Cardiovascular Journal of Africa: Vol 28 No 6 (November/December 2017)

46 / 78

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 6, November/December 2017 384 AFRICA
45. Ulasi II, Ijoma CK, Onodugo OD, Arodiwe EB, Ifebunandu NA,
Okoye JU. Towards prevention of chronic kidney disease in Nigeria: a
community-based study in Southeast Nigeria. Kidney Int Suppl 2013;
3(2): 195–201. doi: 10.1038/kisup.2013.13.
46. Odenigbo C, Oguejiofor O, Onwubuya E, Onwukwe C. The prevalence
of chronic kidney disease in apparently healthy retired subjects in asaba,
Nigeria. Ann Med Health Sci Res 2014; 4(Suppl 2): S128–S132. doi:
10.4103/2141-9248.138031.
47. Oladapo OO, Salako L, Sodiq O, Shoyinka K, Adedapo K, Falase
AO. A prevalence of cardiometabolic risk factors among a rural
Yoruba south-western Nigerian population: a population-based survey.
Cardiovasc J Afr 2010; 21(1): 26–31.
pubmed/20224842
fcgi?artid=PMC3721297.
48. Stamler J, Elliott P, Appel L, et al. Higher blood pressure in middle-aged
American adults with less education-role of multiple dietary factors:
the INTERMAP study. J Hum Hypertens 2003; 17(9): 655–775. doi:
10.1038/sj.jhh.1001608.
49. Craig SR, Amin RV, Russell DW, Paradise NF. Blood cholesterol screen-
ing: Influence of fasting state on cholesterol results and management
decisions. J Gen Intern Med 2000; 15(6): 395–399. doi: 10.1046/j.1525-
1497.2000.03509.x.
50. Mora S, Rifai N, Buring JE, Ridker PM. Fasting compared with
non-fasting lipids and apolipoproteins for predicting incident cardio-
vascular events. Circulation 2008; 118(10): 993–1001. doi: 10.1161/
CIRCULATIONAHA.108.777334.
Dear Sir
We read the article titled ‘Relationship between coronary
tortuosity and plateletcrit coronary tortuosity and plateletcrit’
by Cerit et al., published online in the Cardiovascular Journal of
Africa on 25 April 2017, with great interest (see page 385 in this
issue). However, we have some comments regarding this study.
Although it is a relatively common finding in coronary
angiography, little is known about the importance of coronary
tortuosity (CorT). As mentioned in the article, clinical
studies have demonstrated that CorT may be related to aging,
hypertension, atherosclerosis and diabetes mellitus.1,2
In this study, there was a significant difference between the
groups regarding hypertension, diabetes mellitus and aging.
For this reason, it was to be expected that CorT would be
higher in the group with these risk factors. High blood pressure
itself initiates a chain of events in vessel walls in the form of
oxidative stress, inflammation and endothelial dysfunction.3
Similarly, in diabetes, Herder et al . found an increased level
of inflammatory reactions and their components, including
inflammatory parameters.4 In previous studies, PCT, MPV, NLR
and PLR were found to be markers of inflammatory status.
In conclusion, we would have expected higher PCT, MPV,
NLR and PLR values in the CorT group. It would have been
preferable if there were no differences between the two groups
in terms of hypertension, diabetes mellitus and aging. Then
PCT, MPV, NLR and PLR would have provided more accurate
information about the ability of CorT to predict disease. Future
studies should be directed towards larger randomised trials with
more emphasis on long-term clinical endpoints.
References
1. Han HC. Twisted blood vessels: symptoms, etiology and biomechanical
mechanisms. J Vasc Res 2012; 49: 185–197.
2. Li Y, Shen C, Ji Y, Feng Y, Ma G, Liu N. Clinical implication of coro-
nary tortuosity in patients with coronary artery disease. PLoS One 2011;
6: 24232. doi: 10.1371/journal.pone.0024232.
3. Mittal BV, Singh AK. Hypertension in the developing world: challenges
and opportunities. Am J Kidney Dis2010; 55(3): 590–598. doi: 10.1053/j.
ajkd.2009.06.044.
4. Herder C, Carstensen M, Ouwens DM. Anti-inflammatory cytokines
and risk of type 2 diabetes. Diabetes Obes Metab2013; 15: 39–50.
Training and Research Hospital, Sakarya University,
Sakarya, Turkey
Kahraman Cosansu, MD,
Mustafa Gokhan Vural, MD
Mehmet Akif Cakar, MD
Letter to the Editor