Anemia and stroke: Where do we stand?

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Anemia seems to have a clear relationship with cerebrovascular events (CVEs), as there is a direct connection between central nervous system (CNS), blood supply, and tissue oxygen delivery.1 The odds ratio of morbidity, hospitalization, and mortality in patients with anemia is similar to those of four other common cardiovascular risk factors, namely smoking, diabetes mellitus (DM), hypertension, and hypercholesterolemia.2 It is for this reason that anemia is characterized as “the fifth cardiovascular risk factor.”3 Anemia is usually considered to develop due to a complex interaction between iron deficiency, cytokine production, and impaired renal function, although other agents, such as blood loss, may also contribute.4 Anemia itself is considered to be related with poor outcome among patients with stroke by increasing morbidity and mortality.5 The Framingham Study highlighted the pathogenetic, preventive, and therapeutic implications of anemia, and in particular, the relation between hemoglobin level and stroke would require further investigation.6 Unfortunately, treatment of anemia in cardiovascular and cerebrovascular disease still lacks clear targets and specific therapy has not developed. This review aims to clarify the poorly investigated and defined issues concerning the relation of anemia and CVEs.

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