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The association between red cell distribution width and venous thromboembolism is not explained by myocardial infarction, stroke, or cancer.

https://arctichealth.org/en/permalink/ahliterature293397
Source
Res Pract Thromb Haemost. 2018 Apr; 2(2):327-333
Publication Type
Journal Article
Date
Apr-2018
Author
Trygve S Ellingsen
Jostein Lappegård
Tove Skjelbakken
Ellisiv B Mathiesen
Inger Njølstad
Sigrid K Brækkan
John-Bjarne Hansen
Author Affiliation
K.G. Jebsen Thrombosis Research and Expertise Center (TREC) Department of Clinical Medicine UiT-The Arctic University of Norway Tromsø Norway.
Source
Res Pract Thromb Haemost. 2018 Apr; 2(2):327-333
Date
Apr-2018
Language
English
Publication Type
Journal Article
Abstract
Red cell distribution width (RDW) is a risk marker of venous thromboembolism (VTE), myocardial infarction (MI), stroke, and cancer. Due to interrelations between these diseases, the association between RDW and VTE may be explained by MI, stroke, or cancer.
To investigate whether the effect of RDW on VTE could be explained by intermediate development of MI, stroke, or cancer.
RDW was measured in 24 363 participants of the Tromsø Study in 1994-1995. Incident VTE, MI, stroke, and cancer were registered until December 31, 2010. Conventional and cause-specific Cox-regression models were used to estimate hazard ratios (HR) for VTE with 95% confidence intervals (CI) across categories of RDW.
There were 502 first VTEs during a median follow-up of 16 years. In conventional Cox regression analysis, RDW in the highest quartile was associated with a 71% (HR 1.71, 95% CI 1.09-2.67) and 27% (HR 1.27, 95% CI 0.88-1.85) higher risk of VTE in men and women, respectively, compared to subjects in the lowest quartiles. The risk of VTE among subjects with RDW in the highest quartile was similar for men and women of postmenopausal age. In cause-specific analysis, where each individual contributed with person-time until the first occurring event only, the risk estimates were similar to those of the conventional Cox-regression analysis.
Our findings suggest that the association between RDW and future risk of VTE is not explained by intermediate development of MI, stroke, or cancer.
Notes
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PubMed ID
30046735 View in PubMed
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Impact of Chronic Inflammation, Assessed by hs-CRP, on the Association between Red Cell Distribution Width and Arterial Cardiovascular Disease: The Tromsø Study.

https://arctichealth.org/en/permalink/ahliterature301566
Source
TH Open. 2018 Apr; 2(2):e182-e189
Publication Type
Journal Article
Date
Apr-2018
Author
Jostein Lappegård
Trygve S Ellingsen
Kristian Hindberg
Ellisiv B Mathiesen
Inger Njølstad
Tom Wilsgaard
Maja-Lisa Løchen
Sigrid K Brækkan
John-Bjarne Hansen
Author Affiliation
K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Source
TH Open. 2018 Apr; 2(2):e182-e189
Date
Apr-2018
Language
English
Publication Type
Journal Article
Abstract
Red cell distribution width (RDW), a measure of variability in size of circulating erythrocytes, is associated with arterial cardiovascular disease (CVD), but the underlying mechanism remains unclear. We aimed to investigate the impact of chronic inflammation as measured by high-sensitivity C-reactive protein (hs-CRP) on this relationship, and explore whether RDW could be a mediator in the causal pathway between inflammation and arterial CVD. Baseline characteristics, including RDW and hs-CRP, were obtained from 5,765 individuals attending a population-based cohort study. We followed up participants from inclusion in the fourth survey of the Tromsø Study (1994/1995) until December 31, 2012. Multivariable Cox-regression models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for incident myocardial infarction (MI) and ischemic stroke across quintiles of hs-CRP and RDW. Subjects with hs-CRP in the highest quintile had 44% higher risk of MI (HR: 1.44, 95% CI: 1.14-1.80), and 64% higher risk of ischemic stroke (HR: 1.64, 95% CI: 1.20-2.24) compared with subjects in the lowest quintile. RDW mediated 7.2% (95% CI: 4.0-30.8%) of the association between hs-CRP and ischemic stroke. Subjects with RDW in the highest quintile had 22% higher risk of MI (HR: 1.22, 95% CI: 0.98-1.54) and 44% higher risk of ischemic stroke (HR: 1.44, 95% CI: 1.06-1.97) compared with subjects in the lowest quintile. These risk estimates were slightly attenuated after adjustments for hs-CRP. Our findings suggest that chronic inflammation is not a primary mechanism underlying the relationship between RDW and arterial CVD.
PubMed ID
31249941 View in PubMed
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Impact of red cell distribution width on future risk of cancer and all-cause mortality among cancer patients - the Tromsø Study.

