Abstract 1253: Increased Red Blood Cell Distribution Width is Associated with Greater Risk of All-Cause, Cardiovascular and Non-Cardiovascular Mortality in a Large Community-Based Cohort
Background: The red cell distribution width (RDW), a measure of red cell size heterogeneity (anisocytosis), is a newly recognized risk marker in patients with CVD. It is unknown whether RDW is associated with mortality in the general population.
Methods and results: We examined the association of RDW with mortality risk among 14,953 adult participants in the Third National Health and Nutrition Examination Survey (1988 –1994), a representative sample of the United States population. Over a geometric mean of 8.3 years, 2,372 deaths occurred. Age-standardized mortality rates, excepting external-cause (i.e. accidental) deaths, increased across RDW quintiles (figure⇓). A one standard deviation increment in RDW (0.98) was associated with a 21% greater risk of all-cause (HR 1.21, 95% CI 1.15–1.26) and cardiovascular mortality (HR 1.21, 95% CI 1.13–1.29) after multivariable adjustment including hemoglobin level. RDW was also independently associated with risk of death due to cancer (HR 1.21, 95% CI 1.12–1.30) and chronic lower respiratory disease (HR 1.31, 95% CI 1.14 –1.52). Only age exceeded the statistical strength of RDW’s association with all-cause and cardiovascular mortality; only age and smoking were more strongly associated with cancer and chronic lower respiratory disease mortality.
Conclusions: We found that higher RDW was strongly predictive of increased risk of all-cause, cardiovascular, and non-cardiovascular mortality in this large, community-based sample. Study of anisocytosis may therefore yield broad pathophysiological insights, and measurement of RDW may contribute to patient risk assessment.