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White blood cell count as a risk factor for hypertension; a study of Japanese male office workers
Abstract
To investigate the association of white blood cell (WBC) count with risk of hypertension.
Cross-sectional and longitudinal studies.
A work site in Japan.
A total of 3776 Japanese male office workers aged 23-49 years were enrolled in this study; 2900 hypertension-free [systolic blood pressure (SBP) < 140 mm Hg, diastolic blood pressure (DBP) < 90 mm Hg, no medication for hypertension, and no past history of hypertension] men were followed up over a 4-year period.
Blood pressure levels and the incidence of hypertension (SBP > or = 140 mm Hg and/or DBP > or = 90 mm Hg or medication for hypertension) according to WBC count at study entry.
After controlling for potential predictors of hypertension, SBP and DBP levels increased in a dose-dependent manner among both never-smokers and ex-smokers as WBC count increased. Among current smokers, only SBP level increased progressively with WBC count level. The multivariate-adjusted relative risk for development of hypertension compared with the first WBC count quintile was 1.29, 1.21, 1.67, and 1.92 among never-smokers (P for trend = 0.002): and 1.34, 1.46, 1.84, and 1.97 among ex-smokers (P for trend = 0.030) with the second, third, fourth, and fifth quintiles, respectively. Among current smokers, the respective multivariate-adjusted relative risks for hypertension relative to the first WBC count quintile were 0.91, 0.97, 1.08, and 0.84 (P for trend = 0.999).
WBC count is an important risk factor for hypertension, and the increased risk for hypertension associated with WBC count is more pronounced in non-smokers.
... Elevated levels of systemic inflammatory markers have been found associated with incidence of cardiovascular diseases [3,5]. Furthermore, many epidemiological studies have highlighted that chronic low grade inflammation is associated with diabetes mellitus [8] , hyperten- sion [9], metabolic syndrome [10,11], obesity [12], smoking [13], and other lifestyle habbits [14]. Systemic inflammation can be measured by using a variety of biochemical and haematological markers. ...
... However, we could not explore whether the low grade inflammation in the body was a cause of the co-morbid conditions or an effect. Higher level of white blood cells has been previously linked with incident hypertension among different population based studies [9]. Similarly, systemic inflammation has also been reported as a significant factor for metabolic syndrome including obesity and diabetes mellitus [11]. ...
... One potential explanation is that, cellular response of blood components might be mediated through the endothelial dysfunction. Inflammation modifies endothelial function and an inability of the endothelium to produce nitric oxide and prostacyclin can result in the depletion of vasodilator, antithrombotic and anti-atherogenic properties of the vascular endothe- lium[9]. In addition, stimulated leukocytes alter Imtiaz et al. ...
Preliminary evidence has suggested the role of inflammation in development and prognosis of cardiovascular diseases and cancers. Most of the prognostic studies failed to account for the effects of co-morbid conditions as these might have raised the systemic inflammation. We used neutrophil lymphocyte ratio (NLR) as a measure of systemic inflammation and investigated its association with prevalent chronic conditions.
Present study is a cross sectional study conducted on population of Karachi, Pakistan. A detailed questionnaire about the demographic details of all subjects was filled and an informed consent obtained for blood sampling. Multinomial regression analyses were carried out to investigate the relationship between NLR and prevalent chronic conditions.
1070 apparently healthy individuals participated in the study. Proportion of individuals with hypertension was higher in middle and highest tertile of NLR as compared to the lowest tertile (18.2% & 16.1% compared to 11.8%). Individuals with hypertension were 43% (RRR = 1.43, 95% CI 0.94-2.20) and 66% (RRR = 1.69, 95% CI 1.09-2.54) more likely to be in the middle and highest tertile of NLR respectively compared to the baseline group. Similarly, individuals with diabetes mellitus were 53% (RRR = 1.53, 95% CI 0.93-2.51) and 65% (RRR = 1.65, 95% CI 1.01-2.71) more likely to be in the middle or highest tertile of NLR as compared to the baseline NLR group.
Systemic inflammation measured by NLR has a significant association with prevalent chronic conditions. Future research is needed to investigate this relationship with longitudinal data to establish the temporal association between these variables.
... Also, several studies have reported a positive association between hypertension and elevated white blood cell counts among the number of population types [19][20][21][22][23]. These reports suggest that inflammation could possibly play a key role in the development of cardiovascular disease [24]. ...
... There is increase in WBC count with predominant neutrophilia among hypertensive subjects when compared with the normotensive subjects in this study. This collaborate with the following studies [19,[20][21][22][23][24][25][26][27]. Also, platelet count was high and significant among hypertensive subjects when compared with the normotensive subjects in this study. ...
Aim: The Complete Blood Count (CBC) among hypertensive subjects in Isiala Mbano, Imo State, Nigeria West Africa were studied. Methodology: The American College of Cardiology/American Heart Association (2017) current definition of hypertension was used to ascertain, diagnoses and assigned eighty (80)hypertensive subjects after three different consecutive blood pressure check into tests groups. Other blood pressure measures such as pulse pressure and mean arterial pressure were calculated appropriately. Venous blood samples were collected with 5mls syringe and immediately emptied into EDTA container for complete blood count analysis. Results: The results showed increase in RBC count, HB, PCV and decrease in MCV among hypertensive subjects compared with normotensive subjects. It was statistically insignificant in all age groups. No changes were seen in MCHC and MCH. The results also, showed increase in PLTS count. The increase in PLTS count was statistically significant at P<0.05 and <0.001 among hypertensive age groups 36-65yrs and >66yrs respectively. Increase in PLTS count among 20-35yr age group was not significant. There were increase in WBC count among hypertensive subjects compared with normotensive subjects in all age groups. It was statistically significant at P<0.05 and <0.001 among hypertensive age groups 36-50yrs and >66yrs respectively. Neutrophil was increased in all age groups and was statistically significant at P<0.05 except 20-35yr age group. No changes were seen on lymphocytes, monocytes, eosinophils and basophils. Conclusion: Haematological parameters investigated could predict possible cardiovascular abnormalities such as hypertension.
... Chronic inflammation is a risk factor of hypertension [1,2,[4][5][6][7][8][9]. However current evidence of this risk factor is mainly based on the association between high-sensitivity C-reactive protein and hypertension, and is mainly derived from Western populations [10][11][12][13]. Therefore, whether the white blood cell (WBC) count can also predict development of hypertension in the Asian population is unclear [14]. ...
... A number of previous observational studies reported associations between indicators of inflammation, such as C-reactive protein, interleukin-6, interleukin-8, WBC count, neutrophil count, neutrophil to lymphocyte ratio, and incidence of hypertension [10][11][12][13][19][20][21]. A prospective cohort study of atomic bomb survivors in Japan reported that an elevation in the WBC and neutrophil counts, which were measured in the 1960's, were clearly related to an increased risk of future development of hypertension [22]. ...
Objectives
This study aimed to clarify the relationship between the white blood cell (WBC) count and hypertension in the general Japanese population.
Methods
We conducted a population-based retrospective cohort study using annual health check-up data of residents of Iki City, Nagasaki Prefecture, Japan. A total of 2935 participants without hypertension at baseline were included in the present analysis. WBC counts were classified as tertile 1 (<4700/μL), tertile 2 (4700–5999/μL), and tertile 3 (≥6000/μL). The outcome was incident hypertension (blood pressure ≥140 mmHg). Multivariable-adjusted hazard ratios and 95% confidence intervals (95% CIs) were estimated using the Cox proportional hazards model.
Result
During an average follow-up of 4.5 years, 908 participants developed hypertension. The incidence (per 100 person-years) of hypertension increased with an elevation in the WBC count (6.3 in tertile 1, 7.0 in tertile 2, and 7.4 in tertile 3). This association was significant, even after adjustment for other risk factors, including age, sex, current smoking habits, current alcohol intake, exercise habits, obesity, elevated blood pressure, diabetes mellitus, and dyslipidemia. The hazard ratios were 1.07 for tertile 2 (95% CI 0.90–1.26) and 1.27 for tertile 3 (95% CI 1.06–1.51) compared with the reference group of tertile 1 (p = 0.009).
Conclusion
The WBC count was associated with future development of hypertension in the general Japanese population.
... 10 Several studies have reported a positive association between hypertension and elevated white blood cell (WBC) counts among the number of population types. [11][12][13][14][15] These reports suggest that inflammation could possibly play a key role in the development of cardiovascular disease. 16 For instance, a hypertensive leukocytosis has been described among Indians and Caucasians; initial leukocyte counts have been found to be related to the development of hypertension with increased risk in persons in the highest as compared to the lowest quartile of WBC count. ...
... 18 Among the Japanese, WBC count is an important risk factor for hypertension; the increased risk of hypertension associated with WBC count being more pronounced in nonsmokers. 13 Furthermore, a number of studies within the normotensive blood pressure range suggest a clear association of WBC counts with SBP; 15 with increases in SBP associating with elevated WBC counts. 16 Sex variations described in the present study are consistent with the report of Tatsukawa et al. in 2008 that elevated WBC counts predicted the increased incidence of hypertension, especially among females and neutrophils being the major WBC component contributing to the increased risk. ...
Background
Reports comparing the values of white blood cells (WBCs) and platelet parameters among normotensive, newly diagnosed hypertensive, and known hypertensive participants in Nigeria are relatively scarce. This study sought to compare these hematologic parameters of normotensive and hypertensive participants in the Southeastern Nigeria.
Materials and Methods
Fifty participants each of normotensive, newly diagnosed hypertensive, and known hypertensive and age- and sex-matched individuals were recruited into the study. Using an automated hematology analyzer, the following hematological parameters were determined in all participants: total WBC; neutrophil, lymphocyte and platelet counts; percentage value of neutrophil and lymphocytes; mean platelet volume (MPV); platelet distribution width; and total lymphocyte count.
Results
Significantly higher total WBCs and (absolute) neutrophil counts and lower percentage lymphocyte were observed among known hypertensive male participants, whereas percentage neutrophil was significantly higher among known hypertensive female participants. Platelet count and MPV were significantly higher in hypertensive male participants compared to their normotensive counterparts. MPV was found to be significantly lower in hypertensive female participants compared to normotensive females.
Conclusion
The present study reports significantly higher leukocytes, platelet counts, and MPV among hypertensive males and lower MPV among hypertensive females. Regular assessment of hematological parameters may perhaps be useful indicators of the prognosis of hypertension among the study population.
... Recently, inflammation has been identified as an independent risk factor for cardiovascular disease [5]. The relationship between an increased C-reactive protein (CRP) level, neutrophil activation, chro-nic systemic inflammation and cardiovascular disease risk has been reported in the literature [6,7]. ...
... Urticaria activity score (UAS) was evaluated on the day of blood-letting (rash number: no rash: 0, 1-10 wheals = 1, 11-50 wheals = 2, > 50 wheals = 3+ pruritus intensity: none: 0, mild: 1, moderate: 2, severe: 3; minimum = 0, maximum = 24). UAS was graded as mild (1)(2)(3)(4)(5)(6)(7)(8), moderate (9-16) and severe (17)(18)(19)(20)(21)(22)(23)(24). ...
Introduction:
Low grade inflammation is associated with chronic spontaneous urticaria (CSU) and atherosclerosis. There are little data on the relationship between urticarial inflammation and atherosclerosis. The neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and mean platelet volume (MPV) have recently been studied in many diseases as a biomarker of inflammation.
Aim:
To evaluate hematologic inflammatory parameters and subclinical atherosclerosis in CSU patients.
Material and methods:
C-reactive protein (CRP), NLR, PLR, MPV and carotid intima media thickness (CIMT) in CSU patients were compared with healthy controls. Thirty CSU patients and 30 healthy controls participated in the study.
Results:
Thirty CSU patients and 30 healthy controls participated in the study. 53.3% of the patient group were females, 46.7% were males and the mean age was 37.7 ±7.7. 53.3% of the healthy control group were females, 46.7% were males and the mean age was 37.1 ±7.2. Body mass index was 24.63 ±2.7 kg/m2 in the patient group and 24.83 ±2.5 kg/m2 in the control group. Left and right CIMT and CRP values were higher in CSU patients and high-density lipoproteins (HDL) values were lower in the CSU patients. There was a positive correlation between the right and left CIMT and urticaria activity severity 4 (UAS4), disease severity, and triglycerides in the patient group, also a negative correlation was found between the right and left CIMT and the HDL values. C-reactive protein was also correlated with UAS4 and disease severity.
Conclusions:
This is the first study to evaluate subclinical atherosclerosis in CSU patients. Chronic spontaneous urticaria may be associated with an increased atherosclerotic risk. Serum CRP concentration can also be used as an objective parameter to evaluate disease severity.
... One of the several explanations given for the biological plausibility of the etiological link between cigarette smoking and chronic diseases is tobacco smoke-mediated systemic inflammation (Krüger et al., 2015;Shiels et al., 2014). Several studies have reported that systemic inflammation may be one of the precursors for several chronic diseases, including diabetes mellitus, cardiovascular disorders, and cancers (Folsom et al., 1999(Folsom et al., , 2002Nakanishi et al., 2002;Pitsavos et al., 2007). Thus, it can be speculated that WP smoking may also be associated with these chronic diseases plausibly mediated through its systemic inflammatory effects. ...
