Thromb Haemost 2015; 113(03): 649-654
DOI: 10.1160/TH14-07-0606
Atherosclerosis and Ischaemic Disease
Schattauer GmbH

Red cell distribution width and carotid atherosclerosis progression The Tromsø Study

Jostein Lappegård
1   K.G.Jebsen Thrombosis Research and Expertise Centre, Department of Clinical Medicine, University of Tromsø, Norway
2   Hematological Research Group (HERG), Department of Clinical Medicine, University of Tromsø, Norway
,
Trygve S. Ellingsen
1   K.G.Jebsen Thrombosis Research and Expertise Centre, Department of Clinical Medicine, University of Tromsø, Norway
2   Hematological Research Group (HERG), Department of Clinical Medicine, University of Tromsø, Norway
,
Anders Vik
1   K.G.Jebsen Thrombosis Research and Expertise Centre, Department of Clinical Medicine, University of Tromsø, Norway
2   Hematological Research Group (HERG), Department of Clinical Medicine, University of Tromsø, Norway
3   Division of Internal Medicine, University Hospital of North-Norway, Tromsø, Norway
,
Tove Skjelbakken
1   K.G.Jebsen Thrombosis Research and Expertise Centre, Department of Clinical Medicine, University of Tromsø, Norway
2   Hematological Research Group (HERG), Department of Clinical Medicine, University of Tromsø, Norway
3   Division of Internal Medicine, University Hospital of North-Norway, Tromsø, Norway
,
Jan Brox
1   K.G.Jebsen Thrombosis Research and Expertise Centre, Department of Clinical Medicine, University of Tromsø, Norway
4   Department of Laboratory Medicine, University Hospital of North-Norway, Tromsø, Norway
,
Ellisiv B. Mathiesen
1   K.G.Jebsen Thrombosis Research and Expertise Centre, Department of Clinical Medicine, University of Tromsø, Norway
5   Brain and Circulation Research Group, Department of Clinical Medicine, University of Tromsø, Norway
6   Department of Neurology and Neurophysiology, University Hospital of North-Norway, Tromsø, Norway
,
Stein Harald Johnsen
5   Brain and Circulation Research Group, Department of Clinical Medicine, University of Tromsø, Norway
6   Department of Neurology and Neurophysiology, University Hospital of North-Norway, Tromsø, Norway
,
Sigrid K. Brækkan
1   K.G.Jebsen Thrombosis Research and Expertise Centre, Department of Clinical Medicine, University of Tromsø, Norway
2   Hematological Research Group (HERG), Department of Clinical Medicine, University of Tromsø, Norway
3   Division of Internal Medicine, University Hospital of North-Norway, Tromsø, Norway
,
John-Bjarne Hansen
1   K.G.Jebsen Thrombosis Research and Expertise Centre, Department of Clinical Medicine, University of Tromsø, Norway
2   Hematological Research Group (HERG), Department of Clinical Medicine, University of Tromsø, Norway
3   Division of Internal Medicine, University Hospital of North-Norway, Tromsø, Norway
› Institutsangaben
Financial support: K. G. Jebsen- Thrombosis Research and Expertise Centre (TREC) is supported by an independent grant from the K. G. Jebsen Foundation. SKB and JBH have received research grants from the Northern Norway Regional Health Authority (URL: http://www.helse-nord.no/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Weitere Informationen

Publikationsverlauf

Received: 15. Juli 2014

Accepted after major revision: 13. Januar 2014

Publikationsdatum:
17. November 2017 (online)

