Association of periodontitis with increased white blood cell count and blood pressure

This study was aimed to examine the association of periodontitis with white blood cell (WBC) count and blood pressure (BP). In 2002, 424 subjects (manufacturing workers) were investigated for periodontitis by a general dentist. All were Japanese. Among them, 364 subjects (269 men and 95 women) who also attended the next year's (2003) screening were enrolled for this study. Of the 364 subjects, 55 (15.1%) had periodontitis. We also measured the BP and WBC count in periodontitis and non-periodontitis subjects at baseline and 1-year later follow-up. The WBC count higher in subjects with periodontitis than in subjects without periodontitis, both at baseline [mean +/- standard error (SE) 6.6 x 10(3) +/- 0.2 x 10(3)/ml vs 5.8 +/- 0.3 x 10(3)/ml; p < 0.001] and follow-up (7.0 +/- 0.3(3)/ml vs 6.5 +/- 0.1(3)/ml; p = 0.003). The systolic BP was higher in subjects with periodontitis than in subjects without periodontitis, both at the baseline (128 +/- 2.1 mmHg vs 120.8 +/- 0.8 mmHg; p < 0.001) and follow-up (129.2 +/- 2.3 mmHg vs 123.0 +/- 0.8 mmHg; p = 0.011), and so was the diastolic BP both at baseline (76 +/- 1.5 mmHg vs 71.2 +/- 0.6 mmHg; p = 0.003) and follow-up (80.5 +/- 1.7 mmHg vs 75.4 +/- 0.7 mmHg; p = 0.004). Periodontitis is associated with increased BP and WBC count. This finding may provide one underlying pathway linking periodontitis and cardiovascular disease.     

Relationship between white blood cell count and incident hypertension

BACKGROUND: Elevated white blood cell (WBC) count is considered to be prospectively associated with cardiovascular disease. However, its relationship to hypertension, independent of smoking and other established cardiovascular risk factors, is not clear, especially among women. METHODS: We used data from a large population-based study in Wisconsin (Beaver Dam Eye study) to examine the prospective association between elevated WBC count and incident hypertension among 2459 hypertension-free women (48.6%) and men (51.4%) after adjusting for, and stratifying by smoking and several other potential confounding factors. RESULTS: In multivariable proportional hazards models, increasing tertiles of WBC count was associated with increased risk ratios (RR) of hypertension in the whole cohort (WBC count tertiles 1-3; RR 1, 1.2, 1.7; P <.01), and separately among women (WBC count tertiles 1-3; RR 1, 1.1, 1.4; P <.05) and men (WBC count tertiles 1-3; RR 1, 1.3, 1.9; P <.01). Results from subsequent analyses stratified by smoking and several other related factors were consistent with this finding. CONCLUSIONS: Elevated WBC count is associated with incident hypertension among women and men independent of smoking and most traditional cardiovascular risk factors in this predominantly white cohort. Further research is required to determine whether this association is true among racial minorities (eg, African Americans), and independent of C-reactive protein, a more specific marker of inflammation.     

白细胞总数及分类与血脂异常的相关性观察

目的 通过分析白细胞总数及分类与脂代谢的情况,了解血脂异常是否伴随有慢性炎症产生.方法 从体检人群中纳入22 583位调查对象,按临床血脂分类方法将调查对象分成五组:正常组、高胆固醇血症组、低HDL血症组、高TG血症组和混合型高脂血症组;分析各组调查对象血中的白细胞总数和白细胞各分类的百分比,采用多因素Logistic回归分析脂代谢异常与白细胞总数之间的相关性.结果 与正常组比较,其他各组男性患者的比例明显增加、血中白细胞总数明显增高(P＜0.05);在白细胞分类中,仅高胆固醇血症组和混合型高脂血症组的淋巴细胞百分比(34.05±8.10、34.32±7.45)明显增加(P＜0.05),低HDL血症组和高TG血症组的三类白细胞分类均无统计学差异(P＞0.05);除正常组外白细胞增高的比例明显升高(P＜0.05)、OR值均>1.结论 血脂异常患者血中的白细胞水平比正常人明显增高,其中高胆固醇血症和混合型高脂血症以淋巴细胞增多为主,因此提示慢性炎症可能是血脂异常患者患相关疾病的病理生理基础.     