... In light of existing literature, various mediators have been linked with onset of systemic inflammation, including obesity, lack of physical activity, stress, and even cigarette smoking (Bell and O'Keefe, 2007;Brooks et al., 2010;Copeland et al., 2014;Nakanishi et al., 2002;Pirkola et al., 2010;Pitsavos et al., 2007;Yasue et al., 2006). Comparing study results with existing evidence available in this regard, raised total leukocyte count among WP smokers had been reported in several studies (Bentur et al., 2014;Khabour et al., 2012), and the results are also comparable with studies that have reported raised total leukocyte count among cigarette smokers (Shenwai and Aundhakar, 2012;Tell et al., 1985;Whitehead et al., 1995). ...
Objective:
To determine the levels of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) among exclusive groups of waterpipe (WP) smokers, cigarette smokers, and nonsmokers.
Methods:
This cross-sectional study was conducted among adults, apparently healthy individuals, aged between 18 and 40 years of either gender. NLR and PLR as measures of systemic inflammation were studied in association with individuals' sociodemographic, health, and tobacco use related characteristics. The results of linear and logistic regression models were reported as crude and adjusted beta coefficients and odds ratios with 95% confidence intervals (CIs).
Results:
Out of 190 participants, 34.2% (n = 65) exclusively smoked WP, 32.6% (n = 62) smoked cigarettes, and 33.2% (n = 63) were nonsmokers. The mean NLR and PLR were significantly higher among WP smokers when compared with nonsmokers; however, the comparison between WP smokers and cigarette smokers for both NLR and PLR was not statistically significant. The odds of raised NLR was 4.40 times higher (AOR = 4.40, 95% CI = 1.97, 9.85), and the odds of raised PLR was 3.48 times higher (AOR = 3.48, 95% CI = 1.60, 7.57) for WP smokers compared to nonsmokers.
Conclusions:
WP smoking has a significant association with systemic inflammation as measured by NLR and PLR. The study and existing evidence implicate an urging need to regulate WP industry and its policies.
... ,34 For instance, Nakashiki et al. in a cohort study on 3776 Japanese male office workers aged 23-49 years, demonstrated that WBC count is a risk factor for hypertension.34 ...
... ,34 For instance, Nakashiki et al. in a cohort study on 3776 Japanese male office workers aged 23-49 years, demonstrated that WBC count is a risk factor for hypertension.34 ...
BACKGROUND:
Hypertension (HTN) is a risk factor for stroke, renal failure, and cardiovascular disease. The association between biochemical and hematological parameters with high blood pressure may provide a more precise approach to risk prediction conferred by HTN in these patients.
OBJECTIVE:
The aim of current study was to explore whether biochemical and hematological parameters are associated with HTN in a cohort study with a 7-year follow-up.
MATERIALS AND METHODS:
A total of 9808 individuals were enrolled and recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study, and biochemical and hematological factors were measured in all subjects. Univariate and multivariate logistic regression analysis were performed to determine the association of biochemical and hematological parameters with HTN.
RESULTS:
Several biochemical parameters including fasting plasma glucose (FBG), serum high-sensitivity C-reactive protein (hs-CRP), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and uric acid were increased in hypertensive participants. In contrast, serum high-density lipoprotein cholesterol (HDL-C) was lower in hypertensive individuals. Furthermore, we demonstrated that hematological parameters including white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin (HGB), hematocrit (HCT), and mean corpuscular hemoglobin (MCH) were higher in the hypertensive group compared to the control group. But mean corpuscular volume (MCV), and red cell distribution width (RDW), were decreased in the hypertensive group. Furthermore, our results strongly suggested that among these parameters, hematocrit was the independent risk factor for hypertension in the population.
CONCLUSION:
We demonstrated the association of altered biochemical and hematological factors with hypertension supporting the value of emerging markers for early prediction of high blood pressure in prone individuals.
... (5) Schmid-schonbein et al who has studied the role of leucocyte in hypertension using spontaneous hypertensive rats and Wistar-Kyoto rats(controls); and have demonstrated that the total leucocyte count in hypertensive rats were 50-100% above the controls. (6) Nakanishi et al studied 3776 Japanese male office workers aged 23-49 years. Out of which 2900 hypertension-free [systolic blood pressure (SBP) < 140 mm Hg, diastolic blood pressure (DBP) < 90 mm Hg, no medication for hypertension, and no past history of hypertension] men were followed up over a 4-year period. ...
... Sun et al. [7] proposed that, in the Cardiometabolic Risk in Chinese (CRC) study, WBC count could independently predict hypertension in Chinese adults. Nakanishi et al. [8] followed up Japanese male office workers aged 23-49 years over 4 years, and demonstrated that WBC count might be an important risk factor for hypertension, which was pronounced in non-smokers. On the other hand, Shankar et al. [9] reported that elevated WBC count was associated with incident hypertension among women and men independent of smoking and most traditional risk factors in the white cohort. ...
... Previous studies have proposed WBC and N as risk factors for HTN and HTN with first ischemic stroke, respectively. 30,31 Similarly, a study has shown that N was associated with the occurrence and severity of DM as well as diabetic retinopathy. 32 Based on this, we presumed that patients with DM and HTN of the 5G/5G genotype were at reduced risk of developing complications. ...
Objective
To determine the plasminogen activator inhibitor-1 (PAI-1) 4G/5G (rs1799889) genotype of the subjects in a robust detection method and to explore the association of the PAI-1 4G/5G polymorphism with susceptibility to diabetes mellitus (DM) and hypertension (HTN) as well as clinical characteristics.
Methods
This study recruited 208 patients (68 patients were diagnosed with DM, 70 patients with HTN and 70 patients with DM combined with HTN) and 132 healthy controls (HC). A subset of the population was selected to evaluate the accuracy of the Real-time PCR (RT-PCR) method for detecting PAI-1 4G/5G polymorphism by using the sequencing method as the gold standard. Furthermore, the association of the PAI-1 4G/5G polymorphism with genetic susceptibility to DM and HTN was explored. Moreover, variations in clinical characteristics among individuals with various PAI-1 genotypes were also analyzed in the DM group, the HTN group and the DM+HTN group.
Results
There was a high concordance between the RT-PCR method and the sequencing method in determining the PAI-1 4G/5G polymorphism. No association was observed between the PAI-1 4G/5G polymorphism and susceptibility to DM, HTN and DM+HTN, respectively. There were no statistical differences in all study indicators among individuals that carrying various genotypes in the HC group. There were several variations in clinical characteristics among individuals harboring different PAI-1 4G/5G genotypes in the DM group, the HTN group and the DM+HTN group.
Conclusion
The RT-PCR method can accurately identify the PAI-1 4G/5G genotype in different individuals. The PAI-1 4G/5G polymorphism may not be associated with genetic susceptibility to DM, HTN and DM+HTN, but differences in clinical characteristics among individuals with various genotypes may provide a reference for disease assessment and personalized treatment of patients.
... The count of the white blood cell which is one of the basic cells for inflammation and sub-types are used as a classical marker for the inflammatory state especially in cardiovascular diseases (5). Beyond cardiac diseases, there are studies indicating that a low-grade inflammation exists in some conditions such as diabetes, hypertension, metabolic syndrome and obesity (6)(7)(8)(9). Recently, neutrophil-lymphocyte ratio (NLR) is used as a well indicator of inflammation together with other inflammatory markers for cardiac and non-cardiac diseases and ocular pathologies (10)(11)(12)(13). ...
Objective: Branch retinal vein occlusion (BRVO) is the most common retinal vascular disease following diabetic retinopathy. Pathogenesis of BRVO is multifactorial and could not be clarified enough yet. As BRVO is a disease that goes with thrombosis and inflammatory processes, inflammatory markers could help to predict the risk of BRVO. The aim of this study was to evaluate the association between neutrophil-lymphocyte ratio (NLR) and the BRVO.Materials and Methods: Forty-three patients with BRVO were included to this retrospective study. Forty age and sex-matched healthy volunteers were recruited as the control group. Demographic characteristics, white blood cell (WBC), neutrophil, lymphocyte, monocyte, platelet counts and NLR were recorded and compared between the patients and the control group.Results and Discussion: The mean WBC, neutrophil and NLR were significantly higher in the BRVO patients compared with control group (7.89±1.8fL vs 6.97±1.4fL, p=0.014, 4.85±1.4fL vs 4.01±0.9fL, p=0.002, 2.40±1.2 vs 1.87±0.5, p=0.026, respectively). There were no difference between two groups in terms of lymphocyte, monocyte and platelet counts (p=894, p=0.22, p=0.589, respevtively).Conclusion: NLR was higher in patients with BRVO and higher NLR may contribute to development of BRVO associated with systemic and/or local inflammation.International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 499-502
... 27,28,29,30 Epidemiological studies emphasize that chronic mild inflammation is often found in conditions such as diabetes mellitus, hypertension, metabolic syndrome, obesity, smoking, and other bad habits. 31,32,33,34,35,36,37 Previous studies confirmed a relationship between inflammatory indicators and development of CCC, both in multivessel disease or total coronary occlusion. Increased inflammatory markers, leukocytes and neutrophils were associated with severity of CAD and the grades of coronary collateral circulation. ...
Background: Coronary collateral circulation (CCC) is an adaptive response to chronic myocardial ischemia. Patients with coronary stenosis develop varying degrees of collateral. Levels of inflammatory cells were suggested as potential determinants of collateral development. Neutrophil to lymphocyte (N/L) ratio has been proposed as a prognostic marker to determine systemic inflammatory response and the development of CCC. Our aim was to determine the relationship between N/L ratio and development of CCC in patients with coronary artery disease (CAD) with multivessel disease.Method:A total of 151 patients with multivessel disease were included in this study. Coronary collateral grades were classified according to Rentrop collateral grades as either poorly developed CCC (Rentrop grade 0-1) or well developed CCC (Rentrop grades 2-3). Factors significant at the p≤0.25 in the bivariate models were put into multiple logistic regressions. The receiver–operating characteristic (ROC) analysis were performed to determine the cutoff value of NLR in predicting poor CCC.Result: Of the 151 CAD patients in this study, 76 patients had poorly developed CCC and 75 patients had well developed CCC. Poorly developed CCC had significantly higher N/L ratio than well developed CCC (2.25±1.189 vs. 3.03±1.527, p <0.001). Logistic regression analysis showed that N/L ratio (OR0.756; CI 95% 0.587 – 0.974, p 0.031) was independent predictor of poorly developed CCC. The ROC analysis provided a cut-off value of 1.99 (AUC 0.72, sensitivity 78.9%, specificity 52%) for N/L ratio to predict poorly developed CCC.Conclusion: Higher neutrophil to lymphocyte ratio was useful in predicting poor coronary collateral circulation in stable coronary heart disease with multivessel disease. Neutrophil to lymphocyte ratio >1.99 was independently associated with impairment in coronary collateralization. This value had a sensitivity of 78.9% and specificity of 52%.
... Neutrophil-lymphocyte ratio (NLR) is a novel marker that can be used as a marker of subclinical inflammation. Several epidemiological studies have highlighted that chronic low-grade inflammation is associated with diabetes mellitus, [10] hypertension, [12] obesity, [13] smoking, [14] other lifestyle habits, [15] and even cancers. ...
Introduction: Patients with diabetes mellitus commonly develop chronic vascular complications including diabetic nephropathy (DN). Chronic inflammation plays an important role in pathogenesis of diabetes and its complications. Neutrophil-Lymphocyte Ratio (NLR) is a novel potential marker for determining inflammation.
Objective: To study NLR in type 2 diabetes mellitus and its correlation with renal function.
Method: This study is a cross-sectional observational study conducted at a tertiary care hospital. This study included 200 patients diagnosed with type 2 diabetes mellitus, 100 of whom had deranged renal functions and 100 patients had normal renal function. The control group was composed of 100 healthy age and sex-matched subjects. NLR was calculated and statistical analysis was made using student's t-test, post HOC test, and ANOVA. A value of P < 0.05 was considered significant.
Results: When NLR was compared among three groups, NLR was significantly higher in diabetic patients as compared to controls and NLR was significantly higher in diabetic nephropathy group as compared to the diabetic with normal renal function group and control group.
Conclusions: NLR is a novel, simple and inexpensive marker that can be used as a measure of systemic inflammation in diabetes and correlates with severity of diabetic nephropathy.
... Moreover, an increased inflammatory state would generate a cytokine storm with consequent microvascular alterations responsible for impaired wound and anastomotic healing [29]. ...
Background:
The role of preoperative inflammatory biomarkers (PIBs) in predicting postoperative morbidity has been assessed in colorectal and otorhinolaryngeal surgery. However, data regarding the role that preoperative inflammatory biomarkers have on morbidity after pancreaticoduodenectomiy (PD) are less consistent.
Aim:
To assess the utility of PIBs in predicting postoperative complications after pancreaticoduodenectomy.
Methods:
A database of 317 consecutive pancreaticoduodenectomies performed from April 2003 to November 2018 has been retrospectively analyzed. Data regarding preoperative neutrophil-to-lymphocyte ratio (NLR), derived NLR and C-reactive protein (CRP), and postoperative complications of 238 cases have been evaluated. Exclusion criteria were: age < 18-years-old, previous neoadjuvant treatment, absence of data about PIBs, concomitant hematological disorders, and presence of active infections at the moment of the surgery. PIBs were compared using Mann-Whitney's test and receiver operating characteristic (ROC) analysis was performed to define the cutoffs. The positive predictive value (PPV) was computed to evaluate the probability to develop complication. P-values < 0.05 were considered statistically significant.
