Leukocyte Count and Risks of Stroke and Coronary Heart Disease: The Circulatory Risk in Communities Study (CIRCS)

White blood cell counts can predict 4-year cardiovascular disease risk in patients with stable coronary heart disease: a prospective cohort study

Background

The prevalence of cardiovascular disease has increased sharply in the Asian population, and evaluation of the risk of cardiovascular events with stable coronary heart disease remains challenging. The role of white blood cell (WBC) count in assisting clinical decision-making in this setting is still unclear.

Objectives

This study sought to evaluate the prognostic meaning of WBC count among patients with stable coronary heart disease.

Methods

This study included Asian participants (n = 1,933) from the prospective STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial, which involved 15,828 patients with stable coronary heart disease with 3-5 years of follow-up on optimal secondary preventive treatment. WBC count was measured at baseline. Associations between WBC count and cardiovascular outcomes were evaluated by Cox regression analyses with multivariable adjustments. Hematologic emergencies in patients may introduce potential bias.

Results

In the lower WBC count quartiles, patients had lower-risk clinical profiles. Higher WBC counts were associated with greater event probabilities for cardiovascular death, major cardiovascular events, or all-cause death. In Cox regression models, WBC counts were an independent predictor of major adverse cardiovascular events (OR = 2.445, 95% CI 1.427-4.190, P = 0.001) for the primary outcomes. For the secondary outcomes, including the composite of all-cause death, cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure, WBC counts were significantly predictive of events with similar magnitude (OR = 1.716, 95% CI 1.169-2.521, P = 0.006).

Conclusions

In patients with stable coronary heart disease, higher WBC counts were associated with a heightened risk for the primary or secondary outcomes.

Registration

https://clinicaltrials.gov/; Unique identifier NCT00799903.

Myeloperoxidase and its derivative hypochlorous acid combined clinical indicators predict new-onset atrial fibrillation in sepsis: a case-control study

BACKGROUD

New-onset atrial fibrillation (NOAF) is a common complication of sepsis and linked to higher death rates in affected patients. The lack of effective predictive tools hampers early risk assessment for the development of NOAF. This study aims to develop practical and effective predictive tools for identifying the risk of NOAF.

METHODS

This case-control study retrospectively analyzed patients with sepsis admitted to the emergency department of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from September 2017 to January 2023. Based on electrocardiographic reports and electrocardiogram monitoring records, patients were categorized into NOAF and non-NOAF groups. Laboratory tests, including myeloperoxidase (MPO) and hypochlorous acid (HOCl), were collected, along with demographic data and comorbidities. Least absolute shrinkage and selection operator regression and multivariate logistic regression analyses were employed to identify predictors. The area under the curve (AUC) was used to evaluate the predictive model's performance in identifying NOAF.

RESULTS

A total of 389 patients with sepsis were included in the study, of which 63 developed NOAF. MPO and HOCl levels were significantly higher in the NOAF group compared to the non-NOAF group. Multivariate logistic regression analysis identified MPO, HOCl, tumor necrosis factor-α (TNF-α), white blood cells (WBC), and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score as independent risk factors for NOAF in sepsis. Additionally, a nomogram model developed using these independent risk factors achieved an AUC of 0.897.

CONCLUSION

The combination of MPO and its derivative HOCl with clinical indicators improves the prediction of NOAF in sepsis. The nomogram model can serve as a practical predictive tool for the early identification of NOAF in patients with sepsis.

Development and validation of a diagnostic model for cerebral small vessel disease among rural older adults in China

Objectives

Cerebral small vessel disease (CSVD) visible on MRI can be asymptomatic. We sought to develop and validate a model for detecting CSVD in rural older adults.

