Red blood cell distribution width and the risk of cardiovascular morbidity and all-cause mortality

Summary

Red blood cell distribution width (RDW) has been shown to predict cardiovascular mortality in various populations, but studies were less conclusive regarding cardiovascular morbidity. We aimed at evaluating the prognostic effect of RDW on cardiovascular morbidity and allcause mortality in the largest community cohort to date. We utilised the computerised database of a large community based healthcare maintenance organization (HMO) in Israel to identify a cohort of 225,006 eligible patients aged 40 or above who performed a blood count during 2006. We evaluated the relationship between 1% increments of RDW values and major cardiovascular events and all-cause mortality over a period of five years. A total of 21,939 incident cases of a major cardiovascular event and 4,287 deaths were documented during a total of six years of follow up, respectively. In comparison with patients with RDW level <13%, the hazard ratio for total mortality gradually increased to 4.57 (95% confidence interval [CI]: 3.35–6.24, p<0.001) among male patients and to 3.26 (95% CI: 2.49–4.28, p<0.001) among female patients with a RDW of 17% or above. Similar results were evident in anaemic and non-anaemic populations. RDW above 17% was also associated with a modest increased risk of major cardiovascular events in females 1.26 (95% CI: 1.03–1.52, p=0.021), while in men it was not significant, 1.08 (95% CI: 0.82–1.41, p=NS). In conclusion, increasing RDW levels significantly increased risk of cardiovascular morbidity and all-cause mortality. Our observation is evident in both anaemic and non-anaemic patients.

Keywords

RDW - community cohort - major cardiovascular events - total mortality

• References

• 1 Borne Y, Smith JG, Melander O. et al. Red cell distribution width and risk for first hospitalisation due to heart failure: a population-based cohort study. Eur J Heart Fail 2011; 13: 1355-1361.
• 2 Felker GM, Allen LA, Pocock SJ. et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol 2007; 50: 40-47.
• 3 van Kimmenade RR, Mohammed AA, Uthamalingam S. et al. Red blood cell distribution width and 1-year mortality in acute heart failure. Eur J Heart Fail 2009; 12: 129-136.
• 4 Aung N, Ling HZ, Cheng AS. et al. Expansion of the red cell distribution width and evolving iron deficiency as predictors of poor outcome in chronic heart failure. Int J Cardiol. 2013 Epub ahead of print.
• 5 Aung N, Dworakowski R, Byrne J. et al. Progressive rise in red cell distribution width is associated with poor outcome after transcatheter aortic valve implantation. Heart. 2013 Epub ahead of print.
• 6 Zalawadiya SK, Veeranna V, Niraj A. et al. Red cell distribution width and risk of coronary heart disease events. Am J Cardiol 2010; 106: 988-993.
• 7 Tonelli M, Sacks F, Arnold M. et al. Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease. Circulation 2008; 117: 163-168.
• 8 Arbel Y, Birati EY, Finkelstein A. et al. Red blood cell distribution width and 3-year outcome in patients undergoing cardiac catheterisation. J Thromb Thrombolysis. 2013 Epub ahead of print.
• 9 Chen PC, Sung FC, Chien KL. et al. Red blood cell distribution width and risk of cardiovascular events and mortality in a community cohort in Taiwan. Am J Epidemiol 2010; 171: 214-220.
• 10 Perlstein TS, Weuve J, Pfeffer MA. et al. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009; 169: 588-594.
• 11 Patel KV, Ferrucci L, Ershler WB. et al. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009; 169: 515-523.
• 12 Steinvil A, Leshem-Rubinow E, Berliner S. et al. Vitamin D deficiency prevalence and cardiovascular risk in Israel. Eur J Clin Invest 2010; 41: 263-268.
• 13 Steinvil A, Berliner S, Bromberg M. et al. Micro-inflammatory changes in asymptomatic healthy adults during bouts of respiratory tract infections in the community: potential triggers for atherothrombotic events. Atherosclerosis 2009; 206: 270-275.
• 14 Shalev V, Chodick G, Silber H. et al. Continuation of statin treatment and all-cause mortality: a population-based cohort study. Arch Intern Med 2009; 169: 260-268.
• 15 World Health Organisation: Nutritional anaemia: report of a WHO Scientific Group. Geneva, Switzerland: 1968
• 16 Pencina MJ, D’Agostino Sr. RB, D’Agostino Jr. RB. et al. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassifi-cation and beyond. Statistics Med 2008; 27: 157-172 discussion 207-212
• 17 Sanchez-Chaparro MA, Calvo-Bonacho E, Gonzalez-Quintela A. et al. Higher red blood cell distribution width is associated with the metabolic syndrome: results of the Ibermutuamur CArdiovascular RIsk assessment study. Diabetes Care 2010; 33: e40
• 18 Lee WS, Kim TY. Relation between red blood cell distribution width and inflammatory biomarkers in rheumatoid arthritis. Arch Pathol Lab Med 2010; 134: 505-506.
• 19 Forhecz Z, Gombos T, Borgulya G. et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J 2009; 158: 659-666.
• 20 Tziakas D, Chalikias G, Grapsa A. et al. Red blood cell distribution width: a strong prognostic marker in cardiovascular disease: is associated with cholesterol content of erythrocyte membrane. Clin Haemorheol Microcirc 2012; 51: 243-254.
• 21 Lippi G, Targher G, Montagnana M. et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 2009; 133: 628-632.
• 22 Allen LA, Felker GM, Mehra MR. et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail 2010; 16: 230-238.
• 23 Goldberger NAM, Haklai Z. Leading Causes of Death in Israel 2000-2010. Report of the Israeli ministry of health, Health Information Department. Jerusalem February 2013.
• 24 Shalev V, Chodick G, Heymann AD. et al. Gender differences in healthcare utilisation and medical indicators among patients with diabetes. Public Health 2005; 119: 45-49.
• 25 Pascual-Figal DA, Bonaque JC, Redondo B. et al. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail 2009; 11: 840-846.