https://arctichealth.org/en/permalink/ahliterature264205
Source
Haematologica. 2015 Jun 25;
Publication Type
Article
Date
Jun-25-2015
Author
Trygve S Ellingsen
Jostein Lappegård
Tove Skjelbakken
Sigrid K Brækkan
John-Bjarne Hansen
Source
Haematologica. 2015 Jun 25;
Date
Jun-25-2015
Language
English
Publication Type
Article
PubMed ID
26113420 View in PubMed
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Plasma hepcidin is associated with future risk of venous thromboembolism.

https://arctichealth.org/en/permalink/ahliterature292042
Source
Blood Adv. 2018 Jun 12; 2(11):1191-1197
Publication Type
Journal Article
Date
Jun-12-2018
Author
Trygve S Ellingsen
Jostein Lappegård
Thor Ueland
Pål Aukrust
Sigrid K Brækkan
John-Bjarne Hansen
Author Affiliation
K. G. Jebsen Thrombosis Research and Expertise Center, Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.
Source
Blood Adv. 2018 Jun 12; 2(11):1191-1197
Date
Jun-12-2018
Language
English
Publication Type
Journal Article
Abstract
Red cell distribution width (RDW) is associated with venous thromboembolism (VTE), but the underlying mechanism(s) is unclear. Iron deficiency is associated with high RDW, and studies suggest an association between iron deficiency and VTE. To assess whether iron deficiency is a risk factor for VTE that explains the association between RDW and VTE, we conducted a nested case-control study of 390 patients with VTE and 802 age- and sex-matched controls selected from the population-based cohort of the Tromsø Study. Physical measurements and blood samples were collected from 1994 to 1995. Logistic regression models were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for VTE by RDW, hepcidin, and ferritin light chain (FtL). RDW was inversely associated with hepcidin, FtL, and hemoglobin. The risk of VTE increased linearly across categories of higher plasma hepcidin levels. Participants with hepcidin in the highest quartile had an OR for VTE of 1.32 (95% CI, 1.00-2.42), and those in the >90% percentile had an OR for VTE of 1.66 (95% CI, 1.14-2.42) compared with the reference group (quartiles 2 and 3). The risk estimates remained similar after adjustment for C-reactive protein. The risk of VTE increased by categories of higher RDW and was strengthened after inclusion of hepcidin and FtL in the multivariable model. Our findings reject the hypothesis that iron deficiency explains the association between RDW and VTE and suggest, in contrast, that high body iron levels might increase the risk of VTE.
PubMed ID
29844204 View in PubMed
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Red Cell Distribution Width and Risk of Atrial Fibrillation and Subsequent Thromboembolism: The Tromsø Study.