Methods

This study included 1,192 participants in the MRI sub-study within the Multidomain Interventions to Delay Dementia and Disability in Rural China. Total sample was randomly divided into training set and validation set. MRI markers of CSVD were assessed following the international criteria, and total CSVD burden was assessed on a scale from 0 to 4. Logistic regression analyses were used to screen risk factors and develop the diagnostic model. A nomogram was used to visualize the model. Model performance was assessed using the area under the receiver-operating characteristic curve (AUC), calibration plot, and decision curve analysis.

Results

The model included age, high blood pressure, white blood cell count, neutrophil-to-lymphocyte ratio (NLR), and history of cerebral infarction. The AUC was 0.71 (95% CI, 0.67-0.76) in the training set and 0.69 (95% CI, 0.63-0.76) in the validation set. The model showed high coherence between predicted and observed probabilities in both the training and validation sets. The model had higher net benefits than the strategy assuming all participants either at high risk or low risk of CSVD for probability thresholds ranging 50-90% in the training set, and 65-98% in the validation set.

Conclusion

A model that integrates routine clinical factors could detect CSVD in older adults, with good discrimination and calibration. The model has implication for clinical decision-making.

Associations of Cardiometabolic Indices With Peptides Related to Hypertensive Disorders of Pregnancy in Adult Men

BACKGROUND

Seven peptides with low molecular weights in blood have been identified as possible biomarkers of hypertensive disorders of pregnancy (HDP). A history of HDP is known to be associated with a high risk of cardiovascular disease in the later life of women with HDP. However, it remains to be determined whether HDP-related peptides are useful biomarkers of cardiovascular disease in the general population. The purpose of this study was to determine the relationships between these peptides and cardiometabolic risk in adult men.

METHODS

We investigated the relationships between HDP-related peptides and two recent indices of cardiometabolic risk, hematometabolic index (HMI) and lipid accumulation product (LAP), in male workers aged 35 to 69 years. Concentrations of the HDP-related seven peptides with mass/charge ratios (m/z) of 2081 (P-2081), 2091 (P-2091), 2127 (P-2127), 2209 (P-2209), 2378 (P-2378), 2858 (P-2858), and 3156 (P-3156) were measured simultaneously by using a mass spectrometer. Standardized partial regression coefficients (β) were obtained in multivariable linear regression analysis, and mean levels of the log-transformed HMI and LAP were compared in tertile groups of each peptide in the analysis of covariance with adjustment for age, habits of smoking and alcohol drinking, history of diabetes, and medication therapy for dyslipidemia.

RESULTS

There was a significant positive correlation between the HMI and the serum level of P-2378 (β = 0.310), a fragment of complement component 4, while a significant inverse correlation (β = -0.389) was obtained between the LAP and the serum level of P-3156, a fragment of inter-α-trypsin inhibitor heavy chain H4. Other peptides (P-2081, P-2091, P-2127, P-2209, and P-2858) did not show significant correlations with the HMI or LAP. The log-transformed HMI tended to be higher with an increase in the tertile for P-2378. The mean level of log-transformed LAP in the first tertile group of P-3156 was significantly higher than those in the second and third tertile groups of P-3156.

CONCLUSION

The HDP-related peptides with m/z of 2378 and m/z of 3156 were shown to be associated with the HMI and LAP, respectively, which are recent indices reflecting cardiometabolic risk. Therefore, the peptides with m/z of 2378 and m/z of 3156 were thought to be potential biomarkers for discrimination of cardiovascular risk in adult men. Further studies on the relationships between the peptides and cardiovascular risk factors in non-pregnant women are needed to confirm the findings of this study.

Distinct WBC Trajectories are Associated with the Risks of Incident CVD and All-Cause Mortality

AIMS

To examine the trajectory of white blood cell (WBC) and their potential impacts on cardiovascular disease (CVD) and all-cause mortality (ACM) risks.

METHODS

This prospective cohort included 61,666 participants without CVD on or before June 1, 2012. Latent mixture modeling was used to identify WBC trajectories in 2006-2012 as predictors of CVD and ACM. Incident CVD and ACM in 2012-2019 were the outcomes. Cox proportional hazards models were fitted to analyze the risks of incident CVD and ACM.

