Red cell distribution width (RDW) is an independent predictor of the 10-year estimated risk of coronary heart disease (CHD) events. However, RDW's association with peripheral artery disease (PAD) - a CHD risk equivalent - has not been evaluated to date. In this cross-sectional study, we examined 6950 participants of the National Health and Nutrition Examination Survey, 1999-2004. PAD was defined as an ankle-brachial index below 0.9 (n = 618). RDW was divided into quartiles (Q) (Q1: ≤ 12.2; Q2: 12.3-12.5; Q3: 12.6-13.0; Q4: ≥ 13.1) and PAD risk was compared across these quartiles using adjusted multivariate logistic regression. A graded increase in prevalent PAD with increasing RDW quartiles was observed (4.2% in Q1 vs 13.9% in Q4; test of trend p < 0.001). Risk of PAD was significantly higher (odds ratio (OR) 1.19, 95% confidence interval (CI): 1.06-1.34; p = 0.003) after adjusting for age, sex, race, body mass index, hypertension, hyperlipidemia, diabetes, smoking, estimated glomerular filtration rate, C-reactive protein, hemoglobin, mean corpuscular volume, and nutritional factors (folate, iron and vitamin B(12)) deficiencies with each unit (0.1) increase in RDW. Upon receiver-operating characteristics analysis, the predictive accuracy of the American College of Cardiology / American Heart Association (ACC/AHA)-defined PAD screening criteria (for a high-risk population) was 0.657 at best, but improved significantly (0.727) after addition of RDW (p < 0.0001). In conclusion, higher levels of RDW are independently associated with a higher risk of PAD and can significantly improve the risk prediction beyond that estimated by ACC/AHA-defined PAD screening criteria.
Left ventricular hypertrophy (LVH) has not been evaluated for reclassification improvement in the intermediate Framingham risk category for incident hard coronary events in a large multi ethnic population free of cardiovascular disease at baseline. A post-hoc analysis on the Multi Ethnic Study of Atherosclerosis (MESA) dataset (n = 4921) was performed. LVH was defined as the upper 95 th percentile of cardiac magnetic resonance imaging derived left ventricular mass (LVM) indexed based on body surface area (BSA) and height. Multivariate Cox proportional hazards models were used to assess the independent association between LVH and composite outcomes like all cardiovascular disease (CVDa) and hard coronary heart disease (CHDh) events over a mean follow-up period of 4.5 years. To assess the incremental value of LVH over traditional CV risk factors for CHDh prediction, we compared the discrimination, calibration and net reclassification index (NRI) of models comprising of traditional CV risk factors with and without LVH. LVH derived from LVM indexed by BSA (LVH-BSA) and height1.7(LVH-height) showed an independent association with CVDa (LVH-BSA: hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.05–2.20, p = 0.03; LVH-height1.7: HR 1.58, 95% CI 1.14–2.18, p = 0.012) and CHDh (LVH-BSA: HR 2.36, 95% CI 1.37–4.04, p = 0.002; LVH-height1.7: HR: 1.95, 95% CI: 1.17–3.26, p = 0.01). Addition of LVH to the model based on traditional CV risk factors demonstrated no significant improvement in NRI for CHDh in either the entire cohort (LVH-BSA: NRI 1.7%, 95% CI: –8.3% to 11.7%, p = 0.74; LVH-height1.7: NRI 2.7%, 95% CI: –5.8% to 11.3%, p = 0.62) or the intermediate risk group (LVH-BSA: NRI 12.0%, 95% CI: –5.7% to 29.8%, p = 0.19; LVH-height1.7: NRI 14.5%, 0.1% to 28.8%, p = 0.05). Although an independent predictor of cardiovascular events, LVH does not lead to clinically meaningful reclassification of the overall and intermediate risk population for CHDh.
In our case, dipyridamole-induced ischemia is an unlikely cause. This may suggest the depressive action of dipyridamole through adenosine on the conducting system. We feel that dipyridamole is the probable cause of asystole in this individual, based on a score of 5 on Naranjo’s algorithm, and betablocking agents may have contributed to this. [6] In patients with underlying conduction abnormalities or bradycardia or in those undergoing concomitant beta-blocker administration, a reasonable caution should be exercised before administration of dipyridamole.
