Zekeriya Arslan

Evaluation of the mean platelet volume in patients with cardiac syndrome X

OBJECTIVE: Cardiac syndrome X is characterized by angina-like chest pain, a positive stress test, and normal coronary arteries. A patients mean platelet volume, which potentially reflects platelet function and activity, is associated with coronary atherosclerosis and endothelial dysfunction. The aim of the present study was to evaluate the mean platelet volumes of patients with cardiac syndrome X, those with coronary artery disease and normal subjects. METHODS: Two hundred thirty-six subjects (76 patients with cardiac syndrome X, 78 patients with coronary artery disease, and 82 controls) were enrolled in the study. All of the subjects were evaluated with a detailed medical history, physical examination, and biochemical analyses. The mean platelet volumes were compared between the three groups. RESULTS: The mean platelet volumes in the patients with cardiac syndrome X and with coronary artery disease were significantly higher than those that were observed in the control group. There were no significant differences in the mean platelet volumes between the cardiac syndrome X and the coronary artery disease groups. CONCLUSION: We have established that patients with cardiac syndrome X and coronary artery disease exhibit higher mean platelet volumes compared to controls. Patients with cardiac syndrome X exhibited higher mean platelet volumes compared to the controls, reflecting the presence of subclinical atherosclerosis. These findings suggest that, in addition to endothelial dysfunction, the presence of atherosclerosis may also contribute to the etiopathogenesis of cardiac syndrome X.

Neutrophils/Lymphocytes Ratio in Patients With Cardiac Syndrome X and Its Association With Carotid Intima–Media Thickness

Neutrophils and lymphocytes (N/L) ratio and carotid intima–media thickness (C-IMT) value have been studied as new predictors of cardiovascular risk. We aimed to investigate N/L ratio and C-IMT value in patients with cardiac syndrome X (CSX) and compare patients with coronary artery disease (CAD) and normal participants. A total of 288 participants were enrolled in the study. The N/L ratio and C-IMT value were compared among the 3 groups. There were no statistically significant differences in N/L levels between CSX and CAD groups. The N/L ratio was found significantly increased in patients with CSX and CAD, compared to the control group. Patients with CAD and CSX had significantly higher C-IMT value compared to control participants. Significant positive correlation was found between C-IMT value and plasma level of N/L ratio. The relationship among CSX and higher N/L ratio level and C-IMT suggests that endothelial dysfunction may contribute to the etiopathogenesis of the CSX.

Association between coronary artery ectasia and neutrophil-lymphocyte ratio.

Atherosclerosis plays an important role in the etiopathogenesis of coronary artery ectasia (CAE). Inflammation markers may play a part in the pathogenesis of CAE. We aimed to assess the association between the CAE and the neutrophil–lymphocyte (N/L) ratio. Consecutive eligible patients (n = 181) were divided into 3 groups: patients with CAE, those with newly diagnosed coronary artery disease (CAD), and those with a normal coronary angiogram. The N/L ratio and mean platelet volume (MPV) were measured as part of the automated complete blood count. There were no statistically significant differences in N/L ratio and MPV between the CAE and the CAD groups. The N/L ratio and MPV were significantly higher in patients in both CAE and CAD groups compared to those in the control group (P < .01). An increased N/L ratio may play a role not only in the pathogenesis of CAD but also in the pathophysiology of CAE.

The Comparative Effects of Valsartan and Amlodipine on vWf Levels and N/L Ratio in Patients with Newly Diagnosed Hypertension

