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Antitrombotik ilaçlar stabil anjina pektoris veakut koroner sendrom (kararsız angina pektoris, ST segment yükselmesiz miyokartinfarktüsü, ST segment yükselmeli miyokart infarktüsü) ile başvuran hastalariçin olmazsa olmaz ve en uygun ilaç tedavisidir. Antiplatelet ve antikoagülanilaçlar, akut koroner sendromda ölüm ve transmural miyokart infarktüsüinsidansını azalttı. Bu ilaçların trombüs oluşumunu engelleme ve trombositleriinhibe etme mekanizması ile benzer şekilde kanama riskini artırırlar. Buradagöğüs ağrısı ile kliniğimize başvuran ve anterior miyokart infarktüsü tanısıkonulan bir olgu sunulmuştur. Hastaya rutin klopidogrel 600 mg ve asetilsalisilikasit 300 mg oral başlandıktan sonra sol ön inen arter (LAD)’e predilatasyon vestent implantasyonu uygulandı. Klopidogrel alınmasından iki saat sonra koroneryoğun bakım ünitesindeki takibinde kanlı balgam ve nefes darlığı gelişti.Toraks yüksek rezonans bilgisayarlı tomografide difüz alveoler hemorajisaptandı ve klopidogrel kesildi. Klopidogrele bağlı difüz alveoler hemoraji çoknadir görülen bir komplikasyon olmakla birlikte bu ilacın ne kadar sıklıktakullanıldığı düşünülürse tanı ve tedavinin önemi ortaya çıkar., Anti-thrombotic drugs are inevitable andrepresent the most suitable drug therapy for patients presenting with stableangina pectoris and acute coronary syndromes [unstable angina pectoris, non-STsegment elevation myocardial infarction (NSTEMI) and STEMI]. Anti-platelet andanti-coagulant drugs have reduced the incidence of death and transmuralmyocardial infarction in patients with acute coronary syndromes (ACSs). Besidestheir favourable effect in terms of inhibiting thrombus formation, theyincrease the risk of bleeding by inhibiting platelets in ACS by the samemechanism. Here we present a case of a patient who was admitted to ourinstitution with chest pain and who was diagnosed with anterior myocardialinfarction. After initiating anti-platelet therapy with 300 mg acetylsalicylicacid orally and 600 mg clopidogrel orally, the patient underwent primarypercutaneous coronary intervention, which ended with predilatation and stentimplantation of the left anterior descending artery (LAD). After 2 hours ofclopidogrel ingestion, the patient presented with bloody sputum and dyspnoea inthe coronary care unit just after the intervention. Thoracic high-resonancecomputed tomography (HRCT) revealed diffuse alveolar haemorrhage, andclopidogrel was stopped. Diffuse alveolar haemorrhage due to clopidogrel is avery rare major complication, and considering how commonly clopidogrel is used,diagnosis and management of this complication are crucial.

Background: The aim of this study was to perform a multicenter, prospective investigation regarding the epidemiology, the current effectiveness of therapeutic anticoagulation, and the risk of thromboembolism in patients with valvular atrial fibrillation (AF) based on the records of the Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. Methods: Patients were selected from a total of 2,242 consecutive admissions that presented with AF diagnosed via electrocardiogram. Those diagnosed with non-valvular AF were excluded from the AFTER study population, which left 497 patients with valvular AF for analysis. Results: The etiology of valvular AF in patients was either attributed to rheumatic mitral valve stenosis (n = 217) or possessing a prosthetic heart valve (n = 280). Out of all the patients with valvular AF, 83.1% were taking warfarin for anticoagulation. Only 36.1% demonstrated a therapeutic international normalized ratio (INR), and among those patients it was found that 19.1% exhibited a labile INR. Multivariate analysis revealed that age was the only independent predictor of thromboembolic events in patients with valvular AF. Conclusions: Many valvular AF patients are not maintained at therapeutic INR levels, which poses a threat to patient health as they age and are at greater risk for thromboembolism.

