White Blood Cell Count Predicts Reduction in Coronary Heart Disease Mortality With Pravastatin

Abstract

Background-Elevated serum inflammatory marker levels are associated with a greater long-term risk of cardiovascular events. Because 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors (statins) may have an antiinflammatory action, it has been suggested that patients with elevated inflammatory marker levels may have a greater reduction in cardiovascular risk with statin treatment. Methods and Results-We evaluated the association between the white blood cell count (WBC) and coronary heart disease mortality during a mean follow-up of 6.0 years in the Long-Term Intervention With Pravastatin in Ischemic Disease (LIPID) Study, a clinical trial comparing pravastatin (40 mg/d) with a placebo in 9014 stable patients with previous myocardial infarction or unstable angina. An increase in baseline WBC was associated with greater coronary heart disease mortality in patients randomized to placebo (hazard ratio for 1ϫ10 9 /L increase in WBC, 1.18; 95% CI, 1.12 to 1.25; PϽ0.001) but not pravastatin (hazard ratio, 1.02; 95% CI, 0.96 to 1.09; Pϭ0.56; P for interactionϭ0.004). The numbers of coronary heart disease deaths prevented per 1000 patients treated with pravastatin were 0, 9, 30, and 38 for baseline WBC quartiles of Ͻ5.9, 6.0 to 6.9, 7.0 to 8.1, and Ͼ8.2ϫ10 9 /L, respectively. WBC was a stronger predictor of this treatment benefit than the ratio of total to high-density lipoprotein cholesterol and a global measure of cardiac risk. There was also a greater reduction (Pϭ0.052) in the combined incidence of cardiovascular mortality, nonfatal myocardial infarction, and stroke with pravastatin as baseline WBC increased (by quartile: 3, 41, 61, and 60 events prevented per 1000 patients treated, respectively). Conclusions-These

Leukocyte Count and Vascular Risk in Symptomatic Intracranial Atherosclerosis

“…Blacks have previously been demonstrated to have lower WBC counts than Whites [29, 30]. We also noted that among WASID subjects, an increased baseline WBC was associated with diabetes, obesity and hypertriglyceridemia, thereby supporting the results of previous studies pointing to inflammation as part of the metabolic syndrome [18, 31]. Similar to other studies that showed no association between inflammatory markers and low-density lipoprotein cholesterol level [2, 32], we did not observe any relationship between WBC and low-density lipoprotein cholesterol in this study.…”

Postconditioning attenuates myocardial injury by reducing nitro-oxidative stress in vivo in rats and in humans

“…Elevated WBC and neutrophils in patient [29,30] peripheral circulation have been shown to be associated with a greater risk of cardiovascular events in many epidemiological and clinical studies [31,32]. In our study, peripheral blood WBCs are elevated 4 to 24 h after PCI in patients.…”

Total leucocyte count, but not C-reactive protein, predicts 1-year mortality in patients with acute coronary syndromes treated with percutaneous coronary intervention

“…In the LIPID (Long-term Intervention with Pravastatin in Ischemic Disease) study, leucocyte count predicted cardiac mortality in patients randomized to placebo, but not in those who received pravastatin [22]. In the present study 90 % of patients with ACS received statins within the first year following PCI.…”