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SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 14 NUMBER 2 • DECEMBER 2017
61
Red cell distribution width is correlated with extensive
coronary artery disease in patients with diabetes mellitus
Atac Celik, Metin Karayakali, Fatih Altunkas, Kayihan Karaman, Arif Arisoy, Koksal
Ceyhan, Hasan Kadi, Fatih Koc
Correspondence to: Atac Celik
Metin Karayakali, Fatih Altunkas, Kayihan Karaman, Arif Arisoy,
Koksal Ceyhan
Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University,
Tokat, Turkey
e-mail:
dretaci@yahoo.comHasan Kadi
Department of Cardiology, Faculty of Medicine, Balikesir University,
Balikesir, Turkey
Fatih Koc
Department of Cardiology, Faculty of Medicine, Akdeniz University,
Antalya, Turkey
Previously published in
Cardiovasc J Afr
2017;
28
: 319–323
S Afr J Diabetes Vasc Dis
2017;
14
: 61–65
Abstract
Introduction:
Previous studies have predicted an
independent relationship between red cell distribution
width (RDW) and the risk of death and cardiovascular
events in patients with coronary artery disease (CAD).
The aim of this study was to investigate the relationship
between RDW and extensiveness of CAD in patients with
diabetes mellitus (DM).
Methods:
Two hundred and thirty-three diabetic patients
who underwent coronary angiographies at our centre in
2010 were included in the study. All of the angiograms were
re-evaluated and Gensini scores were calculated. Triple-
vessel disease was diagnosed in the presence of stenosis >
50% in all three coronary artery systems.
Result:
RDW was significantly higher in diabetic CAD
patients (
p
< 0.001). Patients with CAD who had a RDW
value above the cut-off point also had higher Gensini
scores, higher percentages of obstructive CAD and triple-
vessel disease (
p
≤ 0.001 for all). According to the cut-off
values calculated using ROC analysis, RDW > 13.25% had a
high diagnostic accuracy for predicting CAD. RDW was also
positively correlated with Gensini score, obstructive CAD
and triple-vessel disease (
r
< 0.468 and
p
< 0.001 for all).
Conclusion:
RDW values were found to be increased in the
diabetic CAD population. Higher RDW values were related
to more extensive and complex coronary lesions in patients
with DM.
Keywords:
red cell distribution width, coronary artery disease,
diabetes mellitus, Gensini score
Red cell distribution width (RDW) is widely accepted as a measure of
anisocytosis and is routinely reported during automated complete
blood counts.
1
It is commonly used to narrow the differential
diagnosis of anaemia.
2
Many studies have reported that higher
RDW values are associated with a worse prognosis in coronary
artery disease, heart failure, peripheral artery disease, and even in
the unselected population.
3-6
Diabetes mellitus (DM) is one of the major risk factors for
atherosclerosis.
7
Coronary artery disease (CAD) is more common
among patients with DM.
8
CAD is the main cause of death in DM,
and DM is associated with a two- to four-fold increased mortality
risk from heart disease.
9
Moreover, it has a worse prognosis and is
usually more advanced at the time of diagnosis.
10
Previous studies have shown an association between RDW
value and the severity of CAD, but there were no data on the
diabetic population.
11-13
The aim of this study was to investigate
the relationship between RDW and the extensiveness of CAD in
patients with DM.
Methods
The study group was formed retrospectively fromour catheterisation
laboratory registries. Two hundred and thirty-three diabetic patients
who underwent coronary angiography at our centre in 2010 were
included in the study. The diagnosis of DM was based on a previous
history of diabetes treated with or without drug therapies.
Patients with acute or chronic inflammatory disease, severe
liver or renal insufficiency, morbid obesity, malignancy, valvular
heart disease, heart failure, prior coronary intervention, or who
had experienced acute coronary syndrome within 30 days prior to
coronary angiography were excluded from the study. In addition,
subjects were also excluded if they had a history of anaemia and
blood transfusion.
Patient age, gender, past history of disease, smoking habits and
current medications were carefully ascertained. Hypertension was
defined as blood pressure ≥ 140/90 mmHg or if the subject was
taking antihypertensive medications. Dyslipidaemia was defined as
low-density lipoprotein cholesterol ≥ 100 mg/dl (≥ 2.59 mmol/l) or
if they were taking a hypolipidaemic drug. Anaemia was defined as
haemoglobin concentration < 13 mg/dl in men and < 12 mg/dl in
women. Body mass index (BMI) was calculated as weight/height
2
(kg/m
2
).
This investigation was a single-centre study. Informed consent
was obtained from all participants, and the study protocol was
approved by the ethics committee at our institution. The study was
in accordance with the Declaration of Helsinki.
Blood samples were drawn from each patient after overnight
fasting, during admission for routine chemistry. Haemoglobin, white
blood cell count, mean platelet volume (MPV) and RDW values were
measured with a Pentra DX 120 analyser (ABX, Montpellier, France).