Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
The Association Between Complete Blood Count and the Risk of Coronary Heart Disease
Tam Kan Sayımı ile Koroner Kalp Hastalığı Arasındaki İlişki
Jonny Karunia FAJARa, Aditya Indra MAHENDRAb, Fredo TAMARAc, Bagus Aulia MAHDId, Teuku HERIANSYAHe, Mohammad Saifur ROHMANf
aDepartment of Medical Research Unit,
eCardiology and Vascular Medicine, Universitas Syiah Kuala Faculty of Medicine, Banda Aceh, INDONESIA
Departments of
bMagister of Biomedicine,
cInternal Medicine,
fCardiology and Vascular Medicine, Universitas Brawijaya Faculty of Medicine,
dClinic of Emergency Service, Aisyiyah Hospital, Malang, INDONESIA
Turkiye Klinikleri J Med Sci. 2019;39(1):56-64
doi: 10.5336/medsci.2018-61970
Article Language: EN
Full Text
ABSTRACT
Objective: To determine the correlation between complete blood count and the risk of coronary heart disease (CHD). Material and Methods: All CHD patients treated in Aisyiyah Hospital during January 2011 to December 2017 were enrolled for the study. Information related to demographic, clinical, and complete blood count were extracted from medical record. Multiple logistic regression test was employed to evaluate the correlation between complete blood count and CHD incidence. In addition, a meta-analysis was also conducted to summarize findings from other regions. Results: A total of 516 CHD patients and 102 controls were included in our study. We found that elevated hemoglobin (OR 95%CI=4.92 [2.02-12.01], p=0.002), leukocyte (OR 95 CI=5.35 [3.17-9.03], p=0.001), hematocrit (OR 95%CI=2.31 [1.40-3.83], p=0.010), eosinophil (OR 95%CI= 2.78 [1.68-4.26], p=0.001), and monocyte (OR 95%CI=1.31 [0.80-2.16], p=0.023) were associated with the incidence of CHD. Furthermore, our meta-analysis revealed that elevated levels of leukocyte, eosinophil, and monocyte increased the risk of CHD approximately 3.57, 5.34, and 2.77 times, respectively. Conclusion: There is strong evidence that elevated levels of leukocyte, eosinophil, and monocyte are the risk factor for CHD.

Keywords: Complete blood count; coronary heart disease; risk factor
ÖZET
Amaç: Tam kan ayımı ile koroner kalp hastalığı (KKH) arasında korelasyon olup olmadığını araştırmak amaçlandı. Gereç ve Yöntemler: Aisyiyah Hastanesi?nde Ocak 2011-Aralık 2017 arasında tedavi gören tüm KKH hastaları çalışma kapsamına alındı. Hastalarla ilgili demografik bilgiler, klinik veriler ve tam kan sayımları tıbbi kayıtlardan alındı. Aradaki bağlantıyı incelemek için multipl lojistik regresyon analizi yapıldı. KKH insidansı analizine ilaveten diğer yayınlardan elde edilen özet verilerin meta-analizi yapıldı. Bulgular: Toplam 516 KKH hastası ve 102 kontrol kişisi çalışmaya alındı. KKH insidansı ile ilişkili olarak hemoglobin (OR %95 GA=4,92 [2,02-12,01] p=0,002, lökosit (OR %95 GA=5,35 [3,17-9,03] p=0,001, hematokrit (OR %95 GA=2,31 [1,40-3,83] p=0,010, eozinofil (OR %95 GA=2,78 [1,68-4,26] p=0,001 ve monosit (OR %95 GA=1,31 [0,80-2,16] p=0,023 değerlerini yükselmiş olarak bulduk. Üstelik, yaptığımız meta-analize göre, KKH riskinde yükselmiş lökosit, eozinofil ve monosit değerlerinin yaklaşık 3,57; 5,34; ve 2,77 kat artma yarattığını saptadık (sırasıyla). Sonuç: KKH risk faktörü olarak yükselmiş lökosit, eozinofil ve monosit değerlerinin kuvvetli etkin olduğu tespit edilmiştir.