Objectives: We aimed to analyze 1) overall and coronary mortality findings in the Turkish Adult Risk Factor (TARF) study survey 2012 and 2) the temporal trends in prevalence of metabolic syndrome (MetS) and its distribution across seven geographic regions. Study design: Information on the mode of death was obtained from first-degree relatives and/or health personnel of a local health office. Information collected in survivors was based on history, physical examination of the cardiovascular system and Minnesota coding of resting electrocardiograms. Results: Of 1527 participants to be surveyed, 796 were examined; information was obtained on the health status in 502 subjects, and death was ascertained in 56 participants. Thirty deaths were attributed to coronary and cerebrovascular disease. Cumulative 22-year evaluation of participants in the age bracket 45-74 years revealed coronary mortality to be high, with 7.6 per 1000 person-years in men and 3.8 in women. Data used from 1754 identical subjects (median age 46 years initially), and examined in two periods 12 years apart, indicated an increase in the prevalence of MetS by 1.3% per aging of 1 year. Analysis across geographic regions showed a rise in the prevalence in the Mediterranean region, already having highest prevalence along with Southeast Anatolia, while the prevalence declined in the Marmara region and persisted to be lowest in the Aegean region. Conclusion: The prevalence of MetS in Turkish adults aged 40 years or over, currently standing at 53%, shows significant differences across geographic regions, being highest in the two southern regions and lowest in the Aegean region.

OBJECTIVES We analyzed all-cause and coronary mortality data of the Turkish Adult Risk Factor Study cohort in Marmara and Central Anatolia regions, surveyed in 2011, and overall performance of long-term (21 years) follow-up of participants. STUDY DESIGN A total of 1,588 participants with an age range of 45 to 74 years were surveyed. Information on the mode of death was obtained from first-degree relatives and/or personnel of local health offices. Information on survivors was obtained from history, physical examination, and 12-lead electrocardiograms. Loss to follow-up was defined as the lack of physical examination for at least eight years. RESULTS Of the surveyed participants, 854 were examined, information on health status was obtained in 606 subjects, 46 individuals (28 men, 18 women) were ascertained to have died, and 82 subjects were lost to follow-up. A total of 2,800 person-years were added to follow-up. Nineteen deaths were attributed to coronary heart disease (CHD) and five deaths to cerebrovascular events. Overall mortality was estimated as 10.9 per 1000 person-years. In the age bracket of 45-74 years, overall annual all-cause mortality and CHD mortality were 12.8 and 5.5 per mille, respectively. Based on the total loss to follow-up (31.2%) during the past two decades, an annual loss to follow-up may be derived as 19.3 for every 1000 participants. This loss was nearly twice as high in participants living in big cities compared to those in smaller towns and rural areas. CONCLUSION A trend to slight reduction in coronary mortality, though not in overall mortality, before the age 75 years is noted in Turks. Annual loss to follow-up amounts to 2% of the participants.

A 104-year-old male patient was admitted to the emergency department with chest pain. An electrocardiogram showed ST-segment elevation in the anterior leads. He was immediately taken to the catheterisation laboratory for emergency angiography, which showed thrombotic stenosis at the proximal portion of the left anterior descending (LAD) artery. After intervention on the LAD lesion, successful balloon angioplasty with stenting was performed. Here, we report a case of successful primary percutaneous coronary intervention (PCI) in a centenarian patient with acute myocardial infarction. There are few clinical data on centenarian patients with acute myocardial infarction undergoing primary PCI. To the best of best our knowledge, this case is the first reported in the literature where primary PCI was performed on a centenarian patient.

