{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T18:08:29Z","timestamp":1789063709686,"version":"build-2803163510"},"reference-count":116,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Coronary heart disease represents a great economic expense, especially coronary artery calcification (CAC), which is associated with worse clinical outcomes and increased technical complexity of percutaneous coronary intervention. Red cell distribution width (RDW) is a marker of dysregulated erythropoiesis associated with inflammation and iron accumulation in macrophages that is mediated by hepcidin. Research has indicated that higher RDW levels are linked to an increased risk of adverse cardiovascular events, and some studies have shown an association with CAC. This narrative review aims to summarize the current evidence on the mechanisms responsible for elevated RDW and its relationship with inflammation and CAC. Systemic inflammation induces the expression of hepcidin, which alters iron levels; macrophages, depending on iron levels, can help to resolve inflammation or trigger inflammation in atherosclerotic cardiovascular disease (ASCVD) and can induce vascular calcification. This is known as macrophage polarization. Evidence from large-scale clinical trials has established the involvement of immune-mediated inflammation in the pathogenesis of ASCVD. Thus, systemic inflammation is a novel cardiovascular risk factor that can be treated with anti-cytokine therapy. RDW could be a useful marker of inflammation associated with CAC and a risk marker for experiencing adverse cardiovascular events.<\/jats:p>","DOI":"10.3390\/life16091512","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T17:35:01Z","timestamp":1789061701000},"page":"1512","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Red Blood Cell Distribution Width Is a Biomarker of Red Cell Dysfunction Associated with Inflammation, Macrophage Polarization, and Coronary Artery Calcification: A Prognostic Marker in Cardiovascular Disease and a Potential Target for Anti-Cytokine Therapy"],"prefix":"10.3390","volume":"16","author":[{"given":"Kitty","family":"Inzunza-Esparza","sequence":"first","affiliation":[{"name":"Institute for Development and People, Francisco de Vitoria University, M-515, km 1, 800, 28223 Madrid, Spain"},{"name":"Pontificio Instituto Teol\u00f3gico Juan Pablo II Madrid, UCAM, Pl. del Conde de Barajas, 1, Centro, 28005 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6786-3498","authenticated-orcid":false,"given":"Artemio","family":"Garc\u00eda-Escobar","sequence":"additional","affiliation":[{"name":"Cardiology Department, Quironsalud University Hospital Madrid, Calle Diego de Vel\u00e1zquez, 1, 28223 Madrid, Spain"},{"name":"Cardiology Department, Ruber Juan Bravo Quironsalud University Hospital, Calle de Juan Bravo, 49, 28006 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1161\/CIR.0b013e31820a55f5","article-title":"Forecasting the future of cardiovascular disease in the United States: A policy statement from the American Heart Association","volume":"123","author":"Heidenreich","year":"2011","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.jacc.2022.05.033","article-title":"Cardiovascular Disease Projections in the United States Based on the 2020 Census Estimates","volume":"80","author":"Mohebi","year":"2022","journal-title":"J. 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