Top

Published in:

Open Access 01-12-2023 | Coronary Heart Disease | Research

Relationship between red cell distribution width/albumin ratio and carotid plaque in different glucose metabolic states in patients with coronary heart disease: a RCSCD-TCM study in China

Authors: Mengnan Huang, Fanfan Liu, Zhu Li, Yijia Liu, Jinyu Su, Mei Ma, Yuanyuan He, Huaien Bu, Shan Gao, Hongwu Wang, Chunquan Yu

Published in: Cardiovascular Diabetology | Issue 1/2023

Abstract

Background

Red cell distribution width/albumin ratio (RAR) is thought to be associated with the prognosis of a variety of diseases, including diabetes and heart failure. To date, no studies have focused on the relationship between RAR and carotid plaque in patients with coronary heart disease (CHD).

Methods

A total of 10,267 patients with CHD were divided according to RAR quartiles (Q1: RAR ≤ 2.960; Q2: 2.960 < RAR ≤ 3.185; Q3: 3.185 < RAR < 3.441; Q4: RAR ≥ 3.441). Logistic regression was used to analyze the relationship between RAR and carotid plaques in CHD patients. The relationship between RAR and carotid plaques in according to sex, age and glucose regulation state groups were also assessed.

Results

Among the 10,267 participants, 75.43% had carotid plaques. After adjusting for confounding factors, RAR was found to be associated with carotid plaque formation (OR: 1.23; 95% CI 1.08–1.39). The risk of carotid plaque formation in the Q4 group was 1.24 times higher than that in the Q1 group. After multivariate adjustment, RAR was associated with the risk of carotid plaque in female (OR: 1.29; 95% CI 1.09–1.52). And the relationship between RAR and carotid plaques in patients younger than 60 years old (OR: 1.43; 95% CI 1.16–1.75) was stronger than that in those older than 60 years old (OR: 1.29; 95% CI 1.10–1.51). Under different glucose metabolism states, RAR had the highest correlation with the risk of carotid plaques in diabetes patients (OR: 1.28; 95% CI 1.04–1.58).

Conclusions

RAR was significantly related to carotid plaques in patients with CHD. In addition, the correlation between RAR and the incidence of carotid plaque in patients with CHD was higher in women and middle-aged and elderly patients. In patients with CHD and diabetes, the correlation between RAR and carotid plaque was higher.

Graphical Abstract

Available only for authorised users

Polak JF, Szklo M, Kronmal RA, Burke GL, Shea S, Zavodni AE, O’Leary DH. The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease: the multi-ethnic study of atherosclerosis. J Am Heart Assoc. 2013;2(2): e000087. https://doi.org/10.1161/JAHA.113.000087.CrossRefPubMedPubMedCentral

Mehta A, Rigdon J, Tattersall MC, German CA, Barringer TA 3rd, Joshi PH, Sperling LS, Budoff MJ, Bertoni A, Michos ED, Blaha MJ, Stein JH, Shapiro MD. Association of carotid artery plaque with cardiovascular events and incident coronary artery calcium in individuals with absent coronary calcification: the MESA. Circ Cardiovasc Imaging. 2021;14(4): e011701. https://doi.org/10.1161/CIRCIMAGING.120.011701.CrossRefPubMed

Gepner AD, Young R, Delaney JA, Tattersall MC, Blaha MJ, Post WS, Gottesman RF, Kronmal R, Budoff MJ, Burke GL, Folsom AR, Liu K, Kaufman J, Stein JH. Comparison of coronary artery calcium presence, carotid plaque presence, and carotid intima-media thickness for cardiovascular disease prediction in the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging. 2015;8(1): e002262. https://doi.org/10.1161/CIRCIMAGING.114.002262.CrossRefPubMedPubMedCentral

Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015;52(2):86–105. https://doi.org/10.3109/10408363.2014.992064.CrossRefPubMed

