Among community-dwelling older men, low hemoglobin was found to be linked with increased major adverse cardiovascular events (MACE), independent of frailty. Long-term MACE was shown to be predicted by a hemoglobin cut-point of 140g/L, a level that is above contemporary definitions of anemia.

• Anemia has been reported to be linked with elevated risk of all-cause death in older populations.

• In this prospective study (CHAMP: Concord-Health-and-Ageing-in-Men-Project), a total of 1,604 men (mean [±SD] age: 76.9±5.5yrs) were included to examine the link between hemoglobin and MACE and if the association is modulated by frailty.

• Increased comorbidity, frailty and MACE were found in relation to decreasing hemoglobin, with the optimal cut-point for predicting MACE being 140g/L.

• Independent predictors of MACE included hemoglobin, age, and frailty.

• Each 10g/L decrease in hemoglobin concentration was found to be linked with elevated risk of MACE (HR 1.13), all-cause mortality (HR 1.20), cardiovascular mortality (HR 1.07), myocardial infarction (HR 1.17) and heart failure (HR 1.17).

• On stratification into hemoglobin quintiles, an increased risk of MACE, cardiovascular mortality, myocardial infarction and heart failure was observed in men in the lowest two quintiles (Hb 133-140g/L & <132g/L, respectively).