Elevated Plasma Levels of B-Type Natriuretic Peptide but Not C-Reactive Protein Are Associated With Higher Red Cell Distribution Width in Patients With Coronary Artery Disease

Abstract

SummaryAlthough higher red cell distribution width (RDW) has recently been reported to be associated with increased mortality independent of anemia in patients with heart failure and those with coronary artery disease (CAD), the mechanism underlying this association is unknown. We hypothesized that higher RDW may reflect neurohumoral activation and a chronic inflammatory state that each contribute to adverse clinical outcomes in these populations. We measured RDW and plasma levels of B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hs-CRP) in 226 consecutive patients undergoing cardiac catheterization for CAD (age, 67 ± 8 years; males, 77%; RDW, 45.8 ± 3.3 fL; hemoglobin, 13.2 ± 1.4 g/dL; BNP, median [interquartile range], 26.0 [9.0-58.4] pg/mL; hs-CRP, 679 ng/mL).Plasma BNP (r = 0.21, P < 0.01) but not hs-CRP (r = 0.04, P > 0.1) levels correlated with RDW. After adjustment for potential confounders including age, gender, body mass index, glomerular filtration rate, hemoglobin, and known hemodynamic determinants of BNP, including elevated left ventricular end-diastolic pressure and volume and slow left ventricular relaxation, RDW was independently predicted by BNP (r 2 = 0.058, P < 0.001).In conclusion, elevated BNP levels are independently associated with higher RDW in patients with CAD. Neurohumoral activation may be a mechanistic link between increased RDW and adverse clinical outcomes in this population. (Int Heart J 2009; 50: 301-312)

Complete Blood Count Alterations after Six Months of Continuous Positive Airway Pressure Treatment in Patients with Severe Obstructive Sleep Apnea

“…12 The RDW was higher in OSA patients as a result of either ineffective erythropoiesis due to chronic inflammation or enhanced erythropoiesis stimulated by increased production of erythropoietin (EPO), as hypothesized in coronary artery disease patients. 27,28 Although inflammation parameters decrease after treatment, as reported by Zamarron et al, some (such as endothelin, von Willebrand factor, and e-selectin values) were unchanged after 1 year of CPAP therapy. 29 Similar to these parameters, PDW and RDW also did not decrease after treatment.…”

The impact of admission red cell distribution width on long-term cardiovascular events after primary percutaneous intervention: A four-year prospective study

“…Like in the case when a car which gets out of control may cause undesirable conditions, over increased inflammation and oxidative stress in our body leads to undesirable outcomes. As a result of changes, they exerted on erythrocytes; increased inflammation [2,3], oxidative stress [5] and neurohormonal activation [18] lead to different size of erythrocytes to involve in the circulation, namely anisocytosis. Possible contribution of inflammation to anisocytosis results from inhibition of the response production against erythropoietin, impaired iron metabolism, and shortened time of red blood cell survival [19].…”

Red Blood Cell Distribution Width (RDW) and its Association with Coronary Atherosclerotic Burden in Patients with Stable Angina Pectoris

“…Thus elevated RDW means that there is an increased heterogeneity in size of red cells (RBCs) in the peripheral blood (8,9). Elevated RDW levels can be seen in hemolysis, nutritional deficiencies such as iron, vitamin B12, and folate, or after blood transfusion (10). In thrombotic thrombocytopenic purpura, inflammatory bowel diseases and pregnancy, RDW levels can be high (11).…”