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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read with interest the Letter to the Editor titled &#8220;Inflammation&#44; systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome&#8221; from Nicholas G Kounis&#46; In it&#44; 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&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">I would by no means dismiss this as a possible factor&#44; and indeed the literature describes thrombophilias as an associated mechanism that should always be borne in mind&#46; However&#44; I consider that the author&#44; in attempting to demystify the subject&#44; runs the risk of simplifying a disease that is complex&#44; highly prevalent and an important risk factor for cardiovascular disease&#46;</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&#46; All recently published studies draw the same conclusion&#44; that these patients&#8217; coronary arteries show diffuse early atherosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;6</span></a> Chronic systemic inflammation is probably the main cause of the atherosclerotic process&#44; and mast cells may well be involved&#46; However&#44; once again I stress that we should not associate this with vasospasm and put forward a pathophysiological theory as the absolute truth&#44; especially when it is contradicted by the findings of cine coronary angiography in all relevant studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;6</span></a> In conclusion&#44; I believe that further studies are still needed in this area&#46; But until proven otherwise&#44; early atherosclerosis is the best-established process in this disease and rigorous control of conventional risk factors such as systemic hypertension&#44; dyslipidemia&#44; smoking and diabetes is essential&#44; together with appropriate control of the systemic inflammatory disease&#46;</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&#46;</p></span></span>"
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Letter to the Editor
Reply to the Letter to the Editor “Inflammation, systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome”
Resposta à Carta ao Editor «Inflammation, systemic lupus erythematosus and the Kounis mast cell acitvation-associated syndrome»
Alexandre de Matos Soeiro
Unidade Clínica de Emergência do Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read with interest the Letter to the Editor titled &#8220;Inflammation&#44; systemic lupus erythematosus and the Kounis mast cell activation-associated syndrome&#8221; from Nicholas G Kounis&#46; In it&#44; 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&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">I would by no means dismiss this as a possible factor&#44; and indeed the literature describes thrombophilias as an associated mechanism that should always be borne in mind&#46; However&#44; I consider that the author&#44; in attempting to demystify the subject&#44; runs the risk of simplifying a disease that is complex&#44; highly prevalent and an important risk factor for cardiovascular disease&#46;</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&#46; All recently published studies draw the same conclusion&#44; that these patients&#8217; coronary arteries show diffuse early atherosclerosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;6</span></a> Chronic systemic inflammation is probably the main cause of the atherosclerotic process&#44; and mast cells may well be involved&#46; However&#44; once again I stress that we should not associate this with vasospasm and put forward a pathophysiological theory as the absolute truth&#44; especially when it is contradicted by the findings of cine coronary angiography in all relevant studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;6</span></a> In conclusion&#44; I believe that further studies are still needed in this area&#46; But until proven otherwise&#44; early atherosclerosis is the best-established process in this disease and rigorous control of conventional risk factors such as systemic hypertension&#44; dyslipidemia&#44; smoking and diabetes is essential&#44; together with appropriate control of the systemic inflammatory disease&#46;</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&#46;</p></span></span>"
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Revista Portuguesa de Cardiologia (English edition)
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