In contrast to ST-elevation myocardial infarction treatment, there is no clear definition for when and which patient to discharge. Our study's main goal was to test the hypothesis that an early discharge strategy (within 48 to 56 hours) in patients with successful primary percutaneous coronary intervention (PPCI) is as safe as in patients who stay longer. The Early Discharge after Primary Percutaneous Coronary Intervention trial was designed in a prospective, randomized, multicenter fashion and registered with http://clinicaltrials.gov (NCT01860079). Of 900 patients with ST-elevation myocardial infarction, the study randomized 769 eligible patients to the early or the standard discharge group. The study's primary outcomes were all-cause mortality and readmission at 30 days. We considered assessment of functional status and health-related quality of life to be secondary outcomes. The early discharge group had significantly shorter length of hospital stay compared with the standard discharge group (45.99 ± 9.12 vs 114.87 ± 63.53 hours; p

Background: The impact of Cockroft-Gault (C-G) derived estimated glomerular filtration rate (eGFR) on mortality and major adverse cardiac events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was assessed. Methods: A total of 884 patients were classified into four categories according to admission creatine derived eGFR: < 60, 60 - < 90, 90 - < 120, and ≥ 120 mL/min/1.73 m 2 . Results: In-hospital and long-term MACEs were significantly higher in eGFR < 60 mL/min/1.73 m 2 subgroup (P < 0.001 and P = 0.028). Multivariate analysis demonstrated 7.78-fold (95% CI: 0.91 - 66.8) higher mortality risk in eGFR < 60 mL/min/1.73 m 2 subgroup. Conclusion: As an easily applicable bedside method, C-G derived eGFR could be important for prediction of in-hospital and long-term mortality and MACE in STEMI patients undergoing primary PCI. J Clin Med Res. 2016;8(4):325-330 doi: http://dx.doi.org/10.14740/jocmr2482w

BACKGROUND The clinical importance of complete blood count (CBC) parameters such as the neutrophil-to-lymphocyte ratio (NLR) has been shown in cardiovascular diseases. Stent restenosis (SR) is a major adverse event after stent implantation. In this study, we aimed to investigate the correlation of CBC parameters with SR rates after primary percutaneous coronary intervention (PCI). METHODS Patients who had undergone primary PCI for ST-segment elevation myocardial infarction (STEMI) and control angiography during follow-up were retrospectively recruited. Patients were categorized according to admission NLR tertiles, and clinical, hematological, and angiographic data were compared. RESULTS A total of 404 patients (207 patients with SR and 197 patients without SR) were included in the study. Patients were categorized into three groups according to the tertiles of admission NLRs; the NLR was less than 3.38 in tertile 1 (n=134), between 3.38 and 6.26 in tertile 2 (n=135), and greater than 6.26 in tertile 3 (n=135). During a follow-up period of a median of 14 months (minimum 6 months, maximum 60 months) SR developed in 80 patients of tertile 3 (59%), 74 patients of tertile 2 (55%), and 53 patients of tertile 1 (40%), which were significantly different (P=0.01). According to multivariate Cox regression analysis, male sex, stent length (odds ratio 1.04, 95% confidence interval 1.01-1.06, P=0.01), admission NLRs (odds ratio 1.13, 95% confidence interval 1.08-1.19, P=0.01), and white blood cell and neutrophil counts remained the independent predictors of SR in the study population. Other CBC parameters and admission C-reactive protein, creatinine, and fasting glucose levels were not independently correlated with SR. On receiver operating curve analysis, admission NLRs higher than 3.84 were found to predict SR with a sensitivity of 73.4% and a specificity of 50.8% (area under the curve 0.604, P=0.01). CONCLUSION High NLR levels, white blood cell counts, and neutrophil counts at admission are independently correlated with SR after primary PCI.

