Mini Review - (2017) Volume 6, Issue 5

Potential of Monocyte Count for the Assessment of Cardiovascular Disease

Matsumura T1*, Yamamoto E2, Tsujita K2 and Araki E1
1Department of Metabolic Medicine, Kumamoto University, Kumamoto, Japan
2Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan
*Corresponding Author: Matsumura T, Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan, Tel: +81-96-373-5169, Fax: +81-96-366-8397 Email:

Abstract

Atherosclerosis is a chronic inflammatory disease proceeding from an imbalance in lipid metabolism and immune responses. Since leukocytes, especially monocytes and monocyte-derived macrophages, play pivotal roles in the progression of atherosclerosis, it is possible that monocyte count is a beneficial marker for predicting Cardiovascular Disease (CVD). Many epidemiologic and clinical studies have indicated monocytosis to be an independent predictor of cardiovascular events, both in healthy individuals at baseline and in patients with CVD or with high risk diseases for CVD, such as diabetes, dyslipidemia, hypertension and chronic kidney disease. This relationship has been observed in prospective and retrospective cohort studies, and endures after adjustment for several CVD risk factors. Other indicators utilized monocyte count, such as lymphocyte-to-monocyte ratio, monocyte-to-lymphocyte ratio and monocyte-to-high-density lipoprotein cholesterol ratio, were also independently associated with cardiovascular events and its mortality. In this review, we discussed the clinical utility of the monocyte count as a predictive marker in atherosclerotic diseases.

Keywords: Monocyte count; Cardiovascular disease; Cardiovascular mortality; Predictive marker

Introduction

Atherosclerotic diseases, including Cardiovascular Disease (CVD) and peripheral artery disease (PAD), are one of the leading causes of disability and death in the developed countries. Atherosclerosis is now recognized as a chronic inflammatory process characterized by early leukocyte recruitment which followed by plaque maturation and rupture [1]. Therefore, the increase in the number of leukocyte in blood may influence the degree of atherosclerosis. The leukocyte count has been reported to correlate with Coronary Heart Disease (CHD) since 1920s [2]. In addition, many epidemiologic studies have reported that an increased leukocyte count is a strong and independent risk factor for cardiovascular events [3-10] and for the prevalence and progression of subclinical carotid atherosclerosis [11-16], suggesting that leukocyte count is useful as a clinical marker to predict atherosclerotic diseases. On the other hand, leukocyte count includes several types of cells which have different participation form in atherogenesis. In particular, monocytes and monocyte-derived macrophages play a central role in the early phase of atherogenesis [1,17-19]. In this review, we focus on the correlation between peripheral blood monocyte count and atherosclerotic diseases.

Possibility of monocyte count as a marker for atherosclerotic diseases

Prentice et al. reported for the first time to analyze differential leukocyte counts, and they indicated that increasing neutrophil and eosinophil counts were both related to the development of CHD within two years, and suggested a similar relationship with monocyte count [20]. Thereafter, Paris Prospective Study II revealed that, after adjustment for other variables, the risk of CHD increased 1.15 times for each increase of 100 cells/mm3 in monocyte count [21]. We retrospectively investigated the association between monocyte count and future cardiovascular events in patients with Coronary Artery Disease (CAD) [22]. Kaplan-Meier analysis demonstrated a higher probability of cardiovascular events in the high monocyte count (≥ 360/mm3) group compared with the low monocyte count (<360/mm3) group (log-rank test, p=0.047) [22]. Multivariate Cox hazard analysis indicated that a high monocyte count is an independent predictor of cardiovascular events (hazard ratio (HR): 1.63, 95% confidence interval (CI):1.05-2.51, p=0.028) [22]. In addition, Multiple regression analysis in our study showed that the monocyte count was a significant and independent factor associated with reactive hyperemia peripheral arterial tonometry index (adjusted R2=0.126, p<0.001) in CAD patients, suggesting that the monocyte count was a predictor for peripheral endothelial dysfunction [22]. Monocyte count has also been shown to be related to body mass index in middle-aged men [23], and that in the cross-sectional study it was independently and significantly associated with specific features of clustering of metabolic syndrome and prevalence of ischemic cardiovascular diseases in patients with type 2 diabetes [24]. Medical Research Council Cognitive Function and Ageing Study, which was a population based cohort study and focused on the relatively healthy elderly population, revealed that monocyte count was significantly associated with cardiovascular history [25]. Kim et al. also reported in the cross-sectional study that monocyte counts were associated with an increased risk of cardiovascular and cancer-related mortality in the elderly population [26]. In the prospective observational study investigated the association between monocyte count and preclinical CVD in an asymptomatic population, monocyte count was found to have the strongest, independent relationship with overall CVD risk by backgrounds linear regression modeling [27]. On the other hand, Nasir et al. reported the correlation between leukocyte subtype counts and peripheral arterial disease (PAD) in the cross-sectional study of the U.S. population [28]. They revealed that monocytes were the only WBC subtype significantly and independently associated with PAD after adjustment for other inflammatory markers [28]. Concerning a cerebrovascular disease, the prospective study indicated that monocyte count was associated with lacunar infarcts in hypertensive patients [29]. Eventually, it is possible that monocyte count is useful as a predict marker for several atherosclerotic diseases.

