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Current Opinions About Coronary Artery Ectasia

We read with interest the letter by Iscen regarding our article entitled ‘‘Association Between Coronary Artery Ectasia (CAE) and Neutrophil-Lymphocyte (N/L) Ratio.’’ Although the etiopathogenesis of coronary artery ectasia (CAE) is not well known, we considered that endothelial dysfunction contributes to the atherosclerotic process. In a previous study, in 85% of the cases, CAE was accompanied by atherosclerotic coronary artery disease (CAD). Therefore, it is not surprising to suggest that CAE is related to vascular endothelial dysfunction and atherosclerosis. Because intravascular ultrasound (IVUS) provides more precise values about the presence and distribution of atherosclerosis in the vessel lumen and wall, we mentioned the lack of IVUS as a limitation of our study. The IVUS is the gold standard in vivo coronary plaque assessment. A previous study evaluated the performance of manual measures of coronary plaque volumes and atherosclerotic plaque features from coronary computed tomography angiography (CTA), using IVUS as the reference. The CTA may not provide better information about coronary plaque assessment, that is, why it cannot be the reference method for coronary plaque assessment. However, CTA is a relatively noninvasive test for coronary plaque assessment. Elevated differential cell counts, including eosinophil, neutrophil, and monocyte counts, predict the incidence of CAD. The leukocyte count is cheap, safe, easy to interpret, and often ordered routinely. Numerous epidemiologic and clinical studies have demonstrated leukocytosis to be an independent predictor of future cardiovascular events, both in healthy individuals free of CAD at baseline and in patients with acute coronary syndrome or stable angina. Although the total leukocyte count has been found to be an independent predictor of death in patients with or at high risk for CAD, greater predictive ability is provided by a high ratio of neutrophil and lymphocyte (N/L). The N/L ratio is an easy, cheap, noninvasive, and widely available laboratory marker used to evaluate systemic inflammation. The N/L ratio has received increased attention due to its role as an independent prognostic factor for CAD, hypertension, chronic kidney disease, diabetes, heart failure, cerebrovascular disease, peripheral arterial disease, and malignancy. It can also be affected by atherosclerotic risk factors such as smoking, alcohol consumption, hypercholesterolemia, metabolic syndrome, nonalcoholic liver disease, abnormal thyroid function tests, and older age. Furthermore, some medications such as antihypertensive therapy including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, betablockers, and statins used may also influence the N/L ratio. For this reason, we excluded these factors. In conclusion, in spite of everything, we suggest that our findings will enlighten further studies about N/L ratio as a surrogate marker in patients with CAE. Not only the N/L ratio but also the mean platelet volume, red cell distributioın width, platelet distribution width, total bilirubin, uric acid, gammaglutamyl transferase, and N-terminal pro-B-type natriuretic peptide are simple, inexpensive, and reliable markers to evaluate patients with CAE. Finally, the N/L ratio alone without other inflammatory markers may provide less information to clinicians about the risk stratification of patients. So, we suggest that the N/L ratio should be evaluated together with other serum inflammatory markers.