Those who are hesitant to pursue more advanced testing for CVD risk by paying for tests not covered by government-run healthcare, can now get insight into their cardiovascular health in a standard blood test.
The CBC (Complete Blood Count) is routinely done during annual physicals or when you complain of a malady to your GP. Within the results are your white blood-cell count or WBC which among other things lists these two items:
Neutrophils
Lymphocytes
A medical study in 2014 identified the level of Neutrophils as well as the ratio between Neutrophils and Lymphocytes as being a prognostic indicator of elevated CVD risk. You can read the study abstract at the link below:
If your Neutrophil count is above 2.0 xE9/L you may still be in the normal range, however the study notes those with such a reading tend to have an increased risk of developing CVD. Furthermore, the ratio between these two items (NLR) implies elevated CVD risk if it exceeds 1.5. Those with a ratio of 4.5 or greater showed a greater risk of death from CVD.
Out of curiosity, I checked my blood test from 2005, 10 years before I had bypass surgery, and sure enough my neutrophil count was elevated at 3.6 xE9/L, and my ratio was 1.9.
These two platelets are white blood cells that respond to disease and infection. In essence, at the dangerous levels noted, they indicate a level of low-grade inflammation, similar to a CRP test (C-Reactive Protein), that triggers the degradation of LDL into VLDL (Very Low Density Lipoproteins). VLDL is the atherogenic component of LDL-C.
I also noted that my triglyceride level in 2005 was 1.42 mmol/l, which is within the 'normal' guideline, but the optimal level of triglycerides, we now know, is less than 0.79 mmol/l.
My LDL-C was also elevated at the time at 4.58 mmol/l yet the government guideline at the time for 'low-risk' individuals was a value greater than 4.50 mmol/l. Since I wasn't a smoker or drinker, was quite active and only 43 years old at that time, my doctor considered me 'low risk'. He mentioned my cholesterol was 'borderline' and that I should be more careful with my diet but didn't think my risk-stratification should be any different.
Of further interest, my cholesterol/HDL ratio was 5.09, which was below the 6.0 ratio set by the government guideline for 'low risk' individuals. Had this new NLR biomarker been understood at that time, it may have alerted my doctor to place me into a higher risk-stratification and insist on a more aggressive lifestyle and dietary intervention.
A diet that is high in simple carbohydrates, such as white flour products - including pasta and white bread; white rice, white potatoes, as well as refined sugars like the white powder, honey, agave; alcohol, and alcohol derivatives used as sweeteners in packaged products, as well as soft-drinks and fruit juices - leads to elevated levels of triglycerides which cause low-grade inflammation, that eventually leads to CVD.
In my own case, this new information on the NLR and neutrophil levels, in combination with my elevated triglyceride and LDL-C levels, was confirmed by my development of CVD over the subsequent 10-years. I was on a 'Dead-End Road' and didn't know it.
I encourage all of you to ensure you get a hard copy of your blood test results and track the information carefully.
Thanks to Markl60 for providing me with a link to a blog where I uncovered this information.
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What a coincidence because I was reading about the neutrophil:lymphocyte ratio yesterday. My LDL runs high - but every other ratio is good including N:L which is 0.73 and dovetails with my overall low risk for CVD.
Thanks for the link, I was trying to get a hold of the complete document. Credit to Markl60 for turning me on to the original blog website where I found the NLR info.
Great post, you have really drilled down into a thorough risk assessment and highlighted how you slipped through the net. I am sure this will be a great help to others reading this post. If only our doctors were as thorough and analytical but alas as one poster on another blog stated doctors are told what to think not how to think
I'm having trouble computing this - brain fog.. - my recent results are 'Neutrophil count: 2.43 x10^9/L; Lymphocyte count: 3.14 x10^9/L. Apart from it being a different measurement to xE9/L, how do I work out the ratio? Ugh. Me+brainfog+maths: Argh! Thanks for any help
You're over-thinking this. You only need to divide the neutrophil number by the lymphocyte number, forget the rest of the unit of measure and extensions. Example in my case:
Neutrophil to lymphocyte ratio (NLR) is used as a marker of subclinical inflammation. It is calculated by dividing the number of neutrophils by number of lymphocytes (these are usually given in any CBC).
"We have identified that the normal NLR values in an adult, non-geriatric, population in good health are between 0.78 and 3.53. These data will help to define the normal values of the NLR." (Taken from following link.)
While that may be the normal range, the paper I quoted from indicates a ratio of 1.5 or greater demonstrates increased risk of CVD. ShinyB is fine in terms of her ratio, but her Neutrophil number exceeding 2.0 implies some level of inflammation which although not acute at present can cause longer term consequences.
Yes, I quoted the normal range because that is all that is available* (albeit in the other paper). I am not in a position to interpret ShinyB 's results, I just did the arithmetic. I have no idea about anyone else's health status.
Which part of the Shah et al paper are you quoting for the absolute neutrophil count interpretation? There's some discussion of other studies about the absolute values but on pg. 395 of the Shah et al paper, they write: "In our study, we show that neutrophil and lymphocyte counts when considered individually neither predict CHD mortality nor significantly reclassify the FRS".
*The authors write: "Our study findings are not applicable to individuals with inflammatory and autoimmune disorders, malignancies and those on corticosteroid therapy, since they were excluded from our analysis...There are no established cut-off values for NLR, however, in our study we showed NLR greater than 4.5 to be significantly associated with risk of CHD mortality which is consistent with prior findings by Horne et al. [12] who showed that NLR greater than 4.71 predicts cardiovascular risk." (pg. 396).
Your literal interpretation of the Shah study is correct. However,
on Pg. 392 of the Shah study, section 3.2, it shows the increased risk when the population is divided into 4 groups.
The normal group is the one with an NLR < 1.5. That would infer that while the group with the NLR of > 4.5 is the one that is most at risk, there's increased risk beginning with the group that has an NLR > 1.5. People's bio-metrics move from one value to another, incrementally. The idea is not to wait until your NLR is >4.5 to start addressing your diet and lifestyle factors, but to start as soon as your value has exceeded the baseline, or normal value.
To draw an analogy, it's like somebody who has fallen off of a 10 story building and is asked by people living on each floor as they drop past them - 'how are things going?', to which the falling person responds - 'so far so good'. You want to take preventative measures BEFORE you hit the ground.
An incrementally poor result in one area should trigger an individual to assess all data collectively. If there's more than one bio-metric that is sub-optimal, it indicates the 'potential' for trouble and the need to take early preventative measures before health deteriorates to an acute level.
NLR: 2.43/3.14 = 0.77; You don't need to worry about the unit of measure since it is the same for both. Your ratio is good, however, the fact that your Neutrophil value is elevated indicates that your body is experiencing some low grade inflammation. Longer term, inflammation is damaging so you should assess your diet and lifestyle choices.
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