Results:
According to the literature findings, only four papers have been published reporting the relation between the inflammatory biomarkers and PD postoperative morbidity. A combination of preoperative and postoperative inflammatory biomarkers in predicting complications after PD and the utility of preoperative NLR in the development of postoperative pancreatic fistula (POPF) have been reported. The combination of PIBs and postoperative day-1 drains amylase has been reported to predict the incidence of POPF. According to our results, CRP values were significantly different between patients who had/did not have postoperative complications and abdominal collections (P < 0.05). Notably, patients with preoperative CRP > 8.81 mg/dL were at higher risk of both overall complications and abdominal collections (respectively P = 0.0037, PPV = 0.95, negative predictive value [NPV] = 0.27 and P = 0.016, PPV = 0.59, NPV = 0.68). Preoperative derived neutrophil-to-lymphocyte ratio (dNLR) (cut off > 1.47) was also a predictor of abdominal collection (P = 0.021, PPV = 0.48, NPV = 0.71). Combining CRP and dNLR, PPV increased to 0.67. NLR (cut off > 1.65) was significantly associated with postoperative hemorrhage (P = 0.016, PPV = 0.17, NPV = 0.98).
Conclusion:
PIBs may predict complications after PD. During postoperative care, PIB levels could influence decisions regarding the timing of drains removal and the selection of patients who might benefit from second level diagnostic exams.
... In recent studies, it has been shown that adipose tissue is an important source of proinflammatory cytokines 1 . It was shown in many epidemiological studies that chronic low-level inflammation is associated with diabetes, hypertension, metabolic syndrome, obesity, smoking, and other lifestyle habits [2][3][4][5][6][7][8] . ...
Purpose: The aim of this stuıdy was to determine the relation between inflammation markers, anthropometric measurements, and blood lipid values.
Materials and Methods: The present study was conducted with 274 adult healthy subjects in 2019. The relationship between anthropometric measurements and blood lipid values of individuals, full blood count inflammation markers, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and lymphocyte monocyte ratio (LMR) were examined..
Results: The average age of the 274 subjects, who participated in the study, was 34 years. No significant differences were detected between the NLR, PLR and LMR ratios according to the BMI scores. A very weak and negative correlation was detected between PLR and skeletal muscle, basal metabolic rate, body fluid amount and lean mass; and a weak and negative correlation was detected between HDL and BMI, body fat amount, and internal fat amount. A weak and positive correlation was detected between NLR and LDL.
Conclusion: There was a very weak correlation between anthropometric values and inflammation markers, a weak-moderate correlation between blood lipid levels, and a weak correlation between inflammation markers and cholesterol levels.
... First, neutrophil-mediated cellular inflammation has been shown to play a role in the early phase of NAION [18,23]. Some studies have demonstrated that increased neutrophil count is related to areas of ischemic injury [24][25][26]. The association between neutrophilia and impaired microvascular perfusion may be a manifestation of neutrophil-mediated microvascular plugging. ...
Purpose:
To evaluate the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in patients with non-arteritic anterior ischemic optic neuropathy (NAION).
Methods:
Fifty-six patients with NAION and 60 age-sex matched healthy controls were included in the study. Demographic characteristics and laboratory findings of the patients and the controls were obtained from the electronic medical records. NLR, PLR, MLR, and SII were calculated and compared between the groups. Cutoff values were also determined.
Results:
Neutrophil, monocyte and platelet counts were higher in the NAION group than in the control group, but the difference was not statistically significant (p > 0.05). The mean NLR and SII were higher in the NAION group than in the control group (p = 0.004 and p = 0.011, respectively). In the receiver operating characteristic curve analysis, the areas under the curve for NLR were 0.67, and NLR >1.79 predicted NAION with a sensitivity of 71% and specificity of 59%. The areas under the curve for SII was 0.66, and SII of >417 predicted NAION with a sensitivity of 71% and specificity of 49%. There was no significant difference in PLR and MLR between the groups (p = 0.105 and p = 0.347, respectively).
Conclusions:
The current study demonstrated that NAION patients had increased NLR and SII levels compared with control subjects. Elevated NLR and SII might serve as readily available inflammatory predictors in NAION patients.
... Previous studies have shown that elevated levels of neutrophil count are associated with increased risks of hypertension, 30,31 and have found a positive association between neutrophil count and CVD. 32,33 However, the exact role of neutrophils in hypercoagulability in EH remains to be explored. ...
Background
Essential hypertension (EH) patients, especially those along with hyperhomocysteinemia (HHcy), suffer from increased thrombotic events, however, the underlying mechanism remains unclear to date.
Objective
We aimed to measure the plasma NETs levels and its role in the induction of procoagulant activity (PCA) in EH, as well as to evaluate its interactions with platelets or endothelial cells (ECs).
Methods
The levels of NETs in the plasma of study subjects were detected by ELISA. NET formation and the morphology of cells were analysed using immunofluorescence or electron. PCA was analysed by purified coagulation complex assays, clotting time and fibrin turbidity. Phosphatidylserine (PS) exposured on ECs was detected with flow cytometry.
Results
We observed that cell free‐DNA and myeloperoxidase‐DNA were significantly higher in EH patients compared to healthy controls. Moreover, NET formation was positively correlated with serum homocysteine (Hcy) levels in EH with HHcy. Furthermore, neutrophils from EH patients were more prone to produce NETs compared to those from controls. More importantly, immunofluorescence showed that HHcy could induce NETs formation in vitvo. Coagulation function assays showed that EH NETs significantly shortened coagulation time and increased thrombin and fibrin generation. The PCA was markedly attenuated approximately 70% by using DNase I. Additionally, isolated NETs from EH neutrophils induced platelet activation, exerted a strong cytotoxic effect on ECs and converted them to a procoagulant phenotype.
Conclusions
Our study revealed a previously unrecognized link between hypercoagulability and NETs in EH. Therefore, blocking NETs may represent a new therapeutic target for preventing thrombosis in these patients.
... 18,19 In recent years blood levels of white blood cells (WBC) and their subtypes have been used as markers in a variety of conditions because their activation leads to the synthesis of inflammatory cytokines. 13,[20][21][22][23][24] Unlike cytokine levels, neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio are easy to calculate, can be easily applied in daily practice and are cost effective. Additionally, NLR is more powerful for the detection of inflammation than subtypes of WBC alone because it combines the predictive values of two parameters of WBC. ...
The purpose of this study was to evaluate the monocyte to high-density lipoprotein (HDL) ratio (MHR) in patients with arteritic anterior ischaemic optic neuropathy (A-AION) and non-arteritic anterior ischaemic optic neuropathy (NA-AION). A total of 98 subjects were included in the study. Patients were divided into three groups: 16 patients with A-AION regarded as group one; 41 patients with NA-AION regarded as group two and 41 healthy subjects regarded as the control group. The MHR was calculated in all participants and compared between the patient and control groups. The mean age of subjects with A-AION, NA-AION and the control group were 75.9 ± 8.9 years, 67.1 ± 9.2 years, and 66.6 ± 6.7 years, respectively. Baseline clinical characteristics, such as diabetes mellitus and hypertension, were similar among groups. The mean MHR was significantly higher only in the A-AION group compared with the NA-AION and control group (p < .001), whereas there was no difference between NA-AION group and control group (p = .110). On receiver operating characteristic analysis, the area under the curve was 0.755, and the best cut- off value was 12.2 with a sensitivity of 72% and a specificity of 80%. An elevated MHR ratio is significantly associated with A-AION and MHR might be used to differentiate A-AION from NA-AION.
... Previous studies have documented that an elevated WBC count was relevant to an increased risk of hypertension in Japanese male office workers, and this relationship was also noted in nonsmokers, especially those who indicated WBC count as a marker of low-grade systemic inflammation to be a significant risk of hypertension [15]. Furthermore, the NLR played an important role in prevalent chronic diseases, and compared to the lowest level, the higher tertile of NLR was associated significantly with the likelihood of hypertension and diabetes mellitus [14], and a large-scale cohort study also demonstrated the same result, consistent with our study [3]. ...
The neutrophil-to-lymphocyte ratio (NLR) has received much attention in recent decades and has been a novel inflammatory marker. NLR has been applied in predicting the prognosis of malignancies, mortality, and chronic diseases. Additionally, hypertension, defined as systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg, a previous diagnosis of hypertension, and taking any antihypertensive drug, has been one of the most common chronic diseases in Asia and is currently the most important risk factor for cardiovascular diseases worldwide. Thus, we aimed to investigate the correlation between NLR and prevalent hypertension in the Taiwanese population. From the data of routine health checkups at the General Health Promotion Center in the Tri-Service General Hospital (TSGH), a total of 6278 participants were included. The NLR value was divided into tertiles. The Cox regression model revealed that the highest NLR group tended to be hypertensive (HR = 1.28, 95% CI 1.03–1.59) after adjustment. Individuals were also divided into age-specific, BMI-specific, or sex-specific groups; compared with the lowest NLR group, elderly individuals in the highest tertile of NLR were relatively likely to be hypertensive after covariate adjustment (HR = 1.88, 95% CI 1.19–2.96). Furthermore, a male group aged more than 60 years was reported to have a significant association with hypertension (HR = 1.84, 95% CI 1.06–3.18). However, there was no significant difference in the BMI-based stratified groups, even after adjustment. Our research revealed a significant association between the NLR and incident hypertension, especially in elderly or male Taiwanese individuals.
... Higher levels of CRP were likely to be associated with incident hypertension in studies of middle-aged and older adults. 9,11,12 In contrast, in the cross-sectional British Women's Heart and Health Study investigating women aged 60-79 years and using a Mendelian randomization approach, elevated levels of CRP were not associated with elevated blood pressure. 23 The CARDINA study examined individuals ranging in age from 18 to 30 years; an association of CRP with incident hypertension was not observed after adjusting for BMI. ...
Inflammation plays a key role in the pathogenesis of cardiovascular diseases via the development of atherosclerosis. Here, we evaluated the impact of serum C‐reactive protein (CRP) and the white blood cell (WBC) count on the risk of hypertension in middle‐aged Japanese men at a work site. We evaluated a total of 2991 Japanese male workers without hypertension who ranged in age from 18 to 64 years (mean age 40.4 ± 0.2 years) at a worksite in 2010. The hazard ratio (HR) for incident hypertension was estimated according to quartile levels of serum high‐sensitivity CRP (hs‐CRP) or WBC count. These men were followed up for 5 years from 2010 to 2015. During the follow‐up period, 579 (19.4%) subjects developed hypertension. In a multivariable analysis, the risk of incident hypertension was significantly increased with higher hs‐CRP levels: HR 1.00 (reference) for the lowest quartile, 1.39 (1.04‐1.85) for the 2nd quartile, 1.46 (1.08‐1.98) for the 3rd quartile, and 1.57 (1.17‐2.11) for the highest quartile. In contrast, the WBC count was not associated with a greater risk of incident hypertension after multivariable adjustment. These findings suggest that higher levels of serum hs‐CRP, but not the WBC count, are associated with the future incidence of hypertension in middle‐aged Japanese men.
... Importantly, elevated WBCs are associated with the incidence of hypertension and predicts CV outcomes in this patient group. [37][38][39] However, the cause of increased WBCs in hypertensive patients has not been resolved. ...
Hypertension is a major, independent risk factor for atherosclerotic cardiovascular disease. However, this pathology can arise through multiple pathways, which could influence vascular disease through distinct mechanisms. An overactive sympathetic nervous system is a dominant pathway that can precipitate in elevated blood pressure. We aimed to determine how the sympathetic nervous system directly promotes atherosclerosis in the setting of hypertension. We used a mouse model of sympathetic nervous system-driven hypertension on the atherosclerotic-prone apolipoprotein E-deficient background. When mice were placed on a western type diet for 16 weeks, we showed the evolution of unstable atherosclerotic lesions. Fortuitously, the changes in lesion composition were independent of endothelial dysfunction, allowing for the discovery of alternative mechanisms. With the use of flow cytometry and bone marrow imaging, we found that sympathetic activation caused deterioration of the hematopoietic stem and progenitor cell niche in the bone marrow, promoting the liberation of these cells into the circulation and extramedullary hematopoiesis in the spleen. Specifically, sympathetic activation reduced the abundance of key hematopoietic stem and progenitor cell niche cells, sinusoidal endothelial cells and osteoblasts. Additionally, sympathetic bone marrow activity prompted neutrophils to secrete proteases to cleave the hematopoietic stem and progenitor cell surface receptor CXCR4. All these effects could be reversed using the b-blocker propranolol during the feeding period. These findings suggest that elevated blood pressure driven by the sympathetic nervous system can influence mechanisms that modulate the hematopoietic system to promote atherosclerosis and contribute to cardiovascular events.
... In this study, the most common complication was anastomotic leakage. Nakanishi et al (33) reported that systemic inflammatory responses modified endothelial function. An inability of the endothelium to produce nitric oxide and prostacyclin could result in depletion of the vasodilator and antithrombotic properties of the vascular endothelium. ...
