An overall and dose-response meta-analysis of red blood cell distribution width and CVD outcomes

Haifeng Hou, Tao Sun, Cheng Li, Yuanmin Li, Zheng Guo, Wei Wang, Dong Li, Haifeng Hou, Tao Sun, Cheng Li, Yuanmin Li, Zheng Guo, Wei Wang, Dong Li

Abstract

Red blood cell distribution width (RDW) is the coefficient of variation of red blood cell size, considered to be associated with cardiovascular disease (CVD). This study aimed to comprehensively synthesize previous studies on RDW and CVD outcomes through an overall and dose-response meta-analysis. PubMed, Embase and Web of Science were searched systematically for English and Chinese language publications up to November 30, 2015. We extracted data from publications matching our inclusion criteria for calculating pooled hazard ratio (HR), which was used to assess prognostic impact of RDW on CVD. Twenty-seven articles, consisting of 28 studies and 102,689 participants (mean age 63.9 years, 63,703 males/36,846 females, 2,140 gender-unmentioned subjects) were included in the present meta-analysis. The pooled HRs are 1.12 (95% CI = 1.09-1.15) for the association of all-cause mortality (ACM) per 1% increase of RDW, 1.12(95% CI = 1.08-1.17) for major adverse cardiac events (MACEs) per 1% increase of RDW. A dose-response curve relating RDW increase to its effect on CVD outcomes was established (pcurve < 0.001). For every 1-unit increase of RDW, there is an increased risk of occurrence of ACM (pooled HR = 1.03, 95% CI = 1.02-1.04) and MACEs (pooled HR = 1.04, 95% CI = 1.01-1.06). This study indicates RDW may be a prognostic indicator for CVD outcomes.

Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1. Flow chart of the study…
Figure 1. Flow chart of the study selection.
Figure 2. Forest plot of the pooled…
Figure 2. Forest plot of the pooled adjusted HR of per 1% RDW increase for the risk of all-cause mortality in overall meta-analysis.
The size of each grey square is proportional to the study’s weight calculated in the meta-analysis. HR: hazard ratio; 95% CI: 95% confidence interval; HF: heart failure; MI: myocardial infarction; CAD: coronary artery disease.
Figure 3. Forest plot of the pooled…
Figure 3. Forest plot of the pooled adjusted HR of per 1% RDW increase for the risk of MACEs in overall meta-analysis.
The size of each grey square is proportional to the study’s weight calculated in the meta-analysis. HR: hazard ratio; 95% CI: 95% confidence interval; HF: heart failure; MI: myocardial infarction; CAD: coronary artery disease.
Figure 4. Dose-response relationship between RDW (per…
Figure 4. Dose-response relationship between RDW (per 1-unit increase) and CVD outcomes.
(A) Relationship between RDW and all-cause mortality. (B) Relationship between RDW and MACEs. Dotted lines represent the 95% CI for the fitted trend. LCI: lower limit of confidence interval; UCI upper limit of confidence interval; 95% CI: 95% confidence interval; RDW: red blood cell distribution width.
Figure 5. Dose-response relationship between RDW/Hb (per…
Figure 5. Dose-response relationship between RDW/Hb (per 1-unit increase) and adverse cardiovascular event risk.
(A) Relationship between RDW and all-cause mortality. (B) Relationship between RDW and MACEs. Dotted lines represent the 95% CI for the fitted trend. LCI: lower limit of confidence interval; UCI upper limit of confidence interval; 95% CI: 95% confidence interval; RDW: red blood cell distribution width; Hb: hemoglobin.

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