Dear Editor,

We have read with interest Forsyth et al’s article in your journal [1]. They have concluded that “angiotensin converting enyzme (ACE) is increasingly identified as a risk factor for cardiovascular disease, and serum activity in infancy may contribute to the link between low birth weight and later cardiovascular events.”

We think, in this manner that it is inappropriate to come to a conclusion by means of Forsyth et al’s study methods since none of the cardiologic parameters of any healthy term infants were assessed in the study. Though emphasizing the ACE being important in regulation of peripheral blood pressure, arterial pressure measurements on infants were done neither at birth, nor 1st and 3rd months. Nevertheless, some influent questions mentioned below remained unanswered:

1.How many infants of high ACE level had any cardiologic problems?
2.How many infants were assessed echocardiographically?
3.Are all of the infants of lower ACE levels healthy cardiologically?

The authors stressed on their conclusion that especially “later” cardiovascular events had a relation with ACE level. However “later” cardiovascular events could not be foreseen by following up the infants for 3 months.

Overall, mentioning the relation would be impossible. There is a need for controlled studies having longitudinal extended case numbers and well- monitorized cardiologic parameters.

Reference

(1). Forsyth JS, Reilly J, Fraser CG, Struthers AD. Angiotensin converting enyzme activity in infancy is related to birth weight. Arch Dis Child Fetal Neonatal Ed 2004;89:F442-F444.