Systemic inflammatory-, immunological- and nutritional-based indices, such as the neutrophil-to-lymphocyte ratio (NLR), the prognostic nutritional index (PNI) and the Glasgow prognostic score (GPS), are drawing considerable research attention to predict the long-term prognosis of many types of cancer. Recently, these parameters have also been reported to be useful in predicting postoperative morbidity in several fields, including colorectal and otolaryngological cancer. However, while distal cholangiocarcinoma exhibits a high morbidity rate, its risk factors of morbidity have not yet been established. This is because previous studies have analyzed distal cholangiocarcinoma as periampullary tumors combined with pancreatic head cancer. Therefore, the aim of the present study was to investigate the application of the NLR, the PNI and the GPS in evaluating risk factors for postoperative morbidity in patients with distal cholangiocellular or ampullary carcinoma. Eighty-four patients who underwent pancreaticoduodenectomy (PD) for distal cholangiocellular or ampullary carcinoma at the Department of Surgery in Kitasato University Hospital between 2008 and 2016 were enrolled. Associations between perioperative characteristics (NLR, PNI and GPS) and postoperative complications (Clavien-Dindo classification grade III or higher) were retrospectively analyzed. In the univariate analysis, neutrophil and lymphocyte counts, body mass index (BMI) and the NLR were associated with postoperative complications (P<0.05). In the multivariate analysis, BMI [>23.0 kg/m²; odds ratio (OR): 3.80, 95.0% confidence interval (CI): 1.35–11.83; P=0.011] and the NLR (>2.0; OR: 6.77, 95.0% CI: 2.44–21.13; P<0.001) were independent risk factors for postoperative complications. BMI and the NLR are valuable predictors of postoperative morbidity following PD in patients with distal cholangiocarcinoma. It would be beneficial to determine treatment strategies for distal cholangiocarcinoma based on the NLR to reduce postoperative complications.
... At further increasing concentration, we observe that shape of leukocytes changes due to dehydration and accumulation of sodium ions inside them increases and clumping is broken down, parts of white blood cells scattered around RBCs. Increasing quantity of sodium serves as an anticoagulant and bursting agent for WBCs as shown in Figure 3(c, d, e, f). WBCs count is elevated in hypertension (WHITWORTH, 2004, NAKANISHI et al., 2002, SUN et al., 2015. ...
The objective of this study was to measure the effects of glucose and salt level on white blood cells, red blood cells and platelets (PLTs) in the blood of a leukemic patient by using a white light microscope. Different concentrations of glucose and salt in the range of 0 mM to 500 mM were admixed in the blood sample to prepare blood smear. We revealed that shape of erythrocytes, leukocytes and platelets changes and form aggregates. Increasing concentrations of glucose cause to increases aggregation process of white blood cells, red blood cells and platelets. And the increasing concentration of sodium chloride causes to increase rouleaux formation and aggregation of platelets but dehydration due to increased sodium chloride concentration causes to break the aggregation of white blood cells. Comparison of CBC reports of these samples with and without analytes shows that total leukocyte count (TLC) decreases gradually towards normal ranges of leukocytes which is favorable in the treatment of leukemia but at the same time decreasing level of hemoglobin HGB, mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and increasing level of red blood cell (RBCs) causes to reduce oxygen supply which is in favor of cancer growth and anemia. This work provides us the base for translation this in vitro study towards the in vivo case of blood microvasculature as a non-invasive methodology. © 2018, Universidade Federal de Uberlandia. All rights reserved.
... [36][37][38] Similarly, systemic inflammation has been reported as a significant factor in metabolic syndromes, including obesity and diabetes mellitus. 39 ...
Introduction
The purpose of this study was to compare the value of hematological parameters, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV), as indicators of anterior uveal segment involvement in patients with Behcet’s disease (BD).
Patients and methods
Hospital-based records of a total of 912 patients with BD from the dermatology clinic and healthy volunteers from the checkup clinic were assessed retrospectively. After applying the exclusion criteria of the study, 71 of the BD patients with anterior uveitis, 69 of the BD patients without ophthalmological pathology and 151 healthy volunteers were included in the study. MPV, PLR, and NLR values of patients and healthy volunteers were compared.
Results
All MPV, PLR, and NLR values of patients who had anterior uveitis were significantly higher than those of other patients and healthy volunteers. Statistically, considering area under curves (ratio): NLR was 0.725 (0.653–0.797), P<0.001; PLR was 0.600 (0.523–0.676), P=0.012, and MPV was 0.358 (0.279–0.437), P<0.001.
Conclusion
MPV, PLR, and NLR are all valuable for assessment of anterior uveal segment involvement in patients with BD. However, the NLR seems to be better than the PLR and MPV for indicating anterior uveitis due to BD.
... 31 An association between increased CRP levels, neutrophil activation, chronic systemic inflammation and risk for cardiovascular diseases has already been reported in the literature. 32,33 Spesifically NLR and serum CRP levels, which were found to be elevated in CSU patients in the present study, have shown to be prognostic and predictor markers in cardiovascular diseases. What we discuss here is, if the patients with CSU without any systemic, inflammatory or autoimmune diseases might be under the risk of development of cardiovascular diseases in the future. ...
Objective: Recent studies implicate the role of inflammatory responses in chronic spontaneous urticaria (CSU). The purpose of this study was to analyse the levels of neutrophil-lymphocyte ratio (NLR), serum C-reactive protein (CRP) and uric acid levels in CSU patients, and to investigate the relationship between these inflammatory parameters and disease activity. Material and Methods: A total of 100 people, consisting of 50 chronic urticaria patients and 50 healthy controls, who have no systemic disease, inflammatory, infectious or autoimmune disease, malignancy, were included in the study. Results: NLR and serum CRP levels were significantly higher in patients with CSU than in healthy controls (p< 0.001, p< 0.001, respectively). The levels of uric acid did not show a statistically significant difference between CSU patients and controls (p= 0.359). A significant positive correlation was found between NLR and CRP in patients with CSU (p= 0.001, r= 0.442).When CSU patients were evaluated according to disease severity, serum CRP levels were significantly higher in patients with severe CSU than in patients with mild-moderate CSU (p= 0.038). Conclusion: Several biomarkers have been studied in systemic diseases to determine the inflammatory process ongoing and the relationship between these markers and disease activity has been investigated. It can be concluded that CRP and NLR can be used to assess the inflammatory status in CSU and may be useful parameters during the follow-up of these patients. It is known that NLR and CRP are diagnostic and prognostic markers of cardiovascular diseases. Elevated values of NLR and CRP may demand caution regarding cardiovascular comorbidities that may accompany chronic urticaria.
... Systemic inflammation is often measured by analyzing biochemical and hematological markers (8). A number of epidemiological studies have demonstrated that DM (9), metabolic syndrome (10), obesity (11), hypertension (12), and smoking habits (13) are related to low-grade chronic inflammation. Additionally, several studies have reported that inflammatory markers, including interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor alpha (TNFα), white blood cell (WBC) count, and C-reactive protein (CRP), are associated with complications in diabetic patients (14,15,16,17). ...
Abstract
BACKGROUND:
Non-alcoholic fatty liver disease is a progressive inflammatory disease that ultimately results in cirrhosis and liver failure. It is assosiciated with two step hit scenario; the first step is fat accumulationin liver and in the second step inflammation and fibrosis are the major compenents. The incidence of this disease is increasing worldwide, following rising incidences of obesity and diabetes mellitus.
AIM:
The aim of this study is to analyze the relationship between non-alcoholic fatty liver disease andseverity and neutrophil-to-lymphocyte ratio among the patients having type 2 diabetes mellitus.
METHODS:
This study involved 143 patients with type 2 diabetes who were placed into four groups (grade 0, 1, 2, 3) based on steatosis level due to blinded ultrasonographic evaluation. Biochemical parameters and counts of total white blood cells, neutrophils, and lymphocytes were determined. Neutrophil-to-lymphocyte ratio was compared across the four patient groups.
RESULTS:
Levels of hemoglobin A1c, creatinine, alanine aminotransferase, high-density lipoprotein cholesterol and triglycerides were significantly different between the four patient groups (ANOVA p-values: p <0.001, p=0.011, p=0.002, p=0.034, p=0.002, respectively). Counts of white blood cells, neutrophils, lymphocytes, and neutrophil-to-lymphocyte ratio significantly differed between the groups (p <0.001). Neutrophil-to-lymphocyte ratio was positively correlated with steatosis grade (p < 0.001).
CONCLUSIONS:
Neutrophil-to-lymphocyte ratio increases with increasing grade of non-alcoholic fatty liver disease in patients with type 2 diabetes, and may be a convenient marker to follow progression of non-alcoholic fatty liver disease. (Acta gastro-enterol. belg., 2016, 79, 295-300).
... It is also investigated in respiratory system diseases, pulmonary tuberculosis and serious infections, colonic polyps, and likewise found higher [13][14][15] . Similarly, systemic inflammation has also been reported as a significant factor for metabolic syndrome including obesity and diabetes mellitus [16][17] . Cananzi et al [18] reviewed recent evidence that immunological phenomena may explain the unexpectedly good response rate in patients with advanced disease. ...
AIM: To investigate the effect of anterior uveitis in Behçet's disease (BD) on neutrophil to lymphocyte ratio (NLR). METHODS: Retrospective research. The patients who were admitted to Kayseri Training and Research Hospital between 2004-2013 and fulfilled the BD criteria are accepted in the study. The records of 735 patients with BD were screened and 135 of them were taken to the study. Sixty-eight of them had anterior uveitis, the rest (n=67) did not have any ophthalmological pathology. The patients' total blood counts were taken at the same visit that anterior uveitis was noted. Then the neutrophil to lymphocyte ratio were calculated. RESULTS: In the anterior uveitis group the mean NLR was 2.55±0.96. In the ophthalmologically normal group it was 1.67±0.50. NLR was determined higher in the anterior uveitis group (P<0.05). CONCLUSION: The NLR is found higher in the Behçet's disease with anterior uveitis patients when compared with the ophthalmologically normal patients.
... Inflammation modifies endothelial function and an inability of the endotehlium to produce nitric oxide and prostacyclin can result in the depletion of vasodilator, antithrombotic and anti-atherogenic properties of the vascular endothelium. In addition, stimulated leukocytes alter rheological properites with an increased capacity to adhere to vascular endothelium and may result in capillary leukocytosis and subsequent increased vascular resistance (27). All these changes determine a worse long-term prognosis of those hypertensives with absence of nocturnal dip in BP. ...
... It has been shown that increased neutrophil count is related to areas of ischemic injury (6)(7)(8). Furthermore, there are studies showing that there is a chronic low grade inflammation in DM (9), hypertension (10), metabolic syndrome (11), and obesity (12). ...
Background: Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in patients over the age of 50 and is the second most common cause of permanent optic nerve-related visual loss in adults after glaucoma. Although the precise cause of NAION remains elusive, the etiology of NAION is believed to be multifactorial.
Aims: To evaluate the utility of neutrophil-to-lymphocyte ratio (NLR) as a simple and readily available prognostic factor for clinical disease activity in patients with NAION.
Study Design: Case-control study.
Methods: Forty-five patients with the diagnosis of NAION and 50 age- and sex-matched controls with/without any systemic or ocular diseases except cataract were retrospectively enrolled in the study. Demographic characteristics and laboratory findings including complete blood count of all patients and control subjects were obtained from the electronic medical record. The neutrophil and lymphocyte counts were recorded and the NLR was calculated.
Results: White blood cell, neutrophil, NLR and platelet values of the NAION patients were significantly higher than those of the controls (p<0.001, p<0.001, p=0.004, p=0.037, respectively). Initial NLR values were negatively correlated with initial and the third month best corrected visual acuity levels in the study group. The optimum NLR cut-off point for NAION was 1.94.
Conclusion: NLR could be considered as a new inflammatory marker for assessment of the severity of inflammation in NAION patients with its quick, cheap, easily measurable property with routine complete blood count analysis.
... Previous research studies have reported that prehypertensive populations had white blood cell counts of 10% or higher than that of normotensive populations. 33,54 The effect of shear force caused by enhanced blood flow during exercise has been suggested as a reason for the increased leukocytes. However, leukocytes were accentuated toward the end of the race. ...
Objective:
The aim of this study was to observe the changes in endothelial and inflammatory markers in middle-aged male runners with exercise-induced hypertension (EIH) at baseline and at 100-km, 200-km, and 308-km checkpoints during a prolonged endurance ultramarathon.
Design:
Among a total of 62 ultramarathon volunteers, 8 with systolic blood pressure higher than 210 mm Hg and 8 with normal systolic blood pressure were selected for this study. The subjects were designated to EIH and control (CON) groups. Blood was collected for the analysis of soluble vascular cell adhesion molecule-1, soluble E-selectin, leukocytes, creatine kinase, and high-sensitivity C-reactive protein.
Results:
Soluble vascular cell adhesion molecule-1 showed a significantly greater increase in the EIH group than in the CON group at 100 km and 200 km. Soluble E-selectin also showed a significantly greater increase in the EIH group than in the CON group at 100 km. Leukocytes significantly increased in the EIH group than in the CON group at 308 km. Creatine kinase and high-sensitivity C-reactive protein showed no group differences.
Conclusions:
Leukocytes, creatine kinase, and high-sensitivity C-reactive protein showed delayed-onset increases in both groups. Increased exercise intensity may stimulate greater endothelial responses independent of the inflammatory markers in EIH. The loss of a protective effect may be greater in those with EIH than in CONs. Acknowledging and prescribing proper exercise intensity may be critical in preventing possible vascular-related complications in runners with EIH.
Background
Pheochromocytoma is associated with systemic inflammation, but the underlying mechanisms are unclear. Therefore, we investigated the relationship between plasma metanephrine levels and haematological parameters – as a surrogate of inflammation – in patients with pheochromocytoma and the influence of preoperative α-blockade treatment.
