title: Association of neutrophils and future cardiovascular events in patients with peripheral artery disease.
abstract: OBJECTIVE
  We hypothesized that higher neutrophil counts are associated with an increased incidence of major adverse cardiovascular events (MACE) in patients with clinically advanced atherosclerosis.
  
  
  METHODS
  We prospectively studied 398 patients (233 men; median age, 69 years) with symptomatic peripheral artery disease who were admitted to the inpatient ward of the angiology department of a tertiary care university hospital in a cohort study. Total and differential white blood cell (WBC) counts were obtained, and patients were followed for MACE, defined as myocardial infarction, percutaneous coronary interventions, coronary artery bypass grafting, stroke, carotid revascularization, and death.
  
  
  RESULTS
  During a median follow-up of 20 months, 140 MACE occurred in 105 patients (26%). Multivariate Cox proportional hazards analysis was used to assess the association of differential WBC count parameters (in tertiles) with MACE and their interrelation with traditional cardiovascular risk factors and other parameters of inflammation. Patients with neutrophil counts >5.8 G/L (upper tertile) exhibited an increased adjusted risk for all MACE (hazards ratio [HR], 1.83; P = .017), death (HR, 3.39; P = .010), and the composite of myocardial infarction, stroke, and death (HR, 2.20; P = . 012) compared with patients in the lower tertile (<4.4 G/L), independently of traditional cardiovascular risk factors and levels of high-sensitivity C-reactive protein. Only neutrophils, but not eosinophils, basophils, monocytes, lymphocytes, or the total WBC count showed a significant association with cardiovascular outcome.
  
  
  CONCLUSIONS
  In patients with peripheral artery disease, neutrophil counts in the upper tertile (>5.8 G/L) indicate a substantially increased risk for major adverse cardiovascular events, adding to the prognostic information of traditional atherothrombotic risk factors and other parameters of inflammation.
authors.affiliation: Department of Angiology, Vienna General Hospital, Medical School, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Haumer
authors.forename: Jasmin
authors.initials: J
authors.lastname: Amighi
authors.forename: Markus
authors.initials: M
authors.lastname: Exner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Mlekusch
authors.forename: Schila
authors.initials: S
authors.lastname: Sabeti
authors.forename: Oliver
authors.initials: O
authors.lastname: Schlager
authors.forename: Ilse
authors.initials: I
authors.lastname: Schwarzinger
authors.forename: Oswald
authors.initials: O
authors.lastname: Wagner
authors.forename: Erich
authors.initials: E
authors.lastname: Minar
authors.forename: Martin
authors.initials: M
authors.lastname: Schillinger
mesh_terms: D000368:Aged; D002548:Cerebral Revascularization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D009204:Myocardial Revascularization; D009504:Neutrophils; D016491:Peripheral Vascular Diseases / Q000097:blood* / Q000150:complications / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology*