Low eosinophil and low lymphocyte counts and the incidence of 12 cardiovascular diseases: a CALIBER cohort study

Abstract

Background: Eosinophil and lymphocyte counts are commonly performed in clinical practice. Previous studies provide conflicting evidence of association with cardiovascular diseases.

Methods: We used linked primary care, hospitalisation, disease registry and mortality data in England (the CALIBER (CArdiovascular disease research using LInked Bespoke studies and Electronic health Records) programme). We included people aged 30 or older without cardiovascular disease at baseline, and used Cox models to estimate cause-specific HRs for the association of eosinophil or lymphocyte counts with the first occurrence of cardiovascular disease.

Results: The cohort comprised 775 231 individuals, of whom 55 004 presented with cardiovascular disease over median follow-up 3.8 years. Over the first 6 months, there was a strong association of low eosinophil counts (<0.05 compared with 0.15-0.25×10(9)/L) with heart failure (adjusted HR 2.05; 95% CI 1.72 to 2.43), unheralded coronary death (HR 1.94, 95% CI 1.40 to 2.69), ventricular arrhythmia/sudden cardiac death and subarachnoid haemorrhage, but not angina, non-fatal myocardial infarction, transient ischaemic attack, ischaemic stroke, haemorrhagic stroke, subarachnoid haemorrhage or abdominal aortic aneurysm. Low eosinophil count was inversely associated with peripheral arterial disease (HR 0.63, 95% CI 0.44 to 0.89). There were similar associations with low lymphocyte counts (<1.45 vs 1.85-2.15×10(9)/L); adjusted HR over the first 6 months for heart failure was 2.25 (95% CI 1.90 to 2.67). Associations beyond the first 6 months were weaker.

Conclusions: Low eosinophil counts and low lymphocyte counts in the general population are associated with increased short-term incidence of heart failure and coronary death.

Trial registration number: NCT02014610; results.

Keywords: HEART FAILURE.

Figure 1

Cumulative incidence curves for different initial presentations of cardiac disease by category of eosinophil and lymphocyte count. Shading denotes 95% CIs.

Figure 2

Cumulative incidence curves for non-cardiac initial presentations of cardiovascular disease by category of eosinophil and lymphocyte count. Shading denotes 95% CIs.

Figure 3

Association of low eosinophil and lymphocyte counts with different initial presentations of cardiovascular disease over the first 6 months ‘Low eosinophils’ are the lowest category (<0.05) compared with the middle category (0.15−0.25). ‘Low lymphocytes’ are the lowest category (<1.45) compared with the middle category (1.85−2.15). HRs are adjusted for age, sex, deprivation, ethnicity, smoking, diabetes, systolic blood pressure, body mass index, total cholesterol, HDL cholesterol, eGFR, atrial fibrillation, autoimmune conditions, inflammatory bowel disease, COPD, cancer, statin use, blood pressure medication and acute conditions at the time of blood testing. COPD, chronic obstructive pulmonary disease; eGFR, estimated glomerular filtration rate; HDL, high-density lipoprotein.