OJIM  Vol.2 No.3 , September 2012
The relation between differential leukocyte count, neutrophil to lymphocyte ratio and the presence and severity of coronary artery disease
Abstract: Objectives: Total leukocyte count, a marker of inflammation has long been reported to be related with coronary artery disease (CAD). Recently, differenttial leukocyte count and elevated neutrophil to lymphocyte ratio (N/L) has been shown to indicate an increased long-term risk of mortality in patients with stable CAD, myocardial infarction and undergoing cardiovascular surgery. Thses studies offer incremental prognostic value to total leukocyte count. We sought to determine the relationship between the leukocyte subtypes and N/L ratio and the presence and extent of CAD. Study design: The study consisted of 107 patients [70 (65.4%) men, 37 (34.6%) women, mean age 59.5 ± 10.6 years] referred to coronary angiography with suspected CAD. The subjects were classified into two groups according to the presence of significant CAD and the extent of CAD was determined by the Gensini method. Results: The lymphocyte count was found to be lower (2031 ± 741 cells/μL vs 2392 ± 611 cells/μL, p: 0.010) and the N/L ratio was found to be higher in patients with CAD (2.86 ± 1.57 vs 2.04 ± 1.01, p < 0.001). In correlation analysis, the lymphocyte count and N/L ratio were significantly correlated with the presence and severity of CAD. Multivariate analysis identified N/L as the only independent pre dictor of CAD after adjustment for traditional cardiovascular risk factors [odds ratio: 1.961, 95% confidence interval (1.223, 3.143), p: 0.005]. Conclusion: Our findings reveal that N/L ratio, a simple marker which can be derived from a routine complete blood count test was significantly and independently related to presence and severity of coronary atherosclerosis.
Cite this paper: Selcuk, H. , Dinc, L. , Selcuk, M. , Maden, O. and Temizhan, A. (2012) The relation between differential leukocyte count, neutrophil to lymphocyte ratio and the presence and severity of coronary artery disease. Open Journal of Internal Medicine, 2, 163-169. doi: 10.4236/ojim.2012.23025.

[1]   Ross, R. (1999) Atherosclerosis—An inflammatory disease. The New England Journal of Medicine, 340, 115-126. doi:10.1056/NEJM199901143400207

[2]   Lind, L. (2003) Circulating markers of inflammation and atherosclerosis. Atherosclerosis, 169, 203-214. doi:10.1016/S0021-9150(03)00012-1

[3]   Cooper, H.A., et al. (1999) White blood cell count and mortality in patients with ischemic and nonischemic left ventricular systolic dysfunction (an analysis of the studies of left ventricular dysfunction [solvd]). American Journal of Cardiology, 84, 252-257. doi:10.1016/S0002-9149(99)00272-6

[4]   Takeda, Y., et al. (2003) Elevated white blood cell count as a risk factor of coronary artery disease: Inconsistency between forms of the disease. Japanese Heart Journal, 44, 201-211. doi:10.1536/jhj.44.201

[5]   Sabatine, M.S., et al. (2002) Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: A tacticstimi 18 (treat angina with aggrastat and determine cost of therapy with an invasive or conservative strategy-thrombolysis in myocardial infarction 18 trial)substudy. Journal of the American College of Cardiology, 40, 1761-1768. doi:10.1016/S0735-1097(02)02484-1

[6]   Phillips, A.N., et al. (1992) Leukocyte count and risk of major coronary heart disease events. American Journal of Epidemiology, 136, 59-70.

[7]   Gillum, R.F., et al. (1993) White blood cell count, coronary heart disease, and death: The nhanes i epidemiologic follow-up study. American Heart Journal, 125, 855-863. doi:10.1016/0002-8703(93)90181-8

[8]   Beydilli, I., et al. (2010) Importance of high sensitive creactive protein, leukocyte levels and neutrophyl/lymphocyte rate in the patients with acute coronary syndrome. Cardiovascular Sciences—Türkiye Klinikleri, 22, 61-68.

