Author's Reply.

To the Editor,

We thank the authors for their great interest in our work entitled “Predictors of poor coronary collateral development in patients with stable coronary artery disease: Neutrophil-to-lymphocyte ratio and platelets” that was published in the March 2015; 15: 218-23 issue of the Anatol J Cardiol (1). As reported, we found that a lower triglyceride level is significantly associated with good coronary collateral circulation (CCC) and is an independent predictor of CCC. In agreement with our results, previous studies found a significant association between serum triglyceride level and CCC (2, 3). We also found a cut-off value of 2.55 for the neutrophil-to-lymphocyte (N/L) ratio to predict poor CCC with 76% sensitivity and 63% specificity.

It was recently demonstrated that isometric handgrip exercise-induced physical ischemia training may facilitate coronary collateral development in the remote ischemic myocardium (4). Exercise may modulate the development of a coronary collateral development by decreasing the N/L ratio. It is well known that exercise has a positive effect on serum triglyceride levels. We agree that patients who have good CCC exercise more and could lower triglyceride level and that a lower N/L ratio is related to exercise; however, our study is retrospective, and the data of functional status and exercise capacity of the study patients were not found in the medical records of hospitals. We also did not find the data of body mass index. Further studies are warranted to determine whether the amount of exercise that patients perform has a positive effect on coronary collateral development.