Abstract
Introduction: Acute coronary syndrome is a spectrum of disease consisting of ST segment elevated myocardial infarction (STEMI), non-ST segment elevated myocardial infarction (NSTEMI) and unstable angina where the blood flow to the heart is decreased. According to WHO, India contributes to one-fifth of the world's deaths due to cardiovascular disease. In recent times, the RDW has been used as a helpful marker in the diagnosis and prognosis of patients with acute coronary syndrome. However, the relationship between RDW, HDL-C, and ACS has yet to be identified properly.
Aim: To evaluate the association between HDL-C levels and the RDW among patients with ACS and to find its association with the various socio-demographic factors of the patient.
Methods: This hospital-based cross-sectional study was conducted in a tertiary care hospital in Puducherry between October 2023 and February 2024. Patients aged more than 18 with a diagnosis of acute coronary syndrome were included in the study. All the patients were subjected to a complete history followed by laboratory investigations, including the RDW, HDL-C, and troponin-I.
Results: A total of 62 patients participated in the study. The mean age of the patients with ACS was found to be 55.6 + 3.4 years. The study didn’t show any association between the age (p=0.753), gender (p=0.897), residence (p=0.517), Type-2 DM (p=-.924), hypertension (p=0.615), dyslipidemia (p=0.302), smoking (p=0.565), alcohol (p=0.593), ACS type (p=0.714), Troponin-I (p=0.916), HDL-C (p=0.517) and RBS (p=0.078) with the level of the RDW. However, the study showed a significant association between BMI and RDW levels (p<0.001), and there is a significant and negative correlation was noted between the RDW and HDL-C levels (p=0.038).
Conclusion: The study showed a significant and negative correlation between the HDL-C and the RDW among patients with acute coronary syndrome. The study recommends that the RDW be used as an additional marker in predicting the risk of ACS and diagnosing patients with ACS.
Keywords: acute coronary syndrome, RDW, HDL-C, demographic factors.
References
- Singh A, Museedi AS, Grossman SA. Acute Coronary Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Mar 21]. Available from: http:// www.ncbi.nlm.nih.gov/books/NBK459157/
- Kumar A, Cannon CP. Acute Coronary Syndromes: Diagnosis and Management, Part I. Mayo Clin Proc. 2009 Oct;84(10): 917–38.
- Sreeniwas Kumar A, Sinha N. Cardiovascular disease in India: A 360-degree overview. Med J Armed Forces India. 2020 Jan;76(1):1–3.
- Workina A, Habtamu A, Diribsa T, Abebe F. Knowledge of modifiable cardiovascular diseases risk factors and its primary prevention practices among diabetic patients at Jimma University Medical Centre: A cross-sectional study. PLOS Glob Public Health. 2022 Jul 12;2(7):e0000575.
- Malik MA, Alam Khan S, Safdar S, Taseer IUH. Chest Pain as a presenting complaint in patients with acute myocardial infarction (AMI). Pak J MedSci.2013 Apr;29(2):565–8.
- Loria V, Leo M, Biasillo G, Dato I, Biasucci LM. Biomarkers in Acute Coronary Syndrome. Biomark Insights. 2008 Nov 5;3:453–68.
- Polat N, Yildiz A, Oylumlu M, Kaya H, Acet H, Akil MA, et al. Relationship Between Red Cell Distribution Width and the GRACE Risk Score With In-Hospital Death in Patients With Acute Coronary Syndrome. Clin Appl Thromb. 2014 Sep 1;20(6):577–82.
- Reinhart WH, Piety NZ, Goede JS, Shevkoplyas SS. Effect of osmolality on erythrocyte rheology and perfusion of an artificial microvascular network. Microvasc Res. 2015 Mar;98:102–7.
- Yoon HE, Kim SJ, Hwang HS, Chung S, Yang CW, Shin SJ. Progressive Rise in Red Blood Cell Distribution Width Predicts Mortality and Cardiovascular Events in End-Stage Renal Disease Patients. PLoS ONE. 2015 May 11;10(5):e0126272.