cagliyan, caglar/0000-0002-2529-4995; Kaya, Hasan/0000-0003-3923-4026 WOS: 000350492000007 PubMed: 23742948 The aim of the study was to assess the factors associated with the anticoagulation treatment in patients with atrial fibrillation (AF). A total of 2242 consecutive patients who had been admitted with AF on their electrocardiogram were included in the study. After excluding valvular AF, 1745 patients with nonvalvular AF were analyzed. Mean CHA2DS2-VASc score [cardiac failure, hypertension, age >= 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 -74 and sex category (female)], frequency of persistent/permanent AF, hypertension, diabetes mellitus (DM), stroke history, body mass index, and left atrial diameter were significantly higher in patients receiving anticoagulant therapy. Stroke history, persistent/permanent AF, hypertension, DM, age, heart failure, and left atrial diameter were independent predictors of warfarin prescription. Labile international normalized ratio was the only independent negative predictor of effective treatment with warfarin. In this study, we demonstrated that stroke history, persistent/permanent AF, hypertension, DM, and left atrial diameter were positive predictors, whereas advanced age and heart failure were negative predictors of oral anticoagulant use in patients with nonvalvular AF.

Altay, Servet/0000-0001-7112-3970; Ademoglu, Evin/0000-0003-2933-3119; WOS: 000362968700001 PubMed: 25592098 Objective: The potential association of rheumatoid factor (RF) and lipoprotein (Lp)(a) levels, as well as with the likelihood of type 2 diabetes and hypertension, needs exploring. Methods: Cross-sectional associations were sought in this unselected and population-based 1539-adult cohort (age 58.8 +/- 10.6 years). RF was assayed nephelometrically. Multiple logistic regression analyses were used for covariates of RF positivity and for the latter's association with diabetes and hypertension. Results: RF-positive individuals were older, fewer current smokers, had significantly lower fasting triglycerides (by 13%), higher fibrinogen, and tended to higher sex hormone-binding globulin (SHBG) levels. Whereas, women had a similar risk profile irrespective of RF status, RF-positive men had significantly higher Lp(a). In contrast to Lp(a) being positively correlated with SHBG in RF-negative subjects (r = 0.08; p = 0.007), an inverse correlation existed in seropositive individuals (r = -0.32, p = 0.011), suggesting the interplay of an immune complex. In regression analyses, RF positivity was associated with Lp(a) in men but not in women, [OR 1.53 (1.19; 1.96)], independent of age, SHBG, and C-reactive protein (CRP). RF positivity was further associated with diabetes [OR 1.98 (95% CI 1.11; 3.52)] in the whole sample, additively to waist circumference and CRP, major determinants of diabetes. RF-positive subjects were not significantly associated independently with hypertension. Conclusion: Autoimmune activation linked to Lp(a) is mediated by the autoantibody RF in contributing to the development of type 2 diabetes.

Background: Hemoglobin concentration (Hb) and left ventricular ejection fraction (EF) are known predictors of contrast induced nephropathy (CIN). We hypothesized that combination of Hb concentration and left ventricular EF is superior to either variable alone in predicting contrast induced nephropathy in patients with acute coronary syndrome (ACS). Material and methods: Consecutive patients with ACS were prospectively enrolled. Patients considered for invasive strategy were included. Baseline creatinine levels were detected on admission and 24, 48 and 72 hours after coronary intervention. 25% or 0,5 umol/L increase in creatinine level was considered as CIN. Results: 268 patients with ACS (mean age 58±11 years, 77% male) were enrolled. Contrast induced nephropathy was observed in 26 (9.7%) of patients. Baseline creatinine concentration, left ventricular EF, and Hemoglobin was significantly different between two groups. Contrast volume to estimated glomerular filtration rate ratio (OR: 1.310, 95% CI: 1.077-1.593, p=0.007) and the combination of Hb and left ventricular EF (OR: 0.996, 95% CI: 0.994-0.998, p=0.001) were found to be independent predictors for CIN. Hb × LVEF ≤690 had 85% sensitivity and 57% specificity to predict CIN (area under curve: 0.724, 95% CI: 0.625-0.824, p

