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Published on: October 23, 2020
Complete blood count risk score and its components, including RDW, are associated with mortality in the JUPITER trial
Benjamin D Horne1, Jeffrey L Anderson2, Joseph B Muhlestein2
1Intermountain Medical Center, Salt Lake City, USA University of Utah, Salt Lake City, USA benjamin.horne@imail.org.
Insights
A complete blood count (CBC) risk score effectively predicts all-cause mortality in individuals without cardiovascular disease. This validated score also shows promise for identifying those at higher risk of mortality and cardiovascular events.
Area of Science:
- Cardiovascular Disease Research
- Hematology
- Biostatistics
Background:
- Previous research demonstrated sex-specific complete blood count (CBC) risk scores' strong prediction of all-cause mortality in general medical patients.
- This study aimed to validate the CBC risk score in an independent, international primary prevention population free from cardiovascular (CV) disease.
Purpose of the Study:
- To evaluate the association of a previously derived and validated CBC risk score with all-cause mortality in CV disease-free individuals.
- To assess the CBC risk score's predictive capability for CV mortality and major CV disease events.
Main Methods:
- An observational secondary analysis was conducted on data from the randomized Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial.
- The CBC risk score was evaluated for its association with all-cause mortality, CV mortality, and major CV disease in 6,568 females and 10,629 males free from CV disease at baseline.
Main Results:
- The CBC risk score significantly predicted all-cause mortality in a dose-dependent manner, with adjusted hazard ratios of 1.51 and 1.97 for the second and third tertiles, respectively (p trend < 0.001).
- The score also predicted CV mortality (p trend = 0.025) and the primary JUPITER endpoint (p trend = 0.015).
- The c-statistics for mortality prediction were 0.729 overall, 0.722 for females, and 0.750 for males, indicating good discrimination.
Conclusions:
- The CBC risk score demonstrated strong association and good discrimination for all-cause mortality in the JUPITER trial population.
- The score also effectively predicted CV-specific outcomes, suggesting its utility in risk stratification.
- The CBC risk score may serve as a valuable tool for identifying individuals without known cardiac disease who are at an elevated risk of mortality.
Background:
Previously, we showed that sex-specific complete blood count (CBC) risk scores strongly predicted risk of all-cause mortality in multiple sets of general medical patients. This study evaluated the CBC risk score in an independent, well-studied international primary risk population of lower-risk individuals initially free from cardiovascular (CV) disease.
Design:
Observational secondary analysis of a randomized trial population.
Methods:
The previously derived and validated CBC score was evaluated for association with all-cause mortality among CV disease-free females (n = 6568) and males (n = 10,629) enrolled for up to 5 years in the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial. Associations of the CBC score with CV mortality and with major CV disease were also tested.
Results:
The CBC score predicted all-cause mortality, with univariable hazard ratio (HR) 4.83 (95% CI 3.70-6.31) for the third CBC score tertile vs. the first tertile, and HR 2.31 (CI 1.75-3.05) for the second tertile (p trend < 0.001). The CBC score retained significance after adjustment: HR 1.97 (CI 1.46-2.67) and 1.51 (CI 1.13-2.00) for tertiles 3 and 2 vs. 1, respectively (p trend < 0.001). The CBC score also predicted CV mortality (p trend = 0.025) and the primary JUPITER endpoint (p trend = 0.015). c-statistics for mortality were 0.729 among all, and 0.722 and 0.750 for females and males, respectively.
Conclusions:
The CBC risk score was strongly associated with all-cause mortality among JUPITER trial participants and had good discrimination. It also predicted CV-specific outcomes. This CBC score may be useful in identifying cardiac disease-free individuals at increased risk of mortality.
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