Summary

Red cell distribution width (RDW), a measure of the size variability of circulating erythrocytes, is associated with cardiovascular morbidity and mortality. We aimed to investigate whether RDW was associated with progression of atherosclerotic plaques in subjects recruited from the general population. Baseline characteristics, including RDW, were collected from 4677 participants in the fourth survey of the Tromsø Study conducted in 1994/95. Prevalence of carotid plaques and total plaque area (TPA) were assessed by ultrasonographic imaging at baseline and after seven years of follow-up. Generalised linear models were used to analyse change in TPA across tertiles of RDW. Change in TPA was significantly higher across tertiles of RDW in crude analysis and in multivariable analysis adjusted for cardiovascular risk factors. The mean change in TPA increased from 5.6 mm2 (4.9–6.4) in tertile 1 (RDW ≤ 12.6 %) to 6.7 mm2 (5.9–7.6) in tertile 3 (RDW ≥ 13.3) in multivariable analysis adjusted for body mass index, total cholesterol, HDL cholesterol, systolic blood pressure, self-reported diabetes, smoking status, platelet count, white blood cell count, and hs-CRP levels (p for trend 0.003). A 1 % increase in RDW was associated with 0.6 mm2 (0.1–1.2) increase in TPA in multivariable analysis (p=0.03). RDW was associated with progression of atherosclerosis after adjustments for traditional atherosclerotic risk factors. Our findings suggest that the link between RDW and cardiovascular morbidity and mortality may be explained by atherosclerosis.

