Which white blood cell subtypes predict increased cardiovascular risk?

Abstract:

OBJECTIVES:We sought to determine the predictive ability of total white blood cell (WBC) count and its subtypes for risk of death or myocardial infarction (MI). BACKGROUND:An elevated WBC count has been associated with cardiovascular risk, but which leukocyte subtypes carry this risk is uncertain. METHODS:Consecutive patients without acute MI who were assessed angiographically for coronary artery disease (CAD) and were followed up long-term were studied. The predictive ability for death/MI of quartile (Q) 4 versus Q1 total WBC, neutrophil (N), lymphocyte (L), and monocyte (M) counts and N/L ratio were assessed using Cox regressions. RESULTS:A total of 3,227 patients was studied. Mean age was 63 years; 63% of patients were male, and 65% had CAD. In multivariable modeling entering standard risk factors, presentation, and CAD severity, the total WBC (hazard ratio [HR] 1.4, p = 0.01) and M (HR 1.3, p < 0.02) were weaker and N (HR 1.8, p < 0.001), L (HR 0.51, p < 0.001), and N/L ratio (HR 2.2, p < 0.001) were independent predictors of death/MI. When WBC variables were entered together, N/L ratio and M were retained as independent predictors. Risk associations persisted in analyses restricted to CAD patients or including acute MI patients. CONCLUSIONS:Total WBC count is confirmed to be an independent predictor of death/MI in patients with or at high risk for CAD, but greater predictive ability is provided by high N (Q4 >6.6 x 10(3)/microl) or low L counts. The greatest risk prediction is given by the N/L ratio, with Q4 versus Q1 (>4.71 versus <1.96) increasing the hazard 2.2-fold. These findings have important implications for CAD risk assessment.

journal_name

J Am Coll Cardiol

authors

Horne BD,Anderson JL,John JM,Weaver A,Bair TL,Jensen KR,Renlund DG,Muhlestein JB,Intermountain Heart Collaborative Study Group.

doi

10.1016/j.jacc.2005.02.054

subject

Has Abstract

pub_date

2005-05-17 00:00:00

pages

1638-43

issue

10

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(05)00491-2

journal_volume

45

pub_type

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