was read the article
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In it, the author suggests a possible pathophysiological mechanism related to coronary vasospasm due to mast cell activation as the main reason for acute coronary syndrome in patients with systemic lupus erythematosus.</p><p id="par0010" class="elsevierStylePara elsevierViewall">I would by no means dismiss this as a possible factor, and indeed the literature describes thrombophilias as an associated mechanism that should always be borne in mind. However, I consider that the author, in attempting to demystify the subject, runs the risk of simplifying a disease that is complex, highly prevalent and an important risk factor for cardiovascular disease.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The author appears to go against all the efforts by researchers to clarify the main cause of acute myocardial infarction in young patients with lupus. All recently published studies draw the same conclusion, that these patients’ coronary arteries show diffuse early atherosclerosis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–6</span></a> Chronic systemic inflammation is probably the main cause of the atherosclerotic process, and mast cells may well be involved. However, once again I stress that we should not associate this with vasospasm and put forward a pathophysiological theory as the absolute truth, especially when it is contradicted by the findings of cine coronary angiography in all relevant studies.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–6</span></a> In conclusion, I believe that further studies are still needed in this area. But until proven otherwise, early atherosclerosis is the best-established process in this disease and rigorous control of conventional risk factors such as systemic hypertension, dyslipidemia, smoking and diabetes is essential, together with appropriate control of the systemic inflammatory disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The author has no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de Matos Soeiro A. Resposta à Carta ao Editor «Inflammation, systemic lupus erythematosus and the Kounis mast cell acitvation-associated syndrome». Rev Port Cardiol. 2015;34:371.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics and in-hospital outcome of patients with acute coronary syndromes and systemic lupus erythematosus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. De Matos Soeiro" 1 => "M.C. Soeiro" 2 => "M.T. 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2018 June | 21 | 10 | 31 |
2018 May | 26 | 13 | 39 |
2018 April | 48 | 5 | 53 |
2018 March | 37 | 8 | 45 |
2018 February | 24 | 9 | 33 |
2018 January | 24 | 3 | 27 |
2017 December | 52 | 8 | 60 |
2017 November | 26 | 10 | 36 |
2017 October | 32 | 15 | 47 |
2017 September | 29 | 11 | 40 |
2017 August | 48 | 13 | 61 |
2017 July | 34 | 16 | 50 |
2017 June | 32 | 11 | 43 |
2017 May | 33 | 5 | 38 |
2017 April | 23 | 4 | 27 |
2017 March | 22 | 33 | 55 |
2017 February | 27 | 7 | 34 |
2017 January | 30 | 4 | 34 |
2016 December | 30 | 8 | 38 |
2016 November | 20 | 4 | 24 |
2016 October | 26 | 7 | 33 |
2016 September | 22 | 5 | 27 |
2016 August | 9 | 2 | 11 |
2016 July | 17 | 3 | 20 |
2016 June | 15 | 3 | 18 |
2016 May | 22 | 1 | 23 |
2016 April | 20 | 8 | 28 |
2016 March | 23 | 12 | 35 |
2016 February | 28 | 15 | 43 |
2016 January | 25 | 10 | 35 |
2015 December | 29 | 8 | 37 |
2015 November | 22 | 5 | 27 |
2015 October | 32 | 4 | 36 |
2015 September | 31 | 6 | 37 |
2015 August | 27 | 10 | 37 |
2015 July | 17 | 8 | 25 |
2015 June | 16 | 7 | 23 |