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eLetters published in the past 60 days:

Read letters published in the past 7, 14, 21, 30, 60, 90 days.

3 eLetters published for 3 different topic sources.

Articles		Letters
	Systematic reviews: Effects of ambient temperature on the incidence of myocardial infarction Bhaskaran et al. (1 November 2009) [Abstract] [Full text] [PDF]	ozone protective effect Peter M Joseph (20 November 2009) Read every eLetter to this article

	Original articles: Inflammatory biomarkers and the prediction of coronary events among people at intermediate risk: the EPIC-Norfolk prospective population study Rana et al. (15 October 2009) [Abstract] [Full text] [PDF]	Inflamatory Biomarkers Marcio Spagnol, et al. (17 November 2009) Read every eLetter to this article

	Reviews: Non-cardiac surgery and antiplatelet therapy following coronary artery stenting Luckie et al. (15 August 2009) [Abstract] [Full text] [PDF]	�Pro-healing� coronary stent before undeferrable major non-cardiac surgery. Federico Piscione, et al. (12 November 2009) Read every eLetter to this article

Systematic reviews:
Effects of ambient temperature on the incidence of myocardial infarction
Bhaskaran et al. (1 November 2009) [Abstract] [Full text] [PDF]

Effects of ambient temperature on the incidence of myocardial infarction
ozone protective effect

20 November 2009

Peter M Joseph,
Professor
University of Pennsylvania

Send letter to journal:
Re: ozone protective effect

joseph{at}rad.upenn.edu Peter M Joseph

November 11, 2009 Editor, Heart British Medical Journal Dear Sir: I am writing to comment on the excellent article by Bhaskaran et al in Heart[1], and especially on the editorial by David Newby [2] that commented on this paper. In my opinion, Dr. Newby has missed the most important conclusion of the Bhaskaran paper. Dr. Newby�s editorial was focused mainly on the cardiac effects of fine particulate pollution, and included a graph of data from Beijing, China. However, it seems to me that a far more important contribution of the Bhaskaran paper was the observation of an �ozone protective effect� in several parts of the world. The authors pointed out that this effect is probably due to some pollutant that is negatively correlated with ozone, and cites my previous paper[3] suggesting that the effect could be due to unsuspected methyl nitrite (MN) in the air. This hypothesis has a high degree of plausibility because it is known that MN, unlike ozone, is rapidly destroyed by sunlight and so would be negatively correlated with ozone. To the best of my knowledge, this ozone protective effect is totally inexplicable unless an unknown pollutant, such as MN, is present. If Dr. Newby�s point of view is to be accepted, then presumably he must argue that fine particulate pollution is also the cause of the ozone protective effect. However, that hypothesis has been thoroughly discredited in another paper [4]. In that paper I showed that fine particulate matter can not explain the negative ozone associations in any parts of the world in which there is published evidence for the negative effects. I particularly showed that explanation is extremely unlikely in Hong Kong, China. Hence, I feel that the most important contribution of the Bhaskaran paper is to alert the world to the possible existence of a very important toxic pollutant whose presence has escaped attention. Most desperately needed is funding for research to identify MN in engine exhaust. To date, such funding has not been available in the United States. Sincerely, Professor Peter M. Joseph, Ph.D. School of Medicine University of Pennsylvania Philadelphia, PA, USA email = joseph@rad.upenn.edu REFERENCES 1. Bhaskaran K, Hajat S, Haines A, Herrett E, Wilkinson P, Smeeth L. Effects of air pollution on the incidence of myocardial infarction. Heart 2009;95:1746-1759. 2. Langrish JP, Mills NL, Newby DE. Heat and haze: a forecast for myocardial infarction? Heart 2009;95:1721-1722. 3. Joseph PM. Paradoxical ozone associations could be due to methyl nitrite from combustion of methyl ethers or esters in engine fuels. Environ Int 2007;33:1090-106. 4. Joseph PM. Can fine particulate matter explain the paradoxical ozone associations? Environ Int 2008;34:1185-91.

Original articles:
Inflammatory biomarkers and the prediction of coronary events among people at intermediate risk: the EPIC-Norfolk prospective population study
Rana et al. (15 October 2009) [Abstract] [Full text] [PDF]

Inflammatory biomarkers and the prediction of coronary events among people at intermediate...
Inflamatory Biomarkers

17 November 2009

Marcio Spagnol
University of Caxias do Sul,
Eduardo M. da Rosa, Mariana M. Mandelli, Carolina F. el Andari

Send letter to journal:
Re: Inflamatory Biomarkers

marciospagnol{at}gmail.com Marcio Spagnol, et al.