Objective We investigated the association of serum asymmetric dimethylarginine (ADMA) with metabolic syndrome (MetS), type-2 diabetes and coronary heart disease (CHD) in the general population. Methods Cross-sectional and, at 2000 person-years' follow-up, prospective analysis. Adults with measured serum ADMA level (n=848) were analyzed using tertiles or dichotomized values. ADMA concentrations were measured by a validated commercial ELISA kit. Results Dichotomized subjects of combined sexes with low (≤0.68 µmol/L) ADMA values had significantly higher fasting glucose, total cholesterol, apolipoprotein B and lower diastolic blood pressure. In linear regression analyses comprising age, smoking, triglyceride, HDL-cholesterol, C-reactive protein and waist circumference as well, creatinine was significantly and independently associated with ADMA, further in women glucose (inversely). In logistic regression analyses uniformly adjusted for age, smoking status and waist girth, prevalent MetS tended to positive independent association with ADMA tertiles only in men. Combined prevalent and incident diabetes weakly tended to be associated with the lowest (vs mid- and highest) ADMA tertiles in combined gender; and prevalent and incident CHD was not associated with ADMA tertiles in either sex. Conclusion Apparently "low" circulating ADMA is independently associated with fasting glucose and tends to be so with type-2 diabetes. The lack of anticipated positive associations of ADMA with cardiometabolic disorders is likely due to autoimmune responses operating against serum ADMA under oxidative stress, rendering partial failure in immunoassay.

In view of recent evidence that serum creatinine and dysfunctional apolipoprotein (apo)A-I may serve as inflammation mediators in people with enhanced inflammation, we studied whether or not these molecules were interrelated and associated with coronary heart disease (CHD) likelihood even in subjects without metabolic syndrome (MetS) or type-2 diabetes.Among unselected middle-aged Turkish adults with available serum apo A-I, lipoprotein(a) and creatinine measurements, 697 participants (designated as 'healthy') were enrolled, after exclusion of the stated metabolic disorders. CHD was identified in 87 subjects, roughly half during 3.1 years' follow-up.'Healthy' individuals were overweight and had partly impaired fasting glucose but otherwise normal serum creatinine and other biochemical measurements. Being consistent with lacking anti-inflammatory activity, apoA-I was linearly and positively associated with apoB, in women further with creatinine. Logistic regression analyses showed that, beyond age, not non-HDL-cholesterol, systolic blood pressure and smoking status, but serum creatinine in each sex (OR in men 1.63 [95% CI 1.14; 2.31]) and CRP in women were significantly associated with CHD likelihood. The combined highest and lowest creatinine quartiles in women displayed an OR 2.14 (1.02; 4.51) compared with the intermediate quartiles, after similar adjustments.Elevated creatinine levels within normal range, linked to apoA-I dysfunctionality, are independently associated with CHD likelihood even in non-diabetic subjects without MetS. In such women the lowest creatinine quartile is also linked to CHD risk.

Objectıves We aimed to compare inflammatory markers and in hospital clinical course in patients with lead versus non-lead left sided endocarditis which has not been reported previously. Methods One hundred seventy three consecutive infective endocartidis patients with a mean age of 48,5 ± 18,2 (range between 10-89; 99 male, 74 female) were included into the study. Patients were divided into two groups according to endocarditis type (group 1, lead endocarditis, n=17 and group 2, non-lead left sided endocarditis, n=156). Red cell distribution width (RDW), neutrophile-lymphocyte ratio (NLR) and peak high sensitive C-reactive protein (hs-CRP) levels were measured. We also evaluated in hospital clinical course of the patients. Results RDW, NLR and peak hs-CRP levels were significantly lower in patients with lead endocarditis when compared with non-lead endocarditis (14,8 ± 1,6 versus 16,7 ± 3,1, p=0,01, 2,9 ± 1,07 versus 7,4 ± 7, p=0,01 and 22,4 ± 31,3 versus 58,6 ± 69, p=0,03 respectively). In hospital mortality was similar in two groups (11.7% versus 30.1%, p=0.11). Ejection fraction was lower in the group with lead endocarditis (49,7% ± 14,4 versus 55,6% ± 9.8, p=0.03) however, clinical congestive heart failure was more common in the non-lead endocarditis group (28,2% versus 5,8%, p=0.004). Conclusıon In hospital mortality was similar in patients with lead and non-lead left sided endocarditis. Inflammatory markers such as RDW, NLR and hs-CRP were lower in lead endocarditis. Additionally despite of lower ejection, clinical congestive heart failure development was less in lead endocarditis which all should alert physicians that lead endocarditis might have more silent course and might be omitted.

OP-124 SYNTAX score is a unique angiographic scoring system that provide guidance as a predictive tool on the optimal technique of revascularization (CABG or PCI) for patients with multivessel disease as well as left main disease. This scoring system may help predict prognosis based on disease

Summary Objective Given that serum phospholipids (PL) may serve as inflammation mediators, we studied whether they predicted metabolic syndrome (MetS), type-2 diabetes or coronary heart disease (CHD) risk in people prone to enhanced low-grade inflammation. Methods We analyzed unselected middle-aged Turkish adults with available serum total ( n = 852) and HDL-PL ( n = 428) measurements and follow-up (mean 6.6 years) by Cox or logistic regression, after exclusion of prevalent cases of outcome disorder. The enzymatic method used measured total content of phosphatidylcholine, sphingomyelin and lyso-phosphatidylcholine. Results Most lipid and non-lipid variables were significantly different in the upper two compared with the lowest total PL tertile, whereby apolipoprotein (apo)A-I and HDL-cholesterol were higher (not lower). ApoA-I, HDL-cholesterol and uric acid were uniformly positive independent linear covariates of total and HDL PL, apoA-I even in participants without MetS. After adjustment for sex, age, waist circumference, HDL-cholesterol and systolic blood pressure, logistic regression for incident MetS disclosed a 3-fold risk (RR [95% CI 1.28; 6.81]) in the upper HDL-pl tertile. In Cox regression models, while the combined two higher HDL-pl tertiles significantly protected against CHD risk in males (HR 0.29 [95% CI 0.10; 0.89]), they weakly tended to impart risk in females: upper two total PL tertiles tended to increased risk of diabetes and CHD. Conclusion Excess total PL may mediate inflammatory properties to apoA-I, HDL and uric acid. Excess HDL-pl independently predict risk for MetS in each gender, but are protective against CHD risk in men, possibly because oxidized PL content mediated by total PL is sex-dependent, as reviewed elsewhere.

To investigate whether serum adiponectin protects against cardiometabolic risk in a population sample with prevailing metabolic syndrome.Middle-aged adults representative of a general population with baseline circulating adiponectin measurements (n = 1224) were analyzed prospectively at a mean of 3.8 years' follow-up, using continuous values or sex-specific tertiles. Total adiponectin was assayed by an ELISA kit. Type-2 diabetes was identified by criteria of the American Diabetes Association. Hypertension was defined as a blood pressure ≥ 140 mmHg and/or ≥ 90 mmHg and/or use of antihypertensive medication. Outcomes were predicted using Cox proportional hazards regression analysis in models that were controlled for potential confounders.In models of multiple linear regression, sex hormone-binding globulin, fasting insulin (inverse) and, in men, age were significant independent covariates of serum adiponectin which further tended in women to be positively associated with serum creatinine. Cox regression analyses for incident coronary heart disease (CHD), adjusted for sex, age, non-HDL cholesterol, waist circumference and C-reactive protein, revealed significant inverse association with adiponectin tertiles in men but not women (HR = 0.66; 95%CI: 0.32-1.38 for highest tertile). Cox regression for type-2 diabetes in a similar model (wherein glucose replaced non-HDL cholesterol), adiponectin tertiles appeared to protect in each gender. HR for incident hypertension roughly displayed unity in each of the adiponectin tertiles (P-trend = 0.67).High adiponectin levels failed to protect against the development of hypertension and, in women, against CHD, presumably paralleling impairment in renal function as well. Involvement of adiponectin in autoimmune complex with loss of antioxidative-antiatherogenic properties may be underlying.

