from the Third National Health and Nutrition Examination Survey. Atherosclerosis 2003; 168: 351–358.

    Article  CAS  Google Scholar 

  33. Sundell IB, Nilsson TK, Hallmans G, Hellsten G, Dahlén GH . Interrelationships between plasma levels of plasminogen activator inhibitor, tissue plasminogen activator, lipoprotein (a), and established cardiovascular risk factors in a north Swedish population. Atherosclerosis 1989; 80: 9–16.

    Article  CAS  Google Scholar 

  34. De Taeye B, Smith LH, Vaughan DE . Plasminogen activator inhibitor-1: a common denominator in obesity, diabetes and cardiovascular disease. Curr Opin Pharmacol 2005; 5: 149–154.

    Article  CAS  Google Scholar 

  35. Angchaisuksiri P, Atichartakarn V, Aryurachai K, Archararit N, Chuncharunee S, Tiraganjana A et al. Hemostatic and thrombotic markers in patients with hemoglobin E/beta-thalassemia disease. Am J Hematol 2007; 82: 1001–1004.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to D T Farmakis.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Triantafyllou, A., Vyssoulis, G., Karpanou, E. et al. Impact of β-thalassemia trait carrier state on cardiovascular risk factors and metabolic profile in patients with newly diagnosed hypertension. J Hum Hypertens 28, 328–332 (2014). https://doi.org/10.1038/jhh.2013.102

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2013.102

Keywords

This article is cited by

Search

Quick links