LAUSR

We have read with great interest the article published by € Unl€ u et al. which was about the effects of statin use on high sensitive Troponin (hsTn) levels after exercise. Authors reported that statin use is associated with increase in hsTn levels after exercise and it should be taken into account while assessing the hsTn levels in clinical practice [1]. Exercise-related ischaemic myocardial injury is not only caused by stenosis of epicardial coronary arteries; but also due to other reasons including microvascular dysfunction, anaemia, myocarditis and hypoxia due to increased metabolic demands during exercise. Microvascular angina is defined as the presence of myocardial ischaemia during exercise with normal coronary arteries or mild to moderate stenotic lesions [2]. Secondary microvascular angina may occur due to ventricular hypertrophy or hypoxemia [3]. Lung diseases and conditions causing right to left shunt are related with exercise-related hypoxaemia, which results in myocardial ischaemia. In the present study, all of the participants underwent coronary angiography and this situation gives rise to the thought that patients had ischaemic symtpoms. Therefore, some parts of the study population might have microvascular angina and exercise-related hsTn increase might be related with microvascular angina rather than statin use. Other important issue is that, there is no data about echocardiographic evaluation in the study. Although the patients had no previous cardiac pathology; echocardiographic evaluation might give chance to detect either there is any cardiac pathology such as congenital heart diseases or ventricular hypertrophy. To conclude, we think that it should be better if microvascular angina was excluded in the study population and echocardiographic data were evaluated to make straight comments on the relationship between statin use and exercise-related hsTn increase.