Red Blood Cell Distribution Width: A Novel Predictive Indicator for Cardiovascular and Cerebrovascular Diseases
Table 3
Studies exploring association between red blood cell distribution width (RDW) and myocardial infarction (MI).
First author, journal, year
Study design
Study population
Mean follow-up
Major outcomes
Major limitations
(i) Tonelli et al. [20]
(ii) Circulation
(iii) 2008
Post hoc analysis
4111 participants with hyperlipidemia and a history of myocardial infarction, age 21–75 years
A median of 59.7 months
The top RDW quartile had a 56% increased risk of fatal coronary disease or nonfatal myocardial infarction when compared to subjects in the lowest quartile (HR 1.56, 95% CI 1.17–2.08)
(i) Not rule out the possibility of residual confounding
(ii) The samples cannot not be representative of the general population
(i) Chen et al. [51]
(ii) American Journal of Epidemiology
(iii) 2010
Prospective cohort
3226 participants without history of stroke, coronary heart disease, or cancer, age>35 years
A median of 15.9 years
The highest RDW quartile was 1.46 for all-cause mortality compared with the lowest quartile (95% CI: 1.17–1.81)
(i) Few cases met the anemia criteria, which resulted in fairly wide confidence intervals
(ii) Not reported data on specific causes of non-CVD death
(iii) Only measured the RDW values once
(i) Zalawadiya et al. [52]
(ii) American Journal of Cardiology
(iii) 2010
Multiethnic cohort
7556 participants, age 41.5–15.8 years
10 years
The risk of being classified in the intermediate risk category of coronary heart disease was 53% greater (95% CI: 1.38–1.69, ) with each unit increase in RDW value
(i) Actual cardiovascular events during a set follow-up period was unavailable
(i) Lee et al. [53]
(ii) Clinical Cardiology
(iii) 2013
Retrospective analysis
1596 patients with acute myocardial infarction, mean age, 64.5 ± 11.9 years
1634 ± 342 days
The RDW levels were significantly higher in patients with 12-month major adverse cardiac events (13.8 ± 1.3% versus 13.3 ± 1.2%, )
(i) Cannot exclude the possibility of residual confounding factors
(ii) Not adjusted the RDW for nutrients (such as iron, folate, and vitamin B12)
(i) Arbel et al. [54]
(ii) Thrombosis and Haemostasis
(iii) 2014
Registry-based, retrospective cohort
225,006 subjects from health registry, age ≥ 40 years
5 years
Compared to patients with a RDW of 13% or lower, patients with RDW > 17% had a HR of 3.83 (95% CI: 3.12–4.69, ) for all-cause mortality and 1.22 (95% CI: 1.04–1.42, ) for major adverse cardiac events
(i) Not rule out the possibility of residual confounding
(ii) Not reported data on specific causes of non-CVD death
(i) Skjelbakken et al. [125]
(ii) Journal of the American Heart Association
(iii) 2014
Prospective cohort
25,612 participants with no previous myocardial infarction, mean age 40.2–52.8 years
15.8 years
There was a linear association between RDW and risk of myocardial infarction, for which a 1% increment in RDW was associated with a 13% increased risk (HR 1.13; 95% CI: 1.07–1.19)
(i) The RDW measure was not repeated, there remained random measurement error
(ii) Participants may underestimate the true prevalence of diabetes
251 adult patients with NSTEMI over a 1-year period, age >50 years
—
The RDW was higher in the group with non-ST-elevation myocardial infarction compared with the patient group with unstable angina (14.6 ± 1.0 versus 13.06 ± 1.7, resp., )
(i) The sample size was relatively small
(ii) Only Hb levels were measured in the study
