Format

Send to

Choose Destination
J Am Coll Cardiol. 2017 Mar 7;69(9):1160-1169. doi: 10.1016/j.jacc.2016.12.022.

Neutrophil Counts and Initial Presentation of 12 Cardiovascular Diseases: A CALIBER Cohort Study.

Author information

1
Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom. Electronic address: anoop@doctors.org.uk.
2
Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, United Kingdom.
3
National Institute for Cardiovascular Outcomes Research, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom.
4
Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom.

Abstract

BACKGROUND:

Neutrophil counts are a ubiquitous measure of inflammation, but previous studies on their association with cardiovascular disease (CVD) were limited by small numbers of patients or a narrow range of endpoints.

OBJECTIVES:

This study investigated associations of clinically recorded neutrophil counts with initial presentation for a range of CVDs.

METHODS:

We used linked primary care, hospitalization, disease registry, and mortality data in England. We included people 30 years or older with complete blood counts performed in usual clinical care and no history of CVD. We used Cox models to estimate cause-specific hazard ratios (HRs) for 12 CVDs, adjusted for cardiovascular risk factors and acute conditions affecting neutrophil counts (such as infections and cancer).

RESULTS:

Among 775,231 individuals in the cohort, 154,179 had complete blood counts performed under acute conditions and 621,052 when they were stable. Over a median 3.8 years of follow-up, 55,004 individuals developed CVD. Adjusted HRs comparing neutrophil counts 6 to 7 versus 2 to 3 × 109/l (both within the 'normal' range) showed strong associations with heart failure (HR: 2.04; 95% confidence interval [CI]: 1.82 to 2.29), peripheral arterial disease (HR: 1.95; 95% CI: 1.72 to 2.21), unheralded coronary death (HR: 1.78; 95% CI: 1.51 to 2.10), abdominal aortic aneurysm (HR: 1.72; 95% CI: 1.34 to 2.21), and nonfatal myocardial infarction (HR: 1.58; 95% CI: 1.42 to 1.76). These associations were linear, with greater risk even among individuals with neutrophil counts of 3 to 4 versus 2 to 3 × 109/l. There was a weak association with ischemic stroke (HR: 1.36; 95% CI: 1.17 to 1.57), but no association with stable angina or intracerebral hemorrhage.

CONCLUSIONS:

Neutrophil counts were strongly associated with the incidence of some CVDs, but not others, even within the normal range, consistent with underlying disease mechanisms differing across CVDs. (White Blood Cell Counts and Onset of Cardiovascular Diseases: a CALIBER Study [CALIBER]; NCT02014610).

KEYWORDS:

disease mechanisms; electronic health records; epidemiology; incidence; inflammation

PMID:
28254179
PMCID:
PMC5332591
DOI:
10.1016/j.jacc.2016.12.022
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center