Brown D W, Giles W H, Croft J B
Cardiovascular Health Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341-3717, USA.
J Clin Epidemiol. 2001 Mar;54(3):316-22. doi: 10.1016/s0895-4356(00)00296-1.
An association between elevated white blood cell (WBC) count and coronary heart disease (CHD) mortality has been previously observed. However, the relationship between WBC count and CHD mortality independent of cigarette smoking and the possible interaction between WBC count and smoking remains unclear. We examined the association between WBC count and CHD mortality with Cox regression analyses of data from 8914 adults, aged 30-75, in the NHANES II Mortality Study (1976-1992). Covariates included age, sex, race, education, physical activity, smoking status, hypertensive status, total serum cholesterol, body mass index, hematocrit, and history of cardiovascular disease, stroke, and diabetes. During 17 follow-up years, there were 548 deaths from CHD (ICD-9 410-414) and 782 deaths from diseases of the heart (ICD-9 390-398, 402, 404, 410-414, 415-417, 420-429). Mean WBC count (x10(9) cells/L) was greater among persons who died from CHD (7.6 vs 7.2, P <.001). Compared to persons with a WBC count <6.1, persons with a WBC count > 7.6 were at increased risk of death from CHD (relative risk = 1.4, 95% confidence interval = 1.1-1.8) after adjustment for smoking status and other CVD risk factors. Similar results were observed among nonsmokers (RR = 1.4, 95% CI = 0.9-2.0). These results suggest that higher WBC counts are a predictor of CHD mortality independent of the effects of smoking and other traditional CVD risk factors, which may indicate a role for inflammation in the pathogenesis of CHD. Additional studies are needed to determine whether interventions to decrease inflammation can reduce the risk for CHD associated with elevated WBC.
此前已观察到白细胞（WBC）计数升高与冠心病（CHD）死亡率之间存在关联。然而，白细胞计数与冠心病死亡率之间独立于吸烟的关系以及白细胞计数与吸烟之间可能的相互作用仍不清楚。我们通过对国家健康与营养检查调查II死亡率研究（1976 - 1992年）中8914名30 - 75岁成年人的数据进行Cox回归分析，研究了白细胞计数与冠心病死亡率之间的关联。协变量包括年龄、性别、种族、教育程度、身体活动、吸烟状况、高血压状况、总血清胆固醇、体重指数、血细胞比容以及心血管疾病、中风和糖尿病史。在17年的随访期间，有548例死于冠心病（国际疾病分类第九版410 - 414），782例死于心脏疾病（国际疾病分类第九版390 - 398、402、404、410 - 414、415 - 417、420 - 429）。死于冠心病的人的平均白细胞计数（x10(9)个细胞/升）更高（7.6对7.2，P <.001）。与白细胞计数<6.1的人相比，在调整吸烟状况和其他心血管疾病风险因素后，白细胞计数>7.6的人死于冠心病的风险增加（相对风险 = 1.4，95%置信区间 = 1.1 - 1.8）。在不吸烟者中也观察到了类似结果（RR = 1.4，95% CI = 0.9 - 2.0）。这些结果表明，较高的白细胞计数是冠心病死亡率的一个预测指标，独立于吸烟和其他传统心血管疾病风险因素的影响，这可能表明炎症在冠心病发病机制中起作用。需要进一步研究以确定减少炎症的干预措施是否能降低与白细胞计数升高相关的冠心病风险。
