The White Blood Cell Count as a Risk Factor-Reply

Richard H. Grimm, MD, PhD; James D. Neaton, PhD
JAMA. 1986;255(14):1877. doi:10.1001/jama.1986.03370140074012.
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In Reply.—  Dr Gottfried's point is valid. However, it should be pointed out that the same is true for all the major coronary heart disease risk factors of blood pressure, serum cholesterol levels, and smoking. That is, although the relative risk may be high for a person, the absolute risk is low and in many persons at high risk the decrease will not develop. This is especially true for the relatively brief time periods of observation for most studies (five to ten years).We appreciate Dr Light's comments. The mechanism he proposes for the increased risk associated with elevated WBC counts is rational. We selected our comments on free oxygen radical production as an illustration of a plausible biologic mechanism for the increased risk. Dr Light provides another and the two are not necessarily mutually exclusive. Indeed, because the WBC count/coronary heart disease and cancer relationships in our study are


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