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(Stroke. 2007;38:2900.)
© 2007 American Heart Association, Inc.

Original Contributions

Association of Leukocyte Count With Progression of Aortic Atheroma in Stroke/Transient Ischemic Attack Patients

Souvik Sen, MD, MS; Alan Hinderliter, MD; Pranab K. Sen, PhD; Jennifer Simmons, BSW; Vicky A. LeGrys, DrA; James Beck, PhD; Steven Offenbacher, DDS, PhD, MMSc; Kevin Moss Stephen M. Oppenheimer, MD, PhD

From the UNC Stroke Program, Departments of Neurology (S.S., J.S.), Cardiology (A.H.), Biostatistics (P.K.S.), Clinical Laboratory Science (V.A.L.), Dental Ecology (J.B., K.M.), and Periodontology (S.O.), University of North Carolina, Chapel Hill; and Sentient Medical Systems (S.M.O.), Cockeysville, Md.

Correspondence to Dr Souvik Sen, MD, MS, Director of UNC Stroke Program, Department of Neurology, 7001C Neuroscience Hospital, CB# 7025, Chapel Hill, NC 27599-7025. E-mail SenS{at}neurology.unc.edu

Background and Purpose— Leukocyte count is an independent predictor of stroke. We investigated the association between leukocyte count and progression of aortic atheroma over 12 months in stroke/transient ischemic attack (TIA) patients.

Methods— Consecutive ischemic stroke and transient ischemic attack patients underwent 12-month sequential transesophageal echocardiography and were assessed for total and differential leukocyte counts on admission. Paired aortic plaque images were assessed for several parameters, including changes in grade, intimal-medial thickness (IMT), and cross-sectional area. Multivariate linear and logistic regressions were used to calculate the effect of leukocyte count on the change in aortic atheromas over 12 months.

Results— Of the 115 participants (mean±SD age, 64.6±11.9 years; 53.1% men; 73.4% white, 24.2% black, and 2.3% Asian), 45 (35%) showed clinically significant progression of aortic atheromas (maximal change in IMT >0.70 mm over 12 months). The mean admission leukocyte count was higher in the progression group compared with the no-progression group (8.6±2.2 vs 7.3±2.2x10⁹/L respectively, P=0.002). Each unit increase in leukocyte count was associated with a 0.26-mm increase in aortic arch IMT over 12 months (P=0.006). After adjustment for other atherosclerosis risk factors, the relation persisted (mean increase in aortic arch IMT per unit increase in leukocyte count=0.27 mm, P=0.007). Each unit increase in leukocyte count was associated with an increased risk of significant progression of aortic atheromas (adjusted odds ratio=1.33; 95% CI, 1.09 to 1.61).

Conclusions— In stroke/transient ischemic attack patients, leukocyte count is independently associated with the progression of aortic atheroma over 12 months (>0.70 mm), which is associated with cardiovascular risk.

Key Words: aorta • atherosclerosis • inflammation • leukocytes • transesophageal echocardiography