Anahtar Kelimeler: Tam kan sayımı; koroner kalp hastalığı; risk faktörü
REFERENCES:
  1. World Health Organization (WHO). WHO Disease and Injury Country Estimates. Geneva: World Health Organization; 2009.
  2. World Health Organization (WHO). Statistical Information System (WHOSIS). Geneva: World Health Organization; 2010.
  3. Nowbar AN, Howard JP, Finegold JA, Asaria P, Francis DP. 2014 global geographic analysis of mortality from ischaemic heart disease by country, age and income: statistics from World Health Organisation and United Nations. Int J Cardiol. 2014;174(2):293-8. [Crossref] [PMC]
  4. Libby P, Theroux P. Pathophysiology of coronary artery disease. Circulation. 2005;111(25): 3481-8. [Crossref]
  5. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med. 2016;4(13):256. [Crossref] [PMC]
  6. Alberto P, Francesca I, Chiara S, Ranuccio N. Acute coronary syndromes: from the laboratory markers to the coronary vessels. Biomarker Insight. 2006;1:123-30. [Crossref]
  7. Biasucci LM. C-reactive protein and secondary prevention of coronary events. Clin Chim Acta. 2001;311(1):49-52. [Crossref]
  8. Selcuk H, Dinc L, Selcuk MT, Maden O, Temizhan A. The relation between differential leukocyte count, neutrophil to lymphocyte ratio and the presence and severity of coronary artery disease. Open Journal of Internal Medicine. 2012;2:163-9. [Crossref]
  9. Elkind MS, Sciacca R, Boden-Albala B, Homma S, Di Tullio MR. Leukocyte count is associated with aortic arch plaque thickness. Stroke. 2002;33(11):2587-92. [Crossref]
  10. Sen S, Hinderliter A, Sen PK, Simmons J, LeGrys VA, Beck J, et al. Association of leukocyte count with progression of aortic atheroma in stroke/transient ischemic attack patients. Stroke. 2007;38(11):2900-5. [Crossref]
  11. Ovbiagele B, Lynn MJ, Saver JL, Chimowitz MI. Leukocyte count and vascular risk in symptomatic intracranial atherosclerosis. Cerebrovasc Dis. 2007;24(2-3):283-8. [Crossref]
  12. Huang G, Zhong XN, Zhong B, Chen YQ, Liu ZZ, Su L, et al. Significance of white blood cell count and its subtypes in patients with acute coronary syndrome. Eur J Clin Invest. 2009;39(5):348-58. [Crossref]
  13. Majid M, Fatemi O. Components of the complete blood count as risk predictors for coronary heart disease: in-depth review and uptake. Tex Heart Inst J. 2013;40(1):17-29.