https://arctichealth.org/en/permalink/ahliterature304624
Source
TH Open. 2020 Jul; 4(3):e280-e287
Publication Type
Journal Article
Date
Jul-2020
Author
Erin M Hald
Maja-Lisa Løchen
Jostein Lappegård
Trygve S Ellingsen
Ellisiv B Mathiesen
Tom Wilsgaard
Inger Njølstad
Sigrid K Brækkan
John-Bjarne Hansen
Author Affiliation
K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Source
TH Open. 2020 Jul; 4(3):e280-e287
Date
Jul-2020
Language
English
Publication Type
Journal Article
Abstract
Introduction Red cell distribution width (RDW) is associated with cardiovascular diseases, including atrial fibrillation (AF) and venous thromboembolism (VTE). Whether RDW is a risk marker for thromboembolic events in AF patients is scarcely known. We aimed to assess the association between RDW and the risk of AF, and AF-related VTE and ischemic stroke, in a population-based cohort. Methods We measured RDW in 26,111 participants from the Tromsø Study (1994-1995), and registered incident AF cases through December 31, 2013. Among participants with AF, first-ever VTEs and ischemic strokes were registered from the date of AF diagnosis through the end of follow-up. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for AF by quartiles of RDW. Furthermore, we calculated cause-specific HRs for VTE and ischemic stroke by tertiles of RDW for participants with AF. Results There were 2,081 incident AF cases during a median of 18.8 years of follow-up. Subjects with RDW in the highest quartile (RDW = 13.3%) had 30% higher risk of AF than those in the lowest quartile (RDW = 12.3%). Among those with AF, subjects with RDW in the upper tertile had a doubled risk of ischemic stroke (HR 2.07, 95% CI 1.20-3.57). In contrast, RDW was not associated with incident VTE in subjects with AF. Conclusion RDW was significantly associated with incident AF in a general population. Among subjects with AF, high RDW was associated with ischemic stroke, but not VTE.
PubMed ID
33005859 View in PubMed
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Red cell distribution width is associated with future risk of incident stroke. The Tromsø Study.

https://arctichealth.org/en/permalink/ahliterature276659
Source
Thromb Haemost. 2016 Jan;115(1):126-34
Publication Type
Article
Date
Jan-2016
Author
Jostein Lappegård
Trygve S Ellingsen
Tove Skjelbakken
Ellisiv B Mathiesen
Inger Njølstad
Tom Wilsgaard
Jan Brox
Sigrid K Brækkan
John-Bjarne Hansen
Source
Thromb Haemost. 2016 Jan;115(1):126-34
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cell Size
Chi-Square Distribution
Erythrocyte Indices
Erythrocytes - pathology
Female
Humans
Incidence
Male
Middle Aged
Multivariate Analysis
Norway - epidemiology
Predictive value of tests
Proportional Hazards Models
Prospective Studies
Risk assessment
Risk factors
Stroke - blood - diagnosis - epidemiology - mortality
Time Factors
Abstract
Red cell distribution width (RDW), a measure of the variability in size of the circulating erythrocytes, is associated with cardiovascular morbidity and mortality. We aimed to investigate whether RDW was associated with incident stroke and case fatality in subjects recruited from the general population. Baseline characteristics were obtained from 25,992 subjects participating in the fourth survey of the Tromsø Study, conducted in 1994/95. Incident stroke was registered from inclusion until December 31, 2010. Cox regression models were used to calculate hazard ratios (HR) with 95% confidence intervals (95% CI) for stroke, adjusted for age, sex, body mass index, smoking, haemoglobin level, white blood cell count, thrombocyte count, hypertension, total cholesterol, triglycerides, self-reported diabetes, and red blood cell count. During a median follow-up of 15.8 years, 1152 participants experienced a first-ever stroke. A 1% increment in RDW yielded a 13% higher risk of stroke (multivariable HR: 1.13, 95% CI: 1.07-1.20). Subjects with RDW in the highest quintile compared to the lowest had a 37% higher risk of stroke in multivariable analysis (HR: 1.37, 95% CI: 1.11-1.69). Subjects with RDW above the 95-percentile had 55% higher risk of stroke compared to those in the lowest quintile (HR: 1.55, 95% CI: 1.16-2.06). All risk estimates remained unchanged after exclusion of subjects with anaemia (n=1102). RDW was not associated with increased risk of death within one year or during the entire follow-up after an incident stroke. RDW is associated with incident stroke in a general population, independent of anaemia and traditional atherosclerotic risk factors.
PubMed ID
26290352 View in PubMed
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Red cell distribution width is associated with incident myocardial infarction in a general population: the Tromsø Study.

