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Correspondence: Tasnim Eghbal Eftekhaari Clinical Research Development Center of Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar-e-Abbas, Iran Tel +9 876 1333 7192 Fax +9 876 1333 7192 Email st.eghbal@yahoo.ca Letter to the editor The aim of Yayan’s study was to utilize the erythrocyte sedimentation rate (ESR) as a rapid guide to identify patients with acute coronary syndrome (ACS) or myocardial infarction. ESR is arguably a nonspecific biomarker which is elevated in almost every condition. Prakash et al have pointed to conflicting reports in the literature documenting the tendency of patients with periodontitis to develop anemia. Hence, this study was undertaken to assess whether periodontitis can cause an anemic state by evaluating and comparing the red blood cell count and levels of hemoglobin, hematocrit, ESR, serum iron, and serum ferritin between subjects with and without periodontitis, anemia, rheumatoid arthritis, and other hematologic conditions. However, this study shows that there is no statistically significant difference between rates of ESR in men and women. The purpose of referring to this reference is that most elderly people suffer from periodontitis and this condition is not negligible given that many older people also suffer for concomitant ischemic heart disease. Inflammation arising within the gastrointestinal tract may be of great importance in the pathogenesis of irritable bowel syndrome, regarding this fact that ESR is commonly used to assess the acute phase response, this acute phase response may be nonspecific. Elevated ESR is seen more often in elderly patients than in their younger counterparts (imagine an elderly patient with elevated ESR and consider whether ESR would be used as the sole basis for diagnosis of heart pain? Of course not!). ESR elevated concomitantly with C-reactive protein is used to confirm adult-onset Still’s disease. In an adult who is a heavy smoker with dyslipidemia, a personal history of Still’s disease, and a family history of ischemic heart disease, would you consider Still’s disease or ACS first? Let us suppose a febrile, middle-aged woman is referred with angina pectoris. She has a positive history of anemia, and is suffering from rheumatoid arthritis. Rheumatoid arthritis is generally associated with mild anemia, which is usually normocytic normochromic. Erythropoietin levels are above normal in this patient to compensate for her anemia, hence the normal relationship between EPO in this patient is not associated with the degree of anemia. Now how can the clinical presentation be judged solely upon basis of ESR, when the fact that CRP and troponin levels may be helpful in management decision of such patients, as the ESR is falsely elevated in response to increased EPO production? C-reactive protein and troponin levels may be helpful in deciding on the management of such patients, because the ESR is falsely elevated in response to increased erythropoietin production. Dovepress

ESR rate can be a marker for coronary artery disease