Introduction: Moderate alcohol intake has been associated with reduced cardiovascular mortality. Red cell distribution width (RDW) is an emerging cardiovascular risk marker, that is increasingly gaining recognition. No prior study has evaluated the association between alcohol intake and RDW. Methods: We evaluated 6,424 nationally representative individuals participating in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2006, free of cardiovascular co-morbidities (including coronary heart disease, diabetes, congestive heart failure, stroke and myocardial infarction) at baseline. RDW was divided into quartiles [Quartile 1 (Q1) ≤12 (reference category), Q2: 12.1-12.5; Q3: 12.6-13; Q4: >13] and alcohol intake was categorized by number of drinks per day [<1 drink/day, reference category), 1 drink/day, 2 drinks/day and ≥3 drinks/day]. Multivariate adjusted logistic regression analysis was performed to evaluate the risk relationship between RDW levels and daily alcohol intake. Results: Mean RDW levels varied inversely with number of drinks per day (12.9 in reference alcohol category versus 12.5 in ≥3 drinks/day, p<0.001). Results of multivariate adjusted logistic regression analysis are shown in Table 1. Conclusion: Moderate alcohol intake [1 to 2 drinks /day] is associated with more favorable levels of RDW. The association appears to be independent of nutritional deficiencies, inflammatory markers and other conventional cardiovascular risk factors. Table 1: Risk of Higher RDW with Increasing Alcohol Intake RDW Categories Alcohol Categories * ≤12 n=1,612 12.1-12.5 n=2,037 12.6-13 n=1,215 >13 n=1,560 1 OR[95% CI] p-value OR [95% CI] p-value OR [95% CI] p-value * <1 drink/day n=2,037 1 1 1 1 1 1 drink/day n=1,510 Model 1 1 0.93 [0.79-1.09] 0.351 0.97 [0.81-1.16] 0.750 0.72 [0.61-0.88] 0.001 Model 2 1 0.96 [0.82-1.13] 0.657 1.01 [0.84-1.21] 0.931 0.76 [0.62-0.93] 0.008 2 drinks/day n=1,212 Model 1 1 1.00 [0.85-1.17] 0.963 0.81 [0.67-0.99] 0.046 0.67 [0.55-0.82] <0.001 Model 2 1 1.04 [0.88-1.22] 0.669 0.90 [0.74-1.11] 0.336 0.71 [0.56-0.88] 0.002 ≥3 drinks/day Model 1 1 1.00 [0.86-1.17] 0.995 0.85 [0.70-1.02] 0.082 0.86 [0.71-1.03] 0.105 Model 2 1 0.98 [0.84-1.15] 0.826 0.88 [0.72 -1.07]0.193 0.91 [0.74-1.11] 0.346 Model 1: Alcohol Drinks + Sex, Age, systolic blood pressure, anti-hypertensive medications, High Density Lipoprotein cholesterol, total cholesterol, ever smoking and deficiency of nutritional factors (Iron, folic acid and vitamin B 12 ) Model 2: Age, sex, race + body mass index, estimated Glomerular Filtration Rate, high sensitivity C - Reactive Protein, hypertension, hyperlipidemia, ever smoking, mean corpuscular volume, hemoglobin and deficiency of nutritional factors Abbreviations: OR - odds ratio, CI - Confidence Interval, RDW - Red cell Distribution Width. * RDW ≤12 and ‘Zero’ Alcohol drinks/day serve as reference categories for the comparison
Culture and society: how do they affect heart disease and treatment 239 abetes (27.1%).In the multivariable model (n=1835), significant positive associations were found between CVD and age (Odds ratio (OR) 1.04, p<0.001), high cholesterol (OR 2.48, p=0.014), hypertension (OR 3.08, p=0.002), and current and former vs never smoking (OR 2.08, p=0.041 and OR 3.27, p=0.014 respectively); and significant negative associations were found between CVD and selfrated health rated as good to excellent vs fair or poor (OR 0.32, p<0.001), and between CVD and trust of others vs no trust (OR0.34,p=0.001).Conclusions: CVD is confirmed as a significant health risk in the Traveller Community, with high rates of CVD risk factors.Associations were noted between CVD and measures of social capital.Given their adverse life-course social circumstances, Irish Travellers may constitute a novel example of the thrifty phenotype in a minority sub population of a developed country.P1493