High levels of circulating Von Willebrand factor (vWf) and increased neutrophil to lymphocyte (N/L) ratio may reflect vascular inflammation in hypertensive patients. In present study, we aimed to investigate the effects of valsartan as an angiotensin II receptor antagonist and amlodipine as a calcium channel blocker on the vWf levels and N/L ratio in patients with essential hypertension. Patients were randomized to one of the following intervention protocols: calcium channel blocker (amlodipine, 5–10 mg/day) as group A (n = 20 mean age = 51.85 ± 11.32 y) and angiotensine II receptor blocker (valsartan, 80–320 mg/day) as group B (n = 26 mean age = 49.12 ± 14.12 y). Endothelial dysfunction and vascular inflammation were evaluated with vWf levels and N/L ratio in hypertensive patients before treatment and after treatment in the 12th week. No statistically significant differences were found among the groups in terms of age, sex, and body mass index (BMI). There was a significant decrease in vWf levels (P < .001) and N/L ratio after treatment (P = .04, P < .001, respectively) in both the groups. Von Willebrand factor levels and N/L ratio are very important markers having a role in vascular inflammation and antihypertensive treatment with amlodipine and valsartan may improve cardiovascular outcomes by decreasing these biomarkers.

Higher Neutrophil to Lymhocyte Ratio in Patients With Metabolic Syndrome

We read with great interest the article ‘‘Correlation of Neutrophil to Lymphocyte Ratio With the Presence and Severity of Metabolic Syndrome’’ by Buyukkaya et al. They aimed to investigate the relationship between the criteria comprising metabolic syndrome (MS) and neutrophil–lymphocyte ratio (N/L ratio) as a novel, simple, and reliable indicator of inflammation. They showed that patients with MS had significantly higher N/L ratio compared to those without MS. Furthermore, N/L ratio increased as the severity of MS increased. A strong positive correlation was revealed between the severity of MS and N/L ratio and between the severity of MS and the highsensitivity C-reactive protein (hsCRP). In addition, the correlation analysis revealed a positive correlation between hsCRP and NLR in the patient population. The measurements of white blood cells (WBCs), neutrophils, and lymphocytes in the patients with MS were higher than those without MS. The study is successful in planning and presenting the results. We believe that these findings will enlighten further studies about the association between the severity of MS and the N/L ratio. Thanks to the authors for their contribution. The WBC count is one of the useful inflammatory biomarkers in clinical practice. Leukocyte subtype and N/L ratio are also indicators of systemic inflammation. Although WBCs are in normal range, subtypes of WBCs may predict cardiovascular mortality. The N/L ratio is also an inflammatory marker of major adverse cardiac events. Some comments may be of interest. Although the authors have showed patients with MS had significantly higher N/L ratio compared to those without MS, some of the factors affecting these markers such as smoking, alcohol, and malignancy were not mentioned in this study. In addition, the authors could add a MS subgroup analysis. A subgroup analysis of MS according to age, sex, CRP, WBCs, neutrophils, and lymphocytes might affect the results of the study.

Carotid intima-media thickness in patients with slow coronary flow and its association with neutrophil-to-lymphocyte ratio: a preliminary report.

Background: The slow coronary flow (SCF) is characterized by angiographically normal or near-normal coronary arteries with delayed progression of the contrast agent into distal vasculature. We aimed to investigate neutrophil-to-lymphocyte (N/L) ratio and the carotid intima-media thickness (CIMT) value in patients with SCF compared to patients with newly diagnosed coronary artery disease (CAD) and normal patients. Materials and Methods: We enrolled 60 consecutive patients with SCF, 68 patients with CAD, and 72 normal patients. The association between thrombolysis in myocardial infarction frame count, CIMT, and N/L ratio and other clinical and laboratory parameters were evaluated. Results: The N/L ratio was significantly higher not only in patients with SCF but also in patients with CAD, compared to those of controls. The N/L ratio was positively and moderately correlated with CIMT in the whole study population. Conclusions: The NL ratio is significantly associated with reduced coronary blood flow, and elevated N/L ratio might be an independent predictor for the presence of SCF.

