Session Information
Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Red cell distribution width (RDW) is a measure of the variation in red blood cell size reported on the automated complete blood count. Although traditionally used to differentiate between causes of anemia, elevated RDW has recently been found to predict cardiovascular (CVS) risk and outcome in patients with and without heart disease. RDW may be a marker for the inflammation that drives CVS risk.
Supporting an inflammatory link, RDW has been shown to correlate with disease activity and inflammatory markers in conditions such as Bechet’s, inflammatory bowel disease, rheumatoid arthritis (RA) and systemic lupus erythematosus .
RA is a chronic inflammatory condition with an increased risk of CVS disease. We hypothesized that RA patients with elevated RDW levels would experience greater burden of myocardial infarction (MI).
Methods:
Utilizing a secure cloud based platform, Explorys, we searched de-identified patient data from multiple US healthcare systems between the years 1999 to 2014. Patients with a diagnosis of RA were identified by CCP and/or RF positivity. To exclude the influence of anemia only patients with Hb>12 mg/dl were included. Patients were stratified into a high (≥15.6 %) RDW group if they ever had an RDW > 15.6% and a low RDW group (< 13.5% and excluding any patient with prior episode of RDW >15.6%). The proportion of patients with a diagnosis of MI in each RDW group was collected.
For comparison, patients were divided into a high and low CRP group (≥ 2.5 and ≤ 0.8 mg/dl) and a high and low ESR group (≥50 and ≤30 mm/hr) and MI data was collected.
Statistical comparison between high and low laboratory test groups was performed with chi square and odds ratios were calculated.
Results:
|
Table 1: Proportion of patients with RA who have had MI |
|||
|
|
N with MI/Total N (%) |
N with MI/Total N (%) |
p-value |
|
RDW |
High RDW (>15.6%) |
Low RDW (<13.5%) |
<.0001 |
|
1410/11250 (11) |
1320/21990 (6) |
||
|
ESR |
High ESR (>50mm/hr) |
Low ESR (<30mm/hr) |
<.0001 |
|
710/5480 (13) |
1120/22490 (5) |
||
|
CRP |
High CRP (>2.5 mg/dL) |
Low CRP (<0.8mg/dL) |
<.0001 |
|
630/5380 (10) |
580/11700 (5) |
||
The total cohort of patients with RA from the database was 35 890; of which 2 810 had an MI.
The proportion of RA patients with MI was significantly increased in the high compared to low RDW, ESR and CRP groups (results depicted in Table 1).
The odds of MI was more likely in the high verses low RDW ( OR 2.1, 95% CI 1.9 to 2.3), ESR (OR 2.6, 95 % CI 2.4-2.9) and CRP (OR 2.4, 95% CI 2.1 to 2.7) groups.
Conclusion:
In keeping with previous findings in RA patients, elevated levels of ESR and CRP were associated with increased risk of MI. Elevated levels of RDW in RA patients also appear to indicate an increased risk of MI. RDW is a widely available laboratory parameter that may be useful as a measure for CVS risk in RA.
We propose that in addition to elevated ESR and CRP, elevated RDW levels in RA patients should prompt physicians to aggressively screen and treat their patients for modifiable CVS risk factors, in addition to treating RA inflammation.
Disclosure:
S. Hassan,
None;
M. Antonelli,
None;
S. P. Ballou,
None.
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