Summary: Red blood cell distribution width (RDW) has been shown to predict cardiovascular mortality in various populations, but studies were less conclusive regarding cardiovascular morbidity. We aimed at evaluating the prognostic effect of RDW on cardiovascular morbidity and allcause mortality in the largest community cohort to date. We utilised the computerised database of a large community based healthcare maintenance organization (HMO) in Israel to identify a cohort of 225,006 eligible patients aged 40 or above who performed a blood count during 2006. We evaluated the relationship between 1% increments of RDW values and major cardiovascular events and all-cause mortality over a period of five years. A total of 21,939 incident cases of a major cardiovascular event and 4,287 deaths were documented during a total of six years of follow up, respectively. In comparison with patients with RDW level <13%, the hazard ratio for total mortality gradually increased to 4.57 (95% confidence interval [CI]: 3.35–6.24, p<0.001) among male patients and to 3.26 (95% CI: 2.49–4.28, p<0.001) among female patients with a RDW of 17% or above. Similar results were evident in anaemic and non-anaemic populations. RDW above 17% was also associated with a modest increased risk of major cardiovascular events in females 1.26 (95% CI: 1.03–1.52, p=0.021), while in men it was not significant, 1.08 (95% CI: 0.82–1.41, p=NS). In conclusion, increasing RDW levels significantly increased risk of cardiovascular morbidity and all-cause mortality. Our observation is evident in both anaemic and non-anaemic patients.

Seventeen percent of youth in the United States are obese. Obesity has been linked to higher prevalence of hypertension. Past studies were limited by their size and conflicting results. The aim of this study was to analyze trends in adolescents’ obesity between 1998 and 2011 and to evaluate the relationship between blood pressure and body mass index (BMI) in healthy adolescents. All adolescents who underwent a medical exam in the years 1998–2011 and were found fit for combat duties in the Israeli Defense Force were included. The cohort included 714,922 healthy adolescents with 59% of them being males. The mean age was 17.4±0.45 and mean BMI was 22±3.5kg/m². The percentage of overweight adolescents (BMI > 25kg/m²) has increased from 13.2% in 1998 to 21% in 2011, P < 0.001. The mean systolic and diastolic blood pressures increased with increasing BMI deciles (systolic blood pressure by 10mm Hg and diastolic blood pressure by 3–4mm Hg from the 1st decile to the 10th decile, P < 0.001 for both). In multivariate analysis, each increase of 1 unit of BMI was associated with an increased risk of systolic blood pressure above 130mm Hg in both males (OR = 1.108, 95% CI 1.107–1.110, P < 0.001) and females (OR = 1.114, 95% CI 1.139–1.146, P < 0.001). BMI in adolescents is significantly associated with systolic blood pressure and diastolic blood pressure in both genders and in both the normal weight and overweight groups. There has been consistent trend of increasing BMI values over recent years.