LETTER TO THE EDITOR doi:10.1093/eurheartj/ehn350

coronary heart disease: but how and why? Leucocytosis, a marker of inflammation, is associated with a greater cardiovascular risk. Thus, leucocyte myeloperoxidase (MPO) could serve as a biomarker of cardiovascular diseases, as shown by Morrow et al.1 But, they did not study as to why and how leuco-cyte activation occurs in coronary heart disease (CHD). Infiltration of intima by leucocytes and macrophages is an early event to occur in ather-osclerosis. Elevated low-density lipoprotein (LDL), hypertension, hyperglycaemia, and other systemic factors initiate and accelerate atherosclerosis. Despite the fact that the entire vascular endothelium is exposed to these systemic factors, atherosclerotic lesions occur in a patchy manner and develop pre-ferentially at bifurcations, branch points, and inner curvatures of arteries, suggesting that local factors play a major role in the develop-ment of atherosclerosis. Haemodynamic forces induce the expression of pro-inflammatory genes2 that initiate and accelerate atherosclerosis at these points of shear stress. Normocholesterolemic C57BL/6 mice and rabbits showed activation of NF-kB and elev