Monocyte count as a predictive marker for cardiovascular mortality

Regarding the cardiovascular mortality, the Atherosclerosis Risk in Communities (ARIC) study found that the highest quartiles of monocyte was associated with respective increase of 40% in cardiovascular disease mortality relative to the lowest quartiles [30]. On the other hand, Kato et al. prospectively studied the predictive value of monocyte count for total and cardiovascular death in hemodialysis patients [31]. Kaplan-Meier analysis revealed that the highest tertile of the baseline monocyte (>270 μl) count had a significantly lower survival rate compared to the middle and the lowest tertiles [31]. Cox hazards analysis after adjustment for other conventional risk factors revealed that monocyte counts of >270/μl became a determinant of total death compared with those of <180/μl (hazards ratio 1.98 [1.10-3.57], p=0.02) [31]. Therefore, monocyte count may be a beneficial predictor for cardiovascular death, as well as CVD.

Monocyte count as a marker for carotid atherosclerosis

Several lines of reports for the correlation between monocyte count and carotid atherosclerosis estimated by ultrasonography were accumulated. Huang et al. reported that the presence of carotid atherosclerosis was associated with significant increases in the counts of monocyte after adjustments for age and body mass index in male non-smokers [32]. Boyajian et al. also reported that monocytes as a percentage of circulating leukocytes was independently associated with carotid stenosis [33]. The community-based Carotid Ultrasound Disease Assessment Study revealed that monocyte count is a better independent predictor of Intima Media Thickness (IMT) and plaque formation in Common Carotid Artery (CCA) than IL-6, hs-CRP, fibrinogen, and WCC in a healthy community population [11]. We also revealed in the cross-sectional study that monocyte counts were positively correlated with both mean CCA-IMT and maximum CCAIMT in patients with type 2 diabetes [34]. The prospective study concern with monocyte count and carotid atherosclerosis revealed that for one standard deviation increase in monocyte count, the risk of being in a higher plaque category increased by 18% (OR, 1.18; 95% CI, 1.08 to 1.29) [13]. Moreover, in the highest monocyte quartile, the risk for having plaque compared with the lowest quartile was 1.85 (OR) (95% CI, 1.41 to 2.43) [36]. Therefore, monocyte count could be an independent predictor of future plaque formation in subjects without pre-existing carotid atherosclerosis.

Monocyte count as a marker for future CVD after intervention

After intervention therapy for atherosclerotic vessels, it is possible that monocyte count is one of the prognosis determining factors. Schillinger et al. reported that pretreatment monocyte counts were associated with restenosis after femoropopliteal Percutaneous Transluminal Angioplasty (PTA) and stent implantation [35]. The study observed in-stent neointima after coronary stent implantation revealed that circulating monocytes increased after coronary stent implantation, and the peak monocyte count related to in-stent neointimal volume [36]. Hong et al. also reported the relationship between preinterventional peak monocyte count and neointimal growth after successful stent implantation using intravascular ultrasound [37]. They revealed that the preinterventional circulating monocyte count was significantly higher in the in-stent restenosis group than that in the group without in-stent restenosis [37]. Moreover, the neointima area associated with preinterventional monocyte count was largest among the patients in the highest tertile than that of the patients in the lowest or middle tertile [37]. On the other hand, Magri et al. reported that patients with critical limb ischemia have increased numbers of circulating monocytes, and the monocyte number decreases with resolution of ischemia after successful revascularization [38]. Taking their results, monocyte count may be a utility value as a predicter for success or failure of revascularization. Interestingly, Mocco et al. reported that preoperative monocyte count was independently associated with acute neurocognitive decline after carotid endarterectomy for asymptomatic stenosis [39].

