Letter to the Editor
Reply to the letter “The relation between inflammation and coronary artery ectasia”
Resposta à carta «A relação entre a inflamação e a ectasia arterial coronária»
Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey
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"Arslan" "email" => array:1 [ 0 => "dr.akifarslan@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiology Department, Medical School, Suleyman Demirel University, Isparta, Turkey" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta à carta «A relação entre a inflamação e a ectasia arterial coronária»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We would like to thank Balta et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> for their interest in our article.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a> In our study, we evaluated the frequency of major cardiovascular risk factors and serum levels of gamma-glutamyltransferase (GGT) and high-sensitivity C-reactive protein (hs-CRP) in a relatively large population of patients with isolated coronary artery ectasia (CAE). We found that CAE can be independently and positively associated with obesity, GGT and hs-CRP levels, but inversely with diabetes. Moreover, its severity may be related to GGT and hs-CRP levels.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Coronary artery ectasia is usually defined as dilation exceeding 1.5 times the diameter of adjacent normal segments in epicardial coronary arteries.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">3,4</span></a> Its underlying causes are poorly understood, but it has frequently been considered as a variant of atherosclerotic vascular disease.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> Atherosclerosis is regarded as a low-grade inflammatory process<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> and thus it is not surprising that there may be a close association between inflammation and CAE. As reported by Balta et al.,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> various studies have shown such an association.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6–10</span></a> Moreover, inflammation may be related to severity of CAE. However, the extent of CAE can be differently defined. Markis et al. categorized CAE in four types, with decreasing severity of CAE from type I to IV according to its topographical extent in the major coronary arteries.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> Based on this definition, types I, II and III CAE can be considered severe ectasia. By contrast, we defined severe CAE as diffuse involvement (≥2 segments) in at least two vessels. This definition corresponds to type I CAE according to Markis's classification. Our definition has also been used in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We agree with Balta et al. that some disorders such as obesity, thyroid dysfunction and malignancy can trigger an inflammatory state in which inflammatory markers like hs-CRP may be elevated. We excluded patients with thyroid dysfunction and known malignancies and inflammatory diseases from the study. With obesity, we consecutively included CAE patients in the study and selected age- and gender-matched controls with normal coronary arteries. Although mean body mass index was comparable between CAE patients and controls, the obesity rate was slightly higher in CAE patients (16% vs. 9%, p=0.06) and obesity was positively associated with CAE. We think that inflammatory activity may contribute to the development of CAE in obese patients.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Serum GGT, a major antioxidant, can oxidize low-density lipoprotein cholesterol, and has a role in the pathogenesis of atherosclerosis.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> GGT can also act as a proinflammatory protein in atherogenesis and is associated with atherosclerotic risk factors including obesity, dyslipidemia, metabolic syndrome, hypertension and diabetes.