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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

IMPACT FACTOR 2018: 3.638

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Volume 54, Issue 5


Platelet volume is associated with the Framingham risk score for cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Chams B. Maluf
  • Department of Clinical Pathology, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Sandhi M. Barreto
  • Department of Public Health, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Rodrigo C.P. dos Reis
  • Department of Public Health, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Pedro G. Vidigal
  • Corresponding author
  • Department of Clinical Pathology, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2015-11-17 | DOI: https://doi.org/10.1515/cclm-2015-0686



Platelet volume indices (PVI), an easy and inexpensive surrogate measure of platelet function, have been associated with cardiovascular diseases (CVD) and their risk factors. However, results are conflicting because of the lack of standardized procedures. The purpose of this study is to investigate the relationship of PVI with the Framingham risk score (FRS).


Baseline data (2008–2010) of 3115 participants enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were used. PVI measurements were strictly controlled. The cohort was distributed according to risk factors and the general FRS was estimated. Multiple linear regression analysis was used to estimate the association between PVI and FRS.


Mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (P-LCR) independently correlated (p≤0.01) with FRS after adjustment for confounding variables. One unit increase in MPV, PDW, or P-LCR increased the FRS by 0.59%, 0.40%, and 0.08%, respectively. Diabetics had higher (p≤0.004) MPV, PDW, and P-LCR, and hypertensive individuals had higher (p≤0.045) PDW and P-LCR.


Increased PVI was independently correlated with higher CVD risk based on the FRS, diabetes, and systolic hypertension. Prospective follow up of this cohort is warranted to confirm that PVI is associated with the development of CVD.

Keywords: cardiovascular disease; Framingham risk score; mean platelet volume; platelet distribution width; platelets


  • 1.

    Kaplan ZS, Jackson SP. The role of platelets in atherothrombosis. Hematology Am Soc Hematol Educ Program 2011;1:51–61.Google Scholar

  • 2.

    Brummitt DR, Barker HF. The determination of a reference range for new platelet parameters produced by the Bayer ADVIA (TM) 120 full blood count analyser. Clin Lab Haematol 2000;22:103–7.Google Scholar

  • 3.

    Martin JF, Kristensen SD, Mathur A, Grove EL, Choudry FA. The causal role of megakaryocyte-platelet hyperactivity in acute coronary syndromes. Nat Rev Cardiol 2012;9:658–70.Google Scholar

  • 4.

    Jackson SR, Carter JM. Platelet volume – laboratory measurement and clinical-application. Blood Rev 1993;7:104–13.Google Scholar

  • 5.

    Dastjerd MS, Emami T, Najafian A, Amini M. Mean platelet volume measurement, EDTA or citrate? Hematology 2006;11:317–9.Google Scholar

  • 6.

    Thompson CB, Love DG, Quinn PG, Valeri CR. Platelet Size does not correlate with platelet age. Blood 1983;62:487–94.Google Scholar

  • 7.

    Slavka G, Perkmann T, Haslacher H, Greisenegger S, Marsik C, Wagner OF, et al. Mean Platelet volume may represent a predictive parameter for overall vascular mortality and ischemic heart disease. Arterioscler Thromb Vasc Biol 2011;31:1215–8.Google Scholar

  • 8.

    Sansanayudh N, Anothaisintaweet, Muntham D, Mcevoy M, Attia J, Thakkinstian A. Mean platelet volume and coronary artery disease: a systematic review and meta-analysis. Int J Cardiol 2014;175:433–40.Google Scholar

  • 9.

    Soranzo N, Spector TD, Mangino M, Kuehnel B, Rendon A, Teumer A, et al. A genome-wide meta-analysis identifies 22 loci associated with eight hematological parameters in the HaemGen consortium. Nat Genet 2009;41:1182–90.Google Scholar

  • 10.

    Kunicki TJ, Nugent DJ. The genetics of normal platelet reactivity. Blood 2010;116:2627–34.Google Scholar

  • 11.

    Johnson AD, Yanek LR, Chen M-H, Faraday N, Larson MG, Tofler G, et al. Genome-wide meta-analyses identifies seven loci associated with platelet aggregation in response to agonists. Nat Genet 2010;42:608–13.Google Scholar

  • 12.

    Johnson AD. The genetics of common variation affecting platelet development, function and pharmaceutical targeting. J Thromb Haemost 2011;9:246–57.Google Scholar

  • 13.

