# Red cell distribution width positively correlates with 10-year risk of cardiovascular disease among people with type 1 diabetes as assessed by the Steno Type 1 Risk Engine

## TL;DR

Higher red cell distribution width is linked to increased 10-year cardiovascular disease risk in people with type 1 diabetes.

## Contribution

RDW is identified as an independent predictor of cardiovascular risk in type 1 diabetes, suggesting potential use in risk stratification.

## Key findings

- RDW positively correlates with predicted 10-year CVD risk in T1D patients.
- RDW remains a significant predictor after adjusting for other risk factors like hypertension and kidney disease.
- Higher RDW tertiles show significantly increased median predicted CVD risk scores.

## Abstract

We evaluated the association between Red Cell Distribution Width (RDW) and predicted 10-year cardiovascular disease (CVD) risk, as estimated by the Steno Type 1 Risk Engine (ST1RE), in individuals with type 1 diabetes (T1D).

We conducted a retrospective analysis of 342 adults with T1D duration > 5 years, (163 women, 179 men) from a tertiary Diabetes Center electronic database. Participants were stratified into tertiles of RDW: Group 1 (G1: < 12.6), Group 2 (G2: 12.6–13.2), and Group 3 (G3: >13.2).

Higher RDW was associated with older age and longer diabetes duration. The prevalence of microvascular complications did not differ across RDW tertiles. Predicted 10-year CVD risk (ST1RE 10Y) increased with higher RDW: median (IQR) 4.5 (3.2–6.1) in G1, 4.5 (2.9–7.2) in G2, and 6.2 (3.5–12.0) in G3 (p < 0.01). In multiple linear regression, RDW was positively associated with ST1RE 10Y, (β = 1.13;95% CI, 0.57–1.70; p < 0.01; R2 = 0.36). In multivariable logistic regression, RDW was independently associated with moderate/high versus low ST1RE 10Y risk (OR = 1.87;95%CI, 1.28–2.75; p = 0.001). Models were adjusted for presence of hypertension, dyslipidemia, diabetic kidney disease, BMI value and hsCRP concentration.

Our results suggest that RDW is independently associated with predicted 10-year CVD risk in individuals with T1D. These findings support RDW as a potential marker for cardiovascular risk stratification. However, external validation is required before clinical application.

The online version contains supplementary material available at 10.1007/s00592-025-02615-y.