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From the Departments of Neurology (Drs. Elkind, Rundek, and Sacco) and Medicine (Dr. Sciacca), Columbia University College of Physicians and Surgeons, and Gertrude H. Sergievsky Center (Drs. Elkind, Boden-Albala, and Sacco) and Divisions of Sociomedical Sciences (Dr. Boden-Albala), Epidemiology (Dr. Sacco), and Biostatistics (Dr. Paik), Joseph Mailman School of Public Health, New York, NY.
Address correspondence and reprint requests to DrV. Elkind, Neurologic Institute, Box 182, 710 W. 168 St., New York, NY, 10032; e-mail: mse13{at}columbia.edu
Background: Atherosclerosis is an inflammatory disease, and leukocyte levels are associated with future risk of ischemic cardiac disease.
Objective: To investigate the hypothesis that relative elevations in leukocyte count in a stroke-free population predict future ischemic stroke (IS).
Methods: A population-based prospective cohort study was performed in a multiethnic urban population. Stroke-free community participants were identified by random-digit dialing. Leukocyte levels were measured at enrollment, and participants were followed annually for IS, myocardial infarction (MI), and cause-specific mortality. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% CIs for IS, MI, and vascular death after adjustment for medical, behavioral, and socioeconomic factors.
Results: Among 3,103 stroke-free community participants (mean age 69.2 ± 10.3 years) with baseline leukocyte levels measured, median follow-up was 5.2 years. After adjusting for stroke risk factors, each SD in leukocyte count (1.8 x 109 cells/L) was associated with an increased risk of IS (HR 1.22, 95% CI 1.05 to 1.42), and IS, MI, or vascular death (HR 1.13, 95% CI 1.02 to 1.26). Compared with those in the lowest quartile of leukocyte count, those in the highest had an increased risk of IS (adjusted HR 1.75, 95% CI 1.08 to 2.82). The effect on atherosclerotic and cardioembolic stroke was greater than in other stroke subtypes.
Conclusion: Relative elevations in leukocyte count are independently associated with an increased risk of future ischemic stroke and other cardiovascular events.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the June 28 issue to find the title link for this article.
Supported by the Kathleen Scott Research Fellowship of the American Heart Association (AHA 0355596T [M.S.V.E.]), grants from the National Institute of Neurologic Disorders and Stroke (R01 NS 29993 [R.L.S.], K23 42912 [M.S.V.E.], R01 NS 48134 [M.S.V.E.]), and the General Clinical Research Center (2 M01 RR00645).
Received December 8, 2004. Accepted in final form March 14, 2005.
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