Anemia and high-output cardiac hypertrophy in Tanzania and Haiti: a cross-sectional analysis
9 affiliations
- 1Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), Port-au‐Prince, Ouest, Haiti
- 2Center for Global Health, Weill Cornell Medicine, New York, NY USA
- 3Department of Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- 4Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- 5Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO USA
- 6Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- 7Department of Epidemiology and Demography, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- 8Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY USA
- 9Department of Medicine, Washington University, St Louis, MO USA
Abstract
Background: Low- and middle-income countries (LMICs) face a growing burden of cardiovascular disease (CVD) that is not fully explained by traditional risk factors like hypertension. Anemia is highly prevalent in LMICs and may be an important non-traditional CVD risk factor. We evaluated the association between anemia and preclinical CVD, including left ventricular hypertrophy (LVH) and other echocardiographic measures, in two diverse LMIC settings.
Methods: This was a cross-sectional analysis of data from two separate cohorts of adults in Mwanza, Tanzania (n = 999; data collected 2022–2023) and Port-au-Prince, Haiti (n = 3,005; data collected 2019–2021). Participants underwent clinical examinations, laboratory testing, and echocardiography. Models assessing the relationship between anemia and echocardiographic outcomes were adjusted for age, sex, HIV status, blood pressure, and body mass index.
Results: Anemia prevalence was 23% in Tanzania and 32% in Haiti. Despite lower blood pressure and BMI among anemic participants, moderate/severe anemia were strongly associated with higher LVMI and LVH in both cohorts. In combined analyses, moderate/severe anemia were associated with LVMI increases of 8.4 g/m² and 29.7 g/m², respectively. Anemia was also associated with echocardiographic changes characteristic of a high-output cardiac state, including increased cardiac and stroke volume indices. Moderate/severe anemia was associated with18.2% of LVH cases in Tanzania and 9.1% in Haiti, and 34.4% among people with HIV.
Conclusions: Anemia was independently associated with high-output cardiac hypertrophy in two distinct LMIC populations, underscoring anemia as a potentially modifiable CVD risk factor. Enhanced anemia screening and management could serve as a vital strategy to mitigate the rising burden of CVD in these regions.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s44263-026-00330-6.
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BibTeX
@article{rouzier2026anemia,
title = {{Anemia and high-output cardiac hypertrophy in Tanzania and Haiti: a cross-sectional analysis}},
author = {Vanessa Rouzier and Grace Ruselu and Megan Willkens and Lily D Yan and Cody Cichowitz and Anju Ogyu and Ayubu Garbindi and Godfrey Kisigo and Benson Issarow and Rodney Sufra and Anthony Etyang and Jean William Pape and Richard B. Devereux and Margaret McNairy and Saidi Kapiga and Robert Peck and Myung Hee Lee},
journal = {BMC Global and Public Health},
year = {2026},
month = oct,
doi = {10.1186/s44263-026-00330-6},
url = {https://doi.org/10.1186/s44263-026-00330-6},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Anemia and high-output cardiac hypertrophy in Tanzania and Haiti: a cross-sectional analysis
AU - Vanessa Rouzier
AU - Grace Ruselu
AU - Megan Willkens
AU - Lily D Yan
AU - Cody Cichowitz
AU - Anju Ogyu
AU - Ayubu Garbindi
AU - Godfrey Kisigo
AU - Benson Issarow
AU - Rodney Sufra
AU - Anthony Etyang
AU - Jean William Pape
AU - Richard B. Devereux
AU - Margaret McNairy
AU - Saidi Kapiga
AU - Robert Peck
AU - Myung Hee Lee
PY - 2026
DA - 2026/10/26
JO - BMC Global and Public Health
DO - 10.1186/s44263-026-00330-6
UR - https://doi.org/10.1186/s44263-026-00330-6
AB - Background: Low- and middle-income countries (LMICs) face a growing burden of cardiovascular disease (CVD) that is not fully explained by traditional risk factors like hypertension. Anemia is highly prevalent in LMICs and may be an important non-traditional CVD risk factor. We evaluated the association between anemia and preclinical CVD, including left ventricular hypertrophy (LVH) and other echocardiographic measures, in two diverse LMIC settings. Methods: This was a cross-sectional analysis of data from two separate cohorts of adults in Mwanza, Tanzania (n = 999; data collected 2022–2023) and Port-au-Prince, Haiti (n = 3,005; data collected 2019–2021). Participants underwent clinical examinations, laboratory testing, and echocardiography. Models assessing the relationship between anemia and echocardiographic outcomes were adjusted for age, sex, HIV status, blood pressure, and body mass index. Results: Anemia prevalence was 23% in Tanzania and 32% in Haiti. Despite lower blood pressure and BMI among anemic participants, moderate/severe anemia were strongly associated with higher LVMI and LVH in both cohorts. In combined analyses, moderate/severe anemia were associated with LVMI increases of 8.4 g/m² and 29.7 g/m², respectively. Anemia was also associated with echocardiographic changes characteristic of a high-output cardiac state, including increased cardiac and stroke volume indices. Moderate/severe anemia was associated with18.2% of LVH cases in Tanzania and 9.1% in Haiti, and 34.4% among people with HIV. Conclusions: Anemia was independently associated with high-output cardiac hypertrophy in two distinct LMIC populations, underscoring anemia as a potentially modifiable CVD risk factor. Enhanced anemia screening and management could serve as a vital strategy to mitigate the rising burden of CVD in these regions. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s44263-026-00330-6.
SN - 2731-913X
ER -