Design and Methods
We retrospectively studied 68 patients with pheochromocytoma who underwent adrenalectomy (median age 53 years, 64.7% females) and two control groups matched for age, sex, and body mass index (BMI): 68 patients with non-functioning adrenocortical tumors (NFAT) and 53 with essential hypertension (EAH). The complete blood count (CBC) and several inflammation-based scores [Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio (LMR), Systemic-Immune-Inflammation Index (SII), Prognostic-Nutrition Index (PNI)] were assessed in all patients and, in a subset of pheochromocytomas, after adrenalectomy (n=26) and before and after preoperative α-blockade treatment (n=29).
Results
A higher inflammatory state, as indicated by both CBC and inflammation-based scores, was observed in patients with pheochromocytoma compared to NFAT and EAH. Plasma metanephrine levels showed a positive correlation with NLR (r=0.4631), PLR (r=0.3174), SII (r=0.3709), and a negative correlation with LMR (r=0.4368) and PNI (r=0.3741), even after adjustment for age, sex, ethnicity, BMI and tumor size (except for PLR). After adrenalectomy, we observed a reduction in NLR (p=0.001), PLR (p=0.003), SII (p=0.004) and a concomitant increase in LMR (p=0.0002). Similarly, α-blockade treatment led to a reduction in NLR (p=0.007) and SII (p=0.03).
Conclusions
Inflammation-based scores in patients with pheochromocytoma showed pro-inflammatory changes that correlated with plasma metanephrine levels and are ameliorated by adrenalectomy and α-blockade.
Background:
To explore the relationship between duration of hypertension and inflammatory cell levels and to assess whether long duration might aggravate these inflammatory cells among Chinese urban community residents.
Methods:
A cross-sectional study of 5199 hypertensive and 2675 no-hypertensive participants who registered in community health service centers for physical examination was performed in Tianjin, China. Data of blood pressure and inflammatory cells were collected. Binary logistic regression was performed to assess the effect of hypertensive duration on the level of inflammatory cells before and after adjustment for the potential confounding factors.
Results:
Individuals with hypertension had significantly higher level of leukocyte count, neutrophil proportion, neutrophil-to-lymphocyte ratio (NLR), and lower level of lymphocyte proportion than those without hypertension. Two-way ANOVA showed that hypertension duration, rather than blood pressure control or their interaction, had significant influence on the levels of neutrophil proportion, lymphocyte proportion, and NLR. With the prolongation of the duration of hypertension, the level of neutrophil proportion and NLR increased, and the level of lymphocyte proportion decreased. Long hypertension duration (>10 years) was significantly associated with high level of neutrophil proportion (OR = 1.48, 95% CI: 1.25, 1.75), high level of NLR (OR = 1.53, 95% CI: 1.29, 1.81), and low level of lymphocyte proportion (OR = 1.54, 95% CI: 1.30, 1.82) in comparison with short duration (<5 years) after adjustment for confounding factors.
Conclusion:
Hypertensive patients had higher level of leukocyte count, neutrophil proportion, NLR, and lower level of lymphocyte proportion than normotensive ones. Long duration of hypertension was associated with aggravated inflammatory biomarkers.
In traditional geriatrics, the study and treatment of diseases follow the same criteria of general medicine, i.e., the diseases are first of all divided according to the affected anatomical or functional system. For example, in the Broklehurst’s Textbook of Geriatric Medicine and Gerontology (Fillit et al. 2017), the subject is divided into the sections Cardiovascular system, Respiratory system, Nervous system, Musculoskeletal system, Gastroenterology, Urinary tract, Women’s health, Endocrinology, Hematology and Oncology, Skin and Special senses, which mirrors the division of general medicine into various specializations.
Background
Total p-cresylsulfate (PCS), indoxyl sulfate (IS) and hippuric acid (HA) are harmful uremic toxins known to be elevated in patients with uremia. Serum total PCS, IS and HA levels have been associated with coronary atherosclerosis, left ventricular hypertrophy, metabolic acidosis, neurological symptoms, and accelerated renal damage associated with chronic kidney disease; however, no study has examined the effect of total PCS, IS and HA on hemodialysis (HD) quality indicators. The aim of this study was to examine associations among total PCS, IS and HA with HD quality indicators in patients undergoing HD treatment.
Methods
This study included 264 consecutive patients at a single HD center who assessed using previously demonstrated HD quality indicators including anemia, bone-mineral metabolism, dialysis dose, cardiovascular risk, and middle molecule removal area. Serum HA was measured using a capillary electrophoresis method. Serum total PCS and IS concentrations were measured using an Ultra Performance LC System.
Results
Multiple regression analysis showed that sex, potassium, systolic blood pressure (SBP), average BP, β2-microglobulin, and creatinine were independently positively associated with IS level, and that age, total cholesterol, and estimated glomerular filtration rate (eGFR) was independently negatively associated with IS level. In addition, β2-microglobulin was independently positively associated with total PCS. Moreover, potassium, diastolic blood pressure, average BP, β2-microglobulin, dialysis vintage, and albumin were independently positively associated with HA level, and age, transferrin saturation, fasting glucose, and eGFR were independently negatively associated with HA level. When the patients were stratified by age and sex, serum IS and HA levels were still independently associated with some hemodialysis quality indicators. In addition, canonical correlation analysis also confirmed the relationship between uremic toxins (IS and HA) and HD quality indicators (potassium, β2-microglobulin, average BP, creatinine, and eGFR).
Conclusion
This study demonstrated that uremic toxins (IS and HA) and HD quality indicators (potassium, β2-microglobulin, average BP, creatinine, and eGFR) constructs were correlated with each other, and that there were sex and age differences in these associations among maintenance HD patients.
Sepsis research
- Anion gap predict lactate
- Timing of antibiotic administration
Arterial hypertension represents the most common non-communicable disease of our time. The prevalence of hypertension varies according to gender and age criteria, but also depends on the geographical, ethnic and racial factors and has the character of an epidemic [1]. Among the adult population, arterial hypertension is considered as one of leading risk factors for the development of atherosclerosis. In a number of epidemiological studies, elevated blood pressure has been identified as a risk factor for heart failure, cerebrovascular disease, peripheral artery disease, renal failure, and, more recently, atrial fibrillation [2, 3].
Increased blood pressure was associated with increased white blood cell count (adjusted p < 0.001) in a community-based health examination survey of adults in China (n = 39 282; aged 18-93 years). Adjusted odds ratios (95% confidence intervals) for hypertension across white blood cell count quintiles were 1.00, 0.99 (0.89-1.09), 1.11 (1.01-1.22), 1.09 (0.99-1.20), and 1.19 (1.08-1.31) (p for trend < 0.001). Body mass index and white blood cell count had an additive effect on systolic blood pressure (p for interaction = 0.047). Therefore, white blood cell count could independently predict hypertension in Chinese adults.
Background: Diabetes mellitus (DM), with the cost of treatment and complications causes the increasing economic burden. Inflammation in the pathogenesis of type 2 DM and developing complications are considered to have a role. Macrovascular complications of diabetes, diabetic foot ulcers and amputations consequently reduce quality of life is seriously. Atherosclerosis and related complications is considered as an inflammatory process. To show the severity and course of this inflammatory process, the studies including many markers are available. Recently, it is reported as a cheap and accessible marker, neutrophil/lymphocyte ratio (NLR) is a good indicator of the inflammatory condition. The aim of this study to investigate the relationship between the presence of the diabetic foot and neutrophil / lymphocyte ratio. Methods: It has been noted retrospectively the charts of the data of internal medicine clinic patients with diabetes. Patients' age, sex, duration of diabetes, blood count and biochemical parameters were recorded. The data of patients with and without diabetic foot ulcers were assessed using SPSS 19.0. Results: Statistically significant differences were also observed according to HbA1c (P = 0.006), serum urea (P = 0.042), CRP (P < 0.001), neutrophil percent (P < 0.001), lymphocyte percent (P < 0.001), NLR (P = 0.001), among the 2 groups. A correlation was determined between NLR and age, serum urea, creatinine, white blood cell (WBC), neutrophil percent, lymphocyte percent, total cholesterol, HDL-cholesterol. Conclusion: The presence of diabetic foot ulcers alone may also represent a systemic inflammatory response. NLR can be a cheap and accessible marker for presence of this inflammatory process via using the response rates and follow-up of patients.
Previous studies reported increased white blood cell counts (WBCCs), an inflammatory marker, in hypertension, prehypertension and metabolic syndrome. Evidence suggests that inflammation precedes blood pressure (BP) elevation and may contribute to incident hypertension. Angiotensin receptor blockers (ARBs) may reduce inflammation. We analyzed WBCC trends in TRial Of Preventing HYpertension (TROPHY) to determine if this inflammatory marker predicted incident hypertension in prehypertensive individuals and whether randomized assignment to the ARB candesartan (391 individuals) for 2 years, lowered WBCC compared with placebo-treated controls (381 individuals).
A new analysis of TROPHY trial data.
In the total population, baseline BMI correlated with WBCC (r = 0.185, P < 0.0001), neutrophils (r = 0.135, P < 0.001) and lymphocytes (r = 0.204, P < 0.0001). Baseline triglycerides also correlated significantly with inflammatory markers. Despite a wide range of home BP (HBP) values, HBP did not correlate with baseline WBCC counts. After 2 years, candesartan decreased placebo corrected HBP by -5.5/-2.5 mmHg, (P < 0.0001), but WBCC, neutrophil and lymphocyte counts were not different in placebo and in candesartan groups. Baseline WBCC, neutrophils and lymphocyte counts did not predict incident hypertension in the placebo group.
In TROPHY, candesartan lowered BP but did not alter WBCC. Baseline WBCC did not predict incident hypertension. Our findings do not support the hypothesis that inflammation contributes to incident hypertension or that ARB treatment suppresses inflammation. The significant independent association of WBCC with baseline BMI and triglycerides is consistent with the evidence that obesity and insulin resistance are associated with inflammation. The findings highlight the importance of effective lifestyle modification in prehypertension to reduce inflammatory cardio-metabolic risk and suppress transition to hypertension.
There are studies showing association of high WBC count with the higher incidence of hypertension though a few are done in the Indian population. The present study was conducted with the view to find any significant increase in total leucocyte count and differential leucocyte count in hypertensive patient Twenty-seven hypertensives with 12 males and 15 females and 27 age and sex matched control subjects (normotensive) were studied. Hypertension was defined when the systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or history of taking antihypertensive medicine. Three blood pressure recordings at an interval of 2 minutes were taken after the patient was made to sit for 30 minutes with a standard mercury sphygmomanometer in the left arm. The disappearance of sound was used for diastolic blood pressure. Blood was drawn into EDTA containing vials. Two separate counts were performed: First for total leucocyte count (TLC) and second for determination of percentage of polymorphonuclear cells. For the TLC, 0.5 part of blood mixed with 10 part of Turk's fluid followed by counting of leucocyte in a counting chamber under light microscope. The percentage of polymorphonuclear leucocyte was performed on a slide after making the slide and staining it with Leishman's stain. The erythrocyte sedimentation rate (ESR) was performed using Wintrobe's methods. The first 1 hour reading on the Wintrobe's tube was taken for analysis. The total leucocyte count (TLC) for the study group as compared to the controls were 7413.70 +/- 735.45 cells/cmm and 5236.30 +/- 528.77 cells/ cmm which was statistically significant. The mean percentage neutrophils were 62.04 +/- 4.99 for study group and 53.00 +/- 3.44 for the controls; the mean percentage lymphocytes for the study group and the controls were 34.37 +/- 4.55 and 39.11 +/- 4.40 respectively. Both the mean percentage neutrophils and lymphocytes showed significant differences. The mean erythrocyte sedimentation rate (ESR) also showed statistically significant when the study group (29.63 +/- 3.76 mm in first hour) was compared to the controls (21.15 +/- 6.88 mm in first hour). In addition, when male and female hypertensive subjects were analysed separately, the TLC, neutrophil, lymphocyte and ESR levels showed significant differences as compared to their respective controls. The result has showed that there is a significant increase in inflammatory markers like TLC and neutrophils counts in hypertensive patients suggestive of hypertension as an inflammatory disease.
Objective:
Psoriasis is a chronic systemic inflammatory disorder. The neutrophil to lymphocyte ratio (N/L ratio) has been used as a marker for systemic inflammatory status. In our study, we aimed to evaluate N/L ratio in patients with psoriasis.
Methods:
This cross-sectional study population consisted of 138 patients with psoriasis and 120 age- and sex-matched control subjects.
Results:
The patients had significantly higher neutrophil counts and lower lymphocyte counts than the controls. The N/L ratios and high sensitivity C reactive protein (hs-CRP) levels were also significantly higher in patients. The N/L ratios and hs-CRP levels were increasing with increasing in Psoriasis Area and Severity Index score. Furthermore, the N/L ratios and hs-CRP levels of patients were found to be positively correlated.
Conclusions:
Our data show that the N/L ratio to be a simple, inexpensive and easily assessable marker of systemic inflammation in patients with psoriasis.
Background:
Chronic inflammation plays an important role on development and progression of Type 2 diabetes (T2DM) through immunologic inflammatory mechanisms. Neutrophil to lymphocyte ratio (NLR) is a new, simple and cheap marker of subclinical inflammation. NLR has recently been used as a systemic inflammation marker in chronic diseases as well as a predictor of prognosis in cardiovascular diseases and malignancies.
Aim:
The objective of the present study was to investigate the relationship between NLR and microvascular complications of diabetes mellitus (DM) in elderly population.
