Red blood cell distribution width for prediction of new-onset heart failure in the general population

BACKGROUND: Red blood cell distribution width (RDW), a routine and inexpensive blood parameter, is widely available and may serve as a useful screening marker for heart failure (HF). This study aims to evaluate RDW's predictive value for new-onset HF in the general population and examine its incremental predictive performance alongside NT-proBNP. METHODS: From a prospective population-based cohort, RDW and NT-proBNP were available for 5814 and 3393 individuals without prior HF, respectively. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Fully adjusted model included variables from the Pooled Cohort Equations (PCE): age, sex, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking, and antihypertensive medication use. Predictive improvement was assessed using the Δc-statistic. RESULTS: Over a median follow-up of 7 years, 433 individuals developed HF (incidence rate: 10.4 per 1000 person-years). Each 1% increase in RDW was associated with a 22% higher HF risk (HR 1.22, 95%CI, 1.12-1.32), and those in the highest RDW quartile had a 71% higher risk (HR 1.71, 95%CI, 1.29-2.25). NT-proBNP showed similar associations (HR 1.68, 95%CI, 1.40-2.01 per 1-unit increase). Adding RDW to the PCE model significantly improved predictive performance (Δc-statistic = 0.008), comparable to NT-proBNP (Δc-statistic = 0.014). CONCLUSIONS: RDW is a robust and accessible predictor of incident HF. Its predictive value, low costs, and routine availability highlight its potential as a useful biomarker for HF risk stratification in the general population. The design and findings are summarized in the graphical abstract.