major finding of the present study is that CHA2DS2-VASc
score is independently associated with severity of atherosclerosis in patients
with CAD. In this study burden of atherosclerosis was assessed by SYNTAX score
and CIMT.

of  CHA2DS2-VASc
score are known to promote atherosclerosis and are associated with severity of
CAD.88  First, low ejection
fraction can be explained that, it is not the cause of complex lesions, but it
is the outcome of CAD severity. As the complexity and number of lesions, such
as chronic total occlusion, bifurcation and ostial lesions increase, it leads
to increase in SYNTAX score. Therefore, angiographic lesion characteristics and
complexity may impact ventricular systolic functions, so low ejection fraction
indirectly indicate angiographic severity of CAD .  Also, patients
with heart failure usually have neurohumoral and inflammatory response and some
of these are associated with atherosclerosis pathogenesis. High levels of
inflammatory markers, especially high sensitive C-reactive protein, have been
associated with left ventricular systolic dysfunction.89

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other components of this score like hypertension, DM and age are traditional
risk factors for CAD. Moreover, diabetic patients are known to have increased
severity of atherosclerosis as well as higher rates of multivessel disease and
more complex lesions such as long lesions, bifurcation lesions and diffuse
small vessel disease.88

component CVA can be explained as suggested by, in Yoo J90 et al. investigators
suggested that a substantial portion of stroke patients have preclinical CAD
and there is a clear association between coronary and cerebral artery
atherosclerosis in terms of location and burden.90 The risk of CAD
is particularly high in stroke patients with multiple risk factors and
atherosclerosis of the carotid and/or vertebrobasilar arteries.88

another study, Korkmaz91 et al. found increased coronary artery
lesion complexity among patients with acute coronary syndrome and peripheral
artery disease. There was a strong correlation between degree of peripheral
artery disease and atherosclerosis severity in coronary arteries.

correlation showed positive correlation between CHA2DS2-VASc
score and SYNTAX score.

established surrogate marker of atherosclerosis is CIMT. In Ikeda N23
et al. study a statistically significant correlation was found between the CIMT
and SYNTAX score and also between the plaque score and SYNTAX score. Pearson
correlation, showed positive correlation between CHA2DS2-VASc
score and CIMT.

score is a simple and easily remembered scoring system. This score is useful in
cardiovascular risk stratification, and its best part would be, it can be done
clinically without additional cost. This clinical score also might enable
physicians to select patients for primary prevention of atherosclerosis and to
identify patients who will benefit from further diagnostic tests for CAD.

Limitations of the
study are, We had no follow-up data such as in hospital or 30-day mortality and
complications that could provide more information on prognostic value of CHA2DS2-VASc
score and it should validated in larger study population.

In conclusion, CHA2DS2-VASc
score may emerge as an excellent bedside simple clinical scoring system to predict
atherosclerosis burden and guide to implement preventive therapy for
cardiovascular disease. This study shows that by calculating CHA2DS2-VASc
score and measuring CIMT with B-mode ultrasound, one can predict CAD burden
non-invasively and can investigate accordingly.

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