Association study of mean corpuscular volume/red blood cell distribution width with the risk of stroke_West China Medical Journal

Authors：

XU Lin ^1,2 , WANG Lu ^1,2 ,  HUANG Liyi ^1,2 ,  WANG Shiqi ^1,2

1. Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

HUANG Liyi, Email: liyi.huang@scu.edu.cn; WANG Shiqi, Email: wsqwangshiqi1@163.com

Keywords：

Mean corpuscular volume; red blood cell distribution width; stroke; National Health and Nutrition Examination Survey; correlation study

DOI：

10.7507/1002-0179.202505127

Video：

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Objective To investigate the relationship between the mean corpuscular volume/red blood cell distribution width ratio (MRR) and stroke, providing a new perspective for the risk assessment and early prevention of stroke. Methods The study was based on the complex sampling design of data from the National Health and Nutrition Examination Survey from 1999 to 2018 and included 17434 eligible participants aged 18 years and older. MRR was calculated based on the mean corpuscular volume and red blood cell distribution width, and stroke patients were determined based on the health status questionnaire. According to the quartiles of MRR, the included participants were divided into Q₁, Q₂, Q₃, and Q₄ groups. Multivariate logistic regression analysis was used to explore the association between MRR and the incidence of stroke. Official sampling weights, stratification variables, and primary sampling units were incorporated throughout this study for weighting adjustment, and weighted statistical methods suitable for complex samples were adopted for data analysis and intergroup comparisons. Results Among all the participants, there were 625 stroke patients, with a weighted stroke prevalence of 2.7%. The MRR of the overall population were (6.58±0.78) fL/%. The results of the multivariate logistic regression analysis showed that, after adjusting for age, gender, race, education level, diabetes, hyperlipidemia, hypertension, smoking history and drinking history, a high level of MRR was independently associated with a reduced risk of stroke [Q₂ vs. Q₁: odds ratio (OR)=0.986, 95% confidence interval (CI) (0.976, 0.996), P=0.005; Q₃ vs. Q₁: OR=0.986, 95%CI (0.975, 0.996), P=0.008; Q₄ vs. Q₁: OR=0.984, 95%CI (0.974, 0.994), P=0.002]. Conclusions The higher the MRR, the lower the risk of stroke. A higher MRR level provides a protective effect against stroke, and the MRR index has potential value in the prevention and management of stroke.

Citation： XU Lin, WANG Lu, HUANG Liyi, WANG Shiqi. Association study of mean corpuscular volume/red blood cell distribution width with the risk of stroke. West China Medical Journal, 2026, 41(5): 723-728. doi: 10.7507/1002-0179.202505127 Copy

1.	《中國卒中中心報告 2022》編寫組. 《中國卒中中心報告 2022》概要. 中國腦血管病雜志, 2024, 21(8): 565-576.
2.	GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol, 2021, 20(10): 795-820.
3.	Prabhakaran S, Ruff I, Bernstein RA. Acute stroke intervention: a systematic review. JAMA, 2015, 313(14): 1451-1462.
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5.	覃鉉, 潘水湘, 梁萍, 等. 紅細胞分布寬度(RDW)與成人卒中風險的關聯研究. 醫學前沿, 2024, 6(2): 151-156.
6.	Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med, 2009, 133(4): 628-632.
7.	Semba RD, Patel KV, Ferrucci L, et al. Serum antioxidants and inflammation predict red cell distribution width in older women: the Women’s Health and Aging Study I. Clin Nutr, 2010, 29(5): 600-604.
8.	Ale L, Gentleman R, Sonmez TF, et al. nhanesA: achieving transparency and reproducibility in NHANES research. Database (Oxford), 2024, 2024: baae028.
9.	Menke A, Casagrande S, Geiss L, et al. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA, 2015, 314(10): 1021-1029.
10.	Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA, 2003, 289(19): 2560-2572.
11.	National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation, 2002, 106(25): 3143-3421.
12.	Wu Z, Li P. Methods for downloading, appending and merging NHANES data. Hypertens Res, 2023, 46(6): 1616-1617.
13.	Kor CT, Hsieh YP, Chang CC, et al. The prognostic value of interaction between mean corpuscular volume and red cell distribution width in mortality in chronic kidney disease. Sci Rep, 2018, 8(1): 11870.
14.	Sanford K, Case N, Blake B, et al. Changes in mean corpuscular volume and RBC distribution width predict erythrocyte engraftment following ABO-incompatible hematopoietic stem cell transplantation. Am J Clin Pathol, 2020, 153(6): 781-789.
15.	Li N, Zhou H, Tang Q. Red blood cell distribution width: a novel predictive indicator for cardiovascular and cerebrovascular diseases. Dis Markers, 2017, 2017: 7089493.
16.	Harshfield EL, Sims MC, Traylor M, et al. The role of haematological traits in risk of ischaemic stroke and its subtypes. Brain, 2020, 143(1): 210-221.
17.	Liu J, Chou EL, Lau KK, et al. A Mendelian randomization-based exploration of red blood cell distribution width and mean corpuscular volume with risk of hemorrhagic strokes. HGG Adv, 2022, 3(4): 100135.
18.	Tomaiuolo G, Lanotte L, D’Apolito R, et al. Microconfined flow behavior of red blood cells. Med Eng Phys, 2016, 38(1): 11-16.
19.	D’Alessandro A, Blasi B, D’Amici GM, et al. Red blood cell subpopulations in freshly drawn blood: application of proteomics and metabolomics to a decades-long biological issue. Blood Transfus, 2013, 11(1): 75-87.
20.	Poz D, De Falco E, Pisano C, et al. Diagnostic and prognostic relevance of red blood cell distribution width for vascular aging and cardiovascular diseases. Rejuvenation Res, 2019, 22(2): 146-162.
21.	Hsieh YP, Chang CC, Kor CT, et al. Mean corpuscular volume and mortality in patients with CKD. Clin J Am Soc Nephrol, 2017, 12(2): 237-244.

