|
|
||||||||||
|
J Am Coll Cardiol, 2004; 44:1945-1956, doi:10.1016/j.jacc.2004.07.056 © 2004 by the American College of Cardiology Foundation |
,*

,
* University of TexasHouston Health Science Center, Houston, Texas
Texas Heart Institute, Houston, Texas
President Bush Center for Cardiovascular Health at Memorial Hermann Hospital, Houston, Texas
Manuscript received March 4, 2004; revised manuscript received July 10, 2004, accepted July 13, 2004.
* Reprint requests and correspondence: Dr. Mohammad Madjid, 6431 Fannin, MSB 1.260, Houston, Texas 77030 (Email: Mohammad.Madjid{at}uth.tmc.edu).
Inflammation is a key feature of atherosclerosis and its clinical manifestations. The leukocyte count is a marker of inflammation that is widely available in clinical practice. This paper reviews the available epidemiologic evidence for a relationship between the leukocyte count and coronary heart disease (CHD). Numerous epidemiologic and clinical studies have shown leukocytosis to be an independent predictor of future cardiovascular events, both in healthy individuals free of CHD at baseline and in patients with stable angina, unstable angina, or a history of myocardial infarction. This relationship has been observed in prospective and retrospective cohort studies, as well as in case-control studies. It is strong, consistent, temporal, dose-dependent, and biologically plausible. The relationship persists after adjustment for multiple CHD risk factors, including smoking. Elevated differential cell counts, including eosinophil, neutrophil, and monocyte counts, also predict the future incidence of CHD. Leukocytosis affects CHD through multiple pathologic mechanisms that mediate inflammation, cause proteolytic and oxidative damage to the endothelial cells, plug the microvasculature, induce hypercoagulability, and promote infarct expansion. In summary, leukocytosis has been consistently shown to be an independent risk factor and prognostic indicator of future cardiovascular outcomes, regardless of disease status. The leukocyte count is inexpensive, reliable, easy to interpret, and ordered routinely in inpatient and outpatient settings. However, its diagnostic and prognostic utility in CHD is widely unappreciated. Further studies are needed to assess the true impact of leukocytosis on CHD, compare it with other inflammatory markers such as C-reactive protein and lipoprotein phospholipase A2 levels, and promote its use in CHD prediction.
| ||||||||||||
This article has been cited by other articles:
![]() |
D. N. Tziakas, G. K. Chalikias, I. K. Tentes, D. Stakos, S. V. Chatzikyriakou, K. Mitrousi, A. X. Kortsaris, J. C. Kaski, and H. Boudoulas Interleukin-8 is increased in the membrane of circulating erythrocytes in patients with acute coronary syndrome Eur. Heart J., September 2, 2008; (2008) ehn382v1. [Abstract] [Full Text] [PDF] |
||||
![]() |
D Tousoulis, M Charakida, and C Stefanadis Endothelial function and inflammation in coronary artery disease Postgrad. Med. J., July 1, 2008; 84(993): 368 - 371. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. Morton, B. Coles, K. Wright, A. Gallimore, J. D. Morrow, E. S. Terry, P. B. Anning, B. P. Morgan, V. Dioszeghy, H. Kuhn, et al. Circulating neutrophils maintain physiological blood pressure by suppressing bacteria and IFN{gamma}-dependent iNOS expression in the vasculature of healthy mice Blood, May 15, 2008; 111(10): 5187 - 5194. [Abstract] [Full Text] [PDF] |
||||
![]() |
V. De Stefano, T. Za, E. Rossi, A. M. Vannucchi, M. Ruggeri, E. Elli, C. Mico, A. Tieghi, R. R. Cacciola, C. Santoro, et al. Recurrent thrombosis in patients with polycythemia vera and essential thrombocythemia: incidence, risk factors, and effect of treatments Haematologica, March 1, 2008; 93(3): 372 - 380. [Abstract] [Full Text] [PDF] |
||||
![]() |
B. H. Buck, D. S. Liebeskind, J. L. Saver, O. Y. Bang, S. W. Yun, S. Starkman, L. K. Ali, D. Kim, J. P. Villablanca, N. Salamon, et al. Early Neutrophilia Is Associated With Volume of Ischemic Tissue in Acute Stroke Stroke, February 1, 2008; 39(2): 355 - 360. [Abstract] [Full Text] [PDF] |
||||
![]() |
