Abstract
Introduction Red cell distribution width (RDW) is associated with cardiovascular diseases, including atrial fibrillation (AF) and venous thromboembolism (VTE). Whether RDW is a risk marker for thromboembolic events in AF patients is scarcely known. We aimed to assess the association between RDW and the risk of AF, and AF-related VTE and ischemic stroke, in a population-based cohort. Methods We measured RDW in 26,111 participants from the Tromsø Study (1994–1995), and registered incident AF cases through December 31, 2013. Among participants with AF, first-ever VTEs and ischemic strokes were registered from the date of AF diagnosis through the end of follow-up. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for AF by quartiles of RDW. Furthermore, we calculated cause-specific HRs for VTE and ischemic stroke by tertiles of RDW for participants with AF. Results There were 2,081 incident AF cases during a median of 18.8 years of follow-up. Subjects with RDW in the highest quartile (RDW ≥ 13.3%) had 30% higher risk of AF than those in the lowest quartile (RDW ≤ 12.3%). Among those with AF, subjects with RDW in the upper tertile had a doubled risk of ischemic stroke (HR 2.07, 95% CI 1.20–3.57). In contrast, RDW was not associated with incident VTE in subjects with AF. Conclusion RDW was significantly associated with incident AF in a general population. Among subjects with AF, high RDW was associated with ischemic stroke, but not VTE.
Highlights
Red cell distribution width (RDW) is associated with cardiovascular diseases, including atrial fibrillation (AF) and venous thromboembolism (VTE)
RDW was not associated with either pulmonary embolisms (PEs) or deep vein thromboses (DVTs). In this population-based cohort study, we confirmed an association between RDW and incident AF and expanded the current knowledge on the impact of RDW on the risk of thromboembolic events in AF patients
Our finding of RDW as a risk marker for incident AF is in concurrence with previous reports
Summary
Red cell distribution width (RDW) is associated with cardiovascular diseases, including atrial fibrillation (AF) and venous thromboembolism (VTE). We aimed to assess the association between RDW and the risk of AF, and AF-related VTE and ischemic stroke, in a population-based cohort. Ischemic stroke is generally considered the most detrimental complication of AF, but recent studies have established AF as a risk factor for venous thromboembolism (VTE).. RDW has been used in the differentiation of anemias, but RDW has recently emerged as a risk marker for cardiovascular morbidity and mortality, including myocardial infarction (MI), heart failure, ischemic stroke, and VTE.. In a case–control study including 117 patients with AF and 60 controls, RDW was found to be associated with AF in multivariable logistic regression analysis, and in another case–control study by Liu et al, RDW was significantly higher in the AF group than in controls (12.7% vs 12.4%; p < 0.05).. RDW has been used in the differentiation of anemias, but RDW has recently emerged as a risk marker for cardiovascular morbidity and mortality, including myocardial infarction (MI), heart failure, ischemic stroke, and VTE. A few studies have implicated RDW as a risk marker for AF. In a case–control study including 117 patients with AF and 60 controls, RDW was found to be associated with AF in multivariable logistic regression analysis, and in another case–control study by Liu et al, RDW was significantly higher in the AF group than in controls (12.7% vs. 12.4%; p < 0.05). A recent meta-analysis examining the impact of hematological parameters on AF occurrence found higher RDW in participants with new-onset AF compared with those with sinus rhythm. RDW was significantly increased in patients with AF recurrence.
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