Enterovirus replication in valvular tissue

We read with interest the article by Thomas et al. on ‘Combined effects of systolic blood pressure and serum cholesterol on cardiovascular mortality in young (<55 years) men and women’. The authors have observed a dramatic increase in cardiovascular disease and coronary heart disease risk in young (especially men) French people due to an associated elevation of high systolic blood pressure and high serum cholesterol. We would like to draw attention to the fact that hypertension and serum cholesterol also enhance the risk of stroke, which is the second most common cause of death worldwide. The authors have recorded a significant proportion of mortality induced by high systolic blood pressure and high serum cholesterol. However, the possibility of a cause and effect relationship between stroke and mortality due to these factors has not been considered in this study. Several studies have shown that treatment of systolic hypertension in the elderly can prevent stroke and cardiovascular events [2]. It appears that few studies have covered the effect of high systolic blood pressure and high serum cholesterol in younger patients. We strongly consider that had the authors taken this point into consideration during their study, it would have benefited the scientific community much more. Additionally, the information pertaining to the role of certain risk factors, such as smoking, has not been addressed clearly. For example, the earlier study, in which patients with 6·7 mmol . l 1 of plasma cholesterol and a borderline systolic blood pressure of 140 mmHg were prone to coronary heart disease and cardiovascular disease, is almost similar to patients with a high cholesterol (9·1 mmol . l ) or a systolic blood pressure of 240 mmHg, if the former patient smokes five cigarettes per day. Therefore, the relationship of borderline elevation of two or three risk factors with serious elevation of one factor, as detailed above, deserves more elucidation. It is documented that isolated systolic hypertension is a good predictor with which to indicate the proneness of cardiovascular disease in those who are above 60 years of age. To the best of our knowledge, information on this is not available in younger patients. In the present study from the provided data, it is difficult to analyse the presence of any case having isolated systolic hypertension. Consideration of this point during analysis also would have strengthened the scientific content. Letters to the Editor 1887