Baggen VJM, van den Bosch AE, van Kimmenade RR, Eindhoven JA, Witsenburg M, Cuypers JAAE, Leebeek FWG, Boersma E, Roos-Hesselink JW. Red cell distribution width in adults with congenital heart disease: a worldwide available and low-cost predictor of cardiovascular events. Int J Cardiol. 2018;260:60–5. https://doi.org/10.1016/j.ijcard.2018.02.118.CrossRefPubMed

Qu J, Zhou T, Xue M, Sun H, Shen Y, Chen Y, Tang L, Qian L, You J, Yang R, Liu Y. Correlation analysis of hemoglobin-to-red blood cell distribution width ratio and frailty in elderly patients with coronary heart disease. Front Cardiovasc Med. 2021;8: 728800. https://doi.org/10.3389/fcvm.2021.728800.CrossRefPubMedPubMedCentral

Engström G, Smith JG, Persson M, Nilsson PM, Melander O, Hedblad B. Red cell distribution width, haemoglobin A1c and incidence of diabetes mellitus. J Intern Med. 2014;276(2):174–83. https://doi.org/10.1111/joim.12188.CrossRefPubMed

Veeranna V, Zalawadiya SK, Panaich SS, Ramesh K, Afonso L. The association of red cell distribution width with glycated hemoglobin among healthy adults without diabetes mellitus. Cardiology. 2012;122(2):129–32. https://doi.org/10.1159/000339225.CrossRefPubMed

Malandrino N, Wu WC, Taveira TH, Whitlatch HB, Smith RJ. Association between red blood cell distribution width and macrovascular and microvascular complications in diabetes. Diabetologia. 2012;55(1):226–35. https://doi.org/10.1007/s00125-011-2331-1.CrossRefPubMed

10.

Che R, Huang X, Zhao W, Jiang F, Wu L, Zhang Z, Bian T, Ma Q, Yu Z, Zhang Q, Dong K, Song H, Ji X. Low serum albumin level as a predictor of hemorrhage transformation after intravenous thrombolysis in ischemic stroke patients. Sci Rep. 2017;7(1):7776. https://doi.org/10.1038/s41598-017-06802-y.CrossRefPubMedPubMedCentral

11.

Grimm G, Haslacher H, Kampitsch T, Endler G, Marsik C, Schickbauer T, Wagner O, Jilma B. Sex differences in the association between albumin and all-cause and vascular mortality. Eur J Clin Invest. 2009;39(10):860–5. https://doi.org/10.1111/j.1365-2362.2009.02189.x.CrossRefPubMed

12.

Ni Q, Wang X, Wang J, Chen P. The red blood cell distribution width-albumin ratio: a promising predictor of mortality in heart failure patients—a cohort study. Clin Chim Acta. 2022;527:38–46. https://doi.org/10.1016/j.cca.2021.12.027.CrossRefPubMed

13.

Long J, Xie X, Xu D, Huang C, Liu Y, Meng X, Cai X, Fang X. Association between red blood cell distribution width-to-albumin ratio and prognosis of patients with aortic aneurysms. Int J Gen Med. 2021;14:6287–94. https://doi.org/10.2147/IJGM.S328035.CrossRefPubMedPubMedCentral

14.

Liu Y, Li Z, Wang X, Ni T, Ma M, He Y, Yang R, Luo M. Effects of adjuvant Chinese patent medicine therapy on major adverse cardiovascular events in patients with coronary heart disease angina pectoris: a population-based retrospective cohort study. Acupunct Herb Med. 2022;2(2):110–8. https://doi.org/10.1097/HM9.0000000000000028.CrossRef

15.

Barua RS, Rigotti NA, Benowitz NL, Cummings KM, Jazayeri MA, Morris PB, Ratchford EV, Sarna L, Stecker EC, Wiggins BS. 2018 ACC expert consensus decision pathway on tobacco cessation treatment: a report of the American college of cardiology task force on clinical expert consensus documents. J Am Coll Cardiol. 2018;72(25):3332–65. https://doi.org/10.1016/j.jacc.2018.10.027.CrossRefPubMed

16.

