Red cell distribution width and risk of cardiovascular mortality: Insights from National Health and Nutrition Examination Survey (NHANES)-III

Neeraj Shah, Mohit Pahuja, Sadip Pant, Aman Handa, Vratika Agarwal, Nileshkumar Patel, Raman Dusaj

Research output: Contribution to journalArticle

7 Citations (Scopus)

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 30–79 years. 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 14.1 years. 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.

Original languageEnglish
Pages (from-to)105-110
Number of pages6
JournalInternational Journal of Cardiology
Volume232
DOIs
Publication statusPublished - 01-04-2017
Externally publishedYes

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Erythrocyte Indices
Nutrition Surveys
Mortality
Coronary Disease
Kaplan-Meier Estimate
Proportional Hazards Models
Calibration
Area Under Curve
Cardiovascular Diseases
Biomarkers
Health

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Shah, Neeraj ; Pahuja, Mohit ; Pant, Sadip ; Handa, Aman ; Agarwal, Vratika ; Patel, Nileshkumar ; Dusaj, Raman. / Red cell distribution width and risk of cardiovascular mortality : Insights from National Health and Nutrition Examination Survey (NHANES)-III. In: International Journal of Cardiology. 2017 ; Vol. 232. pp. 105-110.
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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 30–79 years. 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 14.1 years. 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.",
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Red cell distribution width and risk of cardiovascular mortality : Insights from National Health and Nutrition Examination Survey (NHANES)-III. / Shah, Neeraj; Pahuja, Mohit; Pant, Sadip; Handa, Aman; Agarwal, Vratika; Patel, Nileshkumar; Dusaj, Raman.

In: International Journal of Cardiology, Vol. 232, 01.04.2017, p. 105-110.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Red cell distribution width and risk of cardiovascular mortality

T2 - Insights from National Health and Nutrition Examination Survey (NHANES)-III

AU - Shah, Neeraj

AU - Pahuja, Mohit

AU - Pant, Sadip

AU - Handa, Aman

AU - Agarwal, Vratika

AU - Patel, Nileshkumar

AU - Dusaj, Raman

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N2 - 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 30–79 years. 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 14.1 years. 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.

AB - 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 30–79 years. 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 14.1 years. 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.

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