- Buyukkaya E, Erayman A, Karakas E, Bugra Nacar A, Kurt M, Buyukkaya S, et al. Relation of red cell distribution width with dipper and non-dipper hypertension. Med Glas Off Publ Med Assoc Zenica-Doboj Cant Bosnia Herzeg2016Aug1;13(2):75–81.
- Raza H, Noor T, Umer S, Fatima M, Imran A, Malik N. Relationship Between High-Density Lipoprotein-Cholesterol and Red Cell Distribution Width in Patients With Coronary Artery Disease. Cureus. 14(3):e23132.
- Isik T, Ayhan E, Kurt M, Tanboga IH, Kaya A, Aksakal E. Is Red Cell Distribution Width a Marker for the Presence and Poor Prognosis of Cardiovascular Disease? Eurasian J Med. 2012 Dec;44(3):169–71.
- Montagnana M, Cervellin G, Meschi T, Lippi G. The role of red blood cell distribution width in cardiovascular and thrombotic disorders. Clin Chem Lab Med. 2012 Apr 1;50(4):635–41.
- Chen PC, Sung FC, Chien KL, Hsu HC, Su TC, Lee YT. Red blood cell distribution width and risk of cardiovascular events and mortality in a community cohort in Taiwan. Am J Epidemiol.2010Jan 15;171(2):214–20.
- Patel KV, Semba RD, Ferrucci L, Newman AB, Fried LP, Wallace RB, et al. Red Cell Distribution Width and Mortality in Older Adults: A Meta-analysis. J Gerontol A Biol Sci Med Sci. 2010 Mar;65A(3):258–65.
- Dai X, Busby-Whitehead J, Alexander KP. Acute coronary syndrome in the older adults. J Geriatr Cardiol JGC. 2016 Feb;13(2):101–8.
- Redberg RF. Gender Differences in Acute Coronary Syndrome: Invasive Versus Conservative Approach. Cardiol Rev. 2006 Dec;14(6):299.
- Moniruzzaman M, Koli A, Malik F, Islam S. Association between body mass index (BMI) and severity of coronary artery disease in young onset acute coronary syndrome (ACS). Eur Heart J. 2023 Feb 1;44(Supplement_1):ehac779.058.
- Park SJ, Ha KH, Kim DJ. Body mass index and cardiovascular outcomes in patients with acute coronary syndrome by diabetes status: the obesity paradox in a Korean national cohort study. Cardiovasc Diabetol. 2020 Nov 10;19(1):191.
- Petrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018 May;34(5):575–84.
- Xiong K, Xu C, Shou X, Dong M. Relation of Red Cell Distribution Width to Glucose Metabolism and Adverse Long-Term Prognosis in Patients with Acute Coronary Syndrome. Diabetes Metab Syndr Obes. 2023 Dec 31;16:61–70.
- Talarico M, Manicardi M, Vitolo M, Malavasi VL, Valenti AC, Sgreccia D, et al. Red Cell Distribution Width and Patient Outcome in Cardiovascular Disease: A Real-World’’ Analysis. J Cardiovasc Dev Dis. 2021 Sep 26;8(10):120.
- Zhao N, Mi L, Liu X, Pan S, Xu J, Xia D, et al. Combined Value of Red Blood Cell Distribution Width and Global Registry of Acute Coronary Events Risk Score for Predicting Cardiovascular Events in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. PLOS ONE. 2015 Oct 15;10(10):e0140532.
- Lippi G, Filippozzi L, Montagnana M, Salvagno GL, Franchini M, Guidi GC, et al. Clinical usefulness of measuring red blood cell distribution width on admission in patients with acute coronary syndromes. Clin Chem Lab Med. 2009;47(3):353–7.
- Lippi G, Sanchis-Gomar F, Danese E, Montagnana M. Association of red blood cell distribution width with plasma lipids in a general population of unselected outpatients. Kardiol Pol. 2013;71(9):931–6.
- Avci E, Kiris T, Demirtas AO, Kadi H. Relationship between high-density lipoprotein cholesterol and the red cell distribution width in patients with coronary artery disease. Lipids Health Dis. 2018 Mar 16;17:53.
Corresponding Author
Dr Adrin Suthir A
Post Graduate Resident, Department of Internal Medicine, Sri Manakula Vinayagar Medical College and Hospital – Puducherry