Okada Kozo, Hibi Kiyoshi, Misumi Toshihiro, Iwahashi Noriaki, Gohbara Masaomi, Uemura Kohei, Iwata Hiroshi, Fukumoto Yoshihiro, Hiro Takafumi, Ozaki Yukio, Iimuro Satoshi, Sakuma Ichiro, Hokimoto Seiji, Miyauchi Katsumi, Matsuyama Yutaka, Nakagawa Yoshihisa, Ogawa Hisao, Daida Hiroyuki, Shimokawa Hiroaki, Saito Yasushi, Kimura Takeshi, Matsuzaki Masunori, Kimura Kazuo, Nagai Ryozo
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Department of Data Science, National Cancer Center Hospital East, Kashiwa, Japan.
Am J Prev Cardiol. 2025 Jun 26;23:101052. doi: 10.1016/j.ajpc.2025.101052. eCollection 2025 Sep.
Elevated white blood cell (WBC) counts have been associated with major adverse cardiovascular events (MACE). However, their incremental prognostic values, especially considering factors such as race, sex difference, clinical characteristics, and statin dosage, are not well defined. This study aimed to explore the relationship between baseline WBC counts and subsequent MACE in Japanese patients with stable coronary artery disease (CAD) receiving high and low doses of pitavastatin, as a sub-analysis of the REAL-CAD study.
A total of 10,123 patients with baseline WBC count data were included in this analysis. Patients were categorized into quartiles based on their baseline WBC counts, and the cumulative 4-year incidence of MACE, defined as cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or unstable angina requiring hospitalization, was compared among the quartiles. MACE occurred in 491 patients, and Kaplan-Meier curve analysis showed a significantly higher incidence of MACE in the fourth quartile compared with the first quartile (hazard ratio [HR]: 1.910, 95 % confidence interval [CI]: 1.477-2.471). Multivariate analysis indicated that the highest quartile of WBC count was an independent determinant of future MACE (HR: 1.879, 95 %CI: 1.439-2.454), adjusting for age, sex, diabetes, current smoking, statin dosage, and baseline high-sensitive C-reactive protein.
Elevated WBC counts increased the risk of cardiovascular events in Japanese patients with stable CAD, highlighting the importance of inflammation as a residual risk after statin treatments in the Japanese population. Further research is needed to evaluate the clinical benefits of screening and treatment strategies based on WBC counts.
白细胞（WBC）计数升高与主要不良心血管事件（MACE）相关。然而，其递增的预后价值，尤其是考虑种族、性别差异、临床特征和他汀类药物剂量等因素时，尚未明确界定。本研究旨在探讨接受高剂量和低剂量匹伐他汀的日本稳定型冠状动脉疾病（CAD）患者基线白细胞计数与随后发生的MACE之间的关系，作为REAL-CAD研究的一项亚分析。
本分析纳入了10123例有基线白细胞计数数据的患者。根据基线白细胞计数将患者分为四分位数，并比较各四分位数中心血管死亡、非致死性心肌梗死、非致死性缺血性卒中或需要住院治疗的不稳定型心绞痛定义的MACE的4年累积发生率。491例患者发生了MACE，Kaplan-Meier曲线分析显示，与第一四分位数相比，第四四分位数中MACE的发生率显著更高（风险比[HR]：1.910，95%置信区间[CI]：1.477-2.471）。多变量分析表明，白细胞计数最高的四分位数是未来发生MACE的独立决定因素（HR：1.879，95%CI：1.439-2.454），对年龄、性别、糖尿病、当前吸烟情况、他汀类药物剂量和基线高敏C反应蛋白进行了校正。
白细胞计数升高增加了日本稳定型CAD患者发生心血管事件的风险，突出了炎症作为日本人群他汀类药物治疗后残余风险的重要性。需要进一步研究来评估基于白细胞计数的筛查和治疗策略的临床益处。
