Which white blood cell subtypes predict increased cardiovascular risk?

J Am Coll Cardiol. 2005 May 17;45(10):1638-43. doi: 10.1016/j.jacc.2005.02.054. Epub 2005 Apr 25.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / immunology
  • Coronary Artery Disease / mortality
  • Female
  • Humans
  • Leukocyte Count*
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Monocytes / immunology
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / immunology
  • Myocardial Infarction / mortality
  • Neutrophils / immunology
  • Predictive Value of Tests
  • Reference Values
  • Risk
  • Survival Rate