1. 《中國卒中中心報告 2022》編寫組. 《中國卒中中心報告 2022》概要. 中國腦血管病雜志, 2024, 21(8): 565-576.
2. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol, 2021, 20(10): 795-820.
3. Prabhakaran S, Ruff I, Bernstein RA. Acute stroke intervention: a systematic review. JAMA, 2015, 313(14): 1451-1462.
4. Hatamian H, Saberi A, Pourghasem M. The relationship between stroke mortality and red blood cell parameters. Iran J Neurol, 2014, 13(4): 237-240.
5. 覃鉉, 潘水湘, 梁萍, 等. 紅細胞分布寬度(RDW)與成人卒中風險的關聯研究. 醫學前沿, 2024, 6(2): 151-156.
6. Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med, 2009, 133(4): 628-632.
7. Semba RD, Patel KV, Ferrucci L, et al. Serum antioxidants and inflammation predict red cell distribution width in older women: the Women’s Health and Aging Study I. Clin Nutr, 2010, 29(5): 600-604.
8. Ale L, Gentleman R, Sonmez TF, et al. nhanesA: achieving transparency and reproducibility in NHANES research. Database (Oxford), 2024, 2024: baae028.
9. Menke A, Casagrande S, Geiss L, et al. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA, 2015, 314(10): 1021-1029.
10. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA, 2003, 289(19): 2560-2572.
11. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation, 2002, 106(25): 3143-3421.
12. Wu Z, Li P. Methods for downloading, appending and merging NHANES data. Hypertens Res, 2023, 46(6): 1616-1617.
13. Kor CT, Hsieh YP, Chang CC, et al. The prognostic value of interaction between mean corpuscular volume and red cell distribution width in mortality in chronic kidney disease. Sci Rep, 2018, 8(1): 11870.
14. Sanford K, Case N, Blake B, et al. Changes in mean corpuscular volume and RBC distribution width predict erythrocyte engraftment following ABO-incompatible hematopoietic stem cell transplantation. Am J Clin Pathol, 2020, 153(6): 781-789.
15. Li N, Zhou H, Tang Q. Red blood cell distribution width: a novel predictive indicator for cardiovascular and cerebrovascular diseases. Dis Markers, 2017, 2017: 7089493.
16. Harshfield EL, Sims MC, Traylor M, et al. The role of haematological traits in risk of ischaemic stroke and its subtypes. Brain, 2020, 143(1): 210-221.
17. Liu J, Chou EL, Lau KK, et al. A Mendelian randomization-based exploration of red blood cell distribution width and mean corpuscular volume with risk of hemorrhagic strokes. HGG Adv, 2022, 3(4): 100135.
18. Tomaiuolo G, Lanotte L, D’Apolito R, et al. Microconfined flow behavior of red blood cells. Med Eng Phys, 2016, 38(1): 11-16.
19. D’Alessandro A, Blasi B, D’Amici GM, et al. Red blood cell subpopulations in freshly drawn blood: application of proteomics and metabolomics to a decades-long biological issue. Blood Transfus, 2013, 11(1): 75-87.
20. Poz D, De Falco E, Pisano C, et al. Diagnostic and prognostic relevance of red blood cell distribution width for vascular aging and cardiovascular diseases. Rejuvenation Res, 2019, 22(2): 146-162.
21. Hsieh YP, Chang CC, Kor CT, et al. Mean corpuscular volume and mortality in patients with CKD. Clin J Am Soc Nephrol, 2017, 12(2): 237-244.

West China Medical Journal

Association study of mean corpuscular volume/red blood cell distribution width with the risk of stroke

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