Thromb Haemost
DOI: 10.1055/s-0039-1694969
Cellular Haemostasis and Platelets
Georg Thieme Verlag KG Stuttgart · New York

Platelet Indices and Risk of Death and Cardiovascular Events: Results from a Large Population-Based Cohort Study

Giuseppe Patti
1  Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
,
Giuseppe Di Martino
2  Department of Medicine and Ageing Sciences, School of Hygiene and Preventive Medicine, “G. d'Annunzio” University, Chieti, Italy
,
Fabrizio Ricci
3  Department of Clinical Sciences, Lund University, Malmö, Sweden
4  Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, “G. d'Annunzio” University, Chieti, Italy
5  Fondazione Villa Serena per la Ricerca, Pescara, Italy
,
Giulia Renda
6  Institute of Cardiology, “G. d'Annunzio” University, Chieti, Italy
,
Sabina Gallina
6  Institute of Cardiology, “G. d'Annunzio” University, Chieti, Italy
,
Viktor Hamrefors
3  Department of Clinical Sciences, Lund University, Malmö, Sweden
7  Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
,
Olle Melander
3  Department of Clinical Sciences, Lund University, Malmö, Sweden
7  Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
,
Richard Sutton
8  National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
,
Gunnar Engström
3  Department of Clinical Sciences, Lund University, Malmö, Sweden
,
Raffaele De Caterina
9  Cardiology Division, Pisa University Hospital, University of Pisa, Pisa, Italy
,
3  Department of Clinical Sciences, Lund University, Malmö, Sweden
10  Department of Cardiology, Skåne University Hospital, Malmö, Sweden
› Author Affiliations
Funding This work was supported by grants from the Swedish Medical Research Council, the Swedish Heart and Lung Foundation, the Medical Faculty of Lund University, Malmö University Hospital, the Albert Påhlsson Research Foundation, the Crafoord Foundation, the Ernhold Lundströms Research Foundation, the Region Skane, the Hulda and Conrad Mossfelt Foundation, the King Gustaf V and Queen Victoria Foundation, The Wallenberg Foundation, and the Lennart Hanssons Memorial Fund.
Further Information

Publication History

22 April 2019

28 June 2019

Publication Date:
20 August 2019 (eFirst)

Abstract

Studies evaluating the relationship between platelet indices and cardiovascular (CV) outcomes yielded conflicting results. We assessed the incidence of adverse events according to baseline quintiles of platelet indices in the prospective cohort of the Malmö Diet and Cancer Study. A total of 30,314 individuals (age 57 ± 8 years) were followed for a median of 16 years (468,490 person-years). Outcome measures included all-cause death, CV death, myocardial infarction (MI), and ischemic stroke. The fifth quintile of platelet count (> 274.6 × 109/L) was associated with higher incidence of all-cause death (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09–1.32, p < 0.001), CV death (HR 1.19, 95% CI 1.00–1.42; p = 0.044), MI (HR 1.32, 95% CI 1.12–1.54; p = 0.001), and ischemic stroke (HR 1.27, 95% CI 1.08–1.50, p = 0.004) compared with the first quintile (≤ 185 × 109/L), and also associated with a lower survival, regardless of previous history of MI (p for interaction = 0.58) or stroke (p for interaction = 0.42). In the highest quintile, history of stroke had a higher risk of CV death (HR 3.18, 95% CI 1.54–6.54) compared with no previous stroke (HR 1.12, 95% CI 0.96–1.31). The risk of MI and stroke was greatest in the fifth quintile, regardless of previous MI or previous stroke, respectively. The risk of all adverse events was similar across different quintiles of mean platelet volume. In conclusion, elevated platelet count is associated with higher mortality and risk of CV events, regardless of previous MI and stroke. Platelet count may thus be a useful marker for further stratification of CV risk, and especially of death.