Red cell distribution width is associated with cardiovascular risk in adults

Carvalho, Natane Moreira de; Maluf, Chams Bicalho; Azevedo, Douglas Roberto Mesquita; Reis, Rodrigo Citton Padilha dos; Castilhos, Cristina Dickie de; Barreto, Sandhi Maria; Vidigal, Pedro Guatimosim

doi:10.1590/1413-81232022277.15652021

Brasil

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FREE THEMES • Ciênc. saúde coletiva 27 (7) • July 2022 • https://doi.org/10.1590/1413-81232022277.15652021 linkcopy

Red cell distribution width is associated with cardiovascular risk in adults

A medida da amplitude da distribuição do tamanho dos eritrócitos está associada ao risco cardiovascular em adultos

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Red cell distribution width (RDW) is a measure of erythrocyte size variability. Recent studies have shown that RDW is a predictive, and prognostic marker of mortality and cardiovascular (CVD) events in the general population and in CVD patients. This study aimed to investigate the association between RDW and CVD risk in a large sample of adults. A subsample of CVD free participants of the ELSA-Brasil cohort were included (n=4,481). In the cross-sectional approach, multiple regression analysis was used to investigate the association between RDW and the Framingham Risk Score (FRS). Linear mixed effect model evaluated whether baseline RDW predicted changes in CVD risk after about four-year follow up. Cross-sectional analysis showed that RDW was independently associated with FRS, participants in the fourth-quartile of RDW distribution had a 29% higher FRS than those in the first-quartile RDW (p<0.001). A longitudinal analysis revealed that RDW remained associated with increased FRS. In this large cohort of adult Brazilians, RDW was independently associated with increased CVD risk, as measured by the FRS, both at baseline and after four-year follow-up. However, RDW did not predict change in CVD risk in this short-term follow up.

Key words: Erythrocyte indices; Cardiovascular diseases; Risk

Characteristic		RDW quartiles (%)
Characteristic		Q1 11.1-12.69 N=1,362	Q2 12.7-12.99 N=887	Q3 13.0-13.49 N=1,198	Q4 13.5-20.5 N=1,034	p-value
Sex, women		50.44%	53.10%	53.51%	62.09%	<0.001
Age		51.00 [44.00-58.00]	51.00 [45.00-59.00]	52.00 [46.00-58.00]	53.00 [46.00-59.50]	<0.001
Self-rated race/skin color						<0.001
	White	63.73%	62.34%	60.10%	47.49%
	Brown	23.35%	24.01%	23.54%	28.53%
	Black	8.88%	9.24%	13.27%	21.47%
	Other¹	4.04%	4.40%	3.09%	2.51%
Level of education						0.002
	University degree	59.62%	58.62%	58.85%	51.64%
	Incomplete elementary school	3.60%	5.07%	5.26%	6.19%
	Complete elementary school	5.73%	6.76%	6.18%	6.38%
	Complete high school	31.06%	29.54%	29.72%	35.78%
Smoking status						<0.001
	Never smoked	60.35%	56.82%	58.51%	54.64%
	Former smoker	28.71%	32.81%	28.96%	28.53%
	Current smoker	10.94%	10.37%	12.52%	16.83%
Physical activity²						0.457
	Low	74.06%	73.73%	74.37%	75.80%
	Moderate	18.15%	18.94%	17.45%	18.37%
	High	7.79%	7.33%	8.18%	5.83%
Alcohol consumption³, yes		9.18%	8.34%	9.02%	7.93%	0.688
BMI (kg/m²)		25.41 [23.05-28.05]	25.86 [23.44-29.97]	26.23 [23.57-29.41]	27.01 [24.18-30.54]	<0.001
Diabetes mellitus⁴		13.88%	15.14%	14.94%	19.34%	0.002
Hypertension⁵		10.35%	10.48%	10.77%	13.64%	0.050
Hemoglobin (g/dL)		14.30 [13.50-15.40]	14.20 [13.30-15.20]	14.20 [13.30-15.20]	13.70 [12.70-14.70]	<0.001
MCV (fL)		89.40 [87.00-91.80]	88.60 [86.30-90.80]	88.20 [85.50-90.80]	86.70 [82.90-89.70]	<0.001
Total cholesterol (mg/dL)		206.00 [185.00-232.00]	210.00 [183.00-240.00]	212.00 [188.00-240.00]	213.00 [186.00-241.00]	0.005
HDL cholesterol (mg/dL)		53.00 [45.00-63.00]	54.00 [45.20-64.00]	55.00 [46.00-65.00]	56.00 [47.00-67.00]	<0.001
CRP (mg/dL)		1.17 [0.61-2.51]	1.32 [0.70-2.67]	1.46 [0.74-3.20]	2.05 [0.91-4.31]	<0.001
eGFR⁶>60 mL/min		96.55%	95.71%	95.16%	95.16%	0.267

Model	FRS				R²Aj
	Q1 11.1-12.69 N=1,362	Q2 12.7-12.99 N=887	Q3 13.0-13.49 N=1,198	Q4 13.5-20.5 N=1,034
	e^β; p-value [95%CI]	e^β; p-value [95%CI]	e^β; p-value [95%CI]	e^β; p-value [95%CI]
1¹	Reference	1.062; 0.079 [0.993-1.136]	1.083; 0.011 [1.018-1.153]	1.290; ≤0,001 [1.206-1.380]	0.299
2²	Reference	1.060; 0.088 [0.991-1.134]	1.087; 0.008 [1.021-1.153]	1.299; ≤0.001 [1.215-1.390]	0.298

Model	FRS
	Q1 11.1-12.69 N=1,274	Q2 12.7-12.99 N=818	Q3 13.0-13.49 N=1,112	Q4 13.5-20.5 N=947
	e^β; p-value [95%CI]	e^β; p-value [95%CI]	e^β; p-value [95%CI]	e^β; p-value [95%CI]
1¹	Reference	1.051; 0.122 [0.986-1.121]	1.083; 0.007 [1.021-1.149]	1.280; ≤0.001 [1.201-1.364]
2²	Reference	1.062; 0.070 [0.994-1.134]	1.085; 0.008 [1.021-1.153]	1.290; ≤0.001 [1.208-1.377]
2²	Interaction terms time	(p-value) 0.236	(p-value) 0.455	(p-value) 0.057

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[TFN1] Continuous variables presented as median and interquartile ranges [IQ]. Categorical variables: frequencies (%). ¹Indigenous, Asian, and individuals who did not declare skin color/race; ²Physical activity based on the International Physical Activity Questionnaire (IPAQ); ³Excessive drinker (men≥210 g alcohol/week; women≥140 g alcohol/week); ⁴Diabetes mellitus: defined according to American Diabetes Association (ADA) criteria or by self-report of previous diagnosis of DM and/or use of insulin or oral hypoglycemic agents; ⁵Hypertension: defined as any of the following: self-report of previous diagnosis of hypertension, or use of antihypertensive agents, or blood pressure≥140\90 mmHg from three measurements; ⁶Estimated glomerular filtration rate defined by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. BMI - body mass index; MCV - mean corpuscular volume; HDL - high-density lipoprotein; CRP - c-reactive protein; eGFR - estimated glomerular filtration rate.

[TFN2] Source: Authors.