Does variation in the size of the red blood cells cause increased formation of atherosclerotic plaques?

A recent study from K.G. Jebsen TREC shows an association between the size variation of the red blood cells, and increased progression of atherosclerosis.

As atherosclerosis is the most important cause of heart attack and stroke, our findings may help understanding the association between RDW and these diseases. 

Red cell Distribution Width (RDW) is a measure of the variation in size of red blood cells which is calculated and presented as a percentage. Traditionally, this measure is used to separate different types of anemia from each other.

Over the last few years, many studies have shown associations between RDW and various diseases. An increased variation in size of the red blood cells is associated with increased risk of stroke, heart attack and death following cardiovascular disease.

To what extent this association also exists for RDW and atherosclerosis, the most important cause of heart attacks, is less known. Therefore, we investigated whether RDW was associated with increased presence and progression of atherosclerotic plaques in the general population.

Using ultrasound, presence and size of atherosclerotic plaques in the carotid artery were investigated for in 4677 people participating in the fourth survey of the Tromsø Study. The study participants also had a physical examination, and blood samples were drawn for measurement of RDW.

Atherosclerosis was defined as presence of plaques in the wall of the blood vessel (total plaque area), and/or by a thickening of the vessel wall.

At the first ultrasound, atherosclerosis was found in 2149 (46%) of the participants. During the fifth survey of the Tromsø Study, seven years later, the participants’ carotid artery was re-investigated by ultrasound.

We divided the subjects into three categories based on their RDW values. The proportion of subjects with atherosclerosis increased from 38.2% in category 1 (RDW<12.7%), to 51.3% in category 3 (RDW>13.2%). Moreover, subjects with the highest RDW had the highest degree of plaque growth in the time period between the fourth and fifth Tromsø Study.

Reference: Lappegard, J., et al., Red cell distribution width and carotid atherosclerosis progression. The Tromso Study. Thromb Haemost, 2015. 113(3).


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Last updated: 12.02.2015 13:07