To the Editor,There are large clinical data on the importance of mean platelet volume (MPV) in unstable patients; its importance in stable atherosclerotic disease is scarce. We reported that MPV is independently associated with subclinical thoracic atherosclerosis in the article entitled “Mean platelet volume is associated with aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease” published in Anatol J Cardiol 2015; 15: 753-8.One of the main disturbances that play a role in atherosclerosis is increased platelet aggregation, and increased platelet volume is a marker of increased platelet activity (2). Recently, one meta-analysis showed that a larger MPV is associated with coronary artery disease (3). According to our results, we confirm that an increase in MPV may be an important biochemical marker for initial atherosclerosis.Previous studies demonstrated that platelets play a critical role in carotid atherosclerosis and that P-selectin that is stored in platelet secretory granules is important for the development of atherosclerosis. Additionally, platelets directly affect the degree of plaque maturation, including the existence of smooth muscle cells and calcification (4). These findings comprise the rationale to our hypothesis.As far as we know, our article is the first to report a relationship between thoracic aorta intima media thickness and the mean platelet volume in healthy subjects. Therefore, more studies are needed to confirm this finding. Our study is not a prospective clinical study, so we do not know whether the mean platelet volume is a predictor of future cardiovascular events in healthy subjects or not. Prospective clinical trials must be conducted to investigate the prognostic importance of the mean platelet volume.