Elevated White Blood Cell Count (WBC) Linked With Cardiovascular Disease

A growing body of evidence suggests that low grade inflammation contributes to the development of cardiovascular disease and, specifically, coronary artery disease (CAD). WBC-derived macrophages and other phagocytes are believed to contribute to vascular injury and atherosclerotic progression. Multiple markers of inflammation have been tested as potential risk factors for the development of CAD such as IL-6, E-selectin and CRP.

Elevated white blood cell count (WBC) that is well within the normal range was associated with an increased risk for developing CAD in multiple studies. 

A large-scale study demonstrated that a single measurement of WBC in healthy young men may predict CAD incidence independently from other risk factors for CAD such as elevated lipids, and a positive family history. WBC level above 6,900 cells/mm3 was associated with a 2-fold increase in the risk for CAD with a significant 17.4% increase in CAD incidence observed for every increment of 1,000 WBC/mm3: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0047183

An elevated WBC count may enhance atherogenesis. Granulocytes and monocytes are believed to be involved in the pathogenesis of atherosclerosis. Monocyte-derived macrophages produce oxidants that can induce endothelial cell injury and subsequent thrombus formation. Activated WBCs also reflect the inflammatory activity of atherosclerosis that perpetuates vascular injury and tissue ischemia.

WBC count is associated with several cardiovascular disease risk factors:

- positive associations with body weight, systolic blood pressure, cigarette smoking, fasting glucose level, and fasting insulin level

- negative associations with high density lipoprotein cholesterol level, family income, alcohol consumption, and physical activity or physical fitness

High-normal WBC count is an independent and reliable risk factor for CAD.

The joint effect of WBC count, a readily available measurement, with other known risk factors for CAD may help to better identify people at either high or low cardiovascular risk.

References:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0047183

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533311/

https://academic.oup.com/aje/article/154/8/758/131409

Latest in lipidology: is lipoprotein(a), Lp(a), "the most dangerous particle you’ve never heard of"?

Dr Attia's podcast on Lp(a), the link is here: https://peterattiamd.com/tomdayspring6/

Discussed:

- ApoB as a preferred metric over LDL-P [16:30]; Atherogenic lipoproteins (apoB/LDL-P) as front and center in pathogenesis of CVD. ApoB and LDL-P are used interchangeably, but this is not quite accurate.

- Therapeutic goals for apoB concentration [21:45]

- Lipoprotein(a)—the most dangerous particle you’ve never heard of [55:00];
preferred lab measurements [1:17:45]; 

Lipoprotein(a), or Lp(a), is a distinctive particle with 2 components: 

 - a lipoprotein core that resembles LDL
-  a shell that contains apolipoprotein(a), or apo(a)

Lp(a) is dubbed one of the final frontiers in lipid management. Elevated blood Lp(a) levels are primarily due to genetic variations in the LPA gene that encodes for apo(a) and cannot be lowered by diet, exercise or current lipid-lowering therapies. 

“By combining the atherosclerotic effects of LDL with the prothrombotic effects of apo(a), elevated Lp(a) essentially delivers a double whammy of noxious atherothrombotic effects", as per Dr Nissen. 

Normal Lp(a) levels are less than 25 mg/dL, with significant risk of atherothrombotic events beginning at levels 50-70 mg/dL and rising thereafter. And that risk is not at all rare: 64 million U.S. residents have an Lp(a) level of 60 mg/dL or higher. Over 3 million have levels of 180 mg/dL or more, which confer extremely high risks. There are no effective Lp(a)-lowering pharmacotherapies to date. That includes statins, which actually can slightly raise Lp(a) levels.

It is estimated that about one in five people in the U.S. has an Lp(a) level that puts them at risk. And, even people with a healthy level of LDL cholesterol could have a high Lp(a) level. So many people are walking around with abnormally high Lp(a) but don’t know it. Lp(a) could be a factor in the rise in heart attacks in younger, seemingly healthy adults who do not have high LDL cholesterol. The other tricky thing is that your Lp(a) level is in large part genetically wired, so things like diet and exercise won’t really change it. There are currently no FDA-approved drugs to lower it, either. Focus on strategies for lowering that risk focus on addressing other risk factors, such as high LDL cholesterol, BMI and blood pressure.

Here is Dr Nissen and Dr Cho from Cleveland Clinic on Lp(a). They discussed rosuvastatin 5 mg once a week. Dr Nissen mentioned that rosuvastatin at 1 mg per day reduced LDL by 33%. Rosuvastatin has a very long half life of 19 hours vs 14 hours for atorvastatin. Rosuvastatin is hydrophilic vs atorvastatin which is lipophilic.

 

 

References:

https://health.clevelandclinic.org/why-would-my-doctor-order-a-lipoproteina-blood-test/

https://consultqd.clevelandclinic.org/elevated-lipoproteina-is-a-long-sought-treatment-finally-on-the-way/

Mayo Clinic Lp(a) review and some nice diagrams and algorithm flow charts: https://www.mayoclinicproceedings.org/article/S0025-6196(13)00795-7/pdf

"At the end of our lives, we all become philosophers"

"At the end of our lives, we all become philosophers" is a quote from the podcast episode "Life Lessons From Dead Philosophers" by AoM:

https://www.artofmanliness.com/articles/podcast-643-life-lessons-from-dead-philosophers/

The Greek word “philosophy” (philosophia) is a compound word, composed of two parts: 'Philos' (love) and 'Sophia' (wisdom), "love of wisdom". 

Eric Weiner traveled thousands of miles around the world to visit the haunts of philosophers as he sought to better understand their insights and how he might apply them to his own life. He wrote about this philosophic pilgrimage in The Socrates Express: In Search of Life Lessons From Dead Philosophers

Google Podcasts link

"Bacon is a Killer": 1 daily serving of processed meat, such as bacon, increases risk of colorectal cancer by 18% - Physicians Committee PSA

According to the World Health Organization, eating even one serving of processed meat, including bacon, daily increases the risk of colorectal cancer by 18 percent. This public health awareness campaign
is sponsored by The Physicians Committee—a nonprofit of 12,000 doctors.

https://www.youtube.com/watch?v=eZ1Va4NaU5E

The most practical/cost effective point of care ultrasound (POCUS) device as of 2020: Butterfly iQ

From CNN:

"Handheld devices also cost much less than traditional ultrasound machines. The ones sold by Butterfly, GE and Philips range in price from around $2,000 to $5,000, whereas traditional devices can cost tens or even hundreds of thousands of dollars.

The Butterfly iQ is currently equipped for 19 different types of scans and tests. A "major" limitation is the inability to perform the spectral Doppler test used to identify some more acute heart conditions."



The Butterfly iQ costs $2,000. There is a first-year fee of $400:

https://store.butterflynetwork.com/us/en/iq/configure/

References:

https://www.cnn.com/2020/07/08/tech/ultrasound-machine-handheld-coronavirus/index.html