Fan AZ, Ruan WJ, Chou SP. Re-examining the relationship between alcohol consumption and coronary heart disease with a new lens. Prev Med. 2019;118:336–43. https://doi.org/10.1016/j.ypmed.2018.11.022.CrossRefPubMed

17.

Flack JM, Adekola B. Blood pressure and the new ACC/AHA hypertension guidelines. Trends Cardiovasc Med. 2020;30(3):160–4. https://doi.org/10.1016/j.tcm.2019.05.003.CrossRefPubMed

18.

Li Z, Cheng Q, Liu Y, Cheng X, Wang S, He Y, Wang X, Huang M, Li Y, Xue X, Xu Y, Li L, Zheng Y, Yang R, Gao S, Yu C. Low-/high-density lipoprotein cholesterol ratio and carotid plaques in patients with coronary heart disease: a Chinese cohort study. Lipids Health Dis. 2021;20(1):144. https://doi.org/10.1186/s12944-021-01575-w.CrossRefPubMedPubMedCentral

19.

Yang L, Li Z, Song Y, Liu Y, Zhao H, Liu Y, Zhang T, Yuan Y, Cai X, Wang S, Wang P, Gao S, Li L, Li Y, Yu C. Study on urine metabolic profiling and pathogenesis of hyperlipidemia. Clin Chim Acta. 2019;495:365–73. https://doi.org/10.1016/j.cca.2019.05.001.CrossRefPubMed

20.

American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S15–33. https://doi.org/10.2337/dc21-S002.CrossRef

21.

Targoński R, Sadowski J, Starek-Stelmaszczyk M, Targoński R, Rynkiewicz A. Prognostic significance of red cell distribution width and its relation to increased pulmonary pressure and inflammation in acute heart failure. Cardiol J. 2020;27(4):394–403. https://doi.org/10.5603/CJ.a2018.0103.CrossRefPubMedPubMedCentral

22.

Arbel Y, Weitzman D, Raz R, Steinvil A, Zeltser D, Berliner S, Chodick G, Shalev V. Red blood cell distribution width and the risk of cardiovascular morbidity and all-cause mortality. A population-based study. Thromb Haemost. 2014;111(2):300–7. https://doi.org/10.1160/TH13-07-0567.CrossRefPubMed

23.

Pascual-Figal DA, Bonaque JC, Redondo B, Caro C, Manzano-Fernandez S, Sánchez-Mas J, Garrido IP, Valdes M. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail. 2009;11(9):840–6. https://doi.org/10.1093/eurjhf/hfp109.CrossRefPubMed

24.

Wonnerth A, Krychtiuk KA, Mayer FJ, Minar E, Wojta J, Schillinger M, Koppensteiner R, Hoke M. Red cell distribution width and mortality in carotid atherosclerosis. Eur J Clin Invest. 2016;46(2):198–204. https://doi.org/10.1111/eci.12584.CrossRefPubMed

25.

Furer A, Finkelstein A, Halkin A, Revivo M, Zuzut M, Berliner S, Herz I, Solodukhin A, Ofer H, Keren G, Banai S, Arbel Y. High red blood cell distribution width and preclinical carotid atherosclerosis. Biomarkers. 2015;20(6–7):376–81. https://doi.org/10.3109/1354750X.2015.1096304.CrossRefPubMed

26.

Wen Y. High red blood cell distribution width is closely associated with risk of carotid artery atherosclerosis in patients with hypertension. Exp Clin Cardiol. 2010;15(3):37–40.PubMedPubMedCentral

27.

Lappegård J, Ellingsen TS, Vik A, Skjelbakken T, Brox J, Mathiesen EB, Johnsen SH, Brækkan SK, Hansen JB. Red cell distribution width and carotid atherosclerosis progression. The Tromsø Study. Thromb Haemost. 2015;113(3):649–54. https://doi.org/10.1160/TH14-07-0606.CrossRefPubMed

28.