[9]   Tamhane, U.U., et al. (2008) Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. American Journal of Cardiology, 102, 653-657. doi:10.1016/j.amjcard.2008.05.006

[10]   Nunez, J., et al. (2008) Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in st segment elevation myocardial infarction. American Journal of Cardiology, 101, 747-752. doi:10.1016/j.amjcard.2007.11.004

[11]   Papa, A., et al. (2008) Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clinica Chimica Acta, 395, 27-31. doi:10.1016/j.cca.2008.04.019

[12]   Madjid, M., et al. (2004) Leukocyte count and coronary heart disease: Implications for risk assessment. Journal of the American College of Cardiology, 44, 1945-1956. doi:10.1016/j.jacc.2004.07.056

[13]   Welt, F.G., et al. (2001) Atherosclerosis and plaque rupture. Catheterization and Cardiovascular Interventions, 53, 56-63. doi:10.1002/ccd.1130

[14]   Harlan, J.M., et al. (1981) Neutrophil-mediated endothelial injury in vitro mechanisms of cell detachment. The Journal of Clinical Investigation, 68, 1394-1403. doi:10.1172/JCI110390

[15]   Mehta, J., et al. (1989) Neutrophil function in ischemic heart disease. Circulation, 79, 549-556. doi:10.1161/01.CIR.79.3.549

[16]   Ricevuti, G., et al. (1989) New trends in coronary artery disease: The role of granulocyte activation. Atherosclerosis, 78, 261-265. doi:10.1016/0021-9150(89)90232-3

[17]   Lucchesi, B.R. (1990) Myocardial ischemia, reperfusion and free radical injury. American Journal of Cardiology, 65, 14I-23I. doi:10.1016/0002-9149(90)90120-P

[18]   Mehta, J.L., et al. (1988) Neutrophils as potential participants in acute myocardial ischemia: Relevance to reperfusion. Journal of the American College of Cardiology, 11, 1309-1316. doi:10.1016/0735-1097(88)90297-5

[19]   Jolly, S.R., et al. (1986) Reduction of myocardial infarct size by neutrophil depletion: Effect of duration of occlusion. American Heart Journal, 112, 682-690. doi:10.1016/0002-8703(86)90461-8

[20]   Michelson, A.D., et al. (2001) Circulating monocyte-platelet aggregates are a more sensitive marker of in vivo platelet activation than platelet surface pselectin: Studies in baboons, human coronary intervention, and human acute myocardial infarction. Circulation, 104, 1533-1537. doi:10.1161/hc3801.095588

[21]   Prentice, R.L., et al. (1982) Leukocyte counts and coronary heart disease in a japanese cohort. American Journal of Epidemiology, 116, 496-509.

[22]   Olivares, R., et al. (1993) Monocyte count: A risk factor for coronary heart disease? American Journal of Epidemiology, 137, 49-53.

[23]   Rasouli, M., et al. (2007) Total and differential leukocytes counts, but not hscrp, esr, and five fractioned serum proteins have significant potency to predict stable coronary artery disease. Clinica Chimica Acta, 377, 127-132. doi:10.1016/j.cca.2006.09.009

[24]   Wheeler, J.G., et al. (2004) Associations between differential leucocyte count and incident coronary heart disease: 1764 incident cases from seven prospective studies of 30,374 individuals. European Heart Journal, 25, 1287-1292. doi:10.1016/j.ehj.2004.05.002

[25]   Amaro, A., et al. (1993) Leukocyte count as a predictor of the severity ischaemic heart disease as evaluated by coronary angiography. Revista Portuguesa de Cardiologia, 12, 913-917.

[26]   Jia, E.Z., et al. (2005) Relationship between leukocyte count and angiographical characteristics of coronary atherosclerosis. Acta Pharmacologica Sinica, 26, 1057-1062. doi:10.1111/j.1745-7254.2005.00169.x

[27]   Horne, B.D., et al. (2005) Which white blood cell subtypes predict increased cardiovascular risk? Journal of the American College of Cardiology, 45, 1638-1643. doi:10.1016/j.jacc.2005.02.054

[28]   Mallat, Z., et al. (2004) Immunomodulation to combat atherosclerosis: The potential role of immune regulatory cells. Expert Opinion on Biological Therapy, 4, 1387-1393. doi:10.1517/14712598.4.9.1387

[29]   Ommen, S.R., et al. (1997) Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. American Journal of Cardiology, 79, 812-814. doi:10.1016/S0002-9149(96)00878-8

[30]   Ommen, S.R., et al. (1998) Predictive power of the relative lymphocyte concentration in patients with advanced heart failure. Circulation, 97, 19-22. doi:10.1161/01.CIR.97.1.19

[31]   Nunez, J., et al. (2009) Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal troponin levels. Atherosclerosis, 206, 251-257. doi:10.1016/j.atherosclerosis.2009.01.029

[32]   Nelson, D.H., et al. (1952) Blood levels of 17-hydroxy-corticosteroids following the administration of adrenal steroids and their relation to levels of circulating leuko-cytes. Journal of Clinical Investigation, 31, 843-849. doi:10.1172/JCI102671

[33]   Thomson, S.P., et al. (1980) Endogenous cortisol: A regulator of the number of lymphocytes in peripheral blood. Clinical Immunology and Immunopathology, 17, 506-514. doi:10.1016/0090-1229(80)90146-4