title: Comparative analysis of red cell distribution width and high sensitivity C-reactive protein for coronary heart disease mortality prediction in multi-ethnic population: findings from the 1999-2004 NHANES.
abstract: BACKGROUND
  Red cell distribution width (RDW) has been shown to predict all-cause and cardiovascular (CVD) mortality. However, the predictive ability of RDW for future coronary heart disease (CHD) mortality in comparison to high sensitivity C-reactive protein (hs-CRP) has not been assessed in a population cohort free of CVD.
  
  
  METHODS
  Analysis was performed on 8,513 adult participants (age > 20 years) free of CVD from the National Health and Nutrition Examination Surveys 1999-2004. Cox-proportional hazard analyses were used to assess the role of RDW and hs-CRP in CHD mortality and in subgroups based on high and low RDW and hs-CRP.
  
  
  RESULTS
  On adjustment for traditional risk factors (age, sex, systolic blood pressure, anti-hypertensive medication use, total cholesterol, high density lipoprotein cholesterol, lipid lowering therapy, smoking, diabetes mellitus, anemia, mean corpuscular volume and nutritional deficiencies), RDW [hazard ratio (HR) 1.26 95% Confidence Interval (CI) [1.12-1.42] p < 0.001] remained an independent predictor, while hs-CRP [HR 1.18 95% CI [0.98-1.41] p = 0.077] did not. On comparative analysis, high RDW (> 12.6%) was predictive of CHD mortality irrespective of hs-CRP status [hs-CRP ≤ 3 mg/L (HR 1.17 95% CI [1.01-1.36] p = 0.031)] and hs-CRP > 3 mg/L (HR 1.44 95% CI [1.23-1.68] p < 0.001). Hs-CRP was not predictive in either high or low RDW subgroup.
  
  
  CONCLUSIONS
  RDW but not hs-CRP was associated with CHD mortality independent of traditional risk factors in a cohort with no pre-existing CVD. RDW may be considered a stronger biomarker for CHD death than hs-CRP and needs further prospective evaluation in CVD risk assessment.
authors.affiliation: Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, MI, USA; Department of Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, MI, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Veeranna
authors.forename: Sandip K
authors.initials: SK
authors.lastname: Zalawadiya
authors.forename: Sidakpal
authors.initials: S
authors.lastname: Panaich
authors.forename: Kushang V
authors.initials: KV
authors.lastname: Patel
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000208:ethnology / Q000401:mortality; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D008076:Cholesterol, HDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood* / Q000208:ethnology / Q000401:mortality*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000208:ethnology / Q000401:mortality; D004909:Erythrocyte Indices; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000097:blood / Q000208:ethnology / Q000401:mortality; D055815:Young Adult
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D002097:C-Reactive Protein
keywords: Coronary heart disease mortality; High sensitivity C-reactive protein; Red cell distribution width; Risk stratification