Subjects and methods:
Two hundred and forty-two patients with DM (145 diabetic patients with complications, 97 diabetic patients without complications) and 218 control subjects were enrolled in this study. NLR and microvascular complications because of DM were evaluated and compared with other inflammatory markers.
Results:
NLR was higher in the diabetic group (2.21±1.14) than in the controls (2.18±0.76). Furthermore, there was a statistically significant difference between NLR levels in diabetic patients with and without complications (2.46±1.26 vs 2.04±0.51, respectively; p<0.001). The results of themultiple logistic regression analysis depicted that NLR is also an independent predictor for microvascular complications (odds ratio 2.217; 95%confidence interval 1.086-4.526, p=0.029). Receiver operating curve analysis suggested that the optimum NLR cutoff point for microvascular complication was 2.89 with 96.72% specificity, 94.4% positive predictive value.
Conclusion:
Increased NLR levels may be associated with microvascular complications of DM in the elderly population.
The total white blood cell count, and in particular, the neutrophil count, has been reported to be positively associated with the risk of cardiovascular disease. The aim of this study is to clarify the association between hypertension and peripheral blood neutrophil count as an inflammatory marker in the occupational setting. 1,244 Japanese men and women were examined controlling for confounding factors. In men, the age, the product of the daily amount of liquor consumed and the weekly drinking frequency, current history of diabetes mellitus, Body Mass Index, and the peripheral blood neutrophil count were associated with an increased odds ratio for hypertension (1.08, 1.06, 1.89, 2.94 and 1.21, respectively); in contrast, a current history of smoking was inversely related to the risk of hypertension (odds ratio 0.53). In women, a current history of diabetes mellitus and the peripheral blood neutrophil count were associated with an increased odds ratio for hypertension (8.29 and 1.93, respectively). The peripheral blood neutrophil count was positively associated with the risk of hypertension in both men and women, independent of age, alcohol consumption, smoking status, history of diabetes mellitus and Body Mass Index. Follow-up studies and further research are needed to confirm this association.
Elevated white blood cell (WBC) count is considered to be prospectively and positively associated with cardiovascular diseases, particularly hypertension. Also, the positive role of exercise in the management of hypertension has been well and long established. However the relationship between WBC count and hypertensive management particularly in the nonpharmacological technique is ambiguous and unclear. Therefore the purpose of the present study was to determine the effect of interval training program on WBC count and cardiovascular parameters in male hypertensive patients.
A total of 245 male patients with mild to moderate (systolic blood pressure (SBP) between 140 mmHg and 179 mmHg and diastolic blood pressure (DBP) between 90 mmHg and 109 mmHg) essential hypertension were age matched and grouped into experimental and control groups. The experimental (n=140; 58.90±7.35 years) group involved in an 8-week interval training (60-79% HR max reserve) program of between 45 minutes to 60 minutes, while the age-matched controls hypertensive (n=105; 58.27±6.24 years) group remain sedentary during this period. Cardiovascular parameters (SBP, DBP, and VO(2) max) and WBC count were assessed. Student's t and Pearson correlation tests were used in data analysis.
Findings of the study revealed a significant effect of the interval training program on VO2max, SBP, and DBP and WBC count at P<0.05 and VO2max is negatively related to the WBC count (r=-0.339) at P<0.01.
It was concluded that the interval training program is an effective adjunct nonpharmacological management of hypertension and the therapeutic effect of exercise programs may be mediated through suppression of inflammatory (WBC count) reaction.
The metabolic syndrome (MetS) increases the risk of cardiovascular disease morbidity and mortality. MetS is also associated with increases in the number of circulating white blood cells. Lymphocyte sub-population counts have also been implicated in cardiovascular disease; this analysis will examine whether or not they are associated with MetS.
Participants were 4255 Vietnam-era US veterans. From military service files, telephone interviews, and a medical examination, occupational, socio-demographic, and health data were collected. MetS was ascertained from: body mass index; fasting blood glucose or a diabetes medication; blood pressure or a diagnosis of hypertension; HDL cholesterol; and triglyceride levels. Circulating T, T4, T8 and B lymphocytes cell numbers were determined by flow cytometry.
In fully adjusted logistic regression analyses, high lymphocyte sub-population counts were associated with an increased risk of MetS: T cells, OR=2.68, 95%CI 1.99-3.61, p<.001; T4 cells, OR=2.37, 95%CI 1.78-3.15, p<.001; T8 cells, OR=1.79, 95%CI 1.43-2.24, p<.001; B cells, OR=1.82, 95%CI 1.51-2.19, p<.001. High lymphocyte sub-population numbers were also associated with an increased likelihood of possessing each of the MetS components, as well as the number of components possessed.
These results extend previous research which has largely been confined to total white blood cell or overall lymphocyte counts. If the present associations arise in prospective research, it is possible that simple lymphocyte cell counts could provide an additional prognostic indicator of risk for MetS.
Leukopenia, the leukocyte count, and prognosis of disease are interrelated; a systematic search of the literature was undertaken to ascertain the strength of the evidence. One hundred seventy-one studies were found from 1953 onward pertaining to the predictive capabilities of the leukocyte count. Of those studies, 42 met inclusion criteria. An estimated range of 2,200cells/μL to 7,000cells/μL was determined as that which indicates good prognosis in disease and indicates the least amount of risk to an individual overall. Tables of the evidence are included indicating the disparate populations examined and the possible degree of association.
Peripheral arterial disease (PAD) is an inflammatory process. The association between white blood cell (WBC) count and PAD in those with and without traditional risk factors is not clear. We examined data from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004. A total of 5260 participants were included. The result showed that the prevalence of PAD rose from 2.8% +/- 0.5% in the lowest quartile of plasma WBC count to 8.0% +/- 1.2% in the highest quartile. In subgroup analysis, the graded association between WBC count and PAD was significant in patients without hypertension, diabetes, smoking, chronic kidney disease (CKD), and in patients with or without hypercholesterolemia but not significant in patients with hypertension, smoking, diabetes, or CKD. In those without hypertension, diabetes, smoking, or CKD, the cutoff value for WBC count was 6.75 x 10(9)/L. We concluded that the positive association between WBC count and PAD can be demonstrated in this national survey.
Low circulating levels of high-density lipoprotein cholesterol (HDL-C) are associated with increased risk for cardiovascular events. HDL-C has a variety of poorly understood atheroprotective effects, including altering lipid metabolism and reducing inflammation. Increased arterial stiffness is an important predictor of subsequent cardiovascular risk. Therefore, in this study, we sought to determine whether HDL-C levels are associated with carotid arterial stiffness. In addition, we examined potential correlates of this association, such as inflammatory factors, cardiorespiratory fitness and body fat percentage. Carotid artery beta-stiffness was measured by ultrasound in 47 (23 years old) healthy pre-hypertensive men. Low HDL-C was defined as <1.0 mmol l(-1). Body fat was measured by air displacement plethysmography. Cardiorespiratory fitness was measured using a maximal exercise test, with metabolic gas analysis and inflammatory markers consisting of C-reactive protein (CRP), white blood cell (WBC) count and absolute neutrophil count. Men with a low HDL-C had significantly higher carotid artery stiffness, CRP, WBC count, neutrophil count, body fat, fasting glucose and lower cardiorespiratory fitness (P<0.05). Co-varying for cardiorespiratory fitness, % body fat and glucose had no effect on group differences in carotid artery stiffness. Co-varying for inflammatory markers resulted in groups having similar carotid artery stiffness. Pre-hypertensive men with low HDL-C have a higher carotid artery stiffness when compared with those with higher HDL-C. The detrimental effects of low HDL-C on large artery stiffness in pre-hypertensive men may be mediated by inflammation and not by cardiorespiratory fitness or body fat levels.
Endothelium regulates vascular tone by influencing the contractile activity of vascular smooth muscle. This regulatory effect of the endothelium on blood vessels has been shown to be impaired in atherosclerotic arteries in humans and animals and in animal models of hypertension.
To determine whether patients with essential hypertension have an endothelium-dependent abnormality in vascular relaxation, we studied the response of the forearm vasculature to acetylcholine (an endothelium-dependent vasodilator) and sodium nitroprusside (a direct dilator of smooth muscle) in 18 hypertensive patients (mean age [+/- SD], 50.7 +/- 10 years; 10 men and 8 women) two weeks after the withdrawal of antihypertensive medications and in 18 normal controls (mean age, 49.9 +/- 9; 9 men and 9 women). The drugs were infused at increasing concentrations into the brachial artery, and the response in forearm blood flow was measured by strain-gauge plethysmography.
The basal forearm blood flow was similar in the patients and controls (mean +/- SD, 3.4 +/- 1.3 and 3.7 +/- 0.8 ml per minute per 100 ml of forearm tissue, respectively; P not significant). The responses of blood flow and vascular resistance to acetylcholine were significantly reduced in the hypertensive patients (P less than 0.0001); maximal forearm flow was 9.1 +/- 5 ml per minute per 100 ml in the patients and 20.0 +/- 8 ml per minute per 100 ml in the controls (P less than 0.0002). However, there were no significant differences between groups in the responses of blood flow and vascular resistance to sodium nitroprusside. Because the vasodilator effect of acetylcholine might also be due to presynaptic inhibition of the release of norepinephrine by adrenergic nerve terminals, the effect of acetylcholine was assessed during phentolamine-induced alpha-adrenergic blockade. Under these conditions, it was also evident that the responses to acetylcholine were significantly blunted in the hypertensive patients (P less than 0.03).
Endothelium-mediated vasodilation is impaired in patients with essential hypertension. This defect may play an important part in the functional abnormalities of resistance vessels that are observed in hypertensive patients.
Measurement of casual and near basal systolic and diastolic blood pressures were correlated with the severity of cardiorenal manifestations of hypertension in 471 patients. There was a significant association of each of the four blood pressure measurements with each other (P < 0.001). Systolic blood pressure and manifestations of hypertension increased with age. Blacks had higher blood pressures and more manifestations than whites.All four blood pressure measurements were significantly associated (r ≥ 0.78, P < 0.0005) with grade 3 fundi, proteinuria and casts in the urine, electrocardiographic left ventricular hypertrophy, cardiomegaly by chest X-ray and aortic dilatation and/or elongation by chest X-ray.The level of blood pressure is the important correlate of these manifestations of hypertension. This is equally true whether systolic, diastolic, casual or near basal measurements are used. Near basal blood pressure does not correlate better with the cardiorenal manifestations of hypertension than casual blood pressure, neither does diastolic blood pressure correlate better with these manifestations than systolic blood pressure.
To examine the relation of white blood cell (WBC) count to the development of cardiovascular disease (CVD), including coronary heart disease, stroke, peripheral arterial disease, and cardiac failure. Traditional CVD risk factors, hematocrit, and vital capacity were considered.
Prospective cohort analysis with one baseline examination of relevant risk factors and 12 years of follow-up for CVD.
A community-based sample (Farmingham Offspring Study) of 1393 men and 1401 women who were free of CVD at the onset of the study and who were between the ages of 30 and 59 years at baseline. Time-dependent multiple variable logistic regression methods were used.
There were 180 CVD events in men and 80 in women. The WBC count was correlated most strongly with the number of cigarettes smoked per day, hematocrit, and vital capacity. Among nonsmoking men with WBC counts within the normal range, the age-adjusted WBC count was significantly associated with CVD and coronary heart disease incidence. For each 1.0 x 10(9)/L-cell difference in WBC count, the CVD risk increased 32%. In women, each 1.0 x 10(9)/L-cell increment in WBC count was associated with a 17% increase in CVD risk, but only in smokers, and the relationship was not statistically significant after adjustment for relevant risk factors.
The degree of elevation of WBC count within the normal range is a marker for increased risk of CVD that is partially explained by cigarette smoking. Future studies should include differential WBC determinations to assess their association with CVD.
Coronary vasomotion is abnormal in hypertensive patients, as evidenced by reduced coronary vasodilator reserve, but endothelium-dependent coronary vasomotion in hypertensive patients has not been studied. To assess the integrity of endothelium-dependent vasodilation, the response of coronary arteries to acetylcholine (an endothelium-dependent vasodilator) and nitroglycerin (an endothelium-independent vasodilator) was studied in 14 patients undergoing cardiac catheterization. Eight patients with essential hypertension were compared with six normotensive patients. None had obstructive disease detectable by coronary arteriography. Coronary artery diameter was measured with digital-subtracted arteriography and coronary blood flow velocity with a Doppler flow velocity catheter. At baseline, coronary artery diameter was similar in the hypertensive and the normotensive control patients (2.4 +/- 0.3 vs. 2.8 +/- 0.7 mm). During intracoronary acetylcholine infusion (30 micrograms/min), coronary artery diameter decreased to 1.3 +/- 0.7 mm in the hypertensive patients (p less than 0.005), but was unchanged (2.7 +/- 0.8 mm) in the normotensive patients. With intracoronary nitroglycerin (200 micrograms), coronary artery diameter increased significantly in both groups. Calculated coronary blood flow decreased during acetylcholine infusion by 59 +/- 31% in the hypertensive patients but increased by 3 +/- 3% in the normotensive group (p less than 0.005). There was a significant negative correlation between the percent change in estimated coronary blood flow during acetylcholine infusion and mean arterial pressure measured at baseline (r = 0.67, p less than 0.02). Therefore, these hypertensive patients exhibited marked coronary vasoconstriction in response to intracoronary acetylcholine but normal vasodilation in response to nitroglycerin, suggesting abnormal endothelium-dependent vasodilation.(ABSTRACT TRUNCATED AT 250 WORDS)
Correlates of the leucocyte count (WBC) and its relationships to other coronary heart disease (CHD) risk factors were assessed
in 4981 black and white young adults. Mean WBC was higher in women than men, higher in whites than blacks, and higher in those
aged 18–24 than aged 25–30 years. It also varied by season with the highest levels in the autumn. Other characteristics with
persistent statistically significant direct associations with the WBC after multivariate adjustments were cigarette smoking,
marijuana use, geographical location (possibly an inter-laboratory artifact), use of birth control pills, body mass index,
pulse rate, and systolic blood pressure; height, physical fitness and high density lipoprotein cholesterol (HDL-C) level were
inversely associated with the WBC. The negative association of WBC with HDL-C was too small to explain the association of
WBC with CHD found elsewhere. The WBC is a commonly performed clinical test; yet much remains to be learned about its variation
in the general population and its value as a predictor rather than merely an indicator of disease.
