Kartik Gupta1, Rajat Kalra2, Mike Pate3, Shivaraj Nagalli4, Sameer Ather5, Indranee Rajapreyar6, Pankaj Arora7, Ankur Gupta8, Wunan Zhou9, Raul San Jose Estepar10, Marcelo Di Carli11, Sumanth D Prabhu12, Navkaranbir S Bajaj13. 1. Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Birmingham, AL; Division of General Internal Medicine, Henry Ford Hospital, Detroit, MI. 2. Cardiovascular Division, University of Minnesota, Minneapolis, MN. 3. Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Birmingham, AL. 4. Yuma Regional Medical Center, Yuma, AZ. 5. Section of Cardiology, Birmingham Veteran Affairs Medical Center, Birmingham, AL. 6. Division of General Internal Medicine, Henry Ford Hospital, Detroit, MI. 7. Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Birmingham, AL; Section of Cardiology, Birmingham Veteran Affairs Medical Center, Birmingham, AL. 8. Division of Cardiology, Henry Ford Hospital, Detroit, MI. 9. Cardiology Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. 10. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 11. Cardiovascular Imaging Program, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (M.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 12. Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Birmingham, AL; Section of Cardiology, Birmingham Veteran Affairs Medical Center, Birmingham, AL. Electronic address: sprabhu@uabmc.edu. 13. Division of Cardiovascular Disease and Comprehensive Cardiovascular Center, University of Alabama at Birmingham, Birmingham, AL; Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; Section of Cardiology, Birmingham Veteran Affairs Medical Center, Birmingham, AL. Electronic address: nbajaj@uabmc.edu.
Abstract
OBJECTIVE: To investigate the relative predictive value of circulating immune cell markers for cardiovascular mortality in ambulatory adults without cardiovascular disease. METHODS: We analyzed data of participants enrolled in the National Health and Nutrition Examination Survey from January 1, 1999, to December 31, 2010, with the total leukocyte count within a normal range (4000-11,000 cells/μL [to convert to cells ×109/L, multiply by 0.001]) and without cardiovascular disease. The relative predictive value of circulating immune cell markers measured at enrollment-including total leukocyte count, absolute neutrophil count, absolute lymphocyte count, absolute monocyte count, monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio, and C-reactive protein-for cardiovascular mortality was evaluated. The marker with the best predictive value was added to the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score to estimate net risk reclassification indices for 10-year cardiovascular mortality. RESULTS: Among 21,599 participants eligible for this analysis, the median age was 47 years (interquartile range, 34-63 years); 10,651 (49.2%) participants were women, and 10,713 (49.5%) were self-reported non-Hispanic white. During a median follow-up of 9.6 years (interquartile range, 6.8-13.1 years), there were 627 cardiovascular deaths. MLR had the best predictive value for cardiovascular mortality. The addition of elevated MLR (≥0.3) to the 10-year ASCVD risk score improved the classification by 2.7%±1.4% (P=.04). Elevated MLR had better predictive value than C-reactive protein and several components of the 10-year ASCVD risk score. CONCLUSION: Among ambulatory US adults without preexisting cardiovascular disease, we found that MLR had the best predictive value for cardiovascular mortality among circulating immune markers. The addition of MLR to the 10-year risk score significantly improved the risk classification of participants. Published by Elsevier Inc.
OBJECTIVE: To investigate the relative predictive value of circulating immune cell markers for cardiovascular mortality in ambulatory adults without cardiovascular disease. METHODS: We analyzed data of participants enrolled in the National Health and Nutrition Examination Survey from January 1, 1999, to December 31, 2010, with the total leukocyte count within a normal range (4000-11,000 cells/μL [to convert to cells ×109/L, multiply by 0.001]) and without cardiovascular disease. The relative predictive value of circulating immune cell markers measured at enrollment-including total leukocyte count, absolute neutrophil count, absolute lymphocyte count, absolute monocyte count, monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio, and C-reactive protein-for cardiovascular mortality was evaluated. The marker with the best predictive value was added to the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score to estimate net risk reclassification indices for 10-year cardiovascular mortality. RESULTS: Among 21,599 participants eligible for this analysis, the median age was 47 years (interquartile range, 34-63 years); 10,651 (49.2%) participants were women, and 10,713 (49.5%) were self-reported non-Hispanic white. During a median follow-up of 9.6 years (interquartile range, 6.8-13.1 years), there were 627 cardiovascular deaths. MLR had the best predictive value for cardiovascular mortality. The addition of elevated MLR (≥0.3) to the 10-year ASCVD risk score improved the classification by 2.7%±1.4% (P=.04). Elevated MLR had better predictive value than C-reactive protein and several components of the 10-year ASCVD risk score. CONCLUSION: Among ambulatory US adults without preexisting cardiovascular disease, we found that MLR had the best predictive value for cardiovascular mortality among circulating immune markers. The addition of MLR to the 10-year risk score significantly improved the risk classification of participants. Published by Elsevier Inc.
Authors: Jan R Thiele; Jonathon Habersberger; David Braig; Yvonne Schmidt; Kurt Goerendt; Valentin Maurer; Holger Bannasch; Amelie Scheichl; Kevin J Woollard; Ernst von Dobschütz; Frank Kolodgie; Renu Virmani; G Bjoern Stark; Karlheinz Peter; Steffen U Eisenhardt Journal: Circulation Date: 2014-04-28 Impact factor: 29.690
Authors: Paul M Ridker; Brendan M Everett; Tom Thuren; Jean G MacFadyen; William H Chang; Christie Ballantyne; Francisco Fonseca; Jose Nicolau; Wolfgang Koenig; Stefan D Anker; John J P Kastelein; Jan H Cornel; Prem Pais; Daniel Pella; Jacques Genest; Renata Cifkova; Alberto Lorenzatti; Tamas Forster; Zhanna Kobalava; Luminita Vida-Simiti; Marcus Flather; Hiroaki Shimokawa; Hisao Ogawa; Mikael Dellborg; Paulo R F Rossi; Roland P T Troquay; Peter Libby; Robert J Glynn Journal: N Engl J Med Date: 2017-08-27 Impact factor: 91.245
Authors: Matthias Nahrendorf; Filip K Swirski; Elena Aikawa; Lars Stangenberg; Thomas Wurdinger; Jose-Luiz Figueiredo; Peter Libby; Ralph Weissleder; Mikael J Pittet Journal: J Exp Med Date: 2007-11-19 Impact factor: 14.307