Neeraj Shah1, Mohit Pahuja2, Sadip Pant3, Aman Handa4, Vratika Agarwal5, Nileshkumar Patel6, Raman Dusaj7. 1. Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, United States. Electronic address: neerajshah86@gmail.com. 2. Department of Internal Medicine, St. Joseph Hospital and Medical Center, Phoenix, AZ, United States. 3. Department of Cardiology, University of Louisville, Louisville, KY, United States. 4. Medical Student, Kasturba Medical College, India. 5. Department of Cardiology, Staten Island University Hospital, Staten Island, NY. 6. Department of Cardiology, University of Miami, Miami, FL, United States. 7. Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, United States.
Abstract
INTRODUCTION: Red cell distribution width (RDW) has been linked to cardiovascular disease. We sought to determine whether addition of RDW improved the Framingham risk score (FRS) model to predict cardiovascular mortality in a healthy US cohort. METHODS: We performed a post-hoc analysis of the National Health and Nutritional Examination Survey-III (1988-94) cohort, including non-anemic subjects aged 30-79years. Primary endpoint was death from coronary heart disease (CHD). We divided the cohort into three risk categories: <6%, 6-20% and >20%. RDW>14.5 was considered high. Kaplan-Meier survival curves and Cox proportional hazards models were created. Discrimination, calibration and reclassification were used to assess the value of addition of RDW to the FRS model. RESULTS: We included 7005 subjects with a mean follow up of 14.1years. Overall, there were 233 (3.3%) CHD deaths; 27 (8.2%) in subjects with RDW>14.5 compared to 206 (3.1%) in subjects with RDW≤14.5 (p<0.001). Adjusted hazard ratio of RDW in predicting CHD mortality was 2.02 (1.04-3.94, p=0.039). Addition of RDW to FRS model showed significant improvement in C-statistic (0.8784 vs. 0.8751, p=0.032) and area under curve (0.8565 vs. 0.8544, p=0.05). There was significant reclassification of FRS with a net reclassification index (NRI) of 5.6% (p=0.017), and an intermediate-risk NRI of 9.6% (p=0.011). Absolute integrated discrimination index (IDI) was 0.004 (p=0.02), with relative IDI of 10.4%. CONCLUSIONS: Our study demonstrates that RDW is a promising biomarker which improves prediction of cardiovascular mortality over and above traditional cardiovascular risk factors. Copyright Â
INTRODUCTION: Red cell distribution width (RDW) has been linked to cardiovascular disease. We sought to determine whether addition of RDW improved the Framingham risk score (FRS) model to predict cardiovascular mortality in a healthy US cohort. METHODS: We performed a post-hoc analysis of the National Health and Nutritional Examination Survey-III (1988-94) cohort, including non-anemic subjects aged 30-79years. Primary endpoint was death from coronary heart disease (CHD). We divided the cohort into three risk categories: <6%, 6-20% and >20%. RDW>14.5 was considered high. Kaplan-Meier survival curves and Cox proportional hazards models were created. Discrimination, calibration and reclassification were used to assess the value of addition of RDW to the FRS model. RESULTS: We included 7005 subjects with a mean follow up of 14.1years. Overall, there were 233 (3.3%) CHD deaths; 27 (8.2%) in subjects with RDW>14.5 compared to 206 (3.1%) in subjects with RDW≤14.5 (p<0.001). Adjusted hazard ratio of RDW in predicting CHD mortality was 2.02 (1.04-3.94, p=0.039). Addition of RDW to FRS model showed significant improvement in C-statistic (0.8784 vs. 0.8751, p=0.032) and area under curve (0.8565 vs. 0.8544, p=0.05). There was significant reclassification of FRS with a net reclassification index (NRI) of 5.6% (p=0.017), and an intermediate-risk NRI of 9.6% (p=0.011). Absolute integrated discrimination index (IDI) was 0.004 (p=0.02), with relative IDI of 10.4%. CONCLUSIONS: Our study demonstrates that RDW is a promising biomarker which improves prediction of cardiovascular mortality over and above traditional cardiovascular risk factors. Copyright Â
Authors: Bora E Baysal; Abdulrahman A Alahmari; Tori C Rodrick; Debra Tabaczynski; Leslie Curtin; Mukund Seshadri; Drew R Jones; Sandra Sexton Journal: JCI Insight Date: 2022-09-08
Authors: Jennifer Marie Crook; Ann L Horgas; Saunjoo L Yoon; Oliver Grundmann; Versie Johnson-Mallard Journal: Nutrients Date: 2022-03-16 Impact factor: 5.717