Leukocyte count is an independent predictor for risk of acute myocardial infarction in middle-aged Japanese men



      Leukocyte count is recognized as an inflammatory marker and a predictor of cardiovascular events. However, it is uncertain whether the contribution of leukocyte count to the risk of cardiovascular disease is independent of smoking.


      The subjects were 4492 male employees aged 40–59 years who worked for nine companies in Osaka.


      After 9-year follow-up, 40 acute myocardial infarction and 26 ischemic stroke events occurred. Age-adjusted relative risk of acute myocardial infarction in the highest versus lowest quartiles of leukocyte count was 6.0 (95% CI, 1.8–20.5, P for trend <0.001) and the multivariable relative risk adjusted for smoking and other conventional cardiovascular risk factors was 3.7 (1.0–13.4, P for trend = 0.01). The association between leukocyte count and the risk of acute myocardial infarction was also observed among both current smokers and nonsmokers. The positive association between leukocyte count and the risk of ischemic stroke was weak and did not reach statistical significance.


      Leukocyte count is a predictor of acute myocardial infarction among Japanese middle-aged men, both in smokers and nonsmokers.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Danesh J.
        • Collins R.
        • Appleby P.
        • Peto R.
        Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies.
        JAMA. 1998; 279: 1477-1482
        • Lee C.D.
        • Folsom A.R.
        • Nieto F.J.
        • et al.
        White blood cell count and incidence of coronary heart disease and ischemic stroke and mortality from cardiovascular disease in African-American and White men and women: atherosclerosis risk in communities study.
        Am J Epidemiol. 2001; 154: 758-764
        • Margolis K.L.
        • Manson J.E.
        • 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: 500-508
        • Prentice R.L.
        • Szatrowski T.P.
        • Kato H.
        • Mason M.W.
        Leukocyte counts and cerebrovascular disease.
        J Chronic Dis. 1982; 35: 703-714
        • Gillum R.F.
        • Ingram D.D.
        • Makuc D.M.
        White blood cell count and stroke incidence and death. The NHANES I epidemiologic follow-up study.
        Am J Epidemiol. 1994; 139: 894-902
        • Zalokar J.B.
        Leukocyte count, smoking, and myocardial infarction.
        N Engl J Med. 1981; 304: 465-468
        • Kannel W.B.
        • Anderson K.
        • Wilson P.W.
        White blood cell count and cardiovascular disease. Insights from the Framingham Study.
        JAMA. 1992; 267: 1253-1256
        • Phillips A.N.
        • Neaton J.D.
        • Cook D.G.
        • Grimm R.H.
        • Shaper A.G.
        Leukocyte count and risk of major coronary heart disease events.
        Am J Epidemiol. 1992; 136: 59-70
        • Weijenberg M.P.
        • Feskens E.J.
        • Kromhout D.
        White blood cell count and the risk of coronary heart disease and all-cause mortality in elderly men.
        Arterioscler Thromb Vasc Biol. 1996; 16: 499-503
        • Kitamura A.
        • Iso H.
        • Naito Y.
        • et al.
        High-density lipoprotein cholesterol and premature coronary heart disease in urban Japanese men.
        Circulation. 1994; 89: 2533-2539
        • Kitamura A.
        • Iso H.
        • Iida M.
        • et al.
        Trends in the incidence of coronary heart disease and stroke and the prevalence of cardiovascular risk factors among Japanese men from 1963 to 1994.
        Am J Med. 2002; 112: 104-109
        • Iso H.
        • Imano H.
        • Kitamura A.
        • et al.
        Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women.
        Diabetologia. 2004; 47: 2137-2144
        • Usui S.
        • Nakamura M.
        • Jitsukata K.
        • et al.
        Assessment of between-instrument variations in a HPLC method for serum lipoproteins and its traceability to reference methods for total cholesterol and HDL-cholesterol.
        Clin Chem. 2000; 46: 63-72
        • Shimamoto T.
        • Komachi Y.
        • Inada H.
        • et al.
        Trends for coronary heart disease and stroke and their risk factors in Japan.
        Circulation. 1989; 79: 503-515
      1. WHO Expert Committee. Arterial hypertension and ischemic heart disease, prevention aspects. WHO Technical Report Series No. 231. Geneva, Switzerland: World Health Organization; 1962.

        • Iso H.
        • Rexrode K.
        • Hennekens C.H.
        • et al.
        Application of computer tomography-oriented criteria for stroke subtype classification in a prospective study.
        Ann Epidemiol. 2000; 10: 81-87
        • Prentice R.L.
        • Szatrowski T.P.
        • Fujikura T.
        • et al.
        Leukocyte counts and coronary heart disease in a Japanese cohort.
        Am J Epidemiol. 1982; 116: 496-509
        • Manttari M.
        • Manninen V.
        • Koskinen P.
        • et al.
        Leukocytes as a coronary risk factor in a dyslipidemic male population.
        Am Heart J. 1992; 123: 873-877
        • Pearson T.A.
        • Mensah G.A.
        • Alexander R.W.
        • 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
        • Fuster V.
        • Lewis A.
        Conner Memorial Lecture. Mechanisms leading to myocardial infarction: insights from studies of vascular biology.
        Circulation. 1994; 90: 2126-2146
        • Libby P.
        Inflammation in atherosclerosis.
        Nature. 2002; 420: 868-874
        • Dinerman J.L.
        • Mehta J.L.
        Endothelial, platelet and leukocyte interactions in ischemic heart disease: insights into potential mechanisms and their clinical relevance.
        J Am Coll Cardiol. 1990; 16: 207-222
        • Ross R.
        Atherosclerosis—an inflammatory disease.
        N Engl J Med. 1999; 340: 115-126
        • Horne B.D.
        • Anderson J.L.
        • John J.M.
        • et al.
        Which white blood cell subtypes predict increased cardiovascular risk?.
        J Am Coll Cardiol. 2005; 45: 1638-1643
        • Kervinen H.
        • Palosuo T.
        • Manninen V.
        • et al.
        Joint effects of C-reactive protein and other risk factors on acute coronary events.
        Am Heart J. 2001; 141: 580-585