    Shameer K, Denny JC, Ding K, Jouni H, Crosslin DR, de Andrade M, et al. A genome- and phenome-wide association study to identify genetic variants influencing platelet count and volume and their pleiotropic effects. Hum Genet 2014;133:95–109.Google Scholar

  • 14.

    Kario K, Matsuo T, Nakao K. Cigarette-smoking increases the mean platelet volume in elderly patients with risk-factors for atherosclerosis. Clin Lab Haematol 1992;14:281–7.Google Scholar

  • 15.

    Grotto HZ, Noronha JF. Platelet larger cell ratio (P-LCR) in patients with dyslipidemia. Clin Lab Haematol 2004;26:347–9.Google Scholar

  • 16.

    Coban E, Afacan B. The effect of rosuvastatin treatment on the mean platelet volume in patients with uncontrolled primary dyslipidemia with hypolipidemic diet treatment. Platelets 2008;19:111–4.Google Scholar

  • 17.

    De Luca G, Santagostino M, Secco GG, Cassetti E, Giuliani L, Franchi E, et al. Mean platelet volume and the extent of coronary artery disease. Results from a large prospective study. Atheroscler 2009;206:292–7.Google Scholar

  • 18.

    Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost 2010;8:148–56.Google Scholar

  • 19.

    Kutlucan A, Bulur S, Kir S, Bulur S, Onder E, Aslantas Y, et al. The relationship between mean platelet volume with metabolic syndrome in obese individuals. Blood Coagul Fibrinolysis 2012;23:388–90.Google Scholar

  • 20.

    Lippi G, Mattiuzzi C, Comelli I, Cervellin G. Mean platelet volume in patients with ischemic heart disease: meta-analysis of diagnostic studies. Blood Coagul Fibrinolysis 2013;24: 216–9.Google Scholar

  • 21.

    Markovic D, Carevic V, Bonacin D, Sekulic BP, Sapunar A, Fabijanic D. Correlation between mean platelet volume and total risk of cardiovascular disease. Signa Vitae 2013;8:49–55.Google Scholar

  • 22.

    Zaccardi F, Rocca B, Pitocco D, Tanese L, Rizzi A, Ghirlanda G. Platelet mean volume, distribution width, and count in type 2 diabetes, impaired fasting glucose, and metabolic syndrome: a meta-analysis. Diabetes Metab Res Rev 2015;31:402–10.Google Scholar

  • 23.

    Wynn RF, Davies SV, Williams K, Trevett DG. The effects of time from venipuncture and choice of anticoagulant on mean platelet volume estimations. Clin Lab Haematol 1995;17:173–6.Google Scholar

  • 24.

    Diaz-Ricart M, Brunso L, Pino M, Navalon F, Jou J, Heras M, et al. Preanalytical treatment of EDTA-anticoagulated blood to ensure stabilization of the mean platelet volume and component measured with the ADVIA counters. Thromb Res 2010;126:e30–5.Google Scholar

  • 25.

    Lance MD, Sloep M, Henskens YM, Marcus MA. Mean platelet volume as a diagnostic marker for cardiovascular disease: drawbacks of preanalytical conditions and measuring techniques. Clin Appl Thromb Hemost 2012;18:561–8.Google Scholar

  • 26.

    Maluf CB, Barreto SM, Vidigal PG. Standardization and reference intervals of platelet volume indices: insight from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Platelets 2015;26:413–20.Google Scholar

  • 27.

    D’agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care – The Framingham Heart Study. Circulation 2008;117:743–53.Google Scholar

  • 28.

    Aquino EM, Barreto SM, Bensenor IM, Carvalho MS, Chor D, Duncan BB, et al. Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): objectives and design. Am J Epidemiol 2012;175:315–24.Google Scholar

  • 29.

    Schmidt MI, Duncan BB, Mill JG, Lotufo PA, Chor D, Barreto SM, et al. Cohort profile: Longitudinal Study of Adult Health (ELSA-Brasil). Int J Epidemiol 2015;44:68–75.Google Scholar

  • 30.

    CLSI. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; approved standard-sixth edition. CLSI Document H3-A6, Wayne (PA): CLSI, 2007.Google Scholar

  • 31.

