Total and differential leukocytes counts, but not hsCRP, ESR, and five fractioned serum proteins have significant potency to predict stable coronary artery disease Mehdi Rasouli a, ⁎ , Asadollah Mohseni Kiasari b , Babak Bagheri b a Department of Clinical Biochemistry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran b Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran Received 20 April 2006; received in revised form 22 August 2006; accepted 7 September 2006 Available online 22 September 2006 Abstract Background: The role and diagnostic value of markers of inflammation is well recognized in acute coronary syndromes but it is uncertain in patients with stable coronary artery disease (CAD). This study was done to investigate the association of markers of inflammation with the occurrence and severity of CAD and to evaluate their predictive values. Methods: Markers of inflammation, electrophoresis serum protein fractions, serum (apo)lipoproteins and classical risk factors were determined in 270 angiographically documented subjects. The subjects were classified as CAD cases and controls according to angiography. The severity of CAD was scored on the basis of the number and extent of lesions. Results: The counts of total leukocytes (7.14 ± 1.86 cell/nl vs. 6.58 ± 1.62, p ≤ 0.02), neutrophils (3.95 ± 1.42 vs. 3.59 ± 1.07, p ≤ 0.05) and eosinophils (0.25 ± 0.28 vs. 0.19 ± 0.24, p ≤ 0.03) were increased significantly, whereas the concentrations of high-sensitivity C-reactive protein (hsCRP, 2.03 (0.0-32.0) mg/l vs.1.72 (0.09-11.36), p ≤ 0.07) changed modestly in CAD patients relative to controls. There were no significant differences in the counts of monocytes and lymphocytes and the concentrations of erythrocyte sedimentation rate (ESR) and any five fractions of serum proteins between two groups. The counts of total leukocytes, neutrophils and eosinophils, but not hsCRP and ESR exhibited significant associations with the severity of CAD. In univariate logistic regression analysis, leukocytes count associated significantly (OR = 1.97, p ≤ 0.01) whereas hsCRP modestly (OR = 1.76, p ≤ 0.06) with the occurrence of CAD. The association was lessened by diabetes mellitus in multivariable adjustment. Receiver operating characteristic (ROC) analysis showed that, only total leukocyte and differential counts had significant potency to predict CAD (area under curve, AUC = 0.60 ± 0.04, p ≤ 0.02). Conclusions: The total leukocytes count and its subgroups are associated with the presence and severity of CAD, but the associations were not independent. The efficiency was questioned for hsCRP, ESR and five fractioned serum proteins to identify stable CAD. © 2006 Published by Elsevier B.V. Keywords: CAD; Diabetes; Inflammation; hsCRP; Leukocyte; Serum proteins 1. Introduction During the last decade, it has been recognized that low-grade inflammation in the coronary arteries may play a role in the pathogenesis of atherosclerosis and its complications [1]. The probable role of inflammation in coronary artery disease (CAD) has generated a great deal of interest in identifying biochemical markers for better prediction of CAD. The candidates of these proposed inflammatory markers are leukocytes counts and differentiation, high-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR) and acute phase reactant proteins (APRPs) [1]. hsCRP as a sensitive and nonspecific marker of inflammation has been widely studied in CAD patients [1–3], however its value as a predictor of risk has been recently questioned [4–9]. Leukocytes play a major role in inflammatory processes and several studies have reported a relationship between its count and the risk of CAD [10–13]. Nevertheless, few studies have examined the counts of leukocyte subtypes in relation to CAD [14–17]. ESR, an indicator of both Clinica Chimica Acta 377 (2007) 127 – 132 www.elsevier.com/locate/clinchim ⁎ Corresponding author. Tel.: +98 912 3489560; fax: +98 151 3247106. E-mail address: mehdi.rasouli@yahoo.com (M. Rasouli). 0009-8981/$ - see front matter © 2006 Published by Elsevier B.V. doi:10.1016/j.cca.2006.09.009