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Updated: Jun 26, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Hematologic parameters, atherosclerotic progression, and prognosis in patients with previous coronary artery bypass
Kenneth J Mukamal1, Gregory A Wellenius, Murray A Mittleman
1Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Insights
Elevated white blood cell (WBC) counts are linked to increased cardiovascular events and atherosclerotic progression in patients with coronary artery bypass grafts (CABG). This association was more pronounced in patients not receiving warfarin.
Area of Science:
- Cardiovascular Medicine
- Inflammation and Atherosclerosis Research
Background:
- Inflammatory markers and anemia are known prognostic factors in cardiovascular disease.
- The relationship between these markers and atherosclerotic progression post-coronary artery bypass grafting (CABG) remains unclear.
Purpose of the Study:
- To investigate the association between baseline inflammatory markers (white blood cells, hemoglobin, platelets) and atherosclerotic progression in patients with prior CABG.
- To evaluate the impact of these markers on clinical events and graft progression within the Post CABG Trial.
Main Methods:
- 1,273 patients from the Post CABG Trial, who underwent CABG 1-11 years prior, were studied.
- Patients received lovastatin and warfarin or placebo in a factorial design.
- Coronary angiography was performed at baseline and after a mean 4.3-year follow-up; white blood cell (WBC) counts, hemoglobin, and platelets were measured at baseline.
Main Results:
- Higher WBC counts were associated with a trend towards increased risk of clinical events.
- WBC count showed a tendency towards association with significant atherosclerotic progression, particularly in the placebo group compared to warfarin (p interaction = 0.04).
- Hemoglobin and platelet counts were not associated with clinical events or graft progression.
Conclusions:
- White blood cell count is associated with a graded increase in cardiovascular events in patients with coronary artery bypass grafts.
- The findings suggest a role for inflammation in the progression of atherosclerosis post-CABG, with a potential interaction with warfarin therapy.
Abstract:
Although inflammatory markers and anemia have both been associated with prognosis in patients with cardiovascular disease, their relation with atherosclerotic progression in patients with previous coronary artery bypass grafting (CABG) is unknown. A total of 1,273 patients enrolled in the Post CABG Trial who had undergone CABG 1 to 11 years before entry were studied. Subjects were randomly assigned to lovastatin in low or high doses and low-dose warfarin or placebo in a factorial design. Subjects underwent coronary angiography at baseline and after a mean follow-up of 4.3 years. White blood cells (WBCs), hemoglobin, and platelets were measured at baseline in all subjects. Graft progression was defined as a decrease > or =0.6 mm in lumen diameter at the site of greatest change at follow-up. During follow-up, 195 subjects sustained a clinical event and 857 grafts developed significant worsening. Risk of clinical events tended to be greater with higher WBC counts, with hazard ratios for ascending quartiles of 1.4 (95% confidence interval [CI] 0.9 to 2.2), 1.6 (95% CI 1.0 to 2.6), and 1.6 (95% CI 1.0 to 2.7). WBC count also tended to be associated with significant atherosclerotic progression, particularly in subjects assigned to placebo rather than warfarin (p interaction = 0.04). There was no association of hemoglobin or platelet count with risk of clinical events or graft progression, but few trial subjects were anemic. In conclusion, WBC count is associated with a graded increase in cardiovascular events in patients with coronary artery bypass grafts.
