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Inflammatory Markers May Predict Long-Term Cardiovascular Mortality in Patients with Acute Coronary Syndrome

zation and susceptibility to ischemia-driven myocardial damage. High levels of WBCs at admission have been associated with a 5-year cardiovascular mortality in NSTEACS for a long time [3] . In the general population, high plasma levels of inflammatory markers have been found to increase the risk of coronary artery calcium and coronary events, impaired left ventricular function and cardiovascular death [4] . CAD has been increasingly recognized as an inflammatory disease. The inflammatory status has received increased attention due to its role as an independent prognostic factor for hypertension, diabetes and heart failure. Increased inflammation is a common indicator of atherosclerotic involvement of the vascular structure indicating CAD, cerebrovascular disease and peripheral arterial disease [5] . Immune cells and inflammatory mediators, such as interleukins, tumor necrosis factor-α and C-reactive protein, red blood cell distribution width [6] , homocysteine [7] and vascular endothelial growth factor [8] play a pivotal role in atherosclerosis, ischemic stroke and atherosclerotic complications [9] . Previous studies have demonstrated an independent association between hyperglycemia at admission and cardiovascular We have read the article entitled ‘Baseline white blood cell count is an independent predictor of long-term cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome, but it does not improve the risk classification of the GRACE score’ by Taglieri et al. [1] with great interest. In their well-designed and documented study, the authors aimed to investigate the association between baseline white blood cell (WBC) count and long-term cardiovascular mortality in an all-comer cohort of patients with non-STsegment elevation acute coronary syndrome (NSTE-ACS) and, additionally, they aimed to evaluate its additive predictive value beyond the GRACE score. They concluded that the WBC count on admission was an independent predictor of longterm cardiovascular mortality in patients with NSTE-ACS. Coronary artery disease (CAD) are the most important causes of mortality and morbidity in developed countries worldwide [2] . Growing evidence suggests that inflammatory pathways influence the course of CAD, both with regard to the development of mild CAD, but also with regard to the outcome in patients with established severe CAD due to plaque destabiliReceived: February 17, 2013 Accepted: February 26, 2013 Published online: May 24, 2013