Dear Sir, We enjoyed the recent paper in Heart by Rana et 1, but were concerned that the sample was composed of approximately 80% of individuals with intermediate or high-risk of having an event, which impaired the diagnostic and prognostic accuracy of the assessed test. The markers used reflect the biological state of elevated risk of an adverse outcome in the studied subjects that is secondary to the interaction of risk-factors such as smoking, diabetes mellitus and dyslipidemia that can affect the endothelium 2,3,4.

1. Rana JS, Cote M, Despres JP, Sandhu MS, Talmud PJ, Ninio E, et al. Inflammatory biomarkers and the prediction of coronary events among people at intermediate risk: the EPIC-Norfolk prospective population study. Heart 2009;95(20):1682-7.

2. Koskinen J, Kahonen M, Viikari JS, Taittonen L, Laitinen T, Ronnemaa T, et al. Conventional cardiovascular risk factors and metabolic syndrome in predicting carotid intima-media thickness progression in young adults: the cardiovascular risk in young Finns study. Circulation 2009;120(3):229-36.

3. Kalra L, Iveson E, Rambaran C, Sherwood R, Chowienczyk P, Ritter J, et al. Homocysteine, migration and early vascular impairment in people of African descent. Heart 2008;94(9):1171-4.

4. De Michele M, Iannuzzi A, Salvato A, Pauciullo P, Gentile M, Iannuzzo G, et al. Impaired endothelium-dependent vascular reactivity in patients with familial combined hyperlipidaemia. Heart 2007;93(1):78-81.

Reviews:
Non-cardiac surgery and antiplatelet therapy following coronary artery stenting
Luckie et al. (15 August 2009) [Abstract] [Full text] [PDF]

Non-cardiac surgery and antiplatelet therapy following coronary artery stenting
�Pro-healing� coronary stent before undeferrable major non-cardiac surgery.

12 November 2009

Federico Piscione,
Associate Professor of Cardiology
Department of Clinical Medicine, Cardiovascular Science and Immunology, �Federico II University,
Salvatore Cassese

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Re: �Pro-healing� coronary stent before undeferrable major non-cardiac surgery.

piscione{at}unina.it Federico Piscione, et al.

We read with great interest the work by Luckie et al., recently published in this Journal. (1) It's known that for patients who suffer from infiltrative, obstructive or bleeding carcinomas, or for high rupture risk aneurismal disease, a prompt surgical procedure may represent �survival�, and that in case of revascularization requirement, currently available options, either bare-metal or drug-eluting stent or plain-old balloon angioplasty, might put back surgical procedure, according to the mandatory antiplatelet therapy time window. (2) In the section �Stents with pro-healing surfaces� of their manuscript, the Authors reported our preliminary data regarding a pilot study of percutaneous revascularization with a new type of �pro-healing� stent, followed by a short-term dual antiplatelet therapy, and subsequent urgent or life-saving surgery few days after stent deployment. Recently, we published as a full-length manuscript, (3) final data regarding 30 consecutive patients treated with this stenting strategy, with optimal acute procedural result. According to an average antiplatelet therapy time of 12.2�3.9 days, patients included underwent surgery 10 to 22 days after coronary stent deployment (average 17.2�3.9 days). No cardiac event has been reported in the perioperative period up to 30-days follow-up after surgery. Clearly, we did not randomize or match this population with a comparison group because it would not be possible to perform surgical procedure, as soon as we did. (2) Although based on a small sample size, our findings suggest that the �pro-healing� stent should be safe and feasible for patients candidate for upcoming major surgery who need a previous revascularization. Further registries are needed to confirm the safety and furthermore the mid- and long term efficacy of this stent that is racking up among interventional cardiologists, especially in this specific subset of patients. In this respect, we completely agree with Authors regarding the importance of a timely identification of patients who could have an high surgical probability within next months after revascularization. (4) We firmly believe that such patients could take a great advantage from this stenting strategy!

References

1. Luckie M, et al. Non-cardiac surgery and antiplatelet therapy following coronary artery stenting. Heart 2009; 95: 1303-1308 2. Poldermans D, et al., Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). Eur Heart J. 2009 Aug 27. [Epub ahead of print] 3. Piscione F, et al. A new approach to percutaneous coronary revascularization in patients requiring undeferrable non-cardiac surgery. Int J Cardiol. 2009 Aug 21. [Epub ahead of print] 4. Vicenzi MN, et al. Coronary artery stenting and non-cardiac surgery � a prospective outcome study. Br J Anaesth 2006;96:686�93.

No conflict of interests to disclose.

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