O Rogowski, I Shapira, A Shirom, S Melamed, S Toker, and S Berliner Heart rate and microinflammation in men: a relevant atherothrombotic link Heart, August 1, 2007; 93(8): 940 - 944. [Abstract] [Full Text] [PDF] |
||||
![]() |
O. C. Raffel, G. J. Tearney, D. D. Gauthier, E. F. Halpern, B. E. Bouma, and I.-K. Jang Relationship Between a Systemic Inflammatory Marker, Plaque Inflammation, and Plaque Characteristics Determined by Intravascular Optical Coherence Tomography Arterioscler. Thromb. Vasc. Biol., August 1, 2007; 27(8): 1820 - 1827. [Abstract] [Full Text] [PDF] |
||||
![]() |
L. G. Futterman and L. Lemberg The Leukocyte Count, A Measure and Predictor of Coronary Events Am. J. Crit. Care., July 1, 2007; 16(4): 401 - 404. [Full Text] [PDF] |
||||
![]() |
O. Stuve, C. M. Marra, P. D. Cravens, M. P. Singh, W. Hu, A. Lovett-Racke, N. L. Monson, J. T. Phillips, J. W. C. Tervaert, R. A. Nash, et al. Potential Risk of Progressive Multifocal Leukoencephalopathy With Natalizumab Therapy: Possible Interventions Arch Neurol, February 1, 2007; 64(2): 169 - 176. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Anwaruddin, A. T. Askari, and E. J. Topol Redefining Risk in Acute Coronary Syndromes Using Molecular Medicine J. Am. Coll. Cardiol., January 23, 2007; 49(3): 279 - 289. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. D Motton, N. L Keim, F. A Tenorio, W. F Horn, and J. C Rutledge Postprandial monocyte activation in response to meals with high and low glycemic loads in overweight women Am. J. Clinical Nutrition, January 1, 2007; 85(1): 60 - 65. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. Yang, Y. Cheng, R. Ji, and C. Zhang Novel model of inflammatory neointima formation reveals a potential role of myeloperoxidase in neointimal hyperplasia Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H3087 - H3093. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. L. Mehta Oxidized or Native Low-Density Lipoprotein Cholesterol: Which Is More Important in Atherogenesis? J. Am. Coll. Cardiol., September 5, 2006; 48(5): 980 - 982. [Full Text] [PDF] |
||||
![]() |
J. Yang, R. Ji, Y. Cheng, J.-Z. Sun, L. K. Jennings, and C. Zhang L-Arginine Chlorination Results in the Formation of a Nonselective Nitric-Oxide Synthase Inhibitor J. Pharmacol. Exp. Ther., September 1, 2006; 318(3): 1044 - 1049. [Abstract] [Full Text] [PDF] |
||||
![]() |
D Tousoulis, M Charakida, and C Stefanadis Endothelial function and inflammation in coronary artery disease Heart, April 1, 2006; 92(4): 441 - 444. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Zitzmann, M. Erren, A. Kamischke, M. Simoni, and E. Nieschlag Endogenous Progesterone and the Exogenous Progestin Norethisterone Enanthate Are Associated with a Proinflammatory Profile in Healthy Men J. Clin. Endocrinol. Metab., December 1, 2005; 90(12): 6603 - 6608. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. H. Jee, J. Y. Park, H.-S. Kim, T. Y. Lee, and J. M. Samet White Blood Cell Count and Risk for All-Cause, Cardiovascular, and Cancer Mortality in a Cohort of Koreans Am. J. Epidemiol., December 1, 2005; 162(11): 1062 - 1069. [Abstract] [Full Text] [PDF] |
||||
![]() |
H. D. Aronow, M. Shishehbor, D. A. Davis, I. L. Katzan, D. L. Bhatt, C. T. Bajzer, A. Abou-Chebl, K. W. Derk, P. L. Whitlow, and J. S. Yadav Leukocyte Count Predicts Microembolic Doppler Signals During Carotid Stenting: A Link Between Inflammation and Embolization Stroke, September 1, 2005; 36(9): 1910 - 1914. [Abstract] [Full Text] [PDF] |
||||
![]() |
F.-M. Chung, J. C.-R. Tsai, D.-M. Chang, S.-J. Shin, and Y.-J. Lee Peripheral Total and Differential Leukocyte Count in Diabetic Nephropathy: The relationship of plasma leptin to leukocytosis Diabetes Care, July 1, 2005; 28(7): 1710 - 1717. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. A. VanderLaan and C. A. Reardon Thematic review series: The Immune System and Atherogenesis. The unusual suspects:an overview of the minor leukocyte populations in atherosclerosis J. Lipid Res., May 1, 2005; 46(5): 829 - 838. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Cushman Leukocyte Count in Vascular Risk Prediction Arch Intern Med, March 14, 2005; 165(5): 487 - 488. [Full Text] [PDF] |
||||
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |