Ahead in the Count

Research has revealed the significant role inflammation plays in the development of atherosclerosis (narrowing of the arteries). In previous e-Alerts I’ve told you about C-reactive protein (CRP), a key marker for inflammation that many mainstream researchers now regard as a far more reliable predictor of atherosclerosis than elevated LDL cholesterol.

But now CRP may have met its match in white blood cells (WBCs).

Getting a clue

WBCs (also known as leukocytes) provide an indispensable clue for determining immune system stress because WBC count rises when the body is fighting infection from bacteria or viruses. Recent research from the National Institutes of Health (NIH) shows that white blood cell count may also provide doctors with an accurate and easy-to-use tool for predicting heart disease.

A team of researchers led by Karen L. Margolis, M.D., examined data collected from the Women’s Health Initiative, an ongoing study from the NIH. More than 72,000 women participated, aged 50 to 79, who had no history of cardiovascular disease (CVD).

After an average of six years of follow up, researchers found that women with the highest WBC counts at the outset of the study were more than twice as likely to die from coronary heart disease compared to women with the lowest WBC counts. Those with the highest counts also had a significantly increased risk of stroke and nonfatal heart attack.

The researchers noted that the highest WBC counts in the study were considered to be only at the upper end of normal, which is not an extremely high count. They also believe the results demonstrate that WBC count may be just as reliable as CRP in predicting cardiovascular events linked to coronary heart disease. A CRP test generally costs about $75; three times the cost of a white blood cell test.

Writing in the Archives of Internal Medicine, Dr. Margolis and her team conclude that an elevated WBC count is a dependable predictor of CVD events in postmenopausal women, even when there are no other indications of CVD.

Egg rolling

Inflammation presents a chicken-or-egg dilemma. Researchers are not yet sure if atherosclerosis triggers inflammation, or if inflammation sets the stage for atherosclerosis. In either case, inflammation presents a problem that won’t be solved with a one-size-fits-all quick fix. But that doesn’t mean drug companies won’t try.

In the e-Alert “Putting the C in CRP” (4/28/04), I told you how drug companies have started positioning some of their products to treat patients with elevated CRP, even though CRP is considered a MARKER, not the CAUSE of inflammation.

According to a report from Internet Broadcasting Systems (IBS), researchers for AstraZeneca (AZ) have begun testing the effects of their cholesterol-lowering statin drug Crestor on CRP. This study is titled JUPITER (Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin). And the title is revealing: “Justification for the use ” It would seem that the desired conclusion of the study is already written. Now if the results will just cooperate and “justify” the use of statins, the study will provide AZ with a useful marketing tool.

In a side note, the IBS report states that, “there are currently no guidelines to treat high CRP levels.” What they’re saying, of course, is that there are currently no drugs that have been approved to treat high CRP levels. This is a typical mainstream reaction: If we can’t treat it with drugs, there’s nothing we can do.

So if further studies confirm the results of the Margolis research, we certainly won’t be surprised to hear that a drug company has launched a study to test statins on elevated WBC count. In fact, I fully expect it.

In the meantime, if either your WBC count or CRP is elevated, talk to your doctor and examine all aspects of your health profile. Somewhere in there – among chronic problems, family history or subtle symptoms – lies the spark that sets off a potentially dangerous flame.