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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:1966.)
© 2005 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Relationship of Monocyte Count and Peripheral Arterial Disease

Results From the National Health and Nutrition Examination Survey 1999–2002

Khurram Nasir; Eliseo Guallar; Ana Navas-Acien; Michael H. Criqui; João A.C. Lima

From the Division of Cardiology (K.N., J.A.C.L.), Department of Medicine, Johns Hopkins University, Baltimore, Md; the Department of Epidemiology (E.G., A.N.-A.), Johns Hopkins University Bloomberg School of Public Health and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Md; and the Division of Epidemiology (M.H.C.), Department of Family and Preventive Medicine, and Division of Cardiology, Department of Medicine, UCSD School of Medicine, San Diego, Calif.

Correspondence to João A.C. Lima, MD, Cardiology Division, Blalock, 524, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287-0409. E-mail jlima{at}jhmi.edu

Background— Although white blood cell (WBC) count has been consistently associated with cardiovascular end points, little information is available on the independent contribution of specific white blood cell types. The objective of this study is to assess the independent association of WBC types and other inflammatory markers with the presence of reduced ankle-brachial blood pressure index (ABI), a marker of subclinical peripheral arterial disease (PAD).

Methods & Results— Cross-sectional study in 3949 individuals 40 years of age without known cardiovascular disease who participated in the 1999 to 2002 National Health and Nutrition Examination Survey (NHANES). PAD was defined as an ABI <0.9 in at least 1 leg. After adjustment for traditional cardiovascular risk factors, the odds ratios of PAD comparing the highest to the lowest quartiles were 2.24 (95% confidence interval 1.24 to 4.04) for monocytes, 1.74 (0.87 to 3.45) for neutrophils, 2.53 (1.62 to 3.96) for C-reactive protein, and 2.68 (1.03 to 6.94) for fibrinogen. When WBC types and inflammatory markers were simultaneously included in the full model, the corresponding odds ratios were 1.91 (95% confidence interval 1.06 to 3.42) for monocytes, 1.15 (0.49 to 2.69) for neutrophils, 1.37 (0.75 to 2.49) for C-reactive protein, and 2.21 (0.88 to 5.57) for fibrinogen.

Conclusions— Monocytes were the only WBC type significantly and independently associated with PAD in a representative sample of the U.S. population after adjustment for other inflammatory markers. These findings reflect the potential role of circulating monocyte counts as markers of atherosclerosis.

In this study of 3949 individuals 40 years of age without known cardiovascular disease participating in the 1999 to 2002 National Health and Nutrition Examination Survey, monocytes were the only white blood cell types significantly and independently associated with peripheral arterial disease after adjustment for other inflammatory markers.

Key Words: NHANES • subclinical atherosclerosis • peripheral arterial disease • white blood cells • monocyte count

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