Modified marker using monocyte count correlates with cardiovascular outcome

Other predictive markers utilized monocyte count, such as Lymphocyte-to-Monocyte Ratio (LMR), Monocyte-to-Lymphocyte Ratio (MLR) and monocyte-to-high-density lipoprotein cholesterol ratio (MHR), were reported. Ozturk and Kurtul revealed in the crosssectional study that LMR was significantly lower in the intermediatehigh SYNTAX score group compared to low SYNTAX score group in acute coronary syndrome patients [40], and multivariate logistic regression analysis revealed that lower LMR was an independent predictor of intermediate-high SYNTAX score [41]. Furthermore, Gary et al. reported in the cross-sectional study that a decreased LMR is significantly associated with a high risk for critical limb ischemia in peripheral arterial occlusive disease [42]. On the other hand, the Utrecht Coronary Biobank cohort study revealed that MLR showed strong independent predictive value for cardiovascular mortality (HR 1.42 (1.11-1.81), p=0.005) [42]. Other prospective study revealed that MLR was independently associated with all-cause mortality (HR 4.842; 95% CI, 2.091-11.214; P < 0.001) and cardiovascular mortality (HR 6.985, 95% CI 1.943-25.115, P=0.003) as continuous variables in hemodialysis patients [43]. In the study focused on MHR, increased MHR was associated with a worse cardiovascular profile and arose as independent predictors of major cardiovascular events in patients with chronic kidney disease [44]. Likewise, MHR was found to be independently correlated with inhospital major adverse cardiac events and mortality after primary percutaneous coronary intervention (PCI) [45], and with MACEs in patients undergoing coronary angiography [46] and in patients with Acute Coronary Syndrome (ACS) [47]. Moreover, MHR arose as an independent predictor of in-stent restenosis [48]. As stated above, several lines of reports, which referred the benefit of monocyte count-applied predictive markers for CVD, were augmented. However, since it is still unclear what is the best beneficial marker for the prediction of atherosclerotic diseases, further studies are needed to clarify this issue.

Conclusion

Monocytosis is associated with increased CVD risk and CVDrelated mortality in various patient populations and clinical conditions. Monocyte count also emerges to be an independent risk factor for atherosclerotic diseases. However, some epidemiologic and prospective cohort studies indicated that monocytosis was not associated with CHD [49], cardiovascular death [50] or stroke [51]. Moreover, increased circulating monocyte count was correlated with good coronary collateral growth in patients with severely stenotic CAD [52] and with diabetes [53]. Thus, viewed from a different angle, the increased monocyte count may predict the protection of cardiac disorder. Although no one reported the apparent reason for the discrepancy, it is possible that the quality of monocytes may be related with this issue. In fact, it is important to note that monocyte subset count, such as CD14++CD16+ monocytes, independently predicted the cardiovascular events, in patients with previous cardiovascular events [54], in patients with CKD [55] or in dialysis patients [56]. Therefore, to clarify the profitability of monocytosis on the prediction of CVD and cardiovascular mortality, detail examination including monocyte subset count might be needed. Further studies are required to determine the implications of using the monocyte count, monocyte count-utilized factors and monocyte subset count to predict clinical risk and outcome for CVD.

Disclosures and Acknowledgement

This work was supported by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science, Japan (No. 17K09835 to T.M., No. 15K15348 to E.A. and No. 17H04201 to E.A.).