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">12,13</span></a> Primary hepatic diseases such as alcoholic or viral hepatitis and Gilbert syndrome can lead to elevated transaminases, GGT, and bilirubin levels in hepatic function tests. We did not enroll patients who had previously known hepatic disease and who regularly drank ethyl alcohol. Accordingly, we think that the relatively elevated levels of GGT may be associated with CAE itself rather than other disorders or situations.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, there is growing evidence that an inflammatory state may be activated in CAE patients and that its markers may be elevated in CAE patients as in obstructive coronary artery disease. As an oxidative stress and proinflammatory marker, GGT may also have a role in the pathogenesis of CAE. This consideration needs future studies.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts 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 "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relation between inflammation and coronary artery ectasia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 27 | 30 | 57 |
| 2024 September | 38 | 20 | 58 |
| 2024 August | 38 | 31 | 69 |
| 2024 July | 35 | 33 | 68 |
| 2024 June | 23 | 20 | 43 |
| 2024 May | 29 | 26 | 55 |
| 2024 April | 22 | 21 | 43 |
| 2024 March | 23 | 22 | 45 |
| 2024 February | 25 | 35 | 60 |
| 2024 January | 25 | 32 | 57 |
| 2023 December | 18 | 25 | 43 |
| 2023 November | 32 | 18 | 50 |
| 2023 October | 13 | 14 | 27 |
| 2023 September | 16 | 22 | 38 |
| 2023 August | 22 | 17 | 39 |
| 2023 July | 12 | 18 | 30 |
| 2023 June | 16 | 17 | 33 |
| 2023 May | 33 | 20 | 53 |
| 2023 April | 16 | 5 | 21 |
| 2023 March | 32 | 31 | 63 |
| 2023 February | 31 | 19 | 50 |
| 2023 January | 20 | 12 | 32 |
| 2022 December | 32 | 24 | 56 |
| 2022 November | 38 | 30 | 68 |
| 2022 October | 33 | 18 | 51 |
| 2022 September | 25 | 34 | 59 |
| 2022 August | 27 | 29 | 56 |
| 2022 July | 29 | 36 | 65 |
| 2022 June | 17 | 25 | 42 |
| 2022 May | 25 | 20 | 45 |
| 2022 April | 19 | 29 | 48 |
| 2022 March | 27 | 27 | 54 |
| 2022 February | 22 | 16 | 38 |
| 2022 January | 15 | 20 | 35 |
| 2021 December | 14 | 31 | 45 |
| 2021 November | 30 | 38 | 68 |
| 2021 October | 25 | 28 | 53 |
| 2021 September | 16 | 21 | 37 |
| 2021 August | 27 | 33 | 60 |
| 2021 July | 19 | 21 | 40 |
| 2021 June | 17 | 17 | 34 |
| 2021 May | 29 | 44 | 73 |
| 2021 April | 45 | 36 | 81 |
| 2021 March | 44 | 31 | 75 |
| 2021 February | 44 | 15 | 59 |
| 2021 January | 29 | 18 | 47 |
| 2020 December | 30 | 13 | 43 |
| 2020 November | 24 | 13 | 37 |
| 2020 October | 18 | 13 | 31 |
| 2020 September | 29 | 12 | 41 |
| 2020 August | 11 | 8 | 19 |
| 2020 July | 33 | 14 | 47 |
| 2020 June | 30 | 5 | 35 |
| 2020 May | 27 | 5 | 32 |
| 2020 April | 31 | 9 | 40 |
| 2020 March | 33 | 14 | 47 |
| 2020 February | 32 | 16 | 48 |
| 2020 January | 20 | 8 | 28 |
| 2019 December | 29 | 6 | 35 |
| 2019 November | 25 | 14 | 39 |
| 2019 October | 35 | 9 | 44 |
| 2019 September | 23 | 8 | 31 |
| 2019 August | 18 | 5 | 23 |
| 2019 July | 28 | 10 | 38 |
| 2019 June | 23 | 22 | 45 |
| 2019 May | 37 | 10 | 47 |
| 2019 April | 19 | 15 | 34 |
| 2019 March | 22 | 12 | 34 |
| 2019 February | 30 | 11 | 41 |
| 2019 January | 10 | 6 | 16 |
| 2018 December | 30 | 8 | 38 |
| 2018 November | 62 | 7 | 69 |
| 2018 October | 107 | 23 | 130 |
| 2018 September | 28 | 8 | 36 |
| 2018 August | 20 | 7 | 27 |
| 2018 July | 23 | 2 | 25 |
| 2018 June | 24 | 2 | 26 |
| 2018 May | 33 | 5 | 38 |
| 2018 April | 27 | 18 | 45 |
| 2018 March | 27 | 8 | 35 |
| 2018 February | 9 | 7 | 16 |
| 2018 January | 20 | 7 | 27 |
| 2017 December | 22 | 7 | 29 |
| 2017 November | 18 | 11 | 29 |
| 2017 October | 12 | 8 | 20 |
| 2017 September | 19 | 5 | 24 |
| 2017 August | 27 | 9 | 36 |
| 2017 July | 21 | 6 | 27 |
| 2017 June | 29 | 14 | 43 |
| 2017 May | 20 | 16 | 36 |
| 2017 April | 29 | 10 | 39 |
| 2017 March | 19 | 90 | 109 |
| 2017 February | 21 | 13 | 34 |
| 2017 January | 17 | 21 | 38 |
| 2016 December | 42 | 16 | 58 |
| 2016 November | 44 | 18 | 62 |
| 2016 October | 38 | 19 | 57 |
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