Kolodgie FD, Burke AP, Nakazawa G, Cheng Q, Xu X, Virmani R. Free cholesterol in atherosclerotic plaques: where does it come from? Curr Opin Lipidol. 2007;18(5):500–7. https://doi.org/10.1097/MOL.0b013e3282efa35b.CrossRefPubMed

29.

Kolodgie FD, Gold HK, Burke AP, Fowler DR, Kruth HS, Weber DK, Farb A, Guerrero LJ, Hayase M, Kutys R, Narula J, Finn AV, Virmani R. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med. 2003;349(24):2316–25. https://doi.org/10.1056/NEJMoa035655.CrossRefPubMed

30.

Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN. 2019;43(2):181–93. https://doi.org/10.1002/jpen.1451.CrossRef

31.

Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Intern Emerg Med. 2012;7(Suppl 3):S193–9. https://doi.org/10.1007/s11739-012-0802-0.CrossRefPubMed

32.

Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med. 1999;340(2):115–26. https://doi.org/10.1056/NEJM199901143400207. (PMID: 9887164).CrossRefPubMed

33.

Schalk BW, Visser M, Bremmer MA, Penninx BW, Bouter LM, Deeg DJ. Change of serum albumin and risk of cardiovascular disease and all-cause mortality: longitudinal aging study Amsterdam. Am J Epidemiol. 2006;164(10):969–77. https://doi.org/10.1093/aje/kwj312. (Epub 2006 Sep 15).CrossRefPubMed

34.

Gopal DM, Kalogeropoulos AP, Georgiopoulou VV, Tang WW, Methvin A, Smith AL, Bauer DC, Newman AB, Kim L, Harris TB, Kritchevsky SB, Butler J, Health ABC Study. Serum albumin concentration and heart failure risk the health, aging, and body composition study. Am Heart J. 2010;160(2):279–85. https://doi.org/10.1016/j.ahj.2010.05.022.CrossRefPubMedPubMedCentral

35.

Kurtul A, Murat SN, Yarlioglues M, Duran M, Ocek AH, Koseoglu C, Celık IE, Kilic A, Aksoy O. Usefulness of serum albumin concentration to predict high coronary SYNTAX score and in-hospital mortality in patients with acute coronary syndrome. Angiology. 2016;67(1):34–40. https://doi.org/10.1177/0003319715575220. (Epub 2015 Mar 17).CrossRefPubMed

36.

Oduncu V, Erkol A, Karabay CY, Kurt M, Akgün T, Bulut M, Pala S, Kirma C. The prognostic value of serum albumin levels on admission in patients with acute ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention. Coron Artery Dis. 2013;24(2):88–94. https://doi.org/10.1097/MCA.0b013e32835c46fd.CrossRefPubMed

37.

Chien SC, Chen CY, Leu HB, Su CH, Yin WH, Tseng WK, Wu YW, Lin TH, Chang KC, Wang JH, Wu CC, Yeh HI, Chen JW. Association of low serum albumin concentration and adverse cardiovascular events in stable coronary heart disease. Int J Cardiol. 2017;241:1–5. https://doi.org/10.1016/j.ijcard.2017.04.003. (Epub 2017 Apr 7).CrossRefPubMed

38.

Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004;17(6):432–7. https://doi.org/10.1111/j.0894-0959.2004.17603.x.CrossRefPubMed

39.

Joles JA, Willekes-Koolschijn N, Koomans HA. Hypoalbuminemia causes high blood viscosity by increasing red cell lysophosphatidylcholine. Kidney Int. 1997;52(3):761–70. https://doi.org/10.1038/ki.1997.393.CrossRefPubMed

40.

Zhang WJ, Frei B. Albumin selectively inhibits TNF alpha-induced expression of vascular cell adhesion molecule-1 in human aortic endothelial cells. Cardiovasc Res. 2002;55(4):820–9. https://doi.org/10.1016/s0008-6363(02)00492-3.CrossRefPubMed

41.

