Response to: Akhtar MS, Bhat T, Teli S et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev. Cardiovasc. Ther. 11(1), 55-59 (2013).We read the article 'Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: a review' by MS. Akhtar et al. with great interest [1]. In this wellpresented review, the authors discussed the association of N/L ratio with various cardiovascular diseases and its possibility of emerging as a cheap, reliable and independent prognostic marker of cardiovascular disease.Some studies have indicated that NLR is a novel inflammatory marker in various diseases. In this particular review of M. Akhtar that he made reference to in our publication, the authors evaluated the relationship between NLR and the various cardiovascular diseases and their outcomes. White blood cell count is one of the useful inflammatory biomarkers in clinical practice. However, the sub-types, particularly the neutrophils and lymphocytes, and subsequent calculation of NLR are relatively more stable than individual leukocytic parameters. This ratio is significantly altered by many conditions (e.g., dehydration, over-hydration, diluted blood specimens, in-vitro blood specimen handling). As highlighted by this article [1], the authors provided a very concise review of NLR and its association with heart failure, coronary artery bypass surgery and various cardiac rhythm abnormalities [1].Based on this particular review, we designed our research to assess the presence of left atrial thrombus in patients with non-valvular atrial fibrillation (AF). A total of 309 (70.1 ± 9.8 years, 49% males) patients with nonvalvular AF underwent transesophageal echocardiography to assess the presence of left atrium (LA) thrombus. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. Left atrial thrombus was detected in 32 (10.3%) of 309 patients. Mean NLR (2.2 ± 1.0 vs 2.7 ± 1.1, p = 0.026) was significantly higher among patients with LA thrombus compared to patients without LA thrombus. On multivariate analysis, NLR (odds ratio 1.59; 95% CI: 0.87-4.18; p < 0.02) was an independent risk factor for the presence of LA thrombus in patients with non-valvular AF. We concluded that NLR, an emerging marker of inflammation, was independently associated with the presence of LA thrombus in patients with non-valvular AF [2]. I have also developed an association between NLR and anti-hypertensive therapy [3], NLR and its association with metabolic syndrome [4] as well as NLR association with carotid artery thickness in patients with slow coronary flow [5]. In all these studies, M. Akhtar's review [1] provided with greater guidance at each level of research.Recent evidence has extensively indicated that the NLR is a significant predictor of subclinical atherosclerosis. Atherosclerosis plays an important role in the pathogenesis of coronary artery ectasia. We also showed that the NLR was significantly higher in patients with coronary artery ectasia compared to controls [6] in another study that to...