White Blood Cell Count and Haematocrit as Predictors of Coronary Recurrence after Myocardial Infarction

Summary

Baseline white blood cell count (WCC) and haematocrit were examined in relation to recurrent coronary events and to all-cause mortality in 2026 persons enrolled in the first Persantin-Aspirin Reinfarction Study (PARIS-1) 2-60 months after myocardial infarction. WCC was strongly related to coronary recurrence (relative risk 3.5 for men with WCC ≥ 9 × 10⁹/1 vs men with WCC < 5 × 10⁹/1) and total mortality (relative risk 2.6). No such relationships were found for haematocrit. WCC correlated also with cigarette-smoking, diuretic use, serum cholesterol and uric acid; however, the associations with coronary recurrence and total mortality persisted on multiple linear and logistic regression analysis including these variables and treatment group (p <0.001). WCC is therefore an easily-measured prognostic variable in survivors of myocardial infarction. Furthermore, we suggest that white blood cells may promote myocardial ischaemia by capillary plugging and/or release of toxic oxygen metabolites.

Keywords

White cell count - Haematocrit - Myocardial infarction

• References

• 1 Lowe G DO, Forbes CD. Blood rheology and thrombosis. Clin Haematol 1981; 10: 343-367
• 2 Bagge U, Branemark P-I, Skalak R. Measurement and influence of white cell deformability. In Lowe G DO, Barbenel JC, Forbes CD. (eds) Clinical Aspects of Blood Viscosity and Cell Deformability. Berlin - Heidelberg - New York: Springer-Verlag; 1981: 27-36
• 3 Elwood PC, Waters WE, Benjamin IT, Sweetnam PM. Mortality and anaemia in women. Lancet 1974; 1: 891-894
• 4 Bottiger DE, Carlson LA. Risk factors for ischaemic vascular death for men in the Stockholm prospective study. Atherosclerosis 1980; 36: 389-408
• 5 Sorlie PD, Garcia-Palmieri MR, Costas Jr R, Havlik RJ. Haematocrit and risk of coronary heart disease: the Puerto Rico Heart Health Program. Am Heart J 1981; 101: 456-461
• 6 Hey man A, Karp HR, Hey den S, Bartel A, Cassel JC, Tyroler HA, Hames CG. Cerebrovascular disease in the biracial population of Evans County, Georgia. Arch Intern Med 1971; 128: 949-955
• 7 Kannel WB, Gordon T, Wolf PA, McNamara P. Haemoglobin and the risk of cerebral infarction: the Framingham Study. Stroke 1972; 3: 409-420
• 8 Friedman GD, Klatsky AL, Siegelaub AB. The leukocyte count as a predictor of myocardial infarction. N Engl J Med 1974; 290: 1275-1278
• 9 Zalokar JB, Richards JL, Claude JR. Leukocyte count, smoking and myocardial infarction. N Engl J Med 1981; 394: 465-468
• 10 Prentice RL, Shimizu Y, Lin CH, Petersen AV, Kato H, Mason MW, Szatrowski TP. Leucocyte counts and coronary heart disease in a Japanese cohort. Am J Epidemiol 1982; 116: 496-506
• 11 Prentice RL, Szatrowski TP, Kato H, Mason MW. Leucocyte counts and cerebrovascular disease. J Chron Dis 1982; 35: 703-714
• 12 The National Institute of Neurological and Communicative Disorders and Stroke. The National Survey of Stroke. Stroke 1981; 121 Supplement 23-24
• 13 Lowe G DO, Jaap AJ, Forbes CD. Relation of atrial fibrillation and high haematocrit to mortality in acute stroke. Lancet 1983; 1: 784-786
• 14 Haines AP, Howarth D, North W RS, Goldenberg E, Stirling Y, Meade TW, Raftery EB, Millar Craig MW. Haemostatic variables and the outcome of myocardial infarction. Thromb Haemostas 1983; 50: 800-803
• 15 Persantin-Aspirin Reinfarction Study Research Group. Persantin-Aspirin Reinfarction Study - Design, methods and baseline results. Circulation 1980; 62 (Suppl. 02) 1-42
• 16 Persantin-Aspirin Reinfarction Study Research Group. Persantin and aspirin in coronary heart disease. Circulation 1980; 62: 449-461
• 17 Wintrobe MM, Lee GR, Boggs DR, Bithell TC, Foerster J, Athens JW, Lukens JN. Clinical Haematology, Eighth edition. Lea and Febiger, Philadelphia 1981
• 18 Howell RW. Smoking habits and laboratory tests. Lancet 1970; 2: 152