 
  • References

  • 1 Aulakh R, Sohi I, Singh T. et al. Red cell distribution width (RDW) in the diagnosis of iron deficiency with microcytic hypochromic anemia. Indian J Pediatr 2009; 76: 265-268.
  • 2 Monzon CM, Beaver BD, Dillon TD. Evaluation of Erythrocyte Disorders With Mean Corpuscular Volume (MCV) and Red Cell Distribution Width (RDW). Clin Pediatr 1987; 26: 632-638.
  • 3 Nagajothi NMD, Braverman AMD. Elevated Red Cell Distribution Width in the Diagnosis of Thrombotic Thrombocytopenic Purpura in Patients Presenting with Anemia and Thrombocytopenia. South Med J 2007; 100: 257-259.
  • 4 Rodak BF, Fritsma GA, Doig K. Hematology: Clinical Principles and Applications. Saunders Elsevier; 2007
  • 5 Tonelli M, Sacks F, Arnold M. et al. Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease. Circulation 2008; 117: 163-168.
  • 6 Zalawadiya SK, Veeranna V, Niraj A. et al. Red cell distribution width and risk of coronary heart disease events. Am J Cardiol 2010; 106: 988-993.
  • 7 Zalawadiya SK, Veeranna V, Panaich SS. et al. Red cell distribution width and risk of peripheral artery disease: analysis of National Health and Nutrition Examination Survey 1999-2004. Vasc Med 2012; 17: 155-163.
  • 8 Isik T, Uyarel H, Tanboga IH. et al. Relation of red cell distribution width with the presence, severity, and complexity of coronary artery disease. Coron Artery Dis 2012; 23: 51-56.
  • 9 Arbel Y, Weitzman D, Raz R. et al. Red blood cell distribution width and the risk of cardiovascular morbidity and all-cause mortality. A population-based study. Thromb Haemost 2014; 111: 300-307.
  • 10 Felker GM, Allen LA, Pocock SJ. et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol 2007; 50: 40-47.
  • 11 Zalawadiya SK, Zmily H, Farah J. et al. Red cell distribution width and mortality in predominantly African-American population with decompensated heart failure. J Card Fail 2011; 17: 292-298.
  • 12 van Kimmenade RR, Mohammed AA, Uthamalingam S. et al. Red blood cell distribution width and 1-year mortality in acute heart failure. Eur J Heart Fail 2010; 12: 129-136.
  • 13 Cavusoglu E, Chopra V, Gupta A. et al. Relation between red blood cell distribution width (RDW) and all-cause mortality at two years in an unselected population referred for coronary angiography. Int J Cardiol 2010; 141: 141-146.
  • 14 Poludasu S, Marmur JD, Weedon J. et al. Red cell distribution width (RDW) as a predictor of long-term mortality in patients undergoing percutaneous coronary intervention. Thromb Haemost 2009; 102: 581-587.
  • 15 Ross R. Atherosclerosis - An Inflammatory Disease. N Engl J Med 1999; 340: 115-126.
  • 16 Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993; 362: 801-809.
  • 17 Libby P. Current Concepts of the Pathogenesis of the Acute Coronary Syndromes. Circulation 2001; 104: 365-372.
  • 18 Finegold JA, Asaria P, Francis DP. Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations. Int J Cardiol 2013; 168: 934-945.
  • 19 Wen Y. High red blood cell distribution width is closely associated with risk of carotid artery atherosclerosis in patients with hypertension. Exp Clin Cardiol 2010; 15: 37-40.
  • 20 Jacobsen BK, Eggen AE, Mathiesen EB. et al. Cohort profile: the Tromso Study. Int J Epidemiol 2012; 41: 961-967.
  • 21 Braekkan SK, Mathiesen EB, Njolstad I. et al. Family history of myocardial infarction is an independent risk factor for venous thromboembolism: the Tromso study. J Thromb Haemost 2008; 6: 1851-1857.
  • 22 Hald EM, Braekkan SK, Mathiesen EB. et al. High-sensitivity C-reactive protein is not a risk factor for venous thromboembolism: the Tromso study. Haematologica 2011; 96: 1189-1194.
  • 23 Levey AS, Coresh J, Greene T. et al. Using Standardized Serum Creatinine Values in the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate. Ann Intern Med 2006; 145: 247-254.
  • 24 Nutritional anaemias. Report of a WHO scientific group. World Health Organization technical report series 1968; 405: 5-37.
  • 25 Joakimsen O, Bonaa KH, Stensland-Bugge E. Reproducibility of ultrasound assessment of carotid plaque occurrence, thickness, and morphology. The Tromso Study. Stroke 1997; 28: 2201-2207.
  • 26 Johnsen SH, Mathiesen EB, Fosse E. et al. Elevated high-density lipoprotein cholesterol levels are protective against plaque progression: a follow-up study of 1952 persons with carotid atherosclerosis the Tromso study. Circulation 2005; 112: 498-504.
  • 27 Fosse E, Johnsen SH, Stensland-Bugge E. et al. Repeated visual and computerassisted carotid plaque characterization in a longitudinal population-based ultrasound study: the Tromso study. Ultrasound Med Biol 2006; 32: 3-11.
  • 28 Förhecz Z, Gombos T, Borgulya G. et al. Red cell distribution width in heart failure: Prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J 2009; 158: 659-666.
  • 29 Arbel Y, Birati EY, Finkelstein A. et al. Red blood cell distribution width and 3-year outcome in patients undergoing cardiac catheterization. J Thromb Thrombolysis. 2013 Epub ahead of print.
  • 30 Arbel Y, Weitzman D, Raz R. et al. Red blood cell distribution width and the risk of cardiovascular morbidity and all-cause mortality. A population-based study. Thromb Haemost 2014; 111: 300-307.
  • 31 Emans ME, Gaillard CA, Pfister R. et al. Red cell distribution width is associated with physical inactivity and heart failure, independent of established risk factors, inflammation or iron metabolism; the EPIC-Norfolk study. Int J Cardiol 2013; 168: 3550-3555.
  • 32 Kawai C. Pathogenesis of acute myocardial infarction. Novel regulatory systems of bioactive substances in the vessel wall. Circulation 1994; 90: 1033-1043.
  • 33 Lippi G, Targher G, Montagnana M. et al. Relation Between Red Blood Cell Distribution Width and Inflammatory Biomarkers in a Large Cohort of Unselected Outpatients. Arch Pathol Lab Med 2009; 133: 628-632.
  • 34 Kolodgie FD, Burke AP, Nakazawa G. et al. Free cholesterol in atherosclerotic plaques: where does it come from?. Current Opinion in Lipidology 2007; 18: 500-507.
  • 35 Kolodgie FD, Gold HK, Burke AP. et al. Intraplaque Hemorrhage and Progression of Coronary Atheroma. N Engl J Med 2003; 349: 2316-2325.
  • 36 Adams GJ, Simoni DM, Bordelon CB. et al. Bilateral Symmetry of Human Carotid Artery Atherosclerosis. Stroke 2002; 33: 2575-2580