RESULTS

According to WBC ranges and dynamics, five distinct WBC trajectories were identified: low-stable (n=18,432), moderate-stable (n=26,656), elevated-stable (n=3,153), moderate-increasing (n=11,622), and elevated-decreasing (n=1,803). During 6.65±0.83 years of follow-up, we documented 3773 incident CVD cases and 3304 deaths. Relative to the low-stable pattern, the moderate-increasing pattern was predictive of an elevated risk of CVD (HR=1.36, 95% CI: 1.24-1.50), especially acute myocardial infarction (AMI) (HR=1.91, 95% CI: 1.46-2.51), while the elevated-stable pattern was predictive of an elevated risk of ACM (HR=1.77, 95% CI: 1.52-2.06). Among participants with hs-CRP ＜2 mg/L or ≥2 mg/L, similar associations were observed between the moderate-increasing pattern with CVD (HR=1.41, 95% CI: 1.24-1.61) and ACM (HR=1.54, 95% CI: 1.18-2.01, HR=1.89, 95% CI: 1.57-2.29, respectively).

CONCLUSIONS

We found that distinct WBC trajectories were differentially associated with CVD and ACM risks in Chinese adults.

Development of a risk score model for the prediction of patients needing percutaneous coronary intervention

BACKGROUND

The incidence of coronary heart disease (CHD) is increasing worldwide. The need for percutaneous coronary intervention (PCI) is determined by coronary angiography (CAG). As coronary angiography is an invasive and risky test for patients, it will be of great help to develop a predicting model for the assessment of the probability of PCI in patients with CHD using the test indexes and clinical characteristics.

METHODS

A total of 454 patients with CHD were admitted to the cardiovascular medicine department of a hospital from January 2016 to December 2021, including 286 patients who underwent CAG and were treated with PCI, and 168 patients who only underwent CAG to confirm the diagnosis of CHD were set as the control group. Clinical data and laboratory indexes were collected. According to the clinical symptoms and the examination signs, the patients in the PCI therapy group were further split into three subgroups: chronic coronary syndrome (CCS), unstable angina pectoris (UAP), and acute myocardial infarction (AMI). The significant indicators were extracted by comparing the differences among the groups. A nomogram was drawn based on the logistic regression model, and predicted probabilities were performed using R software (version 4.1.3).

RESULTS

Twelve risk factors were selected by regression analysis; the nomogram was successfully constructed to predict the probability of needing PCI in patients with CHD. The calibration curve shows that the predicted probability is in good agreement with the actual probability (C-index = 0.84, 95% CI = 0.79-0.89). According to the results of the fitted model, the ROC curve was plotted, and the area under the curve was 0.801. Among the three subgroups of the treatment group, 17 indexes were statistically different, and the results of the univariable and multivariable logistic regression analysis revealed that cTnI and ALB were the two most important independent impact factors.

CONCLUSION

cTnI and ALB are independent factors for the classification of CHD. A nomogram with 12 risk factors can be used to predict the probability of requiring PCI in patients with suspected CHD, which provided a favorable and discriminative model for clinical diagnosis and treatment.

Lactation prescription plus acupoint stimulation improves breastfeeding quality and alleviates breast tenderness in parturients undergoing cesarean section

PURPOSE

This retrospective study primarily discusses the influence of lactation prescription plus acupoint stimulation on breastfeeding quality and breast tenderness of parturients after cesarean section (CS).

METHODS

First, 149 parturients presented between July 2018 and July 2021 for CS were selected, including 74 cases (test group) treated with lactation prescription plus acupoint stimulation and 75 cases (control group) intervened by routine western medicine nursing intervention. The breastfeeding status, milk yield at 48 hours postpartum, breast tenderness (Visual Analogue Scale, VAS), neonatal weight at 42 days after delivery, and laboratory indexes (white blood cell count, WBC; adrenocorticotropin, ACTH; prolactin, PRL) were compared between the two cohorts. Finally, multivariate analysis was carried out using the logistic regression model to identify factors leading to low milk production in mothers 48 hours after CS.

