Red cell distribution width is associated with cardiovascular risk and disease parameters in rheumatoid arthritis

Rheumatology (Oxford). 2015 Apr;54(4):641-6. doi: 10.1093/rheumatology/keu345. Epub 2014 Sep 18.


Objective: Since red cell distribution width (RDW) has been associated with cardiovascular (CV) disease and inflammation in several conditions, the main aim of this study was to evaluate its prognostic value in RA patients and its potential associations with clinical features.

Methods: The history of CV events was retrospectively reviewed in 160 RA patients and RDW was recorded at disease onset and 6 and 12 months after diagnosis to calculate the accumulated value [area under the curve (AUC) RDW] and change during the first year (ΔRDW). In addition, RDW was analysed in 110 patients with established disease in relation to clinical features.

Results: Increased RDW at diagnosis and AUC RDW were able to predict the occurrence of CV events in RA patients [hazard ratio (HR) 1.247 (95% CI 1.079, 1.441), P = 0.003 and HR 1.038 (95% CI 1.018, 1.059), P = 0.0001, respectively] after adjusting by potential confounding factors. Receiver operating characteristic curve analyses revealed a better power of discrimination for the AUC RDW (P = 3.394 × 10(-5)). In addition, an increase in RDW during the first year was associated with poor CV outcome (P = 0.010). On the other hand, RDW in patients with established RA was significantly associated with disease activity, acute phase reactants and severity.

Conclusion: RDW at disease onset may be used as an early marker of CV risk in RA, whereas in patients with established disease it was related to the activity of the disease. These findings suggest that RDW can be considered as a surrogate marker of inflammation and, consequently, CV risk in RA patients.

Keywords: biomarker; cardiovascular disease; red cell distribution width; rheumatoid arthritis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Arthritis, Rheumatoid / blood*
  • Arthritis, Rheumatoid / epidemiology
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / epidemiology
  • Erythrocyte Indices*
  • Female
  • Heart Failure / blood*
  • Heart Failure / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / blood*
  • Myocardial Ischemia / epidemiology
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Stroke / blood*
  • Stroke / epidemiology
  • Young Adult