Prognostic value of elevated white blood cell count in hypertension

BACKGROUND: Chronic low-grade inflammation may contribute to vascular injury and atherogenesis, and has been described in association to high blood pressure (BP). However, as yet the prognostic significance of white blood cell (WBC) count in the setting of uncomplicated hypertension has not been investigated. METHODS: In the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, 1617 white patients with essential hypertension (aged 49 +/- 12 years, 55% men) without prevalent cardiovascular or renal disease underwent off-treatment baseline clinical evaluation and were then followed up for 11 years (average 4.9 years). RESULTS: The WBC count had a direct association with smoking status, serum triglycerides, body mass index, and 24-h BP, and an inverse one with age (all P < .05). During follow-up, 146 patients developed a major fatal or nonfatal cardiovascular event (1.9 events per 100 patient-years). Patients who will develop a cardiovascular event had a higher WBC count (7.08 +/- 1.6 v 6.68 +/- 1.6 x 10(9) cells/L, P = .004). Event rate increased progressively from the first to the fourth quartile of WBC count distribution (1.2, 1.8, 1.9, and 2.3 events per 100 patient-years; P < .01 by log-rank test). After adjustment (Cox model) for the effect of age, gender, diabetes, serum cholesterol, glomerular filtration rate, smoking, left ventricular hypertrophy, and 24-h systolic BP, cardiovascular event risk increased by 24% (95% confidence interval +4% to +48%; P = .019) for each 2 x 10(9) cells/L increase in WBC. CONCLUSIONS: After adjustment for average 24-h BP, established risk factors and target organ damage, an elevated WBC count remains an independent predictor of cardiovascular morbidity in hypertensive patients.     

Elevated white blood cell count is associated with arterial stiffness

Background and aimsWhite blood cell (WBC) count, a usual marker of systemic inflammation, is known to be associated with atherosclerotic cardiovascular disease. The aim of the present study was to determine the association of WBC count with arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV).Methods and resultsWe examined the association between WBC count and baPWV in 788 Korean adults (375 men, 413 women) in a health examination program. The odds ratios for a high baPWV were calculated using multivariate logistic regression analysis after adjusting for confounding variables across WBC count quartiles (Q1: ≤5190, Q2: 5200–6080, Q3: 6090–7310, and Q4: ≥7320 cells/mm³). A high baPWV was defined as more than 1440 cm/s (>75th percentile).Age-adjusted baPWV mean values gradually increased with WBC quartiles (Q1 = 1294, Q2 = 1322, Q3 = 1347, and Q4 = 1367 cm/s). The odds ratios (95% CI) for a high baPWV in each WBC count quartile were 1.00, 1.34 (0.61–3.00), 2.20 (0.96–5.06), and 2.69 (1.15–6.47) after adjusting for age, sex, cigarette smoking, alcohol intake, regular exercise, body mass index (BMI), mean arterial blood pressure, fasting plasma glucose, triglyceride, HDL-cholesterol, γ-glutamyltransferase (GGT), and uric acid.ConclusionThese findings indicate that elevated WBC count is associated with arterial stiffness. Accordingly, early detection of an elevated WBC count is important for arterial function and the assessment of cardiovascular risk.     

白细胞计数与脂类代谢性疾病的相关性分析

目的分析体检人群的白细胞计数(WBC)与血清甘油三酯(TG)、总胆固醇(TC)、性别、年龄之间的相关性。方法以重庆市40044例体检者为研究对象,检测其WBC、TG、TC含量,按照统计学四分位方法将WBC分为WBC1组、WBC2组、WBC3组、WBC4组,各组的WBC分别为0～4.90×109/L、(4.91～5.79)×109/L、(5.80～6.71)×109/L、6.72×109/L,用SPSS17.0软件分析各WBC水平与血清TC、TG、性别和年龄的相关性,讨论其与相关疾病的关系。结果随着WBC计数增加,各组TG、TC含量以及男性比例均逐渐升高,女性比例逐渐降低(P0.01);WBC1组WBC与TG、TC和性别呈正相关,与年龄负相关,相关系数(r)分别为0.121,0.044,0.099,-0.033(P0.01);WBC2、WBC4两组的WBC也与TG、TC和性别呈正相关,r分别为0.074、0.037、0.035,0.084、0.03、0.042(P0.01),与年龄不相关(P0.05);WBC3组中WBC仅与TG相关(r=0.04,P0.01),而与TC、性别和年龄都不相关(均P0.05)。以WBC计数为因变量,TG、TC、性别和年龄为自变量进行多重线性回归分析,标准化偏回归系数(β)分别为0.123,0.035,0.117,-0.03(P0.01)。结论重庆市民的WBC在一定范围内与TG、TC和性别有关,在此范围内的WBC有望成为脂代谢相关疾病辅助诊断的新指标。     

Relationship between white blood cell count and nonalcoholic fatty liver disease

Background

Higher levels of white blood cell (WBC) count are known to be associated with metabolic syndrome and insulin resistance. Nonalcoholic fatty liver disease (NAFLD) is also considered a hepatic manifestation of insulin resistance.

