DOI QR코드

DOI QR Code

White Blood Cell Count to Mean Platelet Volume Ratio Is a Prognostic Factor in Patients with Non-ST Elevation Acute Coronary Syndrome with or without Metabolic Syndrome

  • Dehghani, Mohammad Reza (Department of Cardiology, Urmia University of Medical Sciences) ;
  • Rezaei, Yousef (Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences) ;
  • Fakour, Sanam (School of Medicine, Urmia University of Medical Sciences) ;
  • Arjmand, Nasim (School of Medicine, Urmia University of Medical Sciences)
  • Received : 2015.06.02
  • Accepted : 2015.08.11
  • Published : 2016.03.30

Abstract

Background and Objectives: Leukocyte and platelet have been found to be associated with metabolic syndrome (MetS). We aimed to determine the usefulness of a novel marker named white blood cell count to mean platelet volume ratio (WMR) for predicting outcomes of non-ST elevation acute coronary syndrome (NSTE-ACS) with or without MetS. Subjects and Methods: A total of 331 NSTE-ACS individuals ($60{\pm}12.5years$, 57.4% male) were enrolled and followed for a median of 24 months. MetS was identified using the National Cholesterol Education Program Adult Treatment Panel III criteria. Results: Patients were divided into two groups: high WMR ($WMR{\geq}720$) and low WMR (WMR<720). Major adverse cardiovascular events (MACE) and MetS rates were significantly greater in the higher WMR group compared to those in the low WMR group (MACE: 14.3% vs. 25%, p=0.014; MetS: 50.9% vs. 75%, p<0.001). MetS was diagnosed in 62.2% of patients. MACE incidence in patients with or without MetS was comparable (p=0.737). Among MetS individuals, patients in the high WMR group had more MACE than the low WMR group (11.2% vs. 26.5%, p=0.007). However, MACE was comparable among non-MetS individuals (p=0.681). In multivariable Cox regression analysis, hazard ratios (HR) of MACE incidence for high-WMR in MetS individuals was 2.616 (95% confidence interval: 1.282-5.339, p=0.008). However, HR of MACE incidence for high WMR in non-MetS individuals was not significant. Conclusion: Among NSTE-ACS patients without revascularization therapy, elevated admission WMR was associated with an increased risk of developing composite MACE in MetS individuals but not in non-MetS patients.