  14. Uysal HB, Dağlı B, Akgüllü C, Avcil M, Zencir C, Ayhan M, et al. Blood count parameters can predict the severity of coronary artery disease. Korean J Intern Med. 2016;31(6):1093100. [Crossref] [PMC]
  15. Fajar JK. The association of ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) K121Q gene polymorphism with the risk of type 2 diabetes mellitus inEuropean, American, and African populations: a metaanalysis. J Health Sci. 2016;6(2):76-86. [Crossref]
  16. Fajar JK. The β fibrinogen gene G-455A polymorphism in Asian subjects with coronary heart disease: a meta analysis. Egypt J Med Hum Genet. 2017;18(1):19-28. [Crossref]
  17. Carter C, McGee D, Reed D, Yano K, Stemmermann G. Hematocrit and the risk of coronary heart disease: the Honolulu Heart Program. Am Heart J. 1982;105(4):674-9. [Crossref]
  18. Gotoh S, Hata J, Ninomiya T, Hirakawa Y, Nagata M, Mukai N, et al. Hematocrit and the risk of cardiovascular disease in a Japanese community: the Hisayama Study. Atherosclerosis. 2015;242(1):199-204. [Crossref]
  19. Gagnon DR, Zhang TJ, Brand FN, Kannel WB. Hematocrit and the risk of cardiovascular disease--the Framingham Study: a 34-year follow-up. Am Heart J. 1994;127(3):674-82. [Crossref]
  20. Zhong Y, Lin SL, Schooling CM. The effect of hematocrit and hemoglobin on the risk of ischemic heart disease: a Mendelian randomization study. Prev Med. 2016;91:351-5. [Crossref]
  21. Kunnas T, Solakivi T, Huuskonen K, Kalela A, Renko J, Nikkari ST. Hematocrit and the risk of coronary heart disease mortality in the TAMRISK study, a 28-year follow-up. Prev Med. 2009;49(1):45-7. [Crossref]
  22. Brown DW, Giles WH, Croft JB. Hematocrit and the risk of coronary heart disease mortality. Am Heart J. 2001;142(4):657-63. [Crossref]
  23. Sorlie PD, Garcia-Palmieri MR, Costas R Jr, Havlik RJ. Hematocrit and risk of coronary heart disease: the Puerto Rico Heart Health Program. Am Heart J. 1981;101(4):456-61. [Crossref]
  24. Sabatine MS, Morrow DA, Giugliano RP, Burton PB, Murphy SA, McCabe CH, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation. 2005;111(16):2042-9. [Crossref]
  25. Chonchol M, Nielson C. Hemoglobin levels and coronary artery disease. Am Heart J. 2008;155(3):494-8. [Crossref]
  26. Padmanaban P, Toora BD. Hemoglobin: emerging marker in stable coronary artery disease. Chron Young Sci. 2011;2(2):109-10. [Crossref]
  27. Shah AD, Nicholas O, Timmis AD, Feder G, Abrams KR, Chen R, et al. Threshold haemoglobin levels and the prognosis of stable coronary disease: two new cohorts and a systematic review and meta-analysis. PLoS Med. 2011;8(5):e1000439. [Crossref] [PMC]
  28. Doganer YC, Rohrer JE, Aydogan U, Bernard ME, Barcin C. Haemoglobin levels correlates with the presence of coronary artery disease. J Eval Clin Pract. 2015;21(5):937-42. [Crossref]
  29. Furman MI, Becker RC, Yarzebski J, Savegeau J, Gore JM, Goldberg RJ. Effect of elevated leukocyte count on in-hospital mortality following acute myocardial infarction. Am J Cardiol. 1996;78(8):945-8. [Crossref]
  30. Olivares R, Ducimetière P, Claude JR. Monocyte count: a risk factor for coronary heart disease? Am J Epidemiol. 1993;137(1):49-53. [Crossref]
  31. Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the blood lymphocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. Am J Cardiol. 2000;86(4):449-51. [Crossref]
  32. Barron HV, Harr SD, Radford MJ, Wang Y, Krumholz HM. The association between white blood cell count and acute myocardial infarction mortality in patients >or=65 years of age: findings from the cooperative cardiovascular project. J Am College Cardiol. 2001;38(6): 1654-61. [Crossref]
