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Red cell distribution width in patients with diabetes and myocardial infarction: An analysis from the EXAMINE trial
Author(s) -
Ferreira João Pedro,
Lamiral Zohra,
Bakris George,
Mehta Cyrus,
White William B.,
Zannad Faiez
Publication year - 2021
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.14371
Subject(s) - medicine , red blood cell distribution width , alogliptin , myocardial infarction , diabetes mellitus , stroke (engine) , proportional hazards model , type 2 diabetes , hazard ratio , acute coronary syndrome , cardiology , confidence interval , endocrinology , dipeptidyl peptidase 4 , mechanical engineering , engineering
Aim To determine the clinical correlates of increased red blood cell distribution width (RDW), its potential mechanistic association with multiple circulating biomarkers, and its prognostic value in patients with type 2 diabetes (T2D) who had a recent acute coronary syndrome. Methods We used time‐updated Cox models applied to patients enrolled in the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAMINE) trial. Results A total of 5380 patients were included, the median age was 61 years and 32% were women. Patients with higher RDW were older, more frequently women, with a longer diabetes duration and increased co‐morbidities. An RDW of more than 16.1% (both baseline and time‐updated) was independently associated with the study primary composite outcome of non‐fatal myocardial infarction, non‐fatal stroke or cardiovascular death (time‐updated adjusted HR = 1.36, 95% CI = 1.16–1.61, p < .001), all‐cause death (time‐updated adjusted HR = 2.01, 95% CI = 1.60–2.53, p < .001), as well as mortality from non‐cardiovascular causes (time‐updated adjusted HR = 2.67, 95% CI = 1.72–4.15, p < .001). RDW had a weak‐to‐moderate correlation with haemoglobin and circulating markers that reflected inflammation, apoptosis, fibrosis and congestion. Alogliptin did not alter RDW values. Conclusions RDW is a marker of disease severity associated with a multitude of poor outcomes, including both cardiovascular and non‐cardiovascular death. RDW correlated modestly with inflammatory, pro‐apoptotic, pro‐fibrotic and congestion markers, and its levels were not affected by alogliptin during the course of the trial.