Assessment of the relationship between red cell distribution width and cardiac syndrome X

BACKGROUND Cardiac syndrome X (CSX) is characterised by angina-like chest pain, a positive stress test, and normal coronary arteries. Increased red cell distribution width (RDW) level may be indicative of an underlying inflammatory state. AIM To investigate RDW level in patients with CSX and compare patients having coronary artery disease (CAD) and normal subjects. METHODS 245 subjects (79 patients with CSX, 81 patients with CAD, and 85 controls) were enrolled in the study. The CSX group consisted of patients with anginal chest pain, ischaemia on noninvasive stress test and a normal coronary angiogram.CAD was defined as ≥ 50% stenosis in at least one coronary artery. The control group was selected from the patients with anginal symptoms but a normal stress test and a normal coronary angiogram. RDW measurements among the three groups were compared. RESULTS Baseline clinical and biochemical characteristics were not different among the three groups. There were no statistically significant differences in RDW levels between the CSX and CAD groups (p = 0.17). RDW measurements in both the CSX and CAD groups were found to be significantly higher than the control group (p < 0.01). CONCLUSIONS We discovered that patients with CSX and CAD have significantly higher RDW measurements compared to controls. The relationship between CSX and higher RDW level suggests that endothelial dysfunction may also contribute to the etiopathogenesis of the CSX phenomenon as it does with CAD.

Carotid Intima Media Thickness and its Association With Total Bilirubin Levels in Patients With Coronary Artery Ectasia.

Atherosclerosis plays an important role in the etiopathogenesis of coronary artery ectasia (CAE). The relationship between total bilirubin (TBil) and carotid intima media thickness (cIMT) in patients with CAE has not been fully investigated. Hence, we evaluated the relationship between TBil levels and cIMT in 142 consecutive eligible patients with CAE, newly diagnosed coronary artery disease (CAD), and normal coronary arteries. There were no significant differences in TBil (P = .772) and cIMT (P = .791) between the CAE and CAD groups. Bilirubin levels were significantly lower in both CAE and CAD groups compared to the controls (P < .01). The cIMT was significantly higher in both CAE and CAD groups compared to control participants (P < .01). A negative correlation between cIMT and TBil was found in all the groups (P < .01, r = .354). We show for the first time that patients with CAE and CAD have lower TBil and greater cIMT compared to controls with normal coronary angiograms.

Arterial Stiffness Itself Without Other Inflammatory Markers May Not Provide Information to Clinicians

To the Editor: We read the article “Association of Arterial Stiffness With Obesity in Australian Women: A Pilot Study” written by Pal and colleagues with interest. The authors investigated the arterial stiffness status in overweight/obese Australian women compared with their lean counterparts. They concluded that increased arterial stiffness existed in overweight patients compared with lean patients, as well as with a positive association of augmentation index with measurements of body composition and blood pressure (BP). These data suggest that greater cardiovascular risk in overweight/obese women may be related to increased arterial stiffness, as well as increased BP and cholesterol. We believe that these findings will act as a guide for further information regarding obesity and cardiovascular disease risk factors related to body composition. Arterial stiffness indicates the viscoelastic properties of the vessel wall. Arterial stiffness represents vascular damage and is a measure of the degree of atherosclerosis. Arterial stiffness has received increased attention because of its role as an independent prognostic factor for hypertension, chronic kidney disease, diabetes, and heart failure. Increased arterial stiffness is a common indicator of atherosclerotic involvement of the vascular structure indicating coronary artery disease (CAD), cerebrovascular disease, and peripheral arterial disease. It can also be affected by atherosclerotic risk factors such as smoking, alcohol consumption, hypercholesterolemia, hypothyroidism, and older age. In this point of view, in the present study, the authors did not mention some of the affecting factors of arterial stiffness, including smoking, alcohol consumption, hypercholesterolemia, hypothyroidism, heart failure, cerebrovascular disease, and peripheral arterial disease. It would have been useful had the authors provided information about these factors. Furthermore, some medications such as antihypertensive treatment including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and statins may influence arterial stiffness paremeters. Had the authors described these factors, it would have been beneficial to the readers and the results may have been different. In addition, the authors did not clearly define that obesity is independently associated with arterial stiffness paremeters. A multivariate regression analysis would have been valuable and adjusted for other related factors (such as hypertension, diabetes mellitus, smoking, hypercholesterolemia, and medications). Finally, arterial stiffness is a noninvasive method to assess endothelial dysfunction in clinical practice and can be affected by many factors. Arterial stiffness itself without other inflammatory markers may not provide information to clinicians about the endothelial inflammation. Therefore, we think that it should be evaluated together with other serum inflammatory markers.

