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Clustering of blood cell count abnormalities and future risk of death
Giuseppe Patti1, Veronica Lio1, Giuseppe Di Martino2
1Chair of Cardiology, University of Eastern Piedmont and Maggiore della Carità Hospital, Novara, Italy.
Insights
Clustering of anemia, leukocytosis, and thrombocytosis predicts higher risk of death and cardiovascular events. This easily assessable combination of blood cell count parameters offers valuable insights for cardiovascular risk stratification.
Area of Science:
- Cardiology
- Hematology
- Epidemiology
Background:
- Identifying novel predictors is crucial for stratifying cardiovascular risk.
- Blood cell count parameters may serve as potential indicators of poor prognosis.
- Long-term cardiovascular event risk assessment benefits from population-based cohort studies.
Purpose of the Study:
- To evaluate the individual and combined impact of anemia, leukocytosis, and thrombocytosis on long-term mortality and major adverse cardiovascular events (MACE).
- To assess the predictive value of clustering these blood cell count abnormalities for cardiovascular outcomes.
- To investigate these associations within the population-based Malmö Diet and Cancer Study cohort.
Main Methods:
- Analysis of 30,447 individuals (mean age 57 years) from the Malmö Diet and Cancer Study.
- Assessment of all-cause death and MACE incidence over a median follow-up of 16 years.
- Stratification of participants based on the presence or absence of one, two, or three factors: anemia, leukocytosis, and thrombocytosis.
Main Results:
- A stepwise increase in all-cause death and MACE incidence was observed with an increasing number of prevalent factors (anemia, leukocytosis, thrombocytosis).
- Individuals with three factors exhibited significantly higher rates of death (46.4%) and MACE (57.1%) compared to those with no factors (19.5% and 28.0%, respectively).
- Multivariate analysis confirmed a dose-dependent, increased risk of mortality and MACE associated with the clustering of these blood cell abnormalities (e.g., three factors: HR for mortality 2.69, HR for MACE 2.03).
Conclusions:
- The combined presence of anemia, leukocytosis, and thrombocytosis is a significant predictor of increased long-term mortality and adverse cardiovascular events.
- This easily assessable clustering of blood cell abnormalities can aid in identifying individuals at higher cardiovascular risk.
- These findings underscore the importance of routine blood cell count monitoring for cardiovascular risk assessment.
Background:
The identification of novel predictors of poor outcome may help stratify cardiovascular risk. Aim was to evaluate the individual contribution of blood cell count parameters, as well as their clustering, on the risk of death and cardiovascular events over the long term in the population-based Malmö Diet and Cancer Study cohort.
Methods:
In 30,447 individuals (age 57 ± 8 years), we assessed the incidence of all-cause death (primary endpoint) and major adverse cardiovascular events (MACE, secondary outcome measure) according to absence or presence of one, two and three factors at baseline out of the following: anaemia, leukocytosis and thrombocytosis. Median follow-up was 16 years.
Results:
The percentages of all-cause death were 19.5% in individuals without factors, 21.3% in those with one factor, 27.4% with two and 46.4% with three (log-rank test P < .001). The crude incidence of MACE was 28.0%, 29.2%, 35.5% and 57.1%, respectively (log-rank test P < .001). At multivariate analysis, we found a stepwise increase in overall mortality with increasing number of prevalent factors (one factor: HR 1.23, 95% CI 1.14-1.31, P < .001; two factors: 1.61, 1.37-1.89, P < .001; three factors: 2.69, 1.44-5.01, P = .002, vs no factor). Similar findings were observed for the incidence of MACE (one factor: adjusted HR 1.18, 95% CI 1.11-1.24, P < .001; two factors: 1.52, 1.33-1.76, P < .001; three factors: 2.03, 1.21-3.67, P < .001, vs no factor).
Conclusions:
The easily assessable clustering of anaemia, leukocytosis and thrombocytosis heralds higher incidence of death and adverse cardiovascular events.
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