LAUSR

I read the article entitled “Inflammatory Cytokine Levels After Endovascular Therapy in Patients With Peripheral Artery Disease” by Ueki et al with interest. They reported that there is an association between inflammation markers such as tumor necrosis factor a, monocyte chemoattractant protein-1, and interleukin 6 levels and patients with peripheral artery disease (PAD) after endovascular therapy. However, there was no association with in-stent restenosis. Inflammation markers can be increased in many chronic diseases, such as diabetes mellitus (DM), hypertension (HT), obesity, cardiovascular diseases, and cancer. In this study, there are 2 exclusion criteria: critical illness and/or active inflammatory status. However, in Table 2 showing the clinical characteristics of patients, there are some chronic diseases such as HT, DM, obesity and dyslipidemia. Also, their percentages are high (88.6% for HT, 60% for DM, and 74.3% for obesity). These chronic diseases involve inflammation that may affect the end result of this study. On the other hand, there is no significant differences in the maximum change in cytokine levels between lesions with restenosis and those without restenosis. In-stent restenosis has been associated with inflammation markers. This result may have been influenced by the inflammation process associated with the conditions mentioned above. Statins may also affect the inflammation process. In the study by Ueki et al, the percentage of statin users was 60%, thus possibly affecting the results of the study. Such valuable markers should not be ignored and study populations should be well adjusted with inclusion and exclusion criteria. If these chronic diseases were taken into consideration, the results may differ.