Associations Of Red Blood Cell Distribution Width And Its Change With Incident Cardiovascular Disease In The Middle-aged And Elderly Chinese

Objectives:Based on the DFTJ cohort,the present study aimed to investigate the correlation of red blood cell distribution width(RDW)with influencing factors,then to investigate the associations of RDW and its change with incident CVD.Methods:The prospective Dongfeng-Tongji cohort enrolled 27,009 participants in baseline survey during 2008-2010 and newly enrolled 14120 in the first follow-up survey in 2013.Excluded participants with coronary heart disease(CHD),stroke,or severely abnormal electrocardiogram(ECG),lost to follow-up,we futher excluded the absence and extremes of RDW.Finally,20586 subjects were included in the correlation of RDW with influencing factors and the association between baseline RDW and incident CVD.8042 subjects were included in the association of RDW change value with incident CVD.The incidence of CVD was followed up until December 31,2016based on the medical records of insurance system and hospitals of Dongfeng Motor corporation and the established baseline database.Spearman rank correlation and multivariate generalized linear regression model were used to evaluate the correlation between RDW and multiple factors.Cox proportional hazard model was used to estimate the associations of RDW and its change with incident CVD and its subtypes.Results:1.Correlation analysis showed:RDW was positively correlated with age(r=0.034,P<0.001),body mass index(BMI)(r=0.039,P<0.001),fasting blood glucose(FG)(r=0.062,P<0.001)and total cholesterol(TC)(r=0.024,P<0.001),while negatively correlated with systolic blood pressure(SBP)(r=-0.021,P=0.003),diastolic blood pressure(DBP)(r=-0.094,P<0.001)and low density lipoprotein cholesterol(LDL-C)(r=-0.053,P<0.001).In the multivariate adjusted model,we found that the elderly(?=0.003,P=0.026),participants with BMI>28kg/m~2(?=0.217,P<0.001),diabetes(?=0.135,P<0.001),sleep duration?9 hours(?=0.092,P=0.00),fruits and vegetables intake?5 times per week(?=0.132,P=0.046),and participants under stress(?=0.108,P<0.001)had higher RDW levels,while the current drinkers(?=-0.082,P=0.001)and participants with central obesity(?=-0.150,P<0.001)had lower RDW level.2.Compared with the moderate RDW group(12.4%?RDW?14.7%),the adjusted HRs(95%CIs)of CVD,CHD,stroke and ACS of the high baseline RDW group(RDW?14.7%)were 1.13(1.04-1.23),1.13(1.04-1.23),1.13(0.95-1.36)and1.17(1.01-1.36),respectively.3.We found non-significant association of RDW change with incident CVD.In addition,participants with low RDW at baseline and continuous decline(RDW?12.4%;RDW change?-0.9%)were at the lowest risk of incident CVD(HR=0.46;95%CI,0.22-0.97),compared with moderate RDW at baseline and a relatively stable level(12.4%?RDW?14.7%;-0.9%?RDW change?1.6%)during the two surveys.Conclusions:This study mainly found that higher RDW at baseline was associated with increased incidence of CVD,CHD and ACS in middle-aged and elderly Chinese,while no significant association was found between the change of RDW and incident CVD.However,the joint effect of baseline RDW and its change were significantly associated with the incidence of CVD.