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Brief Report: Elevated Red Cell Distribution Width Identifies Elevated Cardiovascular Disease Risk in Patients With HIV Infection

Al-Kindi, Sadeer G. MD; Kim, Chang H. MD; Morris, Stephen R. MD; Freeman, Michael L. PhD; Funderburg, Nicholas T. PhD; Rodriguez, Benigno MD; McComsey, Grace A. MD; Dalton, Jarrod E. PhD; Simon, Daniel I. MD; Lederman, Michael M. MD; Longenecker, Chris T. MD; Zidar, David A. MD, PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1st, 2017 - Volume 74 - Issue 3 - p 298–302
doi: 10.1097/QAI.0000000000001231
Clinical Science

Abstract: Red cell distribution width (RDW) is linked to cardiovascular risk in the general population, an association that might be driven by inflammation. Whether this relationship holds for patients with HIV infection has not been previously studied. Using a large clinical registry, we show that elevated RDW (>14.5%) is independently associated with increased risk of coronary artery disease {odds ratio [OR] 1.39 [95% confidence interval (CI): 1.25 to 1.55]}, peripheral vascular disease [OR 1.41 (95% CI: 1.29 to 1.53)], myocardial infarction [1.43 (95% CI: 1.25 to 1.63)], heart failure [OR 2.23 (95% CI: 1.99 to 2.49)], and atrial fibrillation [OR 1.96 (95% CI: 1.64 to 2.33)]. In conclusion, in the context of the inflammatory milieu that accompanies HIV infection, RDW remains a powerful marker of cardiovascular disease.

*Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH;

Division of Infectious Diseases and HIV Medicine, Department of Medicine, Center for AIDS Research, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH;

Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH;

§School of Medicine, Case Western Reserve University, Cleveland, OH; and

Section of Health Outcomes Research and Clinical Epidemiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.

Correspondence to: David A. Zidar, MD, PhD, Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Mailstop LKS 5038, Cleveland, OH 44106 (e-mail:

Supported by the Clinical and Translational Science Collaborative of Cleveland, KL2TR000440 to D.A.Z., from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research; and by K23 HL123341 to C.T.L.

The authors have no conflicts of interest to disclose.

C.T.L. and D.A.Z. have contributed equally.

The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Received June 26, 2016

Accepted September 21, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.