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Predictor of CV Events and Mortality in Postmenopausal Women: Leukocyte Count. Background and objective. Background: Increasing evidence supports a role for inflammation in the atherosclerotic process

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Background and objective

Background: Increasing evidence supports a role for inflammation in the atherosclerotic process

Objective: Describe relationship between baseline leukocyte (WBC) count, future CVD events, and mortality in postmenopausal women

Source: Women’s Health Initiative Observational Study

Margolis KL et al. Arch Intern Med. 2005;165:500-8.

whi os women s health initiative observational study
WHI-OS: Women’s Health Initiative Observational Study
  • Prospective cohort study in 40 US clinical centers
  • 72,242 postmenopausal women age 50–79 yrs, free of CVD and cancer at baseline
  • Main outcome measures: fatal CHD, nonfatal MI, stroke, total mortality

Margolis KL et al. Arch Intern Med. 2005;165:500-8.

whi os baseline characteristics
WHI-OS: Baseline characteristics

PatientsCharacteristic (N = 72,242)

Age (yr) 63.1

White (%) 83.5

Diabetes (%) 4.5

Hypertension (%) 34.6

Elevated cholesterol (%) 12.8

Current smoker (%) 6.1

BMI (kg/m2) 27.1

Margolis KL et al. Arch Intern Med. 2005;165:500-8.

whi os chd risk according to wbc count quartile
WHI-OS: CHD risk according to WBC count quartile

P = 0.02

2.5

2.32

2.0

1.5

OR

0.99

1.00

1.0

0.83

0.5

0

Q12.6–4.9

Q25.0–5.9

Q36.0–7.2

Q47.3–13.35

Quartile of WBC count ( 103 cells/mm3)

Ptrend = 0.01Adjusted for all risk factors, including CRP

Margolis KL et al. Arch Intern Med. 2005;165:500-8.

whi os chd risk according to crp quartile
WHI-OS: CHD risk according to CRP quartile

2.5

P = 0.07

1.95

2.0

1.5

OR

1.16

1.00

0.94

1.0

0.5

0

Q10.02–0.12

Q20.13–0.27

Q30.28–0.59

Q40.60–4.26

Quartile of CRP level (mg/dL)

Ptrend = 0.02Adjusted for all risk factors, including WBC count

Margolis KL et al. Arch Intern Med. 2005;165:500-8.

whi os chd risk in highest wbc count quartile according to crp level
WHI-OS: CHD risk in highest WBC count quartile, according to CRP level

6.80*

7.0

6.0

5.0

4.0

OR

3.10

3.0

2.83

2.70

2.0

1.0

0

Q10.02–0.12

Q20.13–0.27

Q30.28–0.59

Q40.60–4.26

Quartile of CRP level (mg/dL)

*P < 0.001Bivariate logistic regression model based on joint WBC count  CRP relationship, adjusted for TC/HDL-C ratio

Margolis KL et al. Arch Intern Med. 2005;165:500-8.

clinical implications
Clinical implications
  • WBC count >6.7  103 cells/mm3 may identify women at high CVD risk who are not currently identified by traditional CVD risk factors
  • WBC count offers stable, well-standardized, widely available, and inexpensive measure of systemic inflammation
  • Findings add to evidence in men that suggests a similar link; suggest WBC count is predictive independent of CRP

Margolis KL et al. Arch Intern Med. 2005;165:500-8.