Relationship of neutrophil–lymphocyte ratio with arterial stiffness and coronary calcium score
Introduction
Although the atherosclerotic pathogenesis remains unclear, an increasing body of evidence suggests that arterial inflammation may play a crucial role [1], [2]. Higher levels of inflammatory markers, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and interleukin-6 (IL-6) have been significantly associated with cardiovascular disease (CVD) morbidity and mortality [1], [2]. White blood cell (WBC) count is one of the useful inflammatory biomarkers in clinical practice. Recently, WBC count has become a useful predictor of certain diseases as well as a marker of infection. A higher level of WBC count, even within normal range, has been associated with atherosclerotic CVD events [3]. WBCs are composed of five different types of immune cells. Each subtype of WBCs exerts its own effect in different manners. More recently, the neutrophil/lymphocyte ratio (NLR) has been also proposed as a useful biomarker to predict cardiovascular risk [4], [5], [6]. Epidemiologic evidence has shown that NLR could be a prognostic marker in acute coronary syndrome and a more powerful predictor than any other WBC subtypes [6], [7].
Various non-invasive markers of early arterial wall alteration such as arterial wall thickness and stiffness are now available. Pulse wave velocity (PWV) is a reliable indicator of vascular damage and atherosclerosis [8], [9]. Previous studies have shown that increased PWV is independently associated with CVD incidence and mortality [10], [11]. Moreover, the coronary calcium score (CCS), measured by multidetector computed tomography (MDCT), is a sensitive marker of coronary artery atherosclerosis and reflects the severity of coronary artery stenosis to some extent [12], [13]. Recent epidemiologic evidence suggests that the measurement of arterial stiffness and CCS could be additive to the Framingham risk score to help identify patients with cardiovascular risks [14], [15].
Until now, the association between NLR and subclinical atherosclerosis in the general population has been poorly understood. Thus, we examined whether NLR is related to atherosclerosis measured by baPWV and CCS in Korean adults in a health examination program.
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Subjects
We retrospectively reviewed the medical records of 849 consecutive adults (540 men and 309 women) who voluntarily participated in a medical examination program at the Health Promotion Center in Gangnam Severance Hospital, Seoul, Korea, between October 2007 and November 2008. The inclusion criteria included subjects that were healthy, community-dwelling people.
Subjects meeting any of the following criteria were excluded (n = 45): any missing covariate information; age above 80 years to rule out
Results
Table 1 shows the general characteristics of the study population of 804 subjects with mean age 52.4 ± 9.2 y. The mean WBC count (x103 cells/μL) was 5.9±1.6 and the mean NLR was 2.1 ± 0.8. The mean baPWV was 1398.5 cm/s, and the geometric mean CCS was 36.6±6.1. Overall, hypertension was prevalent in 32.5% of the study population, and the proportion of diabetes was 9.0%.
The clinical and biochemical characteristics according to NLR quartiles are shown in Table 2. The percentage of current smokers and
Discussion
In this cross-sectional study, we found that the risk for high baPWV and CCS is significantly increased in the highest quartile of NLR. This effect remained after adjusting the presence of drugs that could modify vascular function parameters, such as blood pressure lowering drugs, anti-diabetic drugs, and lipid lowering drugs.
The reference value for baPWV is different according to age and blood pressure categories [16]. A baPWV > 1400 cm/s has been shown to be a useful predictor of cardiovascular
Acknowledgement
The authors would like to thank Mr. Tim Gitzen for his help in editing the manuscript.
References (37)
- et al.
Counts of neutrophils, lymphocytes, and monocytes, cause-specific mortality and coronary heart disease: the NHANES-I epidemiologic follow-up study
Ann Epidemiol
(2005) - et al.
Intermountain Heart Collaborative Study Group. Which white blood cell subtypes predict increased cardiovascular risk?
J Am Coll Cardiol
(2005) - et al.
Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome
Am J Cardiol
(2008) - et al.
Brachial–ankle pulse wave velocity as a marker of subclinical organ damage in middle-aged patients with hypertension
J Cardiol
(2008) - et al.
Electron beam computed tomographic coronary calcium scanning: a review and guidelines of use in asymptomatic persons
Mayo Clin Proc
(1999) - et al.
Elevated white blood cell count is associated with arterial stiffness
Nutr Metab Cardiovasc Dis
(2009) - et al.
Aortic pulse wave velocity and the degree of atherosclerosis in the elderly: a pathological study based on 304 autopsy cases
Atherosclerosis
(2005) Leukocyte–endothelial interactions
Blood
(1985)- et al.
Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrogram and normal troponin levels
Atherosclerosis
(2009) Beneficial effect(s) of n−3 fatty acids in cardiovascular diseases: but, why and how?
Prostaglandins Leukot Essent Fatty Acids
(2000)
Atherosclerosis—an inflammatory disease
N Engl J Med
Inflammation and atherosclerosis
Circulation
White blood cell count and risk for all-cause, cardiovascular, and cancer mortality in a cohort of Koreans
Am J Epidemiol
Association of peripheral total and differential leukocyte counts with metabolic syndrome and risk of ischemic cardiovascular diseases in patients with type 2 diabetes mellitus
Diab/Metab Res Rev
Validity, reproducibility, and clinical significance of noninvasive brachial–ankle pulse wave velocity measurement
Hypertens Res
Arterial stiffness and cardiovascular risk factors in a population-based study
J Hypertens
Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study
Hypertension
Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients
Hypertension
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