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Leukocytes and the Risk of Ischemic Diseases-Reply

Edzard Ernst, MD; Arpad Matrai, MD
JAMA. 1987;258(7):908. doi:10.1001/jama.1987.03400070045017.
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In Reply.—  In addition to discovering a regrettable mistake in citation, Drs Fava and Lamon-Fava speculate that the elevation of WBC counts is an epiphenomenon and that the true risk factors are stress or the type A behavior pattern. In contrast, we postulate that high WBC counts are an independent risk factor for ischemic disease. In support of this hypothesis, our article cites a large number of epidemiologic and clinical trials. These seem to suggest that even when other conventional risk factors are taken into account, the WBC count emerges as an independent predictive variable. In the second part of the article, we summarize the mechanisms by which WBCs could harm the circulation. Essentially, leukocytes may block the microcirculation because of their rheological behavior. Once trapped there, they can cause damage by releasing free radicals and enzymes. Thus, our hypothesis is supported by epidemiologic, clinical, rheological, and biochemical research. While


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