Association of leukocyte count with atherosclerotic cardiovascular disease in patients with genetically defined familial hypercholesterolaemia

Background and aims: Familial hypercholesterolaemia (FH) is characterized by elevated low-density lipoprotein-cholesterol and increased risk of atherosclerotic cardiovascular disease (ASCVD). Systemic inflammation has been recognized as a contributor to ASCVD. However, its role in patients with heterozygous FH (HeFH) remains unclear. This study examined the association between systemic inflammatory markers and ASCVD risk in HeFH patients. Methods and results: A cross-sectional study of 538 patients with genetically confirmed HeFH were studied. Logistic regression was employed to assess the association between white blood cell count (WBCC), neutrophil count (NC) and monocyte count (MC) and prevalent ASCVD. HeFH patients with ASCVD had higher levels of WBCC, NC and MC than those without ASCVD. A 1-standard deviation increase in WBCC (odds ratio 1.65 [95 % CI: 1.29-2.12]), NC (1.64 [1.29-2.10]) and MC (1.56 [1.21-2.02]) were independently associated with higher ASCVD risk. The upper and middle tertiles of WBCC, NC and MC had a two- to three-fold increased risk of ASCVD compared with those in the bottom tertile. Conclusions: Higher levels of WBCC, NC and MC are significantly associated with an increased prevalence of ASCVD in patients with HeFH. Targeting inflammation may be a valuable strategy for managing the development and progression of ASCVD in FH.