Abstract
BackgroundThe association between white blood cell (WBC) count and coronary artery disease (CAD) is unknown in young adults. Our objective was to assess the association between WBC count and its changes over time with CAD incidence in the Metabolic, Life-style and Nutrition Assessment in Young adults (MELANY) study, a cohort of Israeli army personnel.Methods and Findings29,120 apparently healthy young men (mean age; 31.2±5.5 years) with a normal baseline WBC count (3,000–12,000 cells/mm3) were followed during a mean follow up of 7.5±3.8 years for incidence of CAD. Participants were screened every 3–5 years using a stress test, and CAD was confirmed by coronary angiography. In a multivariate model adjusted for age, body mass index (BMI), LDL- and HDL-cholesterol, blood pressure, family history of CAD, physical activity, diabetes, triglycerides and smoking status, WBC levels (divided to quintiles) above 6,900 cells/mm3 (quintile 4) were associated with a 2.17-fold increase (95%CI = 1.18–3.97) in the risk for CAD as compared with men in quintile 1 (WBC≤5,400 cells/mm3). When modeled as a continuous variable, a WBC increment of 1000 cells/mm3 was associated with a 17.4% increase in CAD risk (HR 1.174; 95%CI = 1.067–1.290, p = 0.001). A decrease in the WBC level (within the normal range) during the follow-up period was associated with increased physical activity and decreased triglyceride levels as well as with reduced incidence of CAD.ConclusionsWBC count is an independent risk factor for CAD in young adults at values well within the normal range. WBC count may assist in detecting subgroups of young men at either low or high risk for progression to CAD.
Highlights
A growing body of evidence suggests that low grade inflammation contributes to the development of coronary artery disease [1]
white blood cell (WBC) count may assist in detecting subgroups of young men at either low or high risk for progression to coronary artery disease (CAD)
The potential interactions of WBC with the ‘classic’ CAD risk factors are largely unknown. Such interactions are important both for defining the relative contribution of WBC count to the development of CAD compared to known risk factors, as well as for identifying risk factors that can be amplified by low-grade inflammation
Summary
A growing body of evidence suggests that low grade inflammation contributes to the development of coronary artery disease [1]. The potential interactions of WBC with the ‘classic’ CAD risk factors are largely unknown Such interactions are important both for defining the relative contribution of WBC count to the development of CAD compared to known risk factors, as well as for identifying risk factors that can be amplified by low-grade inflammation. Most prospective works used a single rather than repeated WBC count evaluations [10,11,12,14,15,16,17,18,19] This methodology raised practical questions on measurement reproducibility and the potential bias by intercurrent medical conditions which are not necessarily attributed to chronic inflammation and do not impose an excess cardiovascular risk. The association between white blood cell (WBC) count and coronary artery disease (CAD) is unknown in young adults. Our objective was to assess the association between WBC count and its changes over time with CAD incidence in the Metabolic, Life-style and Nutrition Assessment in Young adults (MELANY) study, a cohort of Israeli army personnel
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