Potential of Monocyte Count for the Assessment of Cardiovascular Disease

Abstract

Atherosclerosis is a chronic inflammatory disease proceeding from an imbalance in lipid metabolism and immune responses. Since leukocytes, especially monocytes and monocyte-derived macrophages, play pivotal roles in the progression of atherosclerosis, it is possible that monocyte count is a beneficial marker for predicting cardiovascular disease (CVD). Many epidemiologic and clinical studies have indicated monocytosis to be an independent predictor of cardiovascular events, both in healthy individuals at baseline and in patients with CVD or with high risk diseases for CVD, such as diabetes, dyslipidemia, hypertension and chronic kidney disease. This relationship has been observed in prospective and retrospective cohort studies, and endures after adjustment for several CVD risk factors. Other indicators utilized monocyte count, such as lymphocyte-to-monocyte ratio, monocyte-to-lymphocyte ratio and monocyte-to-high-density lipoprotein cholesterol ratio, were also independently associated with cardiovascular events and its mortality. In this review, we discussed the clinical utility of the monocyte count as a predictive marker in atherosclerotic diseases.

Chronic Kidney Disease Severity Is Associated With Selective Expansion of a Distinctive Intermediate Monocyte Subpopulation

“…Abnormalities of the circulating monocyte repertoire may specifically contribute to the escalation of cardiovascular risk that occurs as CKD progresses by driving endothelial dysfunction and atherosclerosis (42). Indeed, blood monocyte number has been known for some time to have general predictive value for ASCVD (43). For example, Prentice et al (44) observed that increased numbers of blood neutrophils and monocytes were associated with coronary artery disease.…”

“…Additionally, in a report from the Atherosclerosis Risk in Communities (ARIC) study, the highest quartile for blood monocyte count had 40% increased cardiovascular mortality compared to the lowest quartile (45). Furthermore, total monocyte count, monocyte-to-lymphocyte ratio and monocyte-to-high density lipoprotein ratio have variously been reported to have prognostic value for ASCVD outcomes (43, 45–47). Most strikingly, in a large epidemiological study in the US, Bowe et al recently demonstrated a linear relationship between blood monocyte count and adverse renal outcomes including doubling of serum creatinine, eGFR decline ≥30%, or a composite of ESRD, dialysis, or renal transplantation (19).…”