Association Between Hemoglobin-to-Red Blood Cell Distribution Width Ratio and Arterial Stiffness

Abstract

This study aimed to investigate the relationship between the hemoglobin-to-red blood cell distribution width (RDW) ratio (HRR), a composite marker of inflammation and oxidative stress, and arterial stiffness. A total of 3657 participants from Health examination center, the Department of General Practice and Geriatrics at the First Affiliated Hospital of Fujian Medical University were included in a cross-sectional analysis conducted between January 2016 and December 2023. Arterial stiffness was defined as a carotid-femoral pulse wave velocity (cfPWV) of ≥10 m/s. HRR was calculated by dividing the hemoglobin concentration by the RDW. Participants were categorized into quartiles (Q1–Q4) based on their HRR values. Associations between HRR and arterial stiffness were evaluated using linear regression analysis, logistic regression models, stratified analyses, and restricted cubic splines (RCS) to identify potential non-linear associations. Age and cfPWV increased significantly across decreasing HRR quartiles. In a fully adjusted model, compared with Q1, participants in Q3 (OR 0.95, 95% CI: 0.91–0.99, p = 0.024) and Q4 (OR 0.93, 95% CI: 0.88–0.97, p < 0.001) exhibited a progressive reduction in arterial stiffness. RCS analysis revealed a linear association between HRR and arterial stiffness. Stratified analysis indicated a stronger inverse association between higher HRR and lower arterial stiffness in individuals with diabetes or hypertension. This study offers additional evidence that supports the role of inflammation and oxidative stress in arterial stiffness.