Counts of Neutrophils, Lymphocytes, and Monocytes, Cause-specific Mortality and Coronary Heart Disease: The NHANES-I Epidemiologic Follow-up Study
Introduction
Like several other circulating markers of inflammation, white blood cell count (WBC) has been reported to be an independent predictor of coronary heart disease (CHD) incidence and all-cause mortality 1, 2, 3, 4. Relatively few studies have examined counts of types of white blood cells. Cigarette smoking produces substantial increases in WBC within the range of normal values 1, 2. The existence of an adverse effect of elevated counts of granulocytes, neutrophils, lymphocytes, and monocytes on mortality independent of smoking requires further study. To test the hypothesis that elevated counts of these cell types are associated with increased risk of death and CHD incidence, and to examine the independence of an effect of these counts from effects of smoking and other risk factors, data were examined from a prospective follow-up study of a national sample.
Section snippets
Methods
The NHANES-I Epidemiologic Follow-up Study (NHEFS) is a longitudinal study of participants in NHANES-I who were 25 to 74 years of age at the time of the survey (1971–1975) 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. The personal interviews, physical and laboratory examinations of NHANES I provided the baseline data for the NHEFS. This analysis was based on four waves of follow-up data collection during 1982 to 1984, 1986, 1987, and 1992. For assessment of mortality and CHD incidence by differential WBC
All causes
There were 1493 deaths from all causes. Persons with a neutrophil count in the third tertile (> 4.802 × 109 cells/L) had a greater risk of death than persons with counts in the first tertile (<3.611 × 109 cells/L): RR = 1.41, p < 0.0001 after adjusting for age and gender (Table 1). The test for trend was significant (p = 0.001). Adjusting for age, gender, and smoking, the RR was diminished but still significant (RR = 1.24, 1.09–1.41, p = 0.001). Adjusting in addition for multiple risk factors with or
Discussion
As for C-reactive protein concentration and other circulating markers of inflammation, the nature of the association of WBC with the risk of CHD, cardiovascular, and non-cardiovascular death is unclear and has been discussed at length elsewhere 19, 20, 21, 22, 23, 24, 25, 26. Elevating WBC may be one mechanism by which cigarette smoking increases the risk of CHD and death. Differential WBC counts were similar in smokers and nonsmokers and the association of WBC with smoking could not be
Conclusions
Findings regarding neutrophil count and death in the NHEFS cohort provide important support for an association of relatively elevated neutrophil count with increased risk of death after adjusting for smoking and other risk factors.
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