References

  1. Ross R (1999) Atherosclerosis: an inflammatory disease. N Engl J Med 40: 115-126.
  2. Keefer CS, Resnik WH (1928) Angina pectoris: a syndrome caused by anoxemia of the myocardium. Arch Intern Med 41: 769-807.
  3. Freidman GD, Klatsky AL, Siegelaub AB (1974) The leukocyte count as a predictor of myocardial infarction. N Engl J Med 290: 1275-1278.
  4. Madjid M, Awan I, Willerson JT, Casscells SW (1990) Leukocyte count and coronary heart disease: implications for risk assessment. J Am Coll Cardiol 44: 1945-1956.
  5. Salonen R, Salonen JT (1990) Progression of carotid atherosclerosis and its determinants: a population-based ultrasonography study. Atherosclerosis 81: 33-40.
  6. Yarnell JWG, Baker IA, Sweetnam PM, Bainton D, O'Brien JR, et al. (1991) Fibrinogen, viscosity and white blood cell count are major risk factors for ischemic heart disease. The Caerphilly and Speedwell Collaborative Heart Disease Studies. Circulation 83: 836-844.
  7. Kannel WB, Anderson K, Wilson PW (1992) White blood cell count and cardiovascular disease. Insights from the Framingham Study. JAMA 267: 1253-1256.
  8. Kavousi M, Elias-Smale S, Rutten JH, Leening MJ, Vliegenthart R, et al. (2012) Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study. Ann Intern Med 156: 438-444.
  9. Lau KK, Wong YK, Chan YH, Yiu KH, Teo KC, et al. (2012) Prognostic implications of surrogate markers of atherosclerosis in low to intermediate risk patients with type 2 diabetes. Cardiovasc Diabetol 11: p101.
  10. Danesh J, Collins R, Appleby P, Peto R (1998) Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. J Am Med Assoc 279: 1477-1482.
  11. Chapman CM, Beilby JP, McQuillan BM, Thompson PL, Hung J (2004) Monocyte count, but not C-reactive protein or interleukin-6, is an independent risk marker for subclinical carotid atherosclerosis. Stroke 35: 1619-1624.
  12. Nozawa N, Hibi K, Endo M, Sugano T, Ebina T, et al. (2010) Association between circulating monocytes and coronary plaque progression in patients with acute myocardial infarction. Circ J 74: 1384-1391.
  13. Johnsen SH, Fosse E, Joakimsen O, Mathiesen EB, Stensland-Bugge E, et al. (2005) Monocyte count is a predictor of novel plaque formation: a 7-year follow-up study of 2610 persons without carotid plaque at baseline the Tromso Study. Stroke 36: 715-719.
  14. Loimaala A, Rontu R, Vuori I, Mercuri M, Lehtimäki T, et al. (2006) Blood leukocyte count is a risk factor for intima-media thickening and subclinical carotid atherosclerosis in middle-aged men. Atherosclerosis 188: 363-369.
  15. Phillips AC, Jiang CQ, Thomas GN, Lin JM, Yue XJ, et al. (2012) White blood cell subsets are associated with carotid intima-media thickness and pulse wave velocity in an older Chinese population: the Guangzhou Biobank Cohort Study. J Hum Hypertens 26: 485-492.
  16. Ortega E, Gilabert R, Nuñez I, Cofán M, Sala-Vila A, et al. (2012) White blood cell count is associated with carotid and femoral atherosclerosis. Atherosclerosis 221: 275-281.
  17. Gerrity RG (1981) The role of the monocyte in atherogenesis: I. Transition of blood-borne monocytes into foam cells in fatty lesions. Am J Pathol 103: 181-190.
  18. Gerrity RG (1981) The role of the monocyte in atherogenesis: II. Migration of foam cells from atherosclerotic lesions. Am J Pathol 103: 191-200.
  19. Moreno PR, Falk E, Palacios IF, Newell JB, Fuster V, et al. (1994) Macrophage infiltration in acute coronary syndromes. Implications for plaque rupture. Circulation 90: 775-778.
  20. Prentice RL, Szatrowski TP, Fujikura T, Kato H, Mason MW, et al. (1982) Leukocyte counts and coronary heart disease in a Japanese cohort. Am J Epidemiol 116: 496-509.
  21. Olivares R, Ducimetiere P, Claude JR (1993) Monocyte count: a risk factor for coronary heart disease? Am J Epidemiol 137: 49-53.