Gresele P, Deckmyn H, Huybrechts E, Vermylen J. Serum albumin enhances the impairment of platelet aggregation with thromboxane synthase inhibition by increasing the formation of prostaglandin D2. Biochem Pharmacol. 1984;33(13):2083–8. https://doi.org/10.1016/0006-2952(84)90577-x.CrossRefPubMed

42.

Mikhailidis DP, Ganotakis ES. Plasma albumin and platelet function: relevance to atherogenesis and thrombosis. Platelets. 1996;7(3):125–37. https://doi.org/10.3109/09537109609023571.CrossRefPubMed

43.

Li D, Ruan Z, Wu B. Association of red blood cell distribution width-albumin ratio for acute myocardial infarction patients with mortality: a retrospective cohort study. Clin Appl Thromb Hemost. 2022;28:10760296221121286. https://doi.org/10.1177/10760296221121286.CrossRefPubMedPubMedCentral

44.

Weng Y, Peng Y, Xu Y, Wang L, Wu B, Xiang H, Ji K, Guan X. The ratio of red blood cell distribution width to albumin is correlated with all-cause mortality of patients after percutaneous coronary intervention—a retrospective cohort study. Front Cardiovasc Med. 2022;9: 869816. https://doi.org/10.3389/fcvm.2022.869816.CrossRefPubMedPubMedCentral

45.

Hong J, Hu X, Liu W, Qian X, Jiang F, Xu Z, Shen F, Zhu H. Impact of red cell distribution width and red cell distribution width/albumin ratio on all-cause mortality in patients with type 2 diabetes and foot ulcers: a retrospective cohort study. Cardiovasc Diabetol. 2022;21(1):91. https://doi.org/10.1186/s12933-022-01534-4.CrossRefPubMedPubMedCentral

46.

Khaw KT, Wareham N. Glycated hemoglobin as a marker of cardiovascular risk. Curr Opin Lipidol. 2006;17(6):637–43. https://doi.org/10.1097/MOL.0b013e3280106b95.CrossRefPubMed

47.

Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011–23. https://doi.org/10.1056/NEJMra041809.CrossRefPubMed

48.

Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009;133(4):628–32. https://doi.org/10.5858/133.4.628.CrossRefPubMed

49.

Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105(9):1135–43. https://doi.org/10.1161/hc0902.104353.CrossRefPubMed

50.

King GL. The role of inflammatory cytokines in diabetes and its complications. J Periodontol. 2008;79(8 Suppl):1527–34. https://doi.org/10.1902/jop.2008.080246.CrossRefPubMed

Title: Relationship between red cell distribution width/albumin ratio and carotid plaque in different glucose metabolic states in patients with coronary heart disease: a RCSCD-TCM study in China
Authors: Mengnan Huang
Fanfan Liu
Zhu Li
Yijia Liu
Jinyu Su
Mei Ma
Yuanyuan He
Huaien Bu
Shan Gao
Hongwu Wang
Chunquan Yu
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Coronary Heart Disease
Published in: Cardiovascular Diabetology / Issue 1/2023
Electronic ISSN: 1475-2840
DOI: https://doi.org/10.1186/s12933-023-01768-w

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical Abstract

Please log in to get access to this content

Other articles of this Issue 1/2023

Subclinical left ventricular deformation and microvascular dysfunction in T2DM patients with and without peripheral neuropathy: assessed by 3.0 T cardiac magnetic resonance imaging

Triglyceride-glucose index in the prediction of adverse cardiovascular events in patients without diabetes mellitus after coronary artery bypass grafting: a multicenter retrospective cohort study

Sex differences and sex steroids influence on the presentation and severity of cardiovascular autonomic neuropathy of patients with type 1 diabetes

Impact of the SGLT2-inhibitor empagliflozin on inflammatory biomarkers after acute myocardial infarction – a post-hoc analysis of the EMMY trial

Global trans-lesional computed tomography-derived fractional flow reserve gradient is associated with clinical outcomes in diabetic patients with non-obstructive coronary artery disease

Safety and efficacy of bempedoic acid: a systematic review and meta-analysis of randomised controlled trials

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials