Hematocrit levels and arterial stiffness: the Cardiometabolic Risk in Chinese (CRC) Study

  • Caiyan Zou
  • Xuekui Liu
  • Qinqin Qiu
  • Jun LiangEmail author
  • Houfa GengEmail author
  • Lu Qi
Original Article



We aimed to investigate the association of haematocrit (HCT) level with central and peripheral arterial stiffness in adults in China. We particularly focussed on the association between HCT and other cardiometabolic risk factors.


Adults aged ≥ 20 years were included in the study. Carotid radial pulse wave velocity (crPWV), carotid femoral pulse wave velocity (cfPWV), carotid dorsalis pedis pulse wave velocity (cdPWV), and HCT were measured.


Overall, 3225 individuals were included in the study. After adjustment for age, sex, and body mass index, HCT level was found to increase significantly with increases in cfPWV, crPWV, and cdPWV (p = 0.001). Following adjustment for heart rate, blood pressure, and blood lipids, the association of HCT level with crPWV and cdPWV was not significant (p = 0.090 and 0.053, respectively); however, the association between HCT level and cfPWV remained significant (p = 0.007). We found significant interactions of HCT level with hypertension and metabolic syndrome in the effect on cfPWV (p = 0.0419 and 0.026, respectively).


In adults in China, HCT level was associated with elevated central arterial stiffness, independent of conventional cardiovascular risk factors. As a serological marker, HCT can predict the degree of central arterial stiffness. HCT combined with other traditional cardiovascular risk factors can better assess vascular heart disease.


Hematocrit Pulse wave velocity Hypertension 





carotid-radial pulse wave velocity


carotid-femoral pulse wave velocity


Carotid dorsalis pedis pulse wave velocity


metabolic syndrome


Cardiometabolic Risk in Chinese


bodymass index


blood pressure


heart rate


serum uric acid


fasting blood glucose;


total cholesterol




high-density lipoprotein cholesterol


low-density lipoprotein cholesterol



We acknowledge and thank all participants for their cooperation and sample contributions.

Availability of data and materials

All data generated or analysed during this study are included in this manuscript.

Authors' contributions

CY Z and XK L were the performer of this study and written this manuscript; QQ Q performed the recruitment of patients; J L and HF G were the guarantor of integrity of the entire study and responsible for the study concepts, study design, and approval of the final version of the manuscript; L Q was responsible for the analysis the data onto this study.

Funding information

This work was supported by (1) The Jiangsu Provincial Bureau of Health Foundation (grant no. H201356 and BRA2014058), (2) The Jiangsu Six Talent Peaks Program (No. 2013-WSN-013), (3) The Xuzhou Outstanding Medical Academic Leader Project and the Xuzhou Science and Technology Grants (nos. XM13B066 and KC14SX013), (4) The generous grants from Jiangsu Province Science and Education Project for Young Talent (QNRC2016388),and (5) The social development project of the Xuzhou Municipal Science and Technology Bureau (KC165W163).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was reviewed and approved by the ethics committee of the Central Hospital of Xuzhou, Affiliated Hospital of Medical School of Southeast University, China. (No. 2015.428).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Consent for publication

None application.