  22. Yamamoto E, Sugiyama S, Hirata Y, Tokitsu T, Tabata N, et al. (2016) Prognostic significance of circulating leukocyte subtype counts in patients with coronary artery disease. Atherosclerosis. 255: 210-216.
  23. Sweetnam PM, Thomas HF, Yarnell JW, Baker IA, Elwood PC (1997) Total and differential leukocyte counts as predictors of ischemic heart disease: the Caerphilly and Speedwell studies. Am J Epidemiol 145: 416-421.
  24. Tsai JC, Sheu SH, Chiu HC, Chung FM, Chang DM, et al. (2007) Association of peripheral total and differential leukocyte counts with metabolic syndrome and risk of ischemic cardiovascular diseases in patients with type 2 diabetes mellitus. Diabetes Metab Res Rev 23: 111-118.
  25. Pinto EM, Huppert FA, Morgan K, Mrc Cfas, Brayne C (2004) Neutrophil counts, monocyte counts and cardiovascular disease in the elderly. Exp Gerontol 39: 615-619.
  26. Kim KI, Lee J, Heo NJ, Kim S, Chin HJ, et al. (2013) Differential white blood cell count and all-cause mortality in the Korean elderly. Exp Gerontol 48: 103-108.
  27. Waterhouse DF, Cahill RA, Sheehan F, McCreery C (2008) Prediction of calculated future cardiovascular disease by monocyte count in an asymptomatic population. Vasc Health Risk Manag 4: 177-187.
  28. Nasir K, Guallar E, Navas-Acien A, Criqui MH, Lima JA (2005) Relationship of monocyte count and peripheral arterial disease: results from the National Health and Nutrition Examination Survey 1999-2002. Arterioscler Thromb Vasc Biol 25: 1966-1971.
  29. Cortina MG, Campello AR, Conde JJ, Ois A, Voustianiouk A, et al. (2008) Monocyte count is an underlying marker of lacunar subtype of hypertensive small vessel disease. Eur J Neurol 15: 671-676.
  30. Lee CD, Folsom AR, Nieto FJ, Chambless LE, Shahar E, et al (2001) White blood cell count and incidence of coronary heart disease and ischemic stroke and mortality from cardiovascular disease in African–American and white men and women. Am J Epidemiol 154: 758-764.
  31. Kato A, Takita T, Furuhashi M, Maruyama Y, Kumagai H, et al. (2008) Blood monocyte count is a predictor of total and cardiovascular mortality in hemodialysis patients. Nephron Clin Pract 110: 235-243.
  32. Huang ZS, Jeng JS, Wang CH, Yip PK, Wu TH, et al. (2001) Correlations between peripheral differential leukocyte counts and carotid atherosclerosis in non-smokers. Atherosclerosis 158: 431-436.
  33. Boyajian RA, Otis SM (2002) Atherogenic progression of carotid stenosis associates selectively with monocyte fraction in circulating leukocytes. Eur J Neurol 9: 307-310.
  34. Matsumura T, Taketa K, Motoshima H, Senokuchi T, Ishii N, et al. (2013) Association between circulating leukocyte subtype counts and carotid intima-media thickness in Japanese subjects with type 2 diabetes. Cardiovasc Diabetol 12: 177.
  35. Schillinger M, Exner M, Mlekusch W, Haumer M, Sabeti S, et al. (2003) Restenosis after femoropopliteal PTA and elective stent implantation: predictive value of monocyte counts. J Endovasc Ther 10: 557-565.
  36. Fukuda D, Shimada K, Tanaka A, Kawarabayashi T, Yoshiyama M, et al. (2004) Circulating monocytes and in-stent neointima after coronary stent implantation. J Am Coll Cardiol 43: 18-23.
  37. Hong YJ, Jeong MH, Lim SY, Lee SR, Kim KH, et al. (2005) Preinterventional peak monocyte count and in-stent intimal hyperplasia after coronary stent implantation in human coronary arteries. Clin Cardiol 28: 512-518.
  38. Magri D, Vasilas P, Muto A, Fitzgerald TN, Fancher TT, et al. (2011) Elevated monocytes in patients with critical limb ischemia diminish after bypass surgery. J Surg Res 167: 140-150.
  39. Mocco J, Wilson DA, Ducruet AF, Komotar RJ, Mack WJ, et al. (2006) Elevations in preoperative monocyte count predispose to acute neurocognitive decline after carotid endarterectomy for asymptomatic carotid artery stenosis. Stroke 37: 240-242.
  40. Ozturk S, Kurtul A (2014) Lymphocyte-to-monocyte ratio is an independent predictor for higher SYNTAX scores and associated with adverse events in acute coronary syndrome. Int J Cardiol in press.
  41. Gary T, Pichler M, Belaj K, Eller P, Hafner F, et al. (2014) Lymphocyte-to-monocyte ratio: a novel marker for critical limb ischemia in PAOD patients. Int J Clin Pract 68: 1483-1487.
  42. Gijsberts CM, Ellenbroek GH, Ten Berg MJ, Huisman A, van Solinge WW, et al. (2016) Routinely analyzed leukocyte characteristics improve prediction of mortality after coronary angiography. Eur J Prev Cardiol 23: 1211-1220.
  43. Xiang F, Chen R, Cao X, Shen B, Liu Z, et al. Monocyte/lymphocyte ratio as a better predictor of cardiovascular and all-cause mortality in hemodialysis patients: A prospective cohort study. Hemodial Int in press.
  44. Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M, et al. (2014) Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol. 46: 1619-1625.
  45. Karata? MB, Çanga Y, Özcan KS, ?pek G, Güngör B, et al. (2016) Monocyte to high-density lipoprotein ratio as a new prognostic marker in patients with STEMI undergoing primary percutaneous coronary intervention. Am J Emerg Med 34: 240-244.
  46. Zhang Y, Li S, Guo YL, Wu NQ, Zhu CG, et al. Is monocyte to HDL ratio superior to monocyte count in predicting the cardiovascular outcomes: evidence from a large cohort of Chinese patients undergoing coronary angiography. Ann Med 48: 305-312.
  47. Cetin MS, Ozcan Cetin EH, Kalender E, Aydin S, Topaloglu S, et al. (2016) Monocyte to HDL Cholesterol Ratio Predicts Coronary Artery Disease Severity and Future Major Cardiovascular Adverse Events in Acute Coronary Syndrome. Heart Lung Circ 25: 1077-1086.
  48. Yilmaz S, Akboga MK, Sen F, Balc? KG, Aras D, et al. (2016) Usefulness of the monocyte-to-high-density lipoprotein cholesterol ratio to predict bare metal stent restenosis. Biomark Med 10: 959-966.
  49. Karino S, Willcox BJ, Fong K, Lo S, Abbott R, et al. (2015) Total and differential white blood cell counts predict eight-year incident coronary heart disease in elderly Japanese-American men: the Honolulu Heart Program. Atherosclerosis 238: 153-158.
  50. Gillum RF, Mussolino ME, Madans JH (2005) Counts of neutrophils, lymphocytes, and monocytes, cause-specific mortality and coronary heart disease: the NHANES-I epidemiologic follow-up study. Ann Epidemiol 15: 266-271.
  51. Huh JY, Ross GW, Chen R, Abbott RD, Bell C, et al. (2015) Total and differential white blood cell counts in late life predict 8-year incident stroke: the Honolulu Heart Program. J Am Geriatr Soc 63: 439-446.
  52. Kocaman SA, Arslan U, Tavil Y, Okuyan H, Abaci A, et al. (2008) Increased circulating monocyte count is related to good collateral development in coronary artery disease. Atherosclerosis 197: 753-756.
  53. Kocaman SA, Sahinarslan A, Akyel A, Timurkaynak T, Boyaci B, et al. (2010) The association of circulating monocyte count with coronary collateral growth in patients with diabetes mellitus. Acta Diabetol 47: 49-54.
  54. Rogacev KS, Cremers B, Zawada AM, Seiler S, Binder N, et al. (2012) CD14++CD16+ monocytes independently predict cardiovascular events: a cohort study of 951 patients referred for elective coronary angiography. J Am Coll Cardiol 60: 1512-1520.
  55. Rogacev KS, Zawada AM, Emrich I, Seiler S, Böhm M, et al. (2014) Lower Apo A-I and lower HDL-C levels are associated with higher intermediate CD14++CD16+ monocyte counts that predict cardiovascular events in chronic kidney disease. Arterioscler Thromb Vasc Biol 34: 2120-2127.
  56. Heine GH, Ulrich C, Seibert E, Seiler S, Marell J, et al. (2008) CD14(++)CD16+ monocytes but not total monocyte numbers predict cardiovascular events in dialysis patients. Kidney Int 73: 622-629.
Citation: Matsumura T, Yamamoto E, Tsujita K, Araki E (2017) Potential of Monocyte Count for the Assessment of Cardiovascular Disease. Cardiovasc Pharm Open Access 6: 217.

Copyright: © 2017 Matsumura T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.