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CLINICAL RESEARCH: WHITE CELL COUNT AND CARDIOVASCULAR MORTALITY

White Blood Cell Count and Mortality in the Baltimore Longitudinal Study of Aging

Carmelinda Ruggiero, MD^_*,,_*, E. Jeffrey Metter, MD^_*, Antonio Cherubini, MD, PhD, Marcello Maggio, MD, PhD^_*, Ranjan Sen, MD, PhD, Samer S. Najjar, MD, Gwen B. Windham, MD^_*, Alessandro Ble, MD^_*, Umberto Senin, MD and Luigi Ferrucci, MD, PhD^_*

^_* Longitudinal Studies Section, Clinical Research Branch USA
Laboratory of Cellular and Molecular Biology, and the USA
Human Cardiovascular Studies Unit, Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
Department of Geriatrics and Gerontology, University of Perugia, Perugia, Italy

Manuscript received October 10, 2006; revised manuscript received January 9, 2007, accepted January 13, 2007.

^_* Reprint requests and correspondence: Dr. Carmelinda Ruggiero, National Institute of Aging, NIH, 3001 South Hanover Street, Baltimore, Maryland 21225. (Email: ruggieroc07{at}hotmail.it).

Objectives: We investigated the secular trend in white blood cell (WBC) count and the relationship between WBC count and mortality between 1958 and 2002.

Background: The WBC count is a clinical marker of inflammation and a strong predictor of mortality. Limited data exist on the WBC count secular trend and the relationship between WBC and mortality.

Methods: One thousand eighty-three women and 1,720 men were evaluated longitudinally in the Baltimore Longitudinal Study of Aging. Blood samples and medical information were collected at the study entry and every 2 years during follow-up visits. The WBC count and all-cause, cardiovascular, and cancer mortality were assessed.

Results: A downward trend in WBC count was observed from 1958 to 2002. The secular downward trend was independent of age, gender, race, smoking, body mass index, and physical activity. The WBC count was nonlinearly associated with all-cause mortality and almost linearly associated with cardiovascular mortality. Participants with baseline WBC <3,500 cells/mm³ and WBC >6,000 cells/mm³ had higher mortality than those with 3,500 to 6,000 WBC/mm³. Within each WBC group, age-adjusted mortality rates declined in successive cohorts from the 1960s to the 1990s. Participants who died had higher WBC than those who survived, and the difference was statistically significant within 5 years before death.

Conclusions: Our study provides evidence for a secular downward trend in WBC count over the period from 1958 to 2002. Higher WBC counts are associated with higher mortality in successive cohorts. We found no evidence that the decline of age-specific mortality rates that occurred from 1960 to 2000 was attributable to a secular downward trend in WBC.

Abbreviations and Acronyms   BMI = body mass index   CI = confidence interval   HR = hazard ratio   MET = metabolic unit   WBC = white blood cell

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