Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Department of Medicine, Yale Univerisity School of Medicine, New Haven, CT 06510, USA.
Rev Cardiovasc Med. 2022 Feb 9;23(2):51. doi: 10.31083/j.rcm2302051.
Although red cell distribution width (RDW) is associated with increased cardiovascular mortality, the relationship between an elevated RDW and cardiovascular mortality among various ASCVD risk groups is unknown.
We utilized the National Health and Nutrition Examination Survey (NHANES) III, which uses a complex, multistage, clustered design to represent the civilian, community-based US population. Out of 30,818 subjects whose data were entered during the 1988-1994 period, 8884 subjects over 40 years of age, representing a weighted sample of 85,323,902 patients, were selected after excluding missing variables. The ACC/AHA pooled cohort equation (PCE) was used to calculate atherosclerotic cardiovascular disease (ASCVD) risk, and low (<7.5%), intermediate (7.5-20%), and high (>20%) risk groups were created. The primary endpoint was cardiovascular mortality. A multivariate proportional hazard regression was performed using the Fine and Gray (sub-distribution) method. Red cell distribution (RDW), C-reactive protein (CRP), age, sex, race, diabetes, smoking status, high-density lipoprotein (HDL), and chronic kidney disease (CKD) were used as covariates in each of the ACC/AHA pooled cohort risk groups.
The adjusted hazard ratios for RDW >14 (Normal range 12.5-14.5 %) as compared to <13 were 2.79 (95% confidence intervals (95% CI) 2.77-2.81, < 0.01), 2.02 (95% CI 2.01-2.02, < 0.01), 1.18 (95% CI 1.18-1.18, < 0.01) in the low, intermediate and high-risk groups respectively. The 20-year cumulative cardiovascular mortality (RDW >14 vs. <13) was 4% vs. 1.3% low, 17.7% vs. 7.7% in intermediate and 28.1% vs. 24.6% in high ASCVD risk groups respectively.
Our findings support that measurement of RDW in the intermediate ASCVD group may be clinically valuable for further risk stratification and prognostication in the general population of people aged more than 40 years of age with regards to identifying those at an increased risk for cardiovascular mortality.
尽管红细胞分布宽度（RDW）与心血管死亡率增加有关，但升高的 RDW 与各种 ASCVD 风险组的心血管死亡率之间的关系尚不清楚。
我们利用了全国健康和营养检查调查（NHANES）III，该调查采用复杂的多阶段、聚类设计来代表美国的平民、社区人群。在 1988-1994 年期间输入数据的 30818 名受试者中，选择了 8884 名年龄超过 40 岁的受试者，这些受试者代表了 85323902 名患者的加权样本，在排除缺失变量后进行了选择。使用 ACC/AHA 合并队列方程（PCE）计算动脉粥样硬化性心血管疾病（ASCVD）风险，并创建低（<7.5%）、中（7.5-20%）和高（>20%）风险组。主要终点是心血管死亡率。使用 Fine 和 Gray（亚分布）方法进行多变量比例风险回归。RDW、C 反应蛋白（CRP）、年龄、性别、种族、糖尿病、吸烟状况、高密度脂蛋白（HDL）和慢性肾脏病（CKD）被用作每个 ACC/AHA 合并队列风险组的协变量。
与<13 相比，RDW>14（正常范围 12.5-14.5%）的调整后的风险比为 2.79（95%置信区间[95%CI]2.77-2.81，<0.01）、2.02（95%CI 2.01-2.02，<0.01）和 1.18（95%CI 1.18-1.18，<0.01），分别在低、中和高风险组中。20 年累积心血管死亡率（RDW>14 与<13）分别为 4%与 1.3%（低）、17.7%与 7.7%（中）和 28.1%与 24.6%（高）。
我们的研究结果支持在中间 ASCVD 组中测量 RDW 可能对进一步分层和预后具有临床价值，可用于识别 40 岁以上人群心血管死亡率增加的风险。
