Published Online
on January 2, 2008

A more recent version of this article appeared on January 15, 2008

This Article Full Text (PDF) All Versions of this Article: 117/2/163    most recent CIRCULATIONAHA.107.727545v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tonelli, M. Search for Related Content PubMed PubMed Citation Articles by Tonelli, M. Related Collections Risk Factors Acute myocardial infarction Epidemiology Related Article

Submitted on July 12, 2007
Accepted on October 10, 2007

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.).

^* To whom correspondence should be addressed. E-mail: no_reprints{at}med.ualberta.ca.

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.

Key words: follow-up studies • mortality • myocardial infarction

Related Article:

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

This article has been cited by other articles:

				Y. Al-Najjar, K. M. Goode, J. Zhang, J. G.F. Cleland, and A. L. Clark Red cell distribution width: an inexpensive and powerful prognostic marker in heart failure Eur J Heart Fail, December 1, 2009; 11(12): 1155 - 1162. [Abstract] [Full Text] [PDF]

				M. Tonelli, G. Curhan, M. Pfeffer, F. Sacks, R. Thadhani, M. L. Melamed, N. Wiebe, and P. Muntner Relation Between Alkaline Phosphatase, Serum Phosphate, and All-Cause or Cardiovascular Mortality Circulation, November 3, 2009; 120(18): 1784 - 1792. [Abstract] [Full Text] [PDF]

				K. V. Patel, R. D. Semba, L. Ferrucci, A. B. Newman, L. P. Fried, R. B. Wallace, S. Bandinelli, C. S. Phillips, B. Yu, S. Connelly, et al. Red Cell Distribution Width and Mortality in Older Adults: A Meta-analysis J Gerontol A Biol Sci Med Sci, October 30, 2009; (2009) glp163v1. [Abstract] [Full Text] [PDF]

				D. A. Pascual-Figal, J. C. Bonaque, B. Redondo, C. Caro, S. Manzano-Fernandez, J. Sanchez-Mas, I. P. Garrido, and M. Valdes Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients Eur J Heart Fail, September 1, 2009; 11(9): 840 - 846. [Abstract] [Full Text] [PDF]

				T. S. Perlstein, J. Weuve, M. A. Pfeffer, and J. A. Beckman Red Blood Cell Distribution Width and Mortality Risk in a Community-Based Prospective Cohort Arch Intern Med, March 23, 2009; 169(6): 588 - 594. [Abstract] [Full Text] [PDF]

				K. V. Patel, L. Ferrucci, W. B. Ershler, D. L. Longo, and J. M. Guralnik Red Blood Cell Distribution Width and the Risk of Death in Middle-aged and Older Adults Arch Intern Med, March 9, 2009; 169(5): 515 - 523. [Abstract] [Full Text] [PDF]