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Original research article
Cardiovascular risk in 159 934 frequent blood donors while addressing the healthy donor effect
  1. Karlijn Peffer1,
  2. Martin den Heijer2,
  3. Wim L A M de Kort1,3,
  4. André L M Verbeek4,
  5. Femke Atsma1,5
  1. 1Department of Donor Medicine Research - Donor Studies, Sanquin Research, Amsterdam, The Netherlands
  2. 2Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
  3. 3Department of Public Health, Academic Medical Center Amsterdam UMC - Location AMC, University of Amsterdam, Amsterdam, The Netherlands
  4. 4Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
  5. 5Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Femke Atsma, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare Radboud University Medical Center Nijmegen The Netherlands ; Femke.Atsma{at}


Objective To investigate whether regular blood donation decreases cardiovascular risk.

Methods All 159 934 Dutch whole-blood donors with an active donation career of at least 10 years were categorised into sex-specific donation tertiles based on the number of donations during this 10-year qualification period. Cardiovascular endpoints were based on hospital discharge diagnoses and death certificates from Dutch Hospital Data and Statistics Netherlands and occurring after the 10-year qualification period. Cox regression was used to estimate the age-adjusted and starting year-adjusted hazard rate ratio (HRR).

Results Female high-frequency blood donors had a reduced cardiovascular morbidity (HRR=0.91, 95% CI 0.85 to 0.98) compared with low-frequency blood donors. No effect was observed in men (HRR=1.00, 95% CI 0.95 to 1.05). To rule out a residual healthy donor effect (HDE), additional sensitivity analyses using a 5-year qualification period were conducted. The results supported the absence of a residual HDE.

Conclusions This study showed a protective effect of long-term, high-frequency blood donation against cardiovascular disease. This effect was only observed in women and not in men.

  • blood donors
  • cardiovascular diseases
  • translational cardiovascular medicine
  • cardiac risk factors and prevention
  • epidemiology

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  • Contributors KP is the guarantor for this study. All authors contributed to the study design and data interpretation. FA, ALMV, MdH and WLAMdK wrote the proposal. KP collected the data, conducted the statistical analysis and wrote the first draft of the paper. FA, ALMV and MdH assisted in the methodology and statistical procedures. All authors contributed to further drafts of the paper and approved the final version. KP, FA and MdH had full access to all of the data, and ALMV and WLAMdK had access to statistical reports and tables of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This study was funded by Sanquin Blood Supply, Grant Product and Process Development Cellular Products-09-024.

  • Competing interests None declared.

  • Ethics approval The accredited Medical Research Ethics Committee Region Arnhem-Nijmegen approved this study’s protocol under registration number 2010/103.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Statistical code and output is available (in Dutch) from the corresponding author at Results are based on calculations by Sanquin Research using non-public microdata from Statistics Netherlands. Under certain conditions, these microdata are accessible for statistical and scientific research. For further information:

  • Correction notice Since this paper was first published online, the corresponding author address has been updated.

  • Patient consent for publication Not required.