  33. Hajj-Ali R, Zareba W, Ezzeddine R, Moss AJ. Relation of the leukocyte count to recurrent cardiac events in stable patients after acute myocardial infarction. Am J Cardiol. 2001;88(11):1221-4. [Crossref]
  34. Lee CD, Folsom AR, Nieto FJ, Chambless LE, Shahar E, Wolfe DA. White blood cell count and incidence of coronary heart disease and ischemic stroke and mortality from cardiovascular disease in African-American and white men and women. Am J Epidemiol. 2001;154(8):758-64. [Crossref]
  35. Sabatine MS, Morrow DA, Cannon CP, Murphy SA, Demopoulos LA, DiBattiste PM, et al. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction 18 trial) substudy. J Am Coll Cardiol. 2002;40(10):1761-8. [Crossref]
  36. Mueller C, Neumann FJ, Perruchoud AP, Buettner HJ. White blood cell count and long term mortality after non-ST elevation acute coronary syndrome treated with very early revascularisation. Heart. 2003;89(4):389-92. [Crossref] [PMC]
  37. Wheeler JG, Mussolino ME, Gillum RF, Danesh J. Associations between differential leucocyte count and incident coronary heart disease: 1764 incident cases from seven prospective studies of 30,374 individuals. Eur Heart J. 2004;25(15):1287-92. [Crossref]
  38. Afiune Neto A, Mansur Ade P, Avakian SD, Gomes EP, Ramires JA. [Monocytosis is an independent risk marker for coronary artery disease]. Arq Bras Cardiol. 2006;86(3):240-4. [Crossref]
  39. Yun KH, Oh SK, Park EM, Kim HJ, Shin SH, Lee EM, et al. An increased monocyte count predicts coronary artery spasm in patients with resting chest pain and insignificant coronary artery stenosis. Korean J Intern Med. 2006;21(2):97-102. [Crossref]
  40. Nadimi AE, Ahmadi J, Mehrabian M. Peripheral eosinophil count and allergy in patients with coronary artery disease. Acta Med Indones. 2008;40(2):74-7.
  41. Ates AH, Canpolat U, Yorgun H, Kaya EB, Sunman H, Demiri E, et al. Total white blood cell count is associated with the presence, severity and extent of coronary atherosclerosis detected by dual-sourcemultislice computed tomographic coronary angiography. Cardiol J. 2011;18(4):371-7.
  42. Twig G, Afek A, Shamiss A, Derazne E, Tzur D, Gordon B, et al. White blood cell count and the risk for coronary artery disease in young adults. PloS One. 2012;7(10):e47183. [Crossref] [PubMed]
  43. Jiang P, Wang DZ, Ren YL, Cai JP, Chen BX. Significance of eosinophil accumulation in the thrombus and decrease in peripheral blood in patients with acute coronary syndrome. Coron Artery Dis. 2015;26(2):101-6. [Crossref] [PubMed]
  44. Borczuk AC, van Hoeven KH, Factor SM. Review and hypothesis: the eosinophil and peripartum heart disease (myocarditis and coronary artery dissection) ecoincidence or pathogenetic significance? Cardiovasc Res. 1997;33:527-32. [Crossref]
  45. Umemoto S, Suzuki N, Fujii K, Fujii A, Fujii T, Iwami T, et al. Eosinophil counts and plasma fibrinogen in patients with vasospastic angina pectoris. Am J Cardiol. 2000;85(6):715-9. [Crossref]
  46. Verdoia M, Schaffer A, Cassetti E, Di Giovine G, Marino P, Suryapranata H, et al. Absolute eosinophils count and the extent of coronary artery disease: a single centre cohort study. J Thromb Thrombolysis. 2015;39(4):459-66. [Crossref] [PubMed]
  47. Gillum RF, Mussolino ME, Madans JH. Counts of neutrophils, lymphocytes, and monocytes, cause-specific mortality and coronary heart disease: the NHANES-I epidemiologic followup study. Ann Epidemiol. 2005;15(4):266-71. [Crossref] [PubMed]
  48. Paoletti R, Gotto AM Jr, Hajjar DP. Inflammation in atherosclerosis and implication for therapy. Circulation. 2004;109(23 Suppl 1):III20-6. [Crossref]
  49. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105(9): 1135-43. [Crossref] [PubMed]