Keywords

References

  1. Libby P. Mechanisms of acute coronary syndromes and their implications for therapy. N Engl J Med 2013;368:2004-13. https://doi.org/10.1056/NEJMra1216063
  2. Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003;107:499-511. https://doi.org/10.1161/01.CIR.0000052939.59093.45
  3. Margolis KL, Manson JE, Greenland P, et al. Leukocyte count as a predictor of cardiovascular events and mortality in postmenopausal women: the Women's Health Initiative Observational Study. Arch Intern Med 2005;165:500-8. https://doi.org/10.1001/archinte.165.5.500
  4. Dehghani MR, Rezaei Y, Taghipour-Sani L. Superiority of total white blood cell count over other leukocyte differentials for predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome. Biomarkers 2014;19:378-84. https://doi.org/10.3109/1354750X.2014.915429
  5. Davi G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med 2007;357:2482-94. https://doi.org/10.1056/NEJMra071014
  6. Rechcinski T, Jasinska A, Forys J, et al. Prognostic value of platelet indices after acute myocardial infarction treated with primary percutaneous coronary intervention. Cardiol J 2013;20:491-8. https://doi.org/10.5603/CJ.2013.0134
  7. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539-53. https://doi.org/10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S
  8. Mottillo S, Filion KB, Genest J, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol 2010;56:1113-32. https://doi.org/10.1016/j.jacc.2010.05.034
  9. Rutter MK, Meigs JB, Sullivan LM, D'Agostino RB Sr, Wilson PW. C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study. Circulation 2004;110:380-5. https://doi.org/10.1161/01.CIR.0000136581.59584.0E
  10. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high Blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143-421.
  11. Dehghani MR, Rezaei Y, Taghipour-Sani L. White blood cell count to mean platelet volume ratio as a novel non-invasive marker predicting long-term outcomes in patients with non-ST elevation acute coronary syndrome. Cardiol J 2015.
  12. Wilson PW, D'Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 2005;112:3066-72. https://doi.org/10.1161/CIRCULATIONAHA.105.539528
  13. Suslova TE, Sitozhevskii AV, Ogurkova ON, et al. Platelet hemostasis in patients with metabolic syndrome and type 2 diabetes mellitus: cGMP- and NO-dependent mechanisms in the insulin-mediated platelet aggregation. Front Physiol 2015;5:501.
  14. Alessi MC, Juhan-Vague I. Metabolic syndrome, haemostasis and thrombosis. Thromb Haemost 2008;99:995-1000. https://doi.org/10.1160/TH07-11-0682
  15. Dohi T, Miyauchi K, Kasai T, et al. Impact of metabolic syndrome on 10-year clinical outcomes among patients with acute coronary syndrome. Circ J 2009;73:1454-8. https://doi.org/10.1253/circj.CJ-08-1122
  16. Kajimoto K, Kasai T, Miyauchi K, et al. Metabolic syndrome predicts 10-year mortality in non-diabetic patients following coronary artery bypass surgery. Circ J 2008;72:1481-6. https://doi.org/10.1253/circj.CJ-07-0928
  17. Mehta RH, Westerhout CM, Zheng Y, et al. Association of metabolic syndrome and its individual components with outcomes among patients with high-risk non-ST-segment elevation acute coronary syndromes. Am Heart J 2014;168:182-8.e1. https://doi.org/10.1016/j.ahj.2014.04.009
  18. Gharipour M, Ramezani MA, Sadeghi M, et al. Sex based levels of C-reactive protein and white blood cell count in subjects with metabolic syndrome: Isfahan Healthy Heart Program. J Res Med Sci 2013;18:467-72.
  19. Jesri A, Okonofua EC, Egan BM. Platelet and white blood cell counts are elevated in patients with the metabolic syndrome. J Clin Hypertens (Greenwich) 2005;7:705-11; quiz 712-3. https://doi.org/10.1111/j.1524-6175.2005.04809.x
  20. Liu H, Hsu CH, Lin JD, et al. Predicting metabolic syndrome by using hematogram models in elderly women. Platelets 2014;25:97-101. https://doi.org/10.3109/09537104.2013.780017
  21. Kutlucan A, Bulur S, Kr S, et al. The relationship between mean platelet volume with metabolic syndrome in obese individuals. Blood Coagul Fibrinolysis 2012;23:388-90. https://doi.org/10.1097/MBC.0b013e328352e8fa
  22. Chen YL, Hung YJ, He CT, et al. Platelet count can predict metabolic syndrome in older women. Platelets 2015;26:31-7. https://doi.org/10.3109/09537104.2014.880415
  23. Park BJ, Shim JY, Lee HR, Jung DH, Lee JH, Lee YJ. The relationship of platelet count, mean platelet volume with metabolic syndrome according to the criteria of the American Association of Clinical Endocrinologists: a focus on gender differences. Platelets 2012;23:45-50. https://doi.org/10.3109/09537104.2011.589014
  24. Zaccardi F, Rocca B, Pitocco D, Tanese L, Rizzi A, Ghirlanda G. Platelet mean volume, distribution width, and count in type 2 diabetes, impaired fasting glucose, and metabolic syndrome: a meta-analysis. Diabetes Metab Res Rev 2015;31:402-10. https://doi.org/10.1002/dmrr.2625
  25. Tavil Y, Sen N, Yazici HU, Hizal F, Abaci A, Cengel A. Mean platelet volume in patients with metabolic syndrome and its relationship with coronary artery disease. Thromb Res 2007;120:245-50. https://doi.org/10.1016/j.thromres.2006.10.005
  26. Chu SG, Becker RC, Berger PB, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost 2010;8:148-56. https://doi.org/10.1111/j.1538-7836.2009.03584.x
  27. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des 2011;17:47-58. https://doi.org/10.2174/138161211795049804
  28. Rinder HM, Bonan JL, Rinder CS, Ault KA, Smith BR. Activated and unactivated platelet adhesion to monocytes and neutrophils. Blood 1991;78:1760-9.

Cited by

  1. Relationship between mean platelet volume and metabolic syndrome in Chinese patients vol.8, pp.None, 2016, https://doi.org/10.1038/s41598-018-32751-1
  2. Usefulness of WBC Count to Mean Platelet Volume Ratio in Predicting Short-Term (30 Days) Major Adverse Cardiac Events in Patients Presenting with Acute Coronary Syndrome and its Comparison in Males an vol.6, pp.2, 2016, https://doi.org/10.1055/s-0041-1732513