Relationship between White Blood Cell Count and Framingham Risk Score in Asymptomatic Men

Background: There is an independent association between white blood cell (WBC) and coronary heart disease (CHD) risk. However, the relationship between WBC and Framingham Risk Score (FRS) remains unclear. Methods: This is a cross-sectional study on a consecutive sample of 520 white asymptomatic men (mean age 46 ± 7 years) without CHD. The study population was divided into WBC quartiles (×10⁹ cells/L): 1^st quartile: 3.1-5.3 (n = 139), 2^nd quartile: 5.4-6.1 (n = 129), 3^rd quartile: 6.2-7.1 (n = 131), 4^th quartile: ≥7.2 (n = 121), and into tertiles according to the 10-year FRS: 1^st tertile (low risk <5%, n = 180, 35%), 2^nd tertile (intermediate risk 5-12%, n = 210, 40%), 3^rd tertile (high risk: ≥13%, n = 130, 25%). Results: WBC correlated only weakly with FRS (r = 0.18, p = 0.001). Among individual components of FRS, WBC correlated minimally with smoking (r = 0.12, p = 0.003), systolic blood pressure (r = 0.07, p = 0.1), and high-density lipoprotein cholesterol (r = -0.06, p = 0.1). However, no correlation was observed with age (p = 0.3) and total cholesterol (p = 0.5). Nearly one third (31%) of men in the low-risk (FRS <5%) had WBC count in the 1^st quartile compared to 20% of those classified as high risk (FRS ≥13%). The prevalence of WBC in the 4^th quartile increased across FRS tertiles (18, 22, 32%) (p = 0.09). Conclusions: WBC correlates weakly with FRS or its individual components. Since WBC count is strongly related to CHD, WBC may reflect different components of cardiovascular risk, which might not be captured by traditional cardiovascular risk factors used in calculating FRS. Inflammatory biomarkers afford adjunctive value to FRS and may be used to improve CHD risk stratification.