• 19 Corre F, Lellouch J, Schwartz D. Smoking and leucocyte counts. Lancet 1971; 2:: 632-634
• 20 Friedman GD, Siegelaub AB, Seltzer CC, Feldman R, Collen MF. Smoking habits and the leukocyte count. Arch Environ Health 1973; 26: 137-143
• 21 Okuno T. Smoking and blood changes. JAMA 1973; 225: 1387-1388
• 22 Dintenfassy L. Elevation of blood viscosity, aggregation of red cells, haematocrit values and fibrinogen levels in cigarette smokers. Med J Austral 1975; 1: 617-620
• 23 Fisch IR, Freedman SH. Smoking, oral contraceptives and obesity. JAMA 1975; 234: 500-506
• 24 Helman N, Rubenstein LS. The effects of age, sex and smoking on erythrocytes and leukocytes. Am J Clin Pathol 1975; 63: 35-44
• 25 Goldbourt V, Medalie JH. Characteristics of smokers, non-smokers and ex-smokers among 10,000 adult males in Israel. Am J Epidemiol 1977; 105: 76-78
• 26 Lowe G DO, Drummond MM, Forbes CD, Barbenel JC. The effects of age and cigarette-smoking on blood and plasma viscosity in men. Scott Med J 1980; 25: 13-7
• 27 Yamori Y, Kihara M, Horie R, Note S, Tsunematsic T, Fukase M. Epidemiological analysis on the mechanism of cigarette smoking as a risk factor in cardiovascular disease. Jpn Circ J 1980; 44: 965-970
• 28 Dodsworth H, Dean A, Broom G. Effects of smoking and the pill on the blood count. Br J Haematol 1981; 49: 484-488
• 29 Chan-Yeung M, DyBuncio A. Leukocyte count, smoking and lung function. Am Rev Resp Dis 1983; 127: 172-179
• 30 McDonough JR, Hames CG, Garrison GE, Stulb SC, Lichtman MA, Hefelfinger DG. The relationship of hematocrit to cardiovascular states of health in the negro and white population of Evans County, Georgia. J Chron Dis 1965; 18: 243-257
• 31 Elwood PC, Mahler R, Sweetnam P, Moore F, Welsby E. Association between circulating haemoglobin level, serum cholesterol and blood pressure. Lancet 1970; 1: 589-591
• 32 Lowe G DO, McArdle BM, Stromberg P, Lorimer AR, Forbes CD, Prentice CRM. Increased blood viscosity and fibrinolytic inhibitor in type II hyperlipoproteinaemia. Lancet 1982; 1: 472-475
• 33 Hershberg PL, Wells RE, McGandy RB. Hematocrit and prognosis in patients with acute myocardial infarction. JAMA 1972; 219: 855-860
• 34 Lowe GD O, Drummond MM, Lorimer AR, Hutton I, Forbes CD, Prentice CRM, Barbenel JC. Relation between extent of coronary artery disease and blood viscosity. Br Med J 1980; 1: 673-674
• 35 Rhoads GG, Blackwelder WC, Stemmermanyg GH, Hayaski T, Kagan A. Coronary risk factors and autopsy findings in Japanese-American men. Lab Invest 1978; 38: 304-311
• 36 Schlant RC, Forman S, Stamler J, Canner PL. The natural history of coronary heart disease: prognostic factors after recovery from myocardial infarction in 2789 men. Circulation 1982; 66: 401-414
• 37 Kostis JB, Turkevich D, Sharp J. Association between leukocyte count and the presence and extent of coronary atherosclerosis as determined by coronary arteriography. Am J Cardiol 1984; 53: 998-999
• 38 Mitchell J RA, Schwartz CJ. Arterial Disease. Blackwell Scientific, Oxford 1965
• 39 Sacks T, Moldow CF, Craddock PR, Bowers TK, Jacobs HS. Oxygen radicals mediate endothelial cell damage by complement-stimulated granulocytes: an in vitro model of immune vascular damage. J Clin Invest 1978; 61: 1161-1167
• 40 Weiss SJ, Young J, LoBuglio AF, Slivka A, Nimeh NF. Role of hydrogen peroxide in neutrophil mediated destruction of cultured endothelial cells. J Clin Invest 1981; 68: 714-721
• 41 Alderman MJ, Ridge A, Morley AA, Ryall RG, Walsh JA. Effect of total leucocyte count on whole blood filterability in patients with peripheral vascular disease. J Clin Pathol 1981; 34: 163-166
• 42 Engler RL, Schmid-Schonbein GW, Pavelec RS. Leukocyte capillary plugging in myocardial ischemia and reperfusion in the dog. Am J Pathol 1983; 111: 98-111
• 43 Romson JL, Hook BG, Rinkel SL, Abrams ED, Schork MA, Lucchesi BR. Reduction of the extent of ischemic myocardial injury by neutrophil depletion in the dog. Circulation 1983; 67: 1016-1023