Red cell distribution width and risk of peripheral artery disease: Analysis of National Health and Nutrition Examination Survey 1999–2004

Abstract

Red cell distribution width (RDW) is an independent predictor of the 10-year estimated risk of coronary heart disease (CHD) events. However, RDW's association with peripheral artery disease (PAD) -a CHD risk equivalent -has not been evaluated to date. In this cross-sectional study, we examined 6950 participants of the National Health and Nutrition Examination Survey, 1999Survey, -2004. PAD was defined as an ankle-brachial index below 0.9 (n = 618). RDW was divided into quartiles (Q) (Q1: ≤ 12.2; Q2: 12.3-12.5; Q3: 12.6-13.0; Q4: ≥ 13.1) and PAD risk was compared across these quartiles using adjusted multivariate logistic regression. A graded increase in prevalent PAD with increasing RDW quartiles was observed (4.2% in Q1 vs 13.9% in Q4; test of trend p < 0.001). Risk of PAD was significantly higher (odds ratio (OR) 1.19, 95% confidence interval (CI): 1.06-1.34; p = 0.003) after adjusting for age, sex, race, body mass index, hypertension, hyperlipidemia, diabetes, smoking, estimated glomerular filtration rate, C-reactive protein, hemoglobin, mean corpuscular volume, and nutritional factors (folate, iron and vitamin B 12 ) deficiencies with each unit (0.1) increase in RDW. Upon receiver-operating characteristics analysis, the predictive accuracy of the American College of Cardiology / American Heart Association (ACC/AHA)-defined PAD screening criteria (for a high-risk population) was 0.657 at best, but improved significantly (0.727) after addition of RDW (p < 0.0001). In conclusion, higher levels of RDW are independently associated with a higher risk of PAD and can significantly improve the risk prediction beyond that estimated by ACC/AHA-defined PAD screening criteria.

Brief Report: Elevated Red Cell Distribution Width Identifies Elevated Cardiovascular Disease Risk in Patients With HIV Infection

“…In a population-based analysis of 25,612 persons in Norway, there was a linear association between baseline RDW and risk of myocardial infarction, with 13% increase in MI risk for every 1% increment in RDW 31 , which persisted after exclusion of patients with anemia 32 . Similarly, studies have associated RDW with the presence of coronary artery disease 33 , peripheral vascular disease 34 , and atrial fibrillation 35 . We are unaware of any prior report describing the relationship between RDW and cardiovascular disease in the context of HIV infection.…”

Exome Genotyping Identifies Pleiotropic Variants Associated with Red Blood Cell Traits

“…7 RDW is also an independent predictor of overall mortality in healthy individuals, as well as a predictor of mortality in patients with various conditions such as cardiovascular diseases, obesity, malignancies, and chronic kidney disease. [8][9][10][11][12] RBC count and indices vary among individuals, and 40%-90% of this phenotypic variation is heritable. [13][14][15][16] Identifying the genes and biological pathways that contribute to this inter-individual variation in RBC traits could highlight modifiers of severity and/or therapeutic options for several hematological diseases.…”

Dynamic Change of Red Cell Distribution Width Levels in Prediction of Hospital Mortality in Chinese Elderly Patients with Septic Shock

“…RDW has been widely accepted as a useful biomarker associated with mortality in patients with various cardiovascular and cerebrovascular diseases, such as heart failure,[1] acute pulmonary embolism,[2] acute coronary syndrome,[34] stroke,[56] and peripheral artery disease. [78] Inflammation and oxidative state play important roles in the pathophysiologic mechanisms underlying the association between RDW and mortality. [910] Furthermore, several studies have indicated that a high RDW level was associated with mortality in patients with community-acquired pneumonia,[1112] severe sepsis or septic shock,[131415] and even in unselected critically ill patients.…”