Cardiovascular Journal of Africa: Vol 28 No 5 (September/October 2017)

45 / 74

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017 AFRICA 319
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
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 coro-
nary 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 posi-
tively 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
Submitted 27/5/16, accepted 8/3/17
Published online 23/8/17
Cardiovasc J Afr 2017; 28: 319–323
DOI: 10.5830/CVJA-2017-015
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 from our
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/height2 (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
Department of Cardiology, Faculty of Medicine,
Gaziosmanpasa University, Tokat, Turkey
Atac Celik, MD,
Metin Karayakali, MD
Fatih Altunkas, MD
Kayihan Karaman, MD
Arif Arisoy, MD
Koksal Ceyhan, MD
Department of Cardiology, Faculty of Medicine, Balikesir
University, Balikesir, Turkey
Hasan Kadi, MD
Department of Cardiology, Faculty of Medicine, Akdeniz
University, Antalya, Turkey
Fatih Koc, MD