    Fedeli LG, Vidigal PG, Leite CM, Castilhos CD, Pimentel RA, Maniero VC, et al. Logistics of collection and transportation of biological samples and the organization of the central laboratory in the ELSA-Brasil. Rev Saúde Pública 2013;47(Suppl 2):63–71.Google Scholar

  • 32.

    Maluf CB, Silva IO, Vidigal PG. Understanding commutability: important quality requirement for clinical laboratories. J Bras Patol Med Lab 2011;47:595–601.Google Scholar

  • 33.

    Ghaffari S, Pourafkari L, Javadzadegan H, Masoumi N, Jafarabadi MA, Nader ND. Mean platelet volume is a predictor of ST resolution following thrombolysis in acute ST elevation myocardial infarction. Thromb Res 2015;136:101–6.Google Scholar

  • 34.

    Lai HM, Chen QJ, Yang YN, Ma YT, Li XM, Xu R, et al. Association of mean platelet volume with impaired myocardial reperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Blood Coagul Fibrinolysis 2015;26:724–33.Google Scholar

  • 35.

    De Luca G, Venegoni L, Iorio S, Secco GG, Cassetti E, Verdoia M, et al. Platelet distribution width and the extent of coronary artery disease: results from a large prospective study. Platelets 2010;21:508–14.Google Scholar

  • 36.

    De Luca G, Secco GG, Verdoia M, Cassetti E, Schaffer A, Coppo L, et al. Novara Atherosclerosis Study G. Combination between mean platelet volume and platelet distribution width to predict the prevalence and extent of coronary artery disease: results from large cohort study. Blood Coagul fibrinol 2014;25:86–91.Google Scholar

  • 37.

    Boos CJ, Beevers GD, Lip GY. Assessment of platelet activation indices using the ADVIATM 120 amongst ‘high-risk’ patients with hypertension. Ann Med 2007;39:72–8.Google Scholar

  • 38.

    Kaya MG, Yarlioglues M, Gunebakmaz O, Gunturk E, Inanc T, Dogan A, et al. Platelet activation and inflammatory response in patients with non-dipper hypertension. Atherosclerosis 2010;209:278–82.Google Scholar

  • 39.

    Yazici M, Kaya A, Kaya Y, Albayrak S, Cinemre H, Ozhan H. Lifestyle modification decreases the mean platelet volume in prehypertensive patients. Platelets 2009;20:58–63.Google Scholar

  • 40.

    Inanc T, Kaya MG, Yarlioglues M, Ardic I, Ozdogru I, Dogan A, et al. The mean platelet volume in patients with non-dipper hypertension compared to dippers and normotensives. Blood Press 2010;19:81–5.Google Scholar

  • 41.

    Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des 2011;17:47–58.Google Scholar

  • 42.

    Wakeman L, Al-Ismail S, Benton A, Beddall A, Gibbs A, Hartnell S, et al. Robust, routine haematology reference ranges for healthy adults. Int J Lab Hematol 2007;29:279–83.Google Scholar

  • 43.

    Yousuf O, Bhatt DL. The evolution of antiplatelet therapy in cardiovascular disease. Nat Rev Cardiol 2011;8: 547–59.Google Scholar

  • 44.

    Pignatelli P, Pastori D, Farcomeni A, Nocella C, Bartimoccia S, Vicario T, et al. Mediterranean diet reduces thromboxane A2 production in atrial fibrillation patients. Clin Nutr 2015;34:899–903.Google Scholar

About the article

Corresponding author: Professor Pedro G. Vidigal, MSc, MD, Department of Clinical Pathology, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Sala 403, Belo Horizonte, Minas Gerais, CEP 30130-100, Brazil, Phone: +55 31 3409-9774, Fax: +55 31 3409-9782, E-mail:

Received: 2015-07-17

Accepted: 2015-10-06

Published Online: 2015-11-17

Published in Print: 2016-05-01

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: The ELSA-Brasil baseline study was supported by the Brazilian Ministry of Health (Science and Technology Department DECIT) and the Brazilian Ministry of Science and Technology (FINEP, Financiadora de Estudos e Projetos and CNPq, National Research Council), grants 01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06 0278.00 MG, 01 06 0115.00 SP, 01 06 0071.00 RJ. SMB is a research fellow of the National Research Council (CNPq, grant number 300159/99-4).

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 54, Issue 5, Pages 879–887, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2015-0686.

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