Aims

The present study aimed to determine the relation between WBC count and the presence of NAFLD based on abdominal sonographic findings.

Methods

A cross-sectional study with 3681 healthy subjects (2066 men, 1615 women) undergoing medical check-up was conducted. The odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD were calculated using multivariate logistic regression analyses across WBC quartiles.

Results

A graded independent relationship between higher levels of WBC count and the prevalence risk of NAFLD was observed. After adjusting for age, smoking status, regular exercise, body mass index (BMI), blood pressure, fasting plasma glucose, triglyceride, and HDL-cholesterol, the ORs (95% CIs) for NAFLD according to WBC quartiles were 1.00, 1.48 (1.10–1.98), 1.59 (1.18–2.14), and 1.84 (1.35–2.51) for men and 1.00, 1.15 (0.67–1.96), 1.88 (1.13–3.11), and 2.74 (1.68–4.46) for women.

Conclusions

WBC count was found to be independently associated with the presence of NAFLD regardless of classical cardiovascular risk factors and other components of metabolic syndrome.     

Preprocedural white blood cell count and death after percutaneous coronary intervention

Background

Elevated inflammatory markers are associated with worse outcome after percutaneous coronary artery interventions (PCI). An elevation in the white blood cell (WBC) count is a nonspecific response to inflammation. We hypothesized that an elevated WBC count would be a predictor of death in patients undergoing PCI.

Methods

A total of 4450 patients undergoing percutaneous coronary artery intervention were divided into quintiles, based on their preprocedural WBC count (mean WBC count: quintile 1, 5.08 × 10³/μL; quintile 2, 6.58 × 10³/μL; quintile 3, 7.70 × 10³/μL; quintile 4, 9.14 × 10³/μL; and quintile 5, 13.4 × 10³/μL). Vital status was assessed through the use of the Social Security Death Index.

Results

There were a total of 504 deaths over a follow-up period of 48 months. The best survival was seen in quintile 2, with an increase in long-term mortality rates seen with both a higher or a lower WBC count (P < .001). This J-shaped curve was preserved after multivariate adjustment, with the adjusted hazard ratio of mortality relative to quintile 2 being 1.95 (95% CI, 1.40 to 2.73) in quintile 1, 1.66 (95% CI, 1.18 to 2.33) in quintile 3, 2.31 (95% CI, 1.67 to 3.17) in quintile 4, and 2.42 (95% CI, 1.76 to 3.34) in quintile 5.

Conclusions

A low or an elevated preprocedural WBC count in patients undergoing PCI is associated with an increased risk of long-term death. Our result provides further evidence to support the important role of inflammation in coronary artery disease.     

Association of white blood cell count with systolic blood pressure within the normotensive range

Hypertension and inflammation promote cardiovascular disease (CVD). Even high normal systolic blood pressure (SBP) is associated with increased CVD risk. We assessed the relationship of elevated SBP within the normotensive range and white blood cell (WBC) count. This is a cross-sectional study of 3484 white asymptomatic individuals (mean age: 43+/-8 years, 79% males) without hypertension with SBP<140 mm Hg. White blood cell count >or=75th percentile (8.35 x 10(9) cells/l) was considered cutoff for elevated WBC. Subjects were classified into three levels of SBP (first: <120 mm Hg, n=1,176, 34%; second: 120-129 mm Hg, n=1,654, 47%; third: 130-139 mm Hg, n=654, 19%). Mean WBC count increased linearly across SBP categories (first: 6.14+/-1.54, second: 6.20+/-1.52, third: 6.41+/-1.62, P=0.02 for trend). There was a linear increase in prevalence of elevated WBC across higher SBP categories (22, 24 and 28%, P=0.02). As compared to those with SBP<120 mm Hg, in multivariate linear regression analyses (adjusting for age, gender, smoking status, diabetes, body mass index, physical activity, cholesterol/high-density lipoprotein cholesterol ratio) WBC count was significantly higher among participants with SBP 130-139 mm Hg (regression coefficient: 2.64, 95% confidence interval: 1.04-4.24, P=0.001). Odds ratio for prevalence of elevated WBC with SBP<120 mm Hg as reference group was 1.14 (0.92-1.41) for SBP 120-129 mm Hg and 1.50 (1.15-1.92) for SBP 130-139 mm Hg. In conclusion, Higher SBP within the normotensive range is also associated with elevated WBC count. Further studies are needed to clarify the role of inflammation in high normal SBP and associated CVD risk.     