Baseline deta for the 12 866 men from the Multiple Risk Factor Intervention Trial was used to study factors related to white
blood cell (WBC) count. White blood cell count was significantly higher in smokers (7853 cells/mm3) and exsmokers (7091 cells/mm3) who stopped smoking less than one year before than in ex-smokers who stopped more than one year before (6255 cells/mm3) and those who never smoked (6094 cells/mm3). In current cigarette smokers, white blood cell count was significantly related to number of cigarettes smoked, degree of
inhalation, and duration of smoking (p<0.001 for each). In addition, white blood cell count was higher in non-cigarette smokers
who smoked pipes, cigars, or cigarillos than among men who did not smoke tobacco (p<0.001). White blood cell count was lower
in blacks (by 877 cells/mm3) and Orientals (by 634 cells/mm3) than in whites. Leukocyte count also showed a strong inverse association with high density lipoprotein (HDL)-cholesterol,
a positive association with triglycerides independent of cigarette use, and a positive association with low density lipoprotein
(LDL)-cholesterol in smokers only. Leukocyte counts were inversely related to total family income and alcohol consumption.
We conclude that elevated leukocyte count is independently associated with other risk factors for coronary heart disease (CHD)
such as amount and duration of smoking as well as an atherogenic profile, and these relationships should be considered when
using white blood cell count as a predictor of coronary heart disease.
In an exploratory study of 1031 persons observed to progress from normotension to essential hypertension and 1031 matched subjects who remained normotensive, the initial leukocyte count (WBC) was found to be related to the development of hypertension, with risk increased 40% (95% confidence interval 12-82%) in persons in the highest as compared to the lowest quartile of WBC. This relationship proved to be largely independent of body mass index, body fat distribution, alcohol and tobacco consumption, and parental history of hypertension. An increased WBC may reflect greater sympathetic tone or may directly increase peripheral vascular resistance by impeding circulation through small blood vessels. If confirmed, this study adds another condition to the growing list for which the WBC is predictive. This simple, cheap test should be considered for inclusion in prospective epidemiological studies of many different diseases.
In isolated blood vessels, acetylcholine releases endothelium-derived relaxing factor (EDRF). In vivo, the vasodilator action of acetylcholine may be mediated by EDRF, but prostacyclin or prejunctional inhibition of adrenergic neurotransmission may also be involved. Therefore, we investigated whether acetylcholine releases EDRF in humans in vivo and, if so, whether the response altered in essential hypertension. Acetylcholine was infused into the brachial artery, and forearm blood flow measured by venous occlusion plethysmography. In control subjects, acetylcholine (0.02-16 micrograms/min/100 ml tissue) increased flow from 2.4 +/- 5.0 to 20.6 +/- 5.2 ml/min/100 ml tissue (n = 14; p less than 0.05) and decreased forearm vascular resistance from 42.0 +/- 4.1 to 6.0 +/- 1.4 units (p less than 0.03), a response comparable to that of sodium nitroprusside (0.6 micrograms/min ml tissue). Acetylsalicylic acid (500 mg i.v.) given to block vascular prostacyclin production did not alter the response (n = 14). alpha-Adrenoceptor blockade by phentolamine (12 micrograms/min/100 ml tissue) did not prevent the increase in flow evoked by acetylcholine. In hypertensive patients, the decrease in forearm vascular resistance induced by acetylcholine but not evoked by sodium nitroprusside was reduced as compared with controls (14.5 +/- 3.1 and 6.1 +/- 1.6 units, respectively; n = 8; p less than 0.05). Thus, the vascular effects of acetylcholine in the human forearm circulation are independent of prostaglandins and adrenergic neurotransmission and therefore are most likely to be mediated by EDRF; the acetylcholine-induced release of EDRF is blunted in patients with essential hypertension.
Body mass index, alcohol and salt consumption, and parental history of hypertension were examined as possible predictors of the development of essential hypertension in 1,031 persons, ages 30-49 years at entry, with documented normotension followed by documented hypertension after a mean interval of 6 years. In a comparison with 1,031 matched persistently normotensive persons initial body mass index and percentage increase in body mass index were each predictive of hypertension. Consumption of three or more alcoholic drinks a day at baseline was also predictive, more so if this level of intake persisted than if it diminished. Heavy salt intake as crudely estimated at baseline by one question was also associated with the development of hypertension. Parental history of hypertension was also predictive, more so for hypertension in the mother than for hypertension in the father, and the association was apparent only in female subjects. These characteristics at baseline showed independent associations with subsequent hypertension in multivariate analysis. When follow-up data were included in the multivariate analysis, alcohol consumption at the hypertensive examination was much more strongly related than at the baseline examination, suggesting a short-term effect, and heavy salt consumption was no longer predictive, possibly because of a marked loss of subjects due to missing follow-up data. This large study confirms longitudinally the importance of obesity, weight gain during adulthood, alcohol, family history, and, to some extent, salt as predictive and possibly causal factors for essential hypertension.
Information from examinations of 62,541 adults enrolled in a study of smoking from 1979 through 1982 in Oakland, California, was used to explore the associations of various measures of intensity of smoking with the leukocyte count and to try to determine whether there was a persistent effect of smoking cigarettes on the leukocyte count. In current, regular cigarette smokers, leukocyte counts were higher in smokers of a large number of cigarettes and were associated with smoking cigarettes with a high tar and nicotine yield, deep inhalation of the cigarette smoke, and a longer duration of smoking. There was an association of past smoking with a high leukocyte count independent of age, sex, and race. In past smokers of cigarettes who used no other form of tobacco, the leukocyte count was related to time since quitting, smokers who had quit more recently having higher leukocyte counts. The study shows that a high leukocyte count is associated consistently with various measures of intensity of cigarette smoking. Moreover, it appears that smoking has an effect on the leukocyte count that persists after quitting. Delineation of the physiologic basis for the acute and chronic effects of cigarette smoking on the leukocyte count might lead eventually to a better understanding of the mechanisms for regulation of granulopoiesis and the release and destruction of leukocytes.
Summary A study of 4264 men showed that the number of leucocytes is increased in smokers, notably in those who inhale. The increase is about 30% for a heavy smoker who inhales, compared with a non-smoker. Investigation of a subgroup of 483 men of the same population confirmed this finding and revealed that the increase was in granulocytes, lymphocytes, and monocytes. The diflerential leucocyte-count showed no real change.
In 86,488 multiphasic examinations, mean leukocyte counts were highest in cigarette smokers, intermediate in ex-cigarette and cigar or pipe smokers, and lowest in nonsmokers. Among the races, whites had the highest, yellows next, and blacks the lowest leukocyte counts. The leukocyte count was related to quantity smoked, inhalation, and smoking duration. Most groups who changed smoking habits showed corresponding changes in leukocyte counts. Higher leukocyte counts in smokers appeared largely to be a direct effect of smoking, although a small part of the increase seemed attributable to chronic bronchitis. A contribution of genetic or constitutional differences between smokers and nonsmokers was not ruled out. “Normal” leukocyte count values should take into account age, sex, race, and smoking status.
Lipoprotein cholesterol determinations in 6328 individuals aged 20 to 79 years in the Framingham Heart Study Cohort and Offspring were related by multiple regression analysis to reported cigarette smoking, alcohol intake, and Quetelet Index (wt/ht2). Cigarette smoking was found to be strongly associated with "atherogenic" lipoprotein cholesterol profiles in young adults, and particularly in women. The associations for alcohol intake were mostly uniform across age groups and lipoprotein cholesterol fractions, while coefficients for Quetelet Index varied considerably. Blood chemistry associations were studied in participants under 50 years, after controlling for smoking, Quetelet Index, and alcohol intake. Significant associations for high density lipoprotein cholesterol (HDL-C) were seen for both sexes with alkaline phosphatase, serum calcium, serum u ric acid, and leucocyte count. Low density lipoprotein cholesterol (LDL-C) associations were observed with calcium, hematocrit, lactate dehydrogenase, and leucocyte count in men and women, while very low density lipoprotein cholesterol (VLDL-C) associations occurred with alkaline phosphatase, glucose, uric acid, and leucocyte count in both sexes. A 1 mg/dl higher calcium corresponded to an HDL-C approximately 4 mg/dl greater and a LDL-C typically 6 mg/dl greater after controlling for 12 other variables. A 1000/ml increase in leucocyte count was typically associated with a decrease in HDL-C by 1 mg/dl and an increase in LDL-C and VLDL-C of 1 mg/dl each.
The arteriovenous (A-V) distribution of microvessel hematocrit (Hmicro) was determined throughout successive microvascular divisions in cat mesentery from in vivo measurements of optical density. In vitro correlations of optical density and tube hematocrit in small-bore glass tubes permitted the computation of in vivo values of Hmicro for luminal diameters ranging from 20 to 70 μm. For smaller-size vessels, Hmicro was determined by microocclusion and red cell counting. The results demonstrate a monotonic fall in the ratio of from 0.80 in the 70-μm arterioles to a minimum of 0.21 in the immediate postcapillaries (10 μm diameter) followed by a subsequent monotonic rise to 0.95 in the 70-μm venules. Conservation of red cell flux throughout the mesenteric network was partially demonstrated upon applying previously established in vitro relationships between discharge and tube hematocrits, the resulting disparity being attributed to the rheological behavior of blood and possible A-V shunting of red cells. Simultaneous measurements of pressure drop and red cell velocity in unbranched arterioles during systemic hemodilution facilitated a comparison of in vivo and in vitro (cone-plate viscometer) apparent viscosities (η). No significant differences between the two approaches were found for arteriole diameters ranging from 24 to 47 μm in the absence of leukocyte-endothelium adhesion, with 0 < Hmicro < 36% and vivo wall shear rates above 500 sec−1. In situ measurements of η were found to increase 74% due to leukocyte adhesion during sustained flow reductions, in one illustrative case. Values of η computed from the A-V distribution of Hmicro and the regression of η vs Hmicro (established without leukocyte adhesion), in comparison with previous measurements of the A-V distribution of η with leukocyte adhesion present, suggest that leukocyte adhesion may result in overall increases in η ranging from 100 to 200%, throughout the mesenteric network.
To test the hypothesis that elevated white blood cell count (WBC) is associated with increased incidence of essential hypertension, data from the NHANES I Epidemiologic Follow-up Study (NHEFS) were analyzed. Incidence of hypertension was determined in a cohort of 5782 white and 674 black persons with complete data who were normotensive at baseline. There was a statistically significant increase of about 50% in risk of hypertension over approximately 10 years' follow-up in white men aged 25-74 years with WBC > 8600 compared to men with WBC < 6200 cells/mm3. The association was independent of other risk variables. In white women, an association of high WBC with increased age-adjusted risk of hypertension was seen only at ages 45-64 and 65-74 years. The association was diminished and no longer significant after controlling for multiple risk variables. Data for black women suggested an increased risk among women with higher WBC compared to those with lower WBC at ages 65-74 after controlling other risk variables (p = 0.0001). No positive association was seen in black men. Thus, data from NHEFS confirm the previously reported association of higher WBC with increased incidence of hypertension in white men, and possibly older white and black women. Given the lack of a compelling biological explanation, further studies of this association are needed, especially in women and blacks.
To evaluate the relationships of total and differential white blood cell (WBC) count to the components of the so-called insulin resistance syndrome.
The study population consisted of a random sample of 90 38-year-old healthy men with normal glucose tolerance.
A 75 g oral glucose tolerance test was performed in all participants.
Total and differential WBC count, lipids, blood pressure, plasma glucose, C-peptide and insulin (at fasting and 2 h after glucose load).
Total WBC count correlated consistently with plasma 2-h glucose (r = 0.38; P < 0.001), fasting and 2-h postload insulin (r = 0.26 and r = 0.33; P < 0.01-0.001, respectively) and C-peptide (r = 0.28 and r = 0.32; P < 0.01-0.001) concentrations. Smokers had significantly higher total leukocytes (P < 0.01), neutrophils and lymphocytes than nonsmokers. Furthermore, total WBC count correlated positively with body mass index, blood pressure, plasma triglycerides, fibrinogen, and negatively with HDL cholesterol concentration. As differential WBC count, most variables correlated essentially to neutrophils and/or lymphocytes, whereas plasma insulin and C-peptide concentrations correlated essentially to lymphocytes and monocytes, but not to neutrophils. In a multiple linear regression analysis, only 2-h plasma glucose (P < 0.01) and fibrinogen (P < 0.05) were positive predictors of total WBC count after adjusting for all potentially confounding variables.
The results indicate that increased, albeit normal, WBC count associates with the cluster of metabolic and haemodynamic disorders typical of the insulin resistance syndrome, and suggest that increased WBC count may be yet another component of this syndrome.