RESULTS

The test group was observed with a higher exclusive breastfeeding rate, higher milk yield at 48 hours postpartum, and milder breast tenderness (lower VAS score) than the control group. Higher neonatal weight at 42 days postpartum was also determined in the test group versus the control group. Moreover, the PRL at 3 days postpartum in the test group was statistically higher than that prenatal and at 1 day postpartum and the control group; markedly elevated WBC and reduced ACTH were observed at 1 d and 3 d postpartum compared with the prenatal, but no significant differences were identified between the test and control groups. According to the Logistic regression analysis, breast tenderness (P=0.009) was an independent risk factor for low lactation in mothers at 48 hours after CS.

CONCLUSION

Lactation prescription plus acupoint stimulation has a positive effect on improving the breastfeeding quality of parturients after CS and relieving breast tenderness, which is worth promoting clinically.

Association Between White Blood Cell Count and Atrial Fibrillation Risk - A Population-Based Prospective Cohort Study

BACKGROUND

The incidence and prevalence of atrial fibrillation (AF) are increasing. The white blood cell (WBC) count is an indicator of systemic inflammation and is related to increased cardiovascular disease risk. Using data from the Suita Study, we investigated the association between WBC count and AF risk in the general Japanese population.

METHODS AND RESULTS

This prospective cohort study included 6,884 people, aged 30-84 years, with no baseline AF. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for AF incidence by WBC count quintile. Within a median follow-up period of 14.6 years, 312 AF cases were diagnosed. Compared with the lowest WBC count quintile, the highest quintile was associated with an increased AF risk (HR 1.57; 95% CI 1.07-2.29). The association was more pronounced among women than men (HR 2.16 [95% CI 1.10-4.26] and 1.55 [95% CI 0.99-2.44], respectively; P interaction=0.07), and among current than non-smokers (HR 4.66 [95% CI 1.89-11.50] and 1.61 [95% CI 1.01-2.57], respectively; P interaction=0.20). For each 1.0×109-cells/L increment in WBC count, AF risk increased by 9% in men (9% in non-smokers, 10% in current smokers) and 20% in women (13% in non-smokers, 32% in current smokers).

CONCLUSIONS

A higher WBC count was positively associated with an elevated AF risk in the general Japanese population, especially in women who smoked.

Associations of Baseline and Changes in Leukocyte Counts with Incident Cardiovascular Events: The Dongfeng-Tongji Cohort Study

AIM

The aim of the present study was to investigate the associations of baseline and longitudinal changes in leukocyte counts with incident cardiovascular disease (CVD).

METHODS

We conducted a prospective study to investigate the associations of baseline and 5-year changes in leukocyte counts with incident CVD and its subtypes in middle-aged and elderly Chinese. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD using the Cox proportional-hazards models.

RESULTS

In the analyses of baseline total leukocyte count of 26,655 participants, compared with the lowest quartile (＜4.71×109/L), participants in the fourth quartile (＞6.70×109/L) had 11% higher risk for CVD. Consistent with total leukocyte count, neutrophil count also exhibited a significant positive association with the risk of CVD. In the analyses of 5-year changes in total leukocyte count of 11,594 participants, the changes in leukocyte count were categorized into three groups, i.e., the decreased group (＜25%), stable group (25%-75%), and increased group (＞75%). Compared with participants in the stable group (-1.18 to 0.44×109/L), participants in the increased group (＞0.44×109/L) had 14% higher risk for CVD. We also observed significant positive associations of the changes in neutrophil and monocyte counts with the risk of CVD. Furthermore, the total leukocyte count in the second or third tertile at the first follow-up with a 5-year increase was related to higher CVD risk.

CONCLUSION

High baseline total leukocyte count and a 5-year increase in total leukocyte count were related to higher CVD risk.