  50. Farhangi MA, Keshavarz SA, Eshraghian M, Ostadrahimi A, Saboor-Yaraghi AA. White blood cell count in women: relation to inflammatory biomarkers, haematological profiles, visceral adiposity, and other cardiovascular risk factors. J Health Popul Nutr. 2013;31(1):58-64. [Crossref] [PubMed]
  51. Fuster V, Lewis A. Mechanisms leading to myocardial infarction: insights from studies of vascular biology. Circulation. 1994;90(4): 2126-46. [Crossref] [PubMed]
  52. Madjid M, Awan I, Willerson JT, Casscells SW. Leukocyte count and coronary heart disease: implications for risk assessment. J Am Coll Cardiol. 2004;44(10):1945-56. [Crossref] [PubMed]
  53. Hong LF, Li XL, Luo SH, Guo YL, Liu J, Zhu CG, et al. Relation of leukocytes and its subsets count with the severity of stable coronary artery disease in patients with diabetic mellitus. PloS One. 2014;9:1-7. [Crossref]
  54. Horwitz LD, Kaufman D, Kong Y. An antibody to leukocyte integrins attenuates coronary vascular injury due to ischemia and reperfusion in dogs. Am J Physiol. 1997;272(2 Pt 2):H618-24. [PubMed]
  55. Barron HV, Cannon CP, Murphy SA, Braunwald E, Gibson CM. Association between white blood cell count, epicardial blood flow, myocardial perfusion, and clinical outcomes in the setting of acute myocardial infarction: a thrombolysis in myocardial infarction 10 substudy. Circulation. 2000;102(19):2329-34. [Crossref] [PubMed]
  56. Ernst E, Hammerschmidt DE, Bagge U, Matrai A, Dormandy JA. Leukocytes and the risk of ischemic diseases. JAMA. 1987;257(17): 2318-24. [Crossref] [PubMed]
  57. Avanzas P, Quiles J, López de Sá E, Sánchez A, Rubio R, García E, et al. Neutrophil count and infarct size in patients with acute myocardial infarction. Int J Cardiol. 2004;97(1):155-6. [Crossref] [PubMed]
  58. Sakatani T, Hadase M, Kawasaki T, Kamitani T, Kawasaki S, Sugihara H. Usefulness of the percentage of plasma lymphocytes as a prognostic marker in patients with congestive heart failure. Jpn Heart J. 2004;45(2):275-84. [Crossref] [PubMed]
  59. Ulfman LH, Joosten DP, van Aalst CW, Lammers JW, van de Graaf EA, Koenderman L, et al. Platelets promote eosinophil adhesion of patients with asthma to endothelium under flow conditions. Am J Respir Cell Mol Biol. 2003;28(4):512-9. [Crossref] [PubMed]
  60. Peterson ED, Shaw LJ, Califf RM. Risk stratification aftermyocardial infarction. Ann Intern Med. 1997;126(7):561-82. [Crossref] [PubMed]
  61. Zientek DM, King DL, Dewan SJ, Harford PH, Youman DJ, Hines TR. Hypereosinophilic syndrome with rapid progression of cardiac involvement and early echocardiographic abnormalities. Am Heart J. 1995;130(6):1295-8. [Crossref]
  62. Séguéla PE, Acar P. Hypereosinophilic heart disease. In: da CruzE, Ivy D, Jaggers J, eds. Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. 1st ed. London: Springer-Verlag; 2014. p.2439-51. [Crossref]
  63. Imanishi T, Ikejima H, Tsujioka H, Kuroi A, Ishibashi K, Komukai K, et al. Association of monocyte subset counts with coronary fibrous cap thickness in patients with unstable angina pectoris. Atherosclerosis. 2010;212(12):628-35. [Crossref] [PubMed]
  64. Woollard KJ, Geissmann F. Monocytes in atherosclerosis: subsets and functions. Nat Rev Cardiol. 2010;7(2):77-86. [Crossref] [PubMed]
  65. Ley K, Miller YI, Hedrick CC. Monocyte and macrophage dynamics during atherogenesis. Arterioscler Thromb Vasc Biol. 2011;31(7): 1506-16. [Crossref] [PubMed]
  66. Jaipersad AS, Lip GY, Silverman S, Shantsila E. The role of monocytes in angiogenesis and atherosclerosis. J Am College Cardiol. 2014;63(1):1-11. [Crossref] [PubMed]

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6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com