AIM: To investigate whether impaired fasting glucose (IFG) confers cardiovascular risk. METHODS: A non-diabetic population-based sample representative of middle-aged and elderly Turks was studied at 8.5 years’ follow-up for incident diabetes and coronary heart disease (CHD). Metabolic syndrome (MetS) was defined by ATP-III criteria modified for male abdominal obesity, and IFG and type 2 diabetes were identified by criteria of the American Diabetes Association. Stratification by presence of MetS was used. Outcomes were predicted providing estimates for hazard ratio (HR) obtained by use of Cox proportional hazards regression analysis in models that controlled for potential confounders. RESULTS: In 3181 adults (aged 52 ± 11.5 years at baseline), analysis stratified by MetS, gender and IFG status distinguished normoglycemic subjects by a “hypertriglyceridemic waist” phenotype consisting of significantly higher waist circumference, fasting triglyceride and lower high-density lipoprotein-cholesterol, regardless of gender and MetS. Additionally, lipoprotein (Lp) (a) tended to be lower in (especially female) participants with MetS. Multivariable linear regression in a subset of the sample demonstrated decreased Lp (a) levels to be associated with increased fasting glucose and insulin concentrations, again particularly in women. In Cox regression analysis, compared with normoglycemia, baseline IFG adjusted for major confounders significantly predicted incident diabetes at a 3-fold HR in men and only women with MetS. Cox models for developing CHD in 339 individuals, adjusted for conventional risk factors, revealed that IFG status protected against CHD risk [HR = 0.37 (95%CI: 0.14-0.998)] in subjects free of MetS, a protection that attenuated partly in male and fully in female participants with MetS. CONCLUSION: IFG status in non-diabetic people without MetS displays reduced future CHD risk, yet is modulated by MetS, likely due to autoimmune activation linked to serum Lp (a).

Amaç: Atriyum fibrilasyonu (AF) klinik pratiğimizde en sık rastlanan ritm bozukluğu olup ülkemizde bu konuda yapılmış çok merkezli bir epidemiyolojik çalışma bulunmamaktadır. Bu çalışmanın amacı ülkemizde ilk kez yapılmış olan çok merkezli, ileriye dönük Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) çalışmasının kayıtlarından yararlanarak AF’ye klinik yönden yaklaşımımızı değerlendirmektir. Çalışma planı: Ülkemizde nüfus dağılımı göz önünde bulundurularak 17 ayrı üçüncü basamak merkezden, elektrokardiyografisinde en az bir defa AF atağı tespit edilmiş olan ardışık 2242 hasta çalışmaya alındı. Acil polikliniğine başvuran ya da yatmakta olan hastalar çalışmadan dışlandı. Hastaların epidemiyolojik verileri ve uygulanan tedaviler değerlendirildi. Bulgular: Çalışma popülasyonunu oluşturan hastaların %60’ı kadındı, hastaların ortalama yaşı 66.8±12.3 yıl olarak saptandı. Türk nüfusunda en sık görülen AF tipi non-valvular AF (%78) olup, AF’li hastaların %81’i ısrarcı-kalıcı AF’li idi. AF’ye en sık eşlik eden komorbid durum hipertansiyon (%67) olarak bulundu. Hastaların %15.3’ünde inme, geçici iskemik atak ve sistemik tromboemboli hikayesi mevcut iken kanama öyküsü hastaların %11.2’sinde kaydedildi. Çalışma süresinde hastaların %50’si warfarin, %53’ü de aspirin kullanıyordu. Oral antikoagülan ilaç kullanan hastaların %41.3’ünde etkin INR düzeyi saptandı. Oral antikoagülan ilaç kullanmamanın en sık nedeni (%69) hekim ihmali olarak saptandı. Sonuç: Bu veriler klinik pratiğimizde özellikle AF’li hastaların antitrombotik tedavileri konusunda daha dikkatli olunması gerektiğini göstermektedir. Objectives: Although atrial fibrillation (AF) is one of the most com- mon rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Tur- key: Epidemiologic Registry (AFTER) study. Study design: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency depart- ments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. Results: The mean age of the patients was determined as 66.8±12.3 years with female patients representing 60% of the study popula- tion. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co- morbidity in patients with AF. While a stroke or transient ischemic at- tack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspi- rin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. Conclusion: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.