Platelet count is positively correlated with white cell count and red cell count

Platelet count is positively correlated with the white cell count in healthy males aged 20-68 years (p less than 0.002) and in healthy medical students of both sexes aged 18-22 years (p less than 0.0001). Platelet count is also positively correlated with red cell count in healthy males (p less than 0.02). Red cell count is positively correlated with white cell count in the older healthy males (p less than 0.02) and in the male medical students (p less than 0.003). These findings provide support for the concept of a single hormone-dependent pluripotent stem cell whose effect is seen concomitantly in all circulating blood cells. The white cell count and platelet count correlation is less significant in the males aged 35 or above which may represent the development of pathological mechanisms.     

Association of white blood cell count with increased mortality in acute myocardial infarction and unstable angina pectoris. OPUS-TIMI 16 Investigators

We observed in a study of 7,651 patients with acute coronary syndromes that a white blood cell (WBC) count of > 10,000 was associated with increased 30-day and 10-month mortality (6.2% vs 3.2% to 3.6% for WBC count < 10,000; p < 0.000). With its simplicity and widespread availability, WBC count could serve as a simple, inexpensive, new tool for risk stratification in acute coronary syndromes.     

The white blood cell count and risk for coronary heart disease.

In conclusion, the WBC count has been demonstrated in several epidemiologic studies to be a strong independent predictor of future coronary heart disease. Although it is not possible at this point in time to be certain that the elevated WBC count is a cause rather than a consequence of ischemic heart disease, recent pathophysiologic studies suggest that the white blood cell, in particular the neutrophil, is instrumental in the pathogenesis of myocardial ischemia. It is conceivable that patients who develop acute myocardial ischemia have abnormal leukocyte function before the onset of the acute event, which provides a pathophysiologic milieu for the progression of the atherosclerotic process. Future research must focus on further elucidation of the properties of WBCs and clarification of the role of the activated neutrophil in the process of vascular injury. Quantitative and qualitative changes in leukocyte function may have important implications in the development of CHD.     

Association between white blood cell count and carotid arteriosclerosis in Japanese smokers

Recent studies have shown the relationship between general inflammatory markers and ischemic heart and cerebrovascular diseases. Here we have investigated the potential association between the circulating white blood cell count and carotid arteriosclerosis in apparently healthy individuals. Between 1994 and 1998, 3455 subjects who had undergone general health screening tests including carotid ultrasonography were enrolled in this study. The intertertile cutoff points for the white blood cell count were 5.1 x 10(3) and 6.4 x 10(3) microL(-1) in the male subjects and 4.6 x 10(3) and microL(-1) in the female subjects. The prevalence of carotid plaque in the first (lowest), the second, and the third tertiles was 19, 28, and 28% in the male subjects, respectively (P < 0.0001), and 10, 15, and 14% in the female subjects, respectively (n.s.). The multivariate analysis showed that the male subjects in the second and third tertiles had increased risk for carotid plaque with odds ratios of 1.54 (95% CI 1.18-2.01) and 1.47 (95% CI 1.11-1.95), respectively, compared to those in the first tertile. When male subjects were subdivided according to their smoking status, the association between white blood cell count and carotid plaque was significant in those who smoked, but not in those who had never smoked. These data suggested the possible association between the circulating white blood cell count and formation of carotid plaque in male smokers, but not in male never smokers or in females, in an apparently healthy Japanese population.     

Differential white blood cell count and all-cause mortality in the Korean elderly

The circulating white blood cell (WBC) count has been considered a good biomarker of systemic inflammation, but the predictive value of this inexpensive and universally obtained test result has not been fully explored in the elderly. The objective of this study was to assess the independent association of WBC count and its individual components with mortality in an elderly population. We studied a total of 9996 participants (age ≥ 65 years) who underwent routine health examinations at the 2 healthcare centers affiliated with Seoul National University. Mortality data were obtained from the National Statistics Office of Korea. The mean age of the study population was 69.7 (SD 4.3) years, and 5491 of the subjects (54.9%) were male. The median length of follow-up was 44.9 months (range, 1.2–78.7 months). There were 118 deaths (1.2%) during the follow-up period. The leading cause of death was cancer. Compared with the survivors, the deceased subjects were older, predominantly male, had increased levels of inflammatory markers, and had poor nutritional status. A significant difference in mortality was identified among patients in different WBC and WBC subtype quartile groups. Cox proportional hazards analysis indicated that monocyte count (HR: 5.18, 95% CI: 2.44–11.02) was a strongest predictor of all-cause mortality than total WBC count (HR: 1.57, 95% CI: 0.88–2.80), granulocyte count (HR: 2.11, 95% CI: 1.15–3.88), and lymphocyte count (HR: 1.11, 95% CI: 0.66–1.86), even after adjusting for possible confounding variables. Monocyte counts were associated with an increased risk of cardiovascular and cancer-related mortality in the elderly population. In conclusion, the total WBC count is an independent predictor of mortality in older adults, but the monocyte subtype provides greater predictive ability.