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(Circulation. 2008;117:163-168.)
© 2008 American Heart Association, Inc.

Coronary Heart Disease

Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease

Marcello Tonelli, MD, SM; Frank Sacks, MD; Malcolm Arnold, MD; Lemuel Moye, MD, PhD; Barry Davis, MD, PhD; Marc Pfeffer, MD, PhD, for the Cholesterol and Recurrent Events (CARE) Trial Investigators

From the Department of Medicine, Division of Nephrology, University of Alberta, Alberta, Edmonton, Canada (M.T.); Harvard School of Public Health, Boston, Mass (F.M.S.); London Health Sciences Center, London, UK (M.A.); University of Texas School of Public Health, Austin (L.A.M., B.R.D.); and Brigham and Women’s Hospital, Boston, Mass (M.P.).

Correspondence to Dr Marcello Tonelli, Division of Nephrology and Immunology, University of Alberta, 7-129 Clinical Science Building, 8440 112 St, Edmonton, Alberta T6B 2B7, Canada. E-mail no_reprints{at}med.ualberta.ca

Received July 12, 2007; accepted October 10, 2007.

Background— Higher levels of red blood cell distribution width (RDW) may be associated with adverse outcomes in patients with heart failure. We examined the association between RDW and the risk of all-cause mortality and adverse cardiovascular outcomes in a population of people with coronary disease who were free of heart failure at baseline.

Methods and Results— We performed a post hoc analysis of data from the Cholesterol and Recurrent Events study. Baseline RDW was measured in 4111 participants who were randomized to receive pravastatin 40 mg daily or placebo and followed for a median of 59.7 months. We used Cox proportional hazards models to examine the association between RDW and adverse clinical outcomes. During nearly 60 months of follow-up, 376 participants died. A significant association was noted between baseline RDW level and the adjusted risk of all-cause mortality (hazard ratio per percent increase in RDW, 1.14; 95% confidence interval, 1.05 to 1.24). After categorization based on quartile of baseline RDW and further adjustment for hematocrit and other cardiovascular risk factors, a graded independent relation between RDW and death was observed (P for trend=0.001). For instance, participants with RDW in the highest quartile had an adjusted hazard ratio for death of 1.78 (95% confidence interval, 1.28 to 2.47) compared with those in the lowest quartile. Higher levels of RDW were also associated with increased risk of coronary death/nonfatal myocardial infarction, new symptomatic heart failure, and stroke.

Conclusions— We found a graded independent relation between higher levels of RDW and the risk of death and cardiovascular events in people with prior myocardial infarction but no symptomatic heart failure at baseline.

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Clinical Summaries
Circulation 2008 117: 127. [Full Text]