The newly published article by Hadaegh's group [1] points to paradoxical aspects regarding the pathogenesis of cardiovascular disease (CVD), yet without optimal evaluation and interpretation. Utilizing a large sample of the Tehran Lipid and Glucose study cohort, authors investigated the predictive value of hypertriglyceridemic waist (HtgW) for CVD and mortality. Authors concluded that, after adjustment for potential confounders, though inwomen incident CVD risk was significantly increased all-cause mortality was inversely associated with HtgW in each gender and CVD mortality in men. HtgW is a crucially important distinct phenotype leading to excess cardiometabolic risk. It is a state of enhanced subclinical inflammation and autoimmune activation in either gender [2]. Sexand age-adjusted differences of this phenotype in the Turkish Adult Risk Factor study participants bystratifying into the categories of “healthy”, onlyabdominal obesity, hypertriglyceridemia (N1.7 mmol/L) aloneandHtgWemergedas follows. Compared with the “healthy” category, HtgW had significantly higher bloodpressure (BP), total, low-density lipoprotein andnon-highdensity lipoprotein(HDL)-cholesterol, apolipoprotein B, glucose, Creactive protein and complement C3 (a marker of autoimmunity) concentrations, and lowerHDL-cholesterol levels andprevalence ineach sex of current smoking. Individuals with HtgW further displayed lower circulating Lp(a), adiponectin, and sex hormone-binding globulin (SHBG). Collectively, these aspects strongly support the notion that HtgW phenotype is driven by oxidized phospholipids, particularly concentrated on Lp(a) particles which also become gradually oxidized, resulting in damaged epitopes that render themnot being captured fully by the immunoassay. The consequence is on one hand an “apparently” low Lp(a) level, on the other higher apoB-containing lipoproteins, because apoB itself, not damaged in the pro-inflammatory milieu, is assayed adequately. Protective plasma proteins such as apoA-I, HDL, adiponectin and SHBG combat the slow process of subclinical inflammation and autoimmune activation but, eventually, may each be converted pro-inflammatory during the stage of HtgW (as yet unpublished findings). In people with this phenotype, adjusting for total and HDLcholesterol, BP, and CRP has inherent bias [3] because HtgW represents enhanced pro-inflammatory state with elevated apoB, and resultant elevated BP. As regards adjusting for smoking status, this is a fallacy by causal relationship, because non-smoking in many ethnicities contributes to drive pro-inflammatory state, and current smoking induces avoidance of abdominal obesity [4,5] and may inhibit the autoimmune process [2,6]. A second important factor that deforms the paradoxical assessment is that HtgW phenotype leads not only to cardiovascular disease and death from it but also to other diseases, such as chronic kidney disease [7], diabetes mellitus [8] and presumably also to certain types of cancer, so that overall mortality is influenced by competing causes. Adjustment for conventional cardiovascular risk factors reduces the attributable part for cardiovascular mortality without substantially modifying mortality due to other causes. Inappropriate evaluation of the huge clinical significance of HtgW maymislead to imperfect guidelines anderraticmedical practice.Hence, the clinical significance of HtgWshouldbeput into proper context in the future by further related research across various ethnicities and appropriate assessment.

Whether impaired fasting glucose (IFG) confers modest cardiovascular risk is controversial and needs further exploration. A non-diabetic population-based sample was studied at 8.5 years follow-up for incident diabetes and coronary heart disease (CHD), using stratification by presence of metabolic