  1. 1.
    F.S Facchini, M Carantoni, J Jeppesen, G.M Reaven, Hematocrit and hemoglobin are independently related to insulin resistance and compensatory hyperinsulinemia in healthy, non-obese men and women[J]. Metabolism; 1998, 47: 831–835.CrossRefGoogle Scholar
  2. 2.
    Barbieri M, Ragno E, Benvenuti E, Zito G. A, Corsi A, Ferrucci L, et al., New aspects of the insulin resistance syndrome: impact on haematological parameters[J]. Diabetologia; 2001, 44:1232–7 .CrossRefGoogle Scholar
  3. 3.
    Kunnas T, Solakivi T, Huuskonen K, Kalela A, Renko J, Nikkari S.T. Hematocrit and the risk of coronary heart disease mortality in the TAMRISK study, a 28-year follow-up [J]. Preventive Medicine;2009,49:45–7.CrossRefGoogle Scholar
  4. 4.
    Meng W, Zhang C, Zhang Q, Song X, Lin H, Zhang D, et al Association between erythrocyte parameters and metabolic syndrome in urban Han Chinese: a longitudinal cohort study [J]. BMC Public Health;2013,13:989–7.Google Scholar
  5. 5.
    Vitool Lohsoonthorn , Wiroj Jiamjarasrungsi , Michelle A Williams. Association of hematological parameters with clustered components of metabolic syndrome among professional and office workers in Bangkok, Thailand[J]. Diabetes & Metabolic Syndrome: Clinical Research & Reviews; 2007,1:143–149.Google Scholar
  6. 6.
    Robinson J G, Stone N J. The 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk: a new paradigm supported by more evidence [J]. Eur Heart J; 2015, 36:2110–2116.CrossRefGoogle Scholar
  7. 7.
    Suttontyrrell K, Najjar S.S, Boudreau R.M, Venkitachalam L, Kupelian V, Simonsick E.M. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults[J]. Circulation;2005, 111: 3384–90.Google Scholar
  8. 8.
    Krantz M.J, Long C.S, Patrick H, Elhum K, Miriam D, Estacio R.O, et al. Pulse wave velocity and carotid atherosclerosis in White and Latino patients with hypertension[J]. BMC Cardiovasc Disord;2011,11, 1–7.Google Scholar
  9. 9.
    Tomiyama H, Hashimoto H, Tanaka H, Matsumoto C, Odaira M, Yamada J, et al. Brachial ankle PWV Collaboration Group. Synergistic relationship between changes in the pulse wave velocity and changes in the heart rate in middle-aged Japanese adults: a prospective study[J]. J Hypertens;2010,28:687–94.CrossRefGoogle Scholar
  10. 10.
    Chanudet X, Bauduceau B, Girerd X, et al. The influence of anthropometric factors, hemorheologic parameters and the level of arterial pressure on pulse wave velocity[J]. J Des Mal Vas. 1989;14(1):15–8.Google Scholar
  11. 11.
    Kim EY, Yi JH, Han SW, Shin J, Lee JU, Kim SG, et al. Clinical factors associated with brachial-ankle pulse wave velocity in patients on maintenance hemodialysis[J]. E & Bp. 2008;6(2):61–7.Google Scholar
  12. 12.
    Masaki N, Hakuno D, Toya T, Shiraishi Y, Kujiraoka T, Namba T, et al. Association between brachial-ankle pulse wave velocity and the ratio of l-arginine to asymmetric dimethylarginine in patients undergoing coronary angiography[J]. J Cardiol. 2015;65(4):311–7.CrossRefGoogle Scholar
  13. 13.
    Clinical practice guidelines for chronic kidney disease. Evaluation, classification and stratification: Part 4. Definition and classification of stages of chronic kidney disease [J]. Am J Kidney Dis;2002,39: S46–5.Google Scholar
  14. 14.
    O’Rourke MF, Pauca A, Jiang X-J. Pulse wave analysis[J]. Br J Clin Pharmacol. 2011;51:507–22.CrossRefGoogle Scholar
  15. 15.
    Velcheva I, Antonova N, Titianova E, Damianov P, Dimitrov N, Ivanov I. Hemorheological parameters in correlation with the risk factors for carotid atherosclerosis[J]. Clinical Hemorheology and Microcirculation;2006,35:195–8.Google Scholar
  16. 16.
    Gori T. Viscosity, platelet activation, and hematocrit: progress in understanding their relationship with clinical and subclinical vascular disease[J]. Clin Hemorheol Microcirc. 2011;49:37–42.CrossRefGoogle Scholar
  17. 17.
    Shen L, Wu W, You B, Gao H, Wang C, Liu Y. Relationship between pulse wave velocity and carotid atherosclerosis in geriatric people[J]. Cerebrovasc Dis. 2011;32:16–20.CrossRefGoogle Scholar
