Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease
Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease
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DOI：
10.1161/circulationaha.107.727545
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发表时间：
2008-01-15
期刊：
影响因子：
37.8
通讯作者：
Pfeffer, Marc
中科院分区：
文献类型：
--
作者：
Tonelli, Marcello;Sacks, Frank;Pfeffer, Marc
背景：红细胞分布宽度（RDW）水平升高可能与心力衰竭患者的不良结局相关。我们研究了RDW与全因死亡率和不良心血管结局风险之间的关系，研究对象是基线时无心力衰竭的冠心病患者。方法和结果-我们对来自胆固醇和复发事件研究的数据进行了事后分析。在4111名参与者中测量基线RDW，这些参与者随机接受普伐他汀40 mg/d或安慰剂，并随访中位数为59.7个月。我们使用考克斯比例风险模型来研究RDW和不良临床结局之间的关系。在近60个月的随访中，376名参与者死亡。基线RDW水平与调整后的全因死亡风险之间存在显著相关性（RDW每增加百分比的风险比为1.14; 95%置信区间为1.05 ~ 1.24）。在基于基线RDW的四分位数进行分类并进一步调整红细胞压积和其他心血管风险因素后，观察到RDW和死亡之间的分级独立关系（趋势P = 0.001）。例如，与最低四分位数的参与者相比，RDW在最高四分位数的参与者的死亡调整风险比为1.78（95%置信区间，1.28至2.47）。更高水平的RDW也与冠状动脉死亡/非致命性心肌梗死，新的症状性心力衰竭，stroke. Conclusions的风险增加，我们发现了一个分级的独立关系RDW和死亡的风险和心血管事件的人与先前的心肌梗死，但没有症状性心力衰竭在基线。
Background-Higher levels of red blood cell distribution width (RDW) may be associated with adverse outcomes in patients with heart failure. We examined the association between RDW and the risk of all- cause mortality and adverse cardiovascular outcomes in a population of people with coronary disease who were free of heart failure at baseline.Methods and Results-We performed a post hoc analysis of data from the Cholesterol and Recurrent Events study. Baseline RDW was measured in 4111 participants who were randomized to receive pravastatin 40 mg daily or placebo and followed for a median of 59.7 months. We used Cox proportional hazards models to examine the association between RDW and adverse clinical outcomes. During nearly 60 months of follow-up, 376 participants died. A significant association was noted between baseline RDW level and the adjusted risk of all-cause mortality (hazard ratio per percent increase in RDW, 1.14; 95% confidence interval, 1.05 to 1.24). After categorization based on quartile of baseline RDW and further adjustment for hematocrit and other cardiovascular risk factors, a graded independent relation between RDW and death was observed (P for trend = 0.001). For instance, participants with RDW in the highest quartile had an adjusted hazard ratio for death of 1.78 (95% confidence interval, 1.28 to 2.47) compared with those in the lowest quartile. Higher levels of RDW were also associated with increased risk of coronary death/nonfatal myocardial infarction, new symptomatic heart failure, and stroke.Conclusions-We found a graded independent relation between higher levels of RDW and the risk of death and cardiovascular events in people with prior myocardial infarction but no symptomatic heart failure at baseline.