Higher white blood cell counts in smokers compared with nonsmokers have been well documented, but the longitudinal relation between changes in smoking and changes in white blood cells has not been well described. Since 1984, data have been collected semiannually by the Multicenter AIDS Cohort Study (MACS), a four-center prospective cohort study of acquired immunodeficiency syndrome (AIDS) in homosexual men. The study population includes 2,435 participants who were human immunodeficiency virus (HIV) seronegative as of September 1994 and who contributed 20,918 person-visits for this analysis. For individuals who modified their smoking behavior, changes in white blood cell counts occurred primarily during the first 6 months following changes in the amount of cigarettes smoked. Among former smokers who resumed smoking, the extent of the increase in white blood cell count depended on the number of cigarettes smoked. Specifically, increases of 241, 340, and 740 cells/microliter were observed for smokers who resumed smoking < 1, 1 to < 2, and > or = 2 packs/day, respectively. Conversely, smokers who quit smoking had a decrease of white blood cell count: -32, -629, and -1,122 cells/microliter for men who previously smoked < 1, 1 to < 2, and > or = 2 packs/day, respectively. Long-term ex-smokers, however, still had higher white blood cell counts than did never smokers. There was a high within-individual correlation of white blood cell count in persons who reported a consistent level of smoking (i.e., average correlations between two white blood cell counts 6 years apart were 0.51 for never smokers, 0.48 for ex-smokers, 0.56 for men who smoked < 1 pack/day, and 0.43 for men who smoked > or = 1 pack/day). These analyses indicate an acute effect of changes in smoking on changes in white blood cell count, a residual effect of having been a smoker, and high long-term tracking for white blood cell count.
Case-control studies have suggested that about 4% of bacteraemic patients will develop acute myocardial infarction within a month of the onset of infection and that up to 10% of all strokes may be associated with preceding bacteraemic infections. 4 Abdominal surgery is commonly associated with transient bacteraemia or leakage of bacterial endotoxin into the circulation, and is accompanied by a systemic inflammatory response with cytokine production. 5 After such surgery too, there is an increase in the risk of cardiovascular disease; the incidence of acute myocardial infarction remains high for several weeks. 6 These observations suggest that infection or acute systemic inflammation might temporarily increase the risk of an acute cardiovascular event. Acute changes in the overall bulk of atheroma are unlikely, but pre-existing atheroma could in some way become more able to support thrombosis and vasospasm. Consistent with this idea, the transition from stable to unstable angina seems to be associated with a systemic inflammatory response, 7
C-reactive protein, a hepatic acute phase protein largely regulated by circulating levels of interleukin-6, predicts coronary heart disease incidence in healthy subjects. We have shown that subcutaneous adipose tissue secretes interleukin-6 in vivo. In this study we have sought associations of levels of C-reactive protein and interleukin-6 with measures of obesity and of chronic infection as their putative determinants. We have also related levels of C-reactive protein and interleukin-6 to markers of the insulin resistance syndrome and of endothelial dysfunction. We performed a cross-sectional study in 107 nondiabetic subjects: (1) Levels of C-reactive protein, and concentrations of the proinflammatory cytokines interleukin-6 and tumor necrosis factor-alpha, were related to all measures of obesity, but titers of antibodies to Helicobacter pylori were only weakly and those of Chlamydia pneumoniae and cytomegalovirus were not significantly correlated with levels of these molecules. Levels of C-reactive protein were significantly related to those of interleukin-6 (r=0.37, P<0.0005) and tumor necrosis factor-alpha (r=0.46, P<0.0001). (2) Concentrations of C-reactive protein were related to insulin resistance as calculated from the homoeostasis model assessment model, blood pressure, HDL, and triglyceride, and to markers of endothelial dysfunction (plasma levels of von Willebrand factor, tissue plasminogen activator, and cellular fibronectin). A mean standard deviation score of levels of acute phase markers correlated closely with a similar score of insulin resistance syndrome variables (r=0.59, P<0.00005), this relationship being weakened only marginally by removing measures of obesity from the insulin resistance score (r=0.53, P<0.00005). These data suggest that adipose tissue is an important determinant of a low level, chronic inflammatory state as reflected by levels of interleukin-6, tumor necrosis factor-alpha, and C-reactive protein, and that infection with H pylori, C pneumoniae, and cytomegalovirus is not. Moreover, our data support the concept that such a low-level, chronic inflammatory state may induce insulin resistance and endothelial dysfunction and thus link the latter phenomena with obesity and cardiovascular disease.
A relationship between calcium dietary intake and incidence of preeclampsia was proposed. In the Andean Ecuadorian population, the average calcium intake, evaluated by a 24 hours dietary recall range between 52.3% of the US RDA to 77%. The calcium intake in women with preeclampsia was significantly lower in relation with normal pregnant women. Three prospective, randomized, double-blind, placebo-controlled clinical trials to investigate the effect of calcium supplementation (2 g/day of elemental calcium) in the incidence of pregnancy-induced hypertension and preeclampsia were conduced between 1984 and 1995. All the subjects included were nulliparous, younger that 25 years old, first prenatal visit before 24 weeks' gestation, residency in Quito, and normotensives. These clinical trials showed a risk reduction in pregnancy induced hypertension and preeclampsia in the calcium group. Calcium supplementation was associated with an increase in the serum ionized calcium concentrations. Moreover, women with preeclampsia showed a significant decrease in the levels of the serum ionized calcium. Ionic calcium is crucial for the synthesis of vasoactive substances in the endothelium as prostacyclin and nitric oxide. Recent results suggest that an alteration in the action of NO may be related to a high inactivation by free radical superoxide, secondary to an inflammatory process.
Endothelium plays a pivotal role in the regulation of vascular relaxation. Inflammation may in turn induce endothelial dysfunction and thus increase the risk of atherothrombosis. We investigated 31 men with angiographically verified coronary heart disease, aged 57. 7+/-5.3 years, in regard to endothelium-dependent, acetylcholine-induced, and to endothelium-independent, sodium nitroprusside-induced vasodilatation in the forearm vasculature by strain-gauge plethysmography. Logistic regression analysis served to determine the relation between forearm vascular function and the inflammatory factors measured, concentration of C-reactive protein, subtypes of peripheral blood T-lymphocytes, and other factors potentially affecting endothelial function (lipoprotein and glucose levels). Concentration of C-reactive protein was an independent determinant of endothelium-dependent vascular function (P<0.001 for low dose acetylcholine, P=0.01 for high dose acetylcholine). Other determinants of endothelium-dependent vascular dysfunction were CD8-lymphocytes expressing ICAM-1 (P=0.001), antibodies to oxidized low-density lipoprotein (P<0.001), and body weight (P=0.007). The present data showed an association between inflammatory risk factors linked to atherothrombosis and endothelial dysfunction in coronary heart disease patients. It is possible that endothelial dysfunction in coronary heart disease patients is related to the chronic inflammation or infection coexisting with atherosclerosis.
Since inflammation is believed to have a role in the pathogenesis of cardiovascular events, measurement of markers of inflammation has been proposed as a method to improve the prediction of the risk of these events.
We conducted a prospective, nested case-control study among 28,263 apparently healthy postmenopausal women over a mean follow-up period of three years to assess the risk of cardiovascular events associated with base-line levels of markers of inflammation. The markers included high-sensitivity C-reactive protein (hs-CRP), serum amyloid A, interleukin-6, and soluble intercellular adhesion molecule type 1 (sICAM-1). We also studied homocysteine and a variety of lipid and lipoprotein measurements. Cardiovascular events were defined as death from coronary heart disease, nonfatal myocardial infarction or stroke, or the need for coronary-revascularization procedures.
Of the 12 markers measured, hs-CRP was the strongest univariate predictor of the risk of cardiovascular events; the relative risk of events for women in the highest as compared with the lowest quartile for this marker was 4.4 (95 percent confidence interval, 2.2 to 8.9). Other markers significantly associated with the risk of cardiovascular events were serum amyloid A (relative risk for the highest as compared with the lowest quartile, 3.0), sICAM-1 (2.6), interleukin-6 (2.2), homocysteine (2.0), total cholesterol (2.4), LDL cholesterol (2.4), apolipoprotein B-100 (3.4), HDL cholesterol (0.3), and the ratio of total cholesterol to HDL cholesterol (3.4). Prediction models that incorporated markers of inflammation in addition to lipids were significantly better at predicting risk than models based on lipid levels alone (P<0.001). The levels of hs-CRP and serum amyloid A were significant predictors of risk even in the subgroup of women with LDL cholesterol levels below 130 mg per deciliter (3.4 mmol per liter), the target for primary prevention established by the National Cholesterol Education Program. In multivariate analyses, the only plasma markers that independently predicted risk were hs-CRP (relative risk for the highest as compared with the lowest quartile, 1.5; 95 percent confidence interval, 1.1 to 2.1) and the ratio of total cholesterol to HDL cholesterol (relative risk, 1.4; 95 percent confidence interval, 1.1 to 1.9).
The addition of the measurement of C-reactive protein to screening based on lipid levels may provide an improved method of identifying persons at risk for cardiovascular events.
Interleukin-6 (IL-6) plays a central role in inflammation and tissue injury. However, epidemiological data evaluating the role of IL-6 in atherogenesis are sparse.
In a prospective study involving 14 916 apparently healthy men, we measured baseline plasma concentration of IL-6 in 202 participants who subsequently developed myocardial infarction (MI) and in 202 study participants matched for age and smoking status who did not report vascular disease during a 6-year follow-up. Median concentrations of IL-6 at baseline were higher among men who subsequently had an MI than among those who did not (1.81 versus 1. 46 pg/mL; P=0.002). The risk of future MI increased with increasing quartiles of baseline IL-6 concentration (P for trend <0.001) such that men in the highest quartile at entry had a relative risk 2.3 times higher than those in the lowest quartile (95% CI 1.3 to 4.3, P=0.005); for each quartile increase in IL-6, there was a 38% increase in risk (P=0.001).This relationship remained significant after adjustment for other cardiovascular risk factors, was stable over long periods of follow-up, and was present in all low-risk subgroups, including nonsmokers. Although the strongest correlate of IL-6 in these data was C-reactive protein (r=0.43, P<0.001), the relationship of IL-6 with subsequent risk remained after control for this factor (P<0.001).
In apparently healthy men, elevated levels of IL-6 are associated with increased risk of future MI. These data thus support a role for cytokine-mediated inflammation in the early stages of atherogenesis.
We tested the hypothesis that endothelial dysfunction underlies the association between an acute inflammatory episode and the transiently increased risk of a cardiovascular event by examining the effects of an experimental inflammatory stimulus on endothelium-dependent vasodilation.
Salmonella typhi vaccine was used to generate a systemic inflammatory response in healthy volunteers. In 12 subjects, dilatation of the brachial artery to flow and to sublingual nitroglycerin (NTG) was recorded (conduit vessel response), and in 6 subjects, venous occlusion plethysmography was used to measure forearm blood flow during intrabrachial infusion of the endothelium-dependent dilators acetylcholine (ACh) and bradykinin (BK) and the endothelium-independent dilators NTG and verapamil (resistance vessel response). Responses were assessed 16 hours before and 8 and 32 hours after vaccination. Vaccination resulted in elevations in white cell count and serum levels of interleukin-6 and interleukin-1 receptor antagonist. Eight hours after vaccination, resistance vessel responses to BK (P:=0.0099) and ACh (P:=0.0414) were markedly attenuated, and brachial artery flow-mediated dilatation was depressed. Resistance vessel responses to verapamil and NTG were unchanged, as was the conduit vessel response to NTG. Thirty-two hours after vaccination, resistance vessel responses to BK and ACh had returned to normal.
S typhi vaccine generates a mild inflammatory reaction associated with temporary but profound dysfunction of the arterial endothelium in both resistance and conduit vessels to both physical and pharmacological dilator stimuli. This finding might explain the association between infection and inflammation and the enhanced risk of an acute cardiovascular event.
C-reactive protein (CRP), predicts coronary heart disease incidence in healthy subjects and has been associated with decreased endothelium-dependent relaxation, a potential risk factor for hypertension. However, the relationship between CRP and hypertension has not been studied.
To assess whether circulating levels of CRP are independently related to essential hypertension.
Cross-sectional population survey. We measured circulating levels of CRP, blood pressure and cardiovascular risk factors among participants. Binomial regression was used to calculate the adjusted effect of CRP on the prevalence of hypertension.
General community of Bucaramanga, Colombia.
A random sample of 300 subjects > or = 30 years old.
Arterial blood pressure.
Overall hypertension prevalence was 46.0%. The unadjusted prevalence of hypertension was 58.7% in the highest quartile of CRP, but only 34.7% in the lowest quartile. After adjustment for age, sex, body mass index, family history of hypertension, fasting glycemia, sedentary behaviour, and alcohol consumption, the prevalence of hypertension was 1.14 [95% confidence interval (CI), 0.82, 1.58; P= 0.442], 1.36 (95% CI, 0.99, 1.87; P= 0.057) and 1.56 (95% CI, 1.14, 2.13; P = 0.005) times higher in subjects in the second, third and fourth quartiles of CRP, as compared to subjects in the first quartile.
Our results suggest, for the first time, that CRP level may be an independent risk factor for the development of hypertension. However, because of the cross-sectional nature of our study, this finding should be confirmed in prospective cohort studies, aimed at elucidating the role of CRP in the prediction, diagnosis and management of hypertension.