  18. 18.
    Salazar Vázquez B.Y, Martini J, Chávez N.A, Cabrales P, Tsai A.G, Intaglietta, M. Microvascular benefits of increasing plasma viscosity and maintaining blood viscosity: counterintuitive experimental findings[J]. Biorheology. 2009,46:167–179.CrossRefGoogle Scholar
  19. 19.
    Carallo C, Irace C, De Franceschi M.S, Coppoletta F, Tiriolo R, Scicchitano C, et al. The effect of aging on blood and plasma viscosity. An 11.6 years follow-up study[J]. Clinical Hemorheology and Microcirculation;2011,47:67–74.CrossRefGoogle Scholar
  20. 20.
    M Choe C. Jackson B.P.Yu. Lipid peroxidation contributes to age-related membrane rigidity [J]. Free Radic Biol Med;1995,18:977–84.CrossRefGoogle Scholar
  21. 21.
    Goi G, Cazzola R, Tringali C., Massaccesi L, Volpe S.R, Rondanelli M, et al. Erythrocyte membrane alterations during ageing affect beta-D-glucuronidase and neutral sialidase in elderly healthy subjects[J]. Exp Gerontol;2005;40:219–25.Google Scholar
  22. 22.
    Jae S.Y, Kurl S, Laukkanen J.A, Heffernan K.S, Choo J, Choi Y.H., et al. Higher blood hematocrit predicts hypertension in men[J]. J Hypertens; 2014;32:245–250.CrossRefGoogle Scholar
  23. 23.
    Khoudary S.R.E, Barinas-Mitchell E, White J, Sutton-Tyrrell K, Kuller L.H, Curb J.D, et al. Adiponectin, systolic blood pressure, and alcohol consumption are associated with more aortic stiffness progression among apparently healthy men [J]. Atherosclerosis; 2012, 225:475–480.
  24. 24.
    Lurbe E, Torro I, Garciavicent C, Alvarez J, Fernándezfornoso J.A, Redon J. Blood pressure and obesity exert independent influences on pulse wave velocity in youth[J]. Hypertension;2012, 60:550–5.
  25. 25.
    Brun J-F, Aloulou I, Varlet-Marie E. Hemorheological aspects of the metabolic syndrome: markers of insulin resistance, obesity or hyperinsulinemia? [J]. Clin Hemorheol Microcirc. 2004;30:203–9.PubMedGoogle Scholar
  26. 26.
    Tuttolomondo A, Di R.D Di, S. R Pecoraro R, Arnao V, Buttà C, et al. Arterial stiffness and ischemic stroke in subjects with and without metabolic syndrome[J]. Atherosclerosis ;2012, 225:216–219.CrossRefGoogle Scholar
  27. 27.
    Scuteri A, Cunha P.G, Rosei E.A, Badariere J, Bekaert S, Cockcroft J.R, et al. Arterial stiffness and influences of the metabolic syndrome:A cross-countries study[J]. Atherosclerosis;2014, 233:654–60.Google Scholar
  28. 28.
    Mahajan A, Jaiswal A, Tabassum R, Podder A, Ghosh S, Madhu S.V, et al. Elevated levels of C-reactive protein as a risk factor for metabolic syndrome in Indians[J]. Atherosclerosis;2012, 220:275–81.Google Scholar
  29. 29.
    Scuteri A, Najjar S.S, Muller D.C., Andres R, Hougaku H, Metter E.J, et al. Metabolic syndrome amplifies the ageassociated increases in vascular thickness and stiffness[J]. J Am Coll Cardiol;2004,43:1388–95.Google Scholar
  30. 30.
    Scuteri A, Najjar S.S., Orru M, Usala G., Piras M.G., Ferrucci L, et al. The central arterial burden of the metabolic syndrome is similar in men and women: the SardiNIA study[J]. Eur Heart J ;2010,31:602–613.CrossRefGoogle Scholar
  31. 31.
    Kawamoto R, Tabara Y, Kohara K, Miki T, Kusunoki T, Abe M, et al. Hematological parameters are associated with etabolic syndrome in Japanese community-dwelling persons[J]. Endocrine;2013, 43:334–41.CrossRefGoogle Scholar
  32. 32.
    Lohsoonthorn V, Dhanamun B, Williams MA. Prevalence of metabolic syndrome and its relationship to White blood cell count in a population of Thai men and women receiving routine health examinations[J]. Am J Hypertens. 2006;19:339–45.CrossRefGoogle Scholar

Copyright information

© Research Society for Study of Diabetes in India 2020

Authors and Affiliations

  1. 1.Department of EndocrinologyXuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, Affiliated Hospital of Southeast UniversityXuzhouChina
  2. 2.Xuzhou Institute of Medical Sciences, Xuzhou Institute of DiabetesXuzhouChina
  3. 3.Department of NutritionHarvard School of Public HealthBostonUSA

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