954Which elements of the complete blood count can predict the incidence of cardiovascular disease? the EPIC-NL cohort study

Abstract

Background: Complete blood count is widely available in clinical practice. All blood cells - white blood cells (WBC), red blood cells (RBC) and platelets - can play a role in atherosclerosis. However, while WBC count is a recognized inflammatory marker, other elements of the blood count remain controversial as potential risk factors for cardiovascular disease (CVD). Purpose: We aimed to assess the associations of pre-diagnostic complete blood count with the incidence of total CVD as well as coronary heart disease (CHD) and stroke. Methods: A total of 14,362 participants in the European Prospective Investigation into Cancer and Nutrition - Netherlands (EPIC-NL) with no prevalent CVD, with a mean (SD) age of 47.8 (11.7) years at baseline were followed-up for a median of 11.4y resulting in 992 incident first fatal or non-fatal CVD cases (196 stroke and 589 CHD). Median time (interquartile range) to CVD incidence was 6.8y (4.0- 9.1y). Cox proportional hazards regressions were used to estimate hazard ratios (HRs) and 95% confidence interval (95% CI), stratified by sex and centre and adjusted for age, lifestyle (smoking, physical activity, alcohol intake, education) and cardiovascular risk factors (waist to hip ratio, BMI, systolic blood pressure, diabetes, HDL-cholesterol). Sex-specific tertiles were computed. Results: Increased total WBC count as well as lymphocyte, monocyte and neutrophil counts were associated with higher CVD risk: HRs (95% CI) were 1.31 (1.10; 1.55), 1.20 (1.02; 1.41), 1.21 (1.03; 1.41) and 1.24 (1.05; 1.47) respectively in the top vs bottom tertile. RBC count and haematocrit showed no clear association with some evidence of a U shape, but individuals with greater mean corpuscular volume (MCV: 1.23 [1.04; 1.46]) and red cell distribution width (RDW: 1.22 [1.03; 1.44]) were at higher risk of CVD in the third vs bottom tertile. Platelets were only associated with CVD risk for count values above the clinically normal range (≥400 109 cells/L vs 150-400): 1.49 (1.00; 2.22). All associations were weaker for CHD than for stroke. Conclusions: Total and differential WBC count, MCV, RDW and platelet count were associated with risk of incident CVD in a general population and may be promising inexpensive biomarkers.