https://arctichealth.org/en/permalink/ahliterature267085
Source
J Am Heart Assoc. 2014 Aug;3(4)
Publication Type
Article
Date
Aug-2014
Author
Tove Skjelbakken
Jostein Lappegård
Trygve S Ellingsen
Elizabeth Barrett-Connor
Jan Brox
Maja-Lisa Løchen
Inger Njølstad
Tom Wilsgaard
Ellisiv B Mathiesen
Sigrid K Brækkan
John-Bjarne Hansen
Source
J Am Heart Assoc. 2014 Aug;3(4)
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Erythrocyte Indices
Female
Humans
Longitudinal Studies
Male
Middle Aged
Myocardial Infarction - blood - epidemiology
Norway - epidemiology
Proportional Hazards Models
Prospective Studies
Abstract
Red cell distribution width (RDW), a measure of the variability in size of circulating erythrocytes, is associated with mortality and adverse outcome in selected populations with cardiovascular disease. It is scarcely known whether RDW is associated with incident myocardial infarction (MI). We aimed to investigate whether RDW was associated with risk of first-ever MI in a large cohort study with participants recruited from a general population.
Baseline characteristics, including RDW, were collected for 25 612 participants in the Tromsø Study in 1994-1995. Incident MI during follow-up was registered from inclusion through December 31, 2010. Cox regression models were used to calculate hazard ratios with 95% confidence intervals for MI, adjusted for age, sex, body mass index, smoking, hemoglobin, white blood cells, platelets, and other traditional cardiovascular risk factors. A total of 1779 participants experienced a first-ever MI during a median follow-up time of 15.8 years. There was a linear association between RDW and risk of MI, for which a 1% increment in RDW was associated with a 13% increased risk (hazard ratio 1.13; 95% CI, 1.07 to 1.19). Participants with RDW above the 95th percentile had 71% higher risk of MI compared with those with RDW in the lowest quintile (hazard ratio 1.71; 95% CI, 1.34 to 2.20). All effect estimates were essentially similar after exclusion of participants with anemia (n=1297) from the analyses.
RDW is associated with incident MI in a general population independent of anemia and cardiovascular risk factors.
Notes
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PubMed ID
25134681 View in PubMed
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Red cell distribution width is associated with incident venous thromboembolism (VTE) and case-fatality after VTE in a general population.

https://arctichealth.org/en/permalink/ahliterature267421
Source
Thromb Haemost. 2015 Jan;113(1):193-200
Publication Type
Article
Date
Jan-2015
Author
Trygve S Ellingsen
Jostein Lappegård
Tove Skjelbakken
Sigrid K Brækkan
John-Bjarne Hansen
Source
Thromb Haemost. 2015 Jan;113(1):193-200
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cause of Death
Erythrocyte Indices
Female
Humans
Incidence
Male
Middle Aged
Multivariate Analysis
Norway - epidemiology
Predictive value of tests
Prognosis
Proportional Hazards Models
Recurrence
Risk assessment
Risk factors
Time Factors
Venous Thromboembolism - blood - diagnosis - mortality
Abstract
Recent studies suggest an association between red cell distribution width (RDW) and incident venous thromboembolism (VTE). We aimed to investigate the impact of RDW on risk of incident and recurrent VTE, and case-fatality, in a general population. RDW was measured in 26,223 participants enrolled in the Tromsø Study in 1994-1995. Incident and recurrent VTE events and deaths during follow-up were registered until January 1, 2012. Multivariate Cox proportional hazards regression models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). There were 647 incident VTE events during a median of 16.8 years of follow-up. Individuals with RDW in the highest quartile (RDW=13.3%) had 50% higher risk of an incident VTE than those in the lowest quartile (RDW=12.3%). The association was strongest for unprovoked deep-vein thrombosis (HR highest vs lowest quartile of RDW: 1.8, 95% CI 1.1-3.1). VTE patients with baseline RDW=13.3% had 30% higher risk of all-cause mortality after the initial VTE event than VTE patients with RDW
PubMed ID
25274492 View in PubMed
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8 records – page 1 of 1.