Other Inflammatory Markers Should Not be Forgetten When Assessing the Neutrophil-to-Lymphocyte Ratio

We read with great interest the article ‘‘Relation of neutrophil to lymphocyte ratio with the presence and severity of stable coronary artery disease’’ by Kaya et al. They aimed to investigate the relationship between the severity of coronary atherosclerosis assessed by SYNTAX score (SS) and the neutrophil-tolymphocyte (N/L) ratio in patients with stable coronary artery disease (CAD) as a novel, simple, and reli-able indicator of inflammation. They concluded that the there exists relation between N/L ratio and the severity and complexity of CAD assessed by SS in stable patients with CAD who underwent coronary angiography. To our knowledge, the present study is the first report evaluating the relationship of N/L ratio with the severity and complexity of CAD by SS in patients with stable CAD. They suggested that N/L ratio appears to be a promising marker that might be used more commonly in the follow-up of patients with CAD in the near future. Thanks to the authors for their contribution. The SS is used for grading coronary complexity based on angiographic visual assessment. The severity of the coronary atherosclerosis in clinical practice has been recommended. Many studies have reported that elevated SS (ie, increased coronary complexity) is associated with higher rates of long-term major adverse cardiovascular events and revascularization after percutaneous coronary intervention or coronary artery bypass graft. A complete blood count is an easy examination technique that gives us information about the patient’s formed blood contents such as the red and white cells, the platelets, the count and dimensions of the subgroups of cells and parameters such as the distribution weights and mean platelet volume. As we know, bacterial infections and steroid usage can increase neutrophil counts, when especially viral infections may cause increase in lymphocyte counts. In recent years, N/L ratio has been proposed as a surrogate marker for endothelial dysfunction and inflammation in distinct populations and has prognostic and predictive values. Although white blood cells are in normal range, subtypes of white blood cells may predict cardiovascular mortality. However, sometimes acute conditions like bacterial or viral infections or drug treatments might affect the neutrophil and lymphocyte counts, and so the ratio of these 2 parameters might be changed. The acute disease situation may overlap the chronic ongoing inflammation. Pentraxin 3 (PTX3) is a recent candidate immunoinflammatory marker that has been reported to be associated with cardiometabolic risk factors and to predict adverse outcomes in individuals with cardiovascular disease. The PTX3, a novel inflammatory marker, plays a major role in vascular microinflammation and endothelial dysfunction, which are listed among the causes of cardiovascular morbidity and mortality and are found associated with the prognosis of cardiovascular outcomes. Furthermore, PTX3 was more closely associated with the complexity and the severity of CAD than high-sensitivity CRP and was found to be an independent predictor for high SS. For this reason, if further studies evaluate the PTX3 level in patients with CAD, it may contribute to the literature. Additionally, they used modification of diet in renal disease (MDRD) formula for glomerular filtration rate (GFR). However, MDRD formula may measure higher GFR in younger age groups in comparison with the Cockcroft-Gault equation, but it can measure lower GFR in older individuals compared to the Cockcroft-Gault equation. For this reason, it may be useful, and the result of the study may be different if the authors had used Cockcroft-Gault equation due to these factors. We believe that these findings will elucidate further studies about N/L ratio as a surrogate marker of endothelial dysfunction and inflammation in patients with CAD. Finally, N/L ratio itself without other inflammatory markers may not give information to clinicians about the chronic endothelial inflammatory condition of the patient. So, we think that it should be evaluated together with other serum inflammatory markers.