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Intracellular Staining and Flow Cytometry to Identify Lymphocyte Subsets within Murine Aorta, Kidney and Lymph Nodes in a Model of Hypertension
Published on: January 28, 2017
Which leukocyte subsets predict cardiovascular mortality? From the LUdwigshafen RIsk and Cardiovascular Health
Bríain ó Hartaigh1, Jos A Bosch, G Neil Thomas
1Public Health, Epidemiology and Biostatistics, University of Birmingham, UK.
Insights
High neutrophil counts, a readily available measure, significantly predict cardiovascular mortality in high-risk patients. This finding may enhance cardiovascular risk prediction strategies.
Area of Science:
- Cardiology
- Immunology
- Public Health
Background:
- White blood cells are known predictors of cardiovascular mortality.
- The heterogeneous nature of white blood cells suggests specific subtypes may hold greater predictive value.
- C-reactive protein is an established inflammatory marker for cardiovascular outcomes.
Purpose of the Study:
- To compare the predictive power of leukocyte subsets for cardiovascular mortality.
- To evaluate leukocyte subsets alone and with C-reactive protein for predicting cardiovascular death.
- To identify specific white blood cell subtypes that disproportionally contribute to cardiovascular risk.
Main Methods:
- Prospective follow-up of 3316 patients undergoing coronary angiography.
- Determination of neutrophil, monocyte, and lymphocyte counts.
- Analysis of leukocyte subsets using surface markers (e.g., CD11b, CD18, CD31, CD40, CD58) and multivariable Cox regression models.
Main Results:
- Neutrophil count and neutrophil/lymphocyte ratio independently predicted cardiovascular mortality.
- Higher neutrophil counts were associated with a 1.90-fold increased risk of cardiovascular death.
- Neutrophil count outperformed C-reactive protein in predicting cardiovascular mortality in this high-risk population.
Conclusions:
- Elevated neutrophil counts are a significant and inexpensive marker for predicting cardiovascular mortality.
- Assessing neutrophil counts may improve the risk stratification of cardiovascular disease.
- Further research into specific neutrophil subsets could refine cardiovascular risk prediction.
Objective:
White blood cells are known to predict cardiovascular mortality, but form a highly heterogeneous population. It is therefore possible that specific subtypes disproportionally contribute to the prediction of cardiovascular outcomes. Therefore, we compared leukocyte subsets alone and in conjunction with an established inflammatory marker, C-reactive protein, for predicting death due to cardiovascular disease in a high-risk population.
Methods:
Patients, 3316, (mean [SD] age, 62 [10] years) scheduled for coronary angiography were prospectively followed up. Neutrophil, monocyte and lymphocyte counts were determined. Neutrophil and monocyte subsets were further analysed on the basis of surface expression of CD11b, CD18, CD31, CD40 and CD58. Lymphocytes were further subdivided into CD3, CD4, CD8, and CD19 subsets. The association between each marker and subsequent cardiovascular mortality was assessed using multivariable Cox regression models.
Results:
During a median follow-up period of 7.8 years, 745 (22.5%) patients died, of which 484 were due to cardiovascular events. After entering conventional risk factors and removing patients with a current infection, neutrophil count (HR [95% CI]=1.90 [1.39, 2.60], P<0.001) and the neutrophil/lymphocyte ratio (HR [95% CI]=1.68 [1.24, 2.27], P=0.003) emerged as independent predictors of cardiovascular mortality. After mutual adjustment, neutrophil count (HR [95% CI]=1.87 [1.35, 2.50], P<0.001) out-performed C-reactive protein (HR [95% CI] 1.32 [0.99, 1.78], P=0.06) as a predictor of cardiovascular mortality.
Conclusions:
Due to its predictive potential and inexpensive determination, assessment of high neutrophil counts may represent an important marker, possibly improving cardiovascular mortality risk prediction.
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