Restless Legs Syndrome (RLS) Discussion Board

I can across this article today and immediately thought of WED patients with our increased risk of heart attacks found in a recent study.

http://health.yahoo.net/articles/health ... youll-live

Here's the part that caught my attention: "Researchers from Intermountain Medical Center in Murray, Utah, and Harvard’s Brigham and Women’s Hospital in Boston followed more than 17,000 men and women for five years as part of a larger clinical trial involving a cholesterol-lowering drug. They discovered that participants with high levels of a measure called "red cell distribution width" (RDW) were twice as likely to die compared to those with low RDW levels. (Find out how to protect your most important organ with our Complete Guide To Preventing Heart Disease.)

Normally, doctors only look at RDW counts when trying to pinpoint very specific diseases, like certain types of anemia. “But it has turned out to be one of the most predictive factors of cardiovascular events and mortality. Peer reviewers actually thought it was too good to be true, because the CBC had been around for 50 years,” says study author Benjamin Horne, PhD, director of cardiovascular and genetic epidemiology at the Intermountain Medical Center Heart Institute."

What caught my eye is that they only usually look at this related to certain types of anemia. Of course, it may bear no relation to WED and our issues with iron. I'll be looking forward to them figuring out what is involved.

Thank you for this. It seems we are quite vulnerable in several ways.

So, if I understand correctly, there's a commonly-done test called "complete blood count risk score", or CBC. It's routinely done on people to get an overall picture of their health. The CBC test has multiple parts, one of which is this RDW measure.

Generally, the RDW value has only been used to distinguish one type of anemia from another. But by combing a large amount of CBC data, the researchers have noticed a strong correlation between high RDW at the time of testing and later death due to cardiovascular disease. This means, if you have a high RDW, you are at risk for cardiovascular disease and should take measures to protect your heart.

Ann, you're wondering what that might mean to WED patients: since RDW is high in cases of anemia caused by low iron, our RDW values might be significant to us in some way. After all, our disease involves low iron in the brain, and a recent study showed that WED patients die sooner than non-WED people.

I looked up RDW to see what I could learn. I found a study linking RDW with mortality that was published in 2009 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2765040/). I wonder if the article linked to above is based on a more recent study, or was it regurgitating the 2009 one? Anyway, the authors of the 2009 study speculate that high RDW might be related to either inflammation or oxidative stress. Their conclusion presents a number of observations in support of such relationships. One of their points is that dialysis patients experience oxidative stress and inflammation because of blood contact with dialysis membranes.

Dialysis patients also commonly have WED. I realized I don't know what the cause is of WED in advanced kidney disease. Is it only present in people on dialysis? or is kidney disease characterized by low iron?

Notes:
- Anemia is low hemoglobin, or low red blood cell count. It can be caused by many things, among them low iron.
- RDW is effectively a measure of the heterogeneity in sizes of red blood cells in a sample of blood. It is higher if the cells are of widely varying sizes.
- Causes of high RDW, besides low iron: low B12, low folate, excessive bleeding, transfusions, and alcohol abuse. (from https://www.sharecare.com/health/blood- ... lood-count and http://en.wikipedia.org/wiki/Red_blood_ ... tion_width )

All this is interesting, but am I missing something? I do not see how this is applicable to WED. Our problem is ferritin levels which are usually rather independent of anemia (or lack thereof).

I took a look at two different CBC tests that I have had done in the last 12 months, one of which included ferritin. RDW and MCV were both in the middle of the normal range, but the one ferritin value was low, by WED standards.

Rustsmith wrote:All this is interesting, but am I missing something? I do not see how this is applicable to WED. Our problem is ferritin levels which are usually rather independent of anemia (or lack thereof).

I took a look at two different CBC tests that I have had done in the last 12 months, one of which included ferritin. RDW and MCV were both in the middle of the normal range, but the one ferritin value was low, by WED standards.

I have NO idea if it's applicable! I just noticed the correlation and wondered if anyone bothered to related the two (which badnights kindly did). While our WED is often independent of anemia, I had no idea if it the RDW might be related to other issues of blood iron. We're odd - we need much higher ferritin than others. So, it's possible our problem isn't seen as a problem, so no one looked at this factor.

It's possible that researchers have not identified a difference between primary and secondary WED in terms of who dies earlier. Is it primarily those with secondary WED, where inflammation is likely an issue? Or does primary WED cause something we haven't yet identified?

Thanks for the clarification. I suspected that was the case. I will also admit that I wanted to get clarification so that some future reader of this thread doesn't get the wrong impression by jumping to conclusions.

I can understand why the field of medicine needs these large statistical studies, but they are so ripe for misinterpretation by those not intimately familiar with how research is actually performed. When I was just getting started in my field (non-medical), they kept beating into our heads that we had to be careful when evaluating results and drawing conclusions about Cause, Effect or pure happenstance.

Once again, this study appears to demonstrate an interesting correlation that will probably get funding from someone. We can only hope that they expand the scope so that it is more applicable to us.

As an update to the information in this thread, during the RLS Foundation Webinar today that was presented by Dr Brian Koo on PLMS, he spent quite a bit of time discussion the relationship between RLS/PLMS and heart type issues such as attacks, strokes, hypertension, etc. He presented the results from a number of different statistical studies. I think that the most important point that he made was that the statistical relationship between RLS/PLMS and heart issues appears to apply primarily to secondary RLS. Further, he stated that he suspects that the correlation is due to the poor health of the individuals in these studies who have secondary RLS. So, although there is a statistical relationship between an increased incidence of heart attacks, strokes and TIAs with RLS, it is quite possible that the relationship does not apply to those of us with idiopathic RLS - unless of course you also have other risk factors for heart problems.

I'm not a very technical person, so I don't totally understand the above information. I do know that when a person has sleep deprivation, it is not good for the heart. During the two months that I was recently sleep deprived, my blood pressure was elevated. I know that I read somewhere that sleep deprivation causes heart disease. I don't know how it is related to the Red blood count. Another thing, since I am at high altitude, I do have a higher count.

Deb, the explanation that Dr Koo gave was that just before a PLM occurs, the heart rate and blood pressure elevate in the same way as a "fight or flight" fear reaction. When this happens many times during a night, it stresses the heart and also causes blood pressure spikes that are not reflected in the doctor's office. He said that it was this constant stress on the heart combined with people whose health is already poor via kidney disease, diabetes or some other disease that is causing the secondary RLS. For those of us with primary RLS, i.e. nothing other than bad genes and/or luck, then the RLS/PLMS does not appear to increase the risk of heart problems above what already exists. The issues that you raised are all things that are all legitimate causes of heart issues, but his point was that the RLS/PLMS did not automatically increase the risk. And I suspect that would be especially true if the sleep deprivation problems could be brought under control.

Interesting. I have primary RLS and PLMs. I also have heart disease and kidney disease. Even though they say that it is not appear to increase the risk, I would hate to bet that it doesn't in my case.