MedicalResearch.com Interview with:
Dr. Karl T. Kelsey, MD, MOH
Professor of Epidemiology and Pathology and Laboratory Medicine
Fellow, Collegium Ramazzini
Providence, R.I. 02912
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is a large literature suggesting that the ratio of neutrophils to lymphocytes (the neutrophil to lymphocyte ratio or NLR) in the peripheral blood at the time of diagnosis is robustly predictive of outcome in acute cardiovascular disease.
We were curious to know if the peripheral blood profile and this ratio was a feature of the disease process, since, to our knowledge, this had not been investigated in a prospective study. Hence, we used the resources of 2 prospective studies to assess this question, the Jackson Heart Study and the Normative Aging Study. In both cases, the NLR predicted all cause mortality and, in the Jackson Heart Study, where we had well adjudicated outcomes, the NLR predicted various specific cardiovascular outcomes as well. Interestingly, the outcome was also modified by a well known genetic polymorphism of African origin that results in a relative neutropenia.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: We believe this is strong support for specific types of inflammation being causally related to the cardiovascular disease process. That is, while monocytes have long been known to be central to the process of atherosclerosis, our data supports involvement of additional immune subtypes and additional immune processes.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We need to pick apart the nature of this ratio in order to understand the immune cell subtypes that contribute to this process. It has been suggested that the NLR rises as a result of the generation of myeloid-derived suppressor cells (which also suppress the lymphocyte response). This needs to be tested directly and we hope to develop tools to do this in population studies. It is also possible that intervention directed to alter the immune profile could be an effective preventive step.
Disclosures: Currently, I am involved in efforts directed at founding a company, Celintec, to pursue the technology to assess immune cell profiles in archived blood.
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Kim S, Eliot M, Koestler DC, Wu W, Kelsey KT. Association of Neutrophil-to-Lymphocyte Ratio With Mortality and Cardiovascular Disease in the Jackson Heart Study and Modification by the Duffy Antigen Variant. JAMA Cardiol. Published online May 02, 2018. doi:10.1001/jamacardio.2018.1042
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