1. VBWG Predictor of CV Events and Mortality in Postmenopausal Women: Leukocyte Count

2. VBWG Background and objective Margolis KL et al. Arch Intern Med. 2005;165:500-8. Background:Increasing evidence supports a role for inflammation in the atherosclerotic process Objective:Describe relationship between baseline leukocyte (WBC) count, future CVD events, and mortality in postmenopausal women Source:Women’s Health Initiative Observational Study

3. VBWG WHI-OS: Women’s Health Initiative Observational Study Prospective cohort study in 40 US clinical centers 72,242 postmenopausal women age 50–79 yrs, free of CVD and cancer at baseline Main outcome measures: fatal CHD, nonfatal MI, stroke, total mortality Margolis KL et al. Arch Intern Med. 2005;165:500-8.

4. VBWG Patients Characteristic (N = 72,242) Age (yr)63.1 White (%)83.5 Diabetes (%)4.5 Hypertension (%)34.6 Elevated cholesterol (%)12.8 Current smoker (%)6.1 BMI (kg/m 2 )27.1 WHI-OS: Baseline characteristics Margolis KL et al. Arch Intern Med. 2005;165:500-8.

5. VBWG WHI-OS: CHD risk according to WBC count quartile P trend = 0.01 Adjusted for all risk factors, including CRP Quartile of WBC count (  10 3 cells/mm 3 ) Q1 2.6–4.9 1.00 OR 2.5 2.0 1.5 1.0 0.5 0 Q2 5.0–5.9 0.83 Q3 6.0–7.2 0.99 Q4 7.3–13.35 2.32 P = 0.02 Margolis KL et al. Arch Intern Med. 2005;165:500-8.

6. VBWG WHI-OS: CHD risk according to CRP quartile Quartile of CRP level (mg/dL) Q1 0.02–0.12 1.00 OR 2.5 2.0 1.5 1.0 0.5 0 Q2 0.13–0.27 0.94 Q3 0.28–0.59 1.16 Q4 0.60–4.26 1.95 P = 0.07 P trend = 0.02 Adjusted for all risk factors, including WBC count Margolis KL et al. Arch Intern Med. 2005;165:500-8.

7. VBWG *P < 0.001 Bivariate logistic regression model based on joint WBC count  CRP relationship, adjusted for TC/HDL-C ratio WHI-OS: CHD risk in highest WBC count quartile, according to CRP level Quartile of CRP level (mg/dL) Q1 0.02–0.12 2.83 OR 7.0 4.0 3.0 2.0 1.0 0 Q2 0.13–0.27 2.70 Q3 0.28–0.59 3.10 Q4 0.60–4.26 6.80* 5.0 6.0 Margolis KL et al. Arch Intern Med. 2005;165:500-8.

8. VBWG Clinical implications WBC count >6.7  10 3 cells/mm 3 may identify women at high CVD risk who are not currently identified by traditional CVD risk factors WBC count offers stable, well-standardized, widely available, and inexpensive measure of systemic inflammation Findings add to evidence in men that suggests a similar link; suggest WBC count is predictive independent of CRP Margolis KL et al. Arch Intern Med. 2005;165:500-8.