title: Do circulating blood cell types correlate with modifiable risk factors and outcomes in patients with acute coronary syndrome (ACS)?
abstract: OBJECTIVE
  Atherosclerosis is an inflammatory process with different cardiovascular risk factors (CVRFs) contributing to its pathogenesis. We aimed to evaluate the specific relationship between circulating blood leukocytes, troponin I and CVRFs.
  
  
  METHODS
  We prospectively enrolled 959 patients with evidence of acute coronary syndrome either in form of unstable angina or STEMI or NSTEMI. Details demographic characteristics, CVRF and biochemical parameters such as total white blood cells (WBC), neutrophil, lymphocytes, platelet, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and troponin I were collected.
  
  
  RESULTS
  The results indicated that patients having either hypertension, diabetes or smoking habit had significantly higher levels of total WBC (p=0.013), neutrophil (p=0.029), NLR (p=0.029) and PLR (p=0.009). The level of troponin I was unaffected by these risk factors. Significant association of hypertension was found with total WBC (p=0.0392), lymphocytes (p=0.0384) and PLR (p=0.0027), whereas in diabetes and females all other leukocyte subtypes were significantly altered except for platelet and troponin I. Smokers had higher level of total WBC count (p=0.0033) and PLR (p=0.0464). No relationship between CVRFs and leukocytes was observed in males. The age independent effect was observed with PLR, whereas association with total WBC, lymphocytes, NLR, platelet was specific in older population. In younger patients NLR (p=0.0453) is more likely to be elevated. Mortality was significantly associated with changes in the leukocytes but not with the CVRF presence.
  
  
  CONCLUSIONS
  We demonstrate that the neutrophils, lymphocytes and total WBC along with its ratios predict mortality and are more likely to be elevated in presence of CVRFs.
authors.affiliation: Associate Professor, Cardiology Department, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Asarwa, Ahmedabad 380016, India. Electronic address: kamalsharma1975@gmail.com.
authors.forename: Kamal H
authors.initials: KH
authors.lastname: Sharma
authors.affiliation: Research Officer, Research Department, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Asarwa, Ahmedabad 380016, India.
authors.forename: Komal H
authors.initials: KH
authors.lastname: Shah
authors.affiliation: Research Fellow, Research Department, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Asarwa, Ahmedabad 380016, India.
authors.forename: Iva
authors.initials: I
authors.lastname: Patel
authors.affiliation: DM Resident, Cardiology Department, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Asarwa, Ahmedabad 380016, India.
authors.forename: Alap K
authors.initials: AK
authors.lastname: Patel
authors.affiliation: Research Fellow, Research Department, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Asarwa, Ahmedabad 380016, India.
authors.forename: Subhash
authors.initials: S
authors.lastname: Chaudhari
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D001772:Blood Cell Count; D001773:Blood Cells / Q000166:cytology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I
keywords: Cardiovascular risk factors; Diabetes; Hypertension; Leukocyte subtypes; Smoking