title: Complete blood count risk score and its components, including RDW, are associated with mortality in the JUPITER trial.
abstract: BACKGROUND
  Previously, we showed that sex-specific complete blood count (CBC) risk scores strongly predicted risk of all-cause mortality in multiple sets of general medical patients. This study evaluated the CBC risk score in an independent, well-studied international primary risk population of lower-risk individuals initially free from cardiovascular (CV) disease.
  
  
  METHODS
  Observational secondary analysis of a randomized trial population.
  
  
  METHODS
  The previously derived and validated CBC score was evaluated for association with all-cause mortality among CV disease-free females (n = 6568) and males (n = 10,629) enrolled for up to 5 years in the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial. Associations of the CBC score with CV mortality and with major CV disease were also tested.
  
  
  RESULTS
  The CBC score predicted all-cause mortality, with univariable hazard ratio (HR) 4.83 (95% CI 3.70-6.31) for the third CBC score tertile vs. the first tertile, and HR 2.31 (CI 1.75-3.05) for the second tertile (p trend < 0.001). The CBC score retained significance after adjustment: HR 1.97 (CI 1.46-2.67) and 1.51 (CI 1.13-2.00) for tertiles 3 and 2 vs. 1, respectively (p trend < 0.001). The CBC score also predicted CV mortality (p trend = 0.025) and the primary JUPITER endpoint (p trend = 0.015). c-statistics for mortality were 0.729 among all, and 0.722 and 0.750 for females and males, respectively.
  
  
  CONCLUSIONS
  The CBC risk score was strongly associated with all-cause mortality among JUPITER trial participants and had good discrimination. It also predicted CV-specific outcomes. This CBC score may be useful in identifying cardiac disease-free individuals at increased risk of mortality.
authors.affiliation: Intermountain Medical Center, Salt Lake City, USA University of Utah, Salt Lake City, USA benjamin.horne@imail.org.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.affiliation: Intermountain Medical Center, Salt Lake City, USA University of Utah, Salt Lake City, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.affiliation: Intermountain Medical Center, Salt Lake City, USA University of Utah, Salt Lake City, USA.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
authors.affiliation: Harvard Medical School, Boston, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ridker
authors.affiliation: Harvard Medical School, Boston, USA.
authors.forename: Nina P
authors.initials: NP
authors.lastname: Paynter
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001772:Blood Cell Count; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control; D003661:Decision Support Techniques; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D004909:Erythrocyte Indices; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D000068718:Rosuvastatin Calcium / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D000094422:Secondary Data Analysis
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000068718:Rosuvastatin Calcium
keywords: CBC; clinical decision rule; clinical prediction rule; red cell distribution width