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Background: The risk of cardiovascular disease is correlated with the frequency and control of associated risk factors in diabetes mellitus and may vary according to country. We evaluated risk factors for cardiovascular disease, cardiovascular events, and the use of preventive medications in patients with diabetes mellitus using the Prospective Urban and Rural Epidemiological Türkiye cohort. Methods: Patients with diabetes mellitus versus without diabetes mellitus were compared for risk factors, cardioprotective drugs (angi otens in-co nvert ing enzyme inhibitors or angiotensin-II receptor antagonists, statins, and antiplatelets), and cardiovascular events. The primary outcome was major cardiovascular events (composite of cardiovascular death, myocardial infarction, stroke, or heart failure). Results: Among 4041 participants, 549 (13.6%) had diabetes mellitus. The mean age (54.8 ± 8.4 vs. 49.3 ± 9.0 years, P < .001) and proportion of women (65.4% vs. 59.9%, P = .014) were higher in diabetics compared with non-diabetics. Hypertension, history of coronary heart disease, and use of statin, antiplatelets, and angiotensin-converting enzyme inhibitors or angiotensin-II receptor antagonists were more common in diabetics; however, the use of these medications at baseline was lower than optimal even in patients with diabetes mellitus and concomitant coronary heart disease (statin 31.2%, antiplatelets 46.9%, and angiotensin-converting enzyme inhibitors or angiotensin-II receptor antagonists 54.7%). During 11.5 years of follow-up, major cardiovascular events occurred in 288 (7.1%) patients, and the risk was higher in diabetics [hazard ratio (95% confidence interval) 1.71 (1.30-2.24); P < .001]. The increase in the risk of future events was comparable for those with diabetes mellitus alone without cardiovascular disease [hazard ratio 1.62 (1.20-2.20)] versus those with cardiovascular disease alone without diabetes mellitus [hazard ratio 1.31 (0.83-2.07)] and was additive in those with both conditions [hazard ratio 2.79 (1.65-4.69)]. The risk of major coronary events (myocardial infarction, angina, percutaneous, or surgical coronary intervention) was also higher in diabetes mellitus [hazard ratio 1.64 (1.26-2.15); P < .001]. Conclusion: Patients with diabetes mellitus have a higher risk of major cardiovascular events, and the risk is comparable to that observed in those with cardiovascular disease but no diabetes mellitus. The use of preventive medicines for cardiovascular diseases is disturbingly low in diabetics. [ABSTRACT FROM AUTHOR]

Objective: Perioperative myocardial infarction is a major cause of morbidity and mortality in patients undergoing surgical operations. We aimed to determine the incidence of perioperative myocardial infarction in patients with intermediate- or high-risk Framingham scores. Methods: One hundred and one patients (62 males, 39 females) over 40 years of age (mean age 72±11 years) median 73 (65-81), min- max (46-96), with Framingham risk scores of 10% or higher, and scheduled for surgical interventions in the orthopedics and urology departments of our hospital were included in the study. Patient demographics, comorbidities, blood pressures, and biochemical data were recorded. Troponin values and electrocardiographic findings were obtained during the immediate preoperative period and on postoperative day 2 and then compared. Perioperative myocardial injury and infarction were diagnosed using the third universal definition of myocardial infarction. Results: In 44 (43%) patients, postoperative troponin values were compared with the preoperative values. In 26 (25%) patients, the changes were consistent with myocardial ischemia or damage. Alterations in troponin values with significant electrocardiogram (ECG) changes were found in 6 patients (6%). Conclusion: The risk of postoperative myocardial damage was high in our patients with intermediate or high-risk Framingham scores. This implies that close follow-up of these patients with abnormal ECG and troponin values during the pre- and postoperative period is required. [ABSTRACT FROM AUTHOR]

Objectives: To determine the rates of antidepressant drug usage and its associated factors in patients with type 2 diabetes mellitus (DM). Methods: Patients with type 2 DM between the ages of 18 and 85 years who were followed-up in the DM outpatient clinic of a university hospital between May and September 2019 were included. The data of patients were analyzed retrospectively and age, duration of DM, comorbid diseases, information on smoking, anthropometric measurements such as, height and weight and antidepressant drug use were assessed from the hospital system. Also, the patients were assesed about their application to the psychiatry clinic and whether or not they were using any antidepressant drug. Results: The study included 463 patients with type 2 DM and 24 (68.6%) of the patients were female. It was found that 56 (12.1%) of the patients applied to the psychiatry outpatient clinic in the last three years and 23 (41.1%) of these patients used antidepressant medication. Patients who did not apply to the psychiatry outpatient clinic were also found to be using antidepressant drugs, accounting for 48 (11.8%) of all patients. Forty-eight (67.7%) of the antidepressant drug users were female and 23 (32.3%) were male (p=0.002). Median body mass index was 32.4 (24.6-45.9) kg/m2 in antidepressant drug users and 30.3 (19.0-52.0) kg/m2 in nonusers (p=0.024). Conclusion: The frequency of antidepressant use in DM patients is quite common, depression and type 2 DM are intertwined diseases. [ABSTRACT FROM AUTHOR]

Objective: Metabolic syndrome (MetS) includes several cardiovascular (CV) risk factors. This study aimed to assess CV risk of MetS, contribution of its components to the risk, and whether MetS provides additional risk beyond its components. Methods: The Prospective Urban Rural Epidemiology (PURE) Turkey cohort included 3933 individuals aged between 35 and 70 years, with a median follow-up of 8.9 years. MetS was diagnosed as the presence of any of the following criteria: high blood pressure, high fasting plasma glucose, abdominal obesity, low HDL-cholesterol, or high triglycerides. The primary outcome was the composite of fatal CV events, non-fatal myocardial infarction, stroke or heart failure, adjusted for age, sex, smoking, family history of CV diseases, and LDL-cholesterol. Results: The primary outcome was more common in the MetS group [178 (9.2%) vs. 70 (3.5%); corresponding incidence rate of 11.3 vs. 4.2 per 1000 person-years; log-rank p<0.001]. Each component was significantly associated with the primary outcome; however, when the components were sequentially included in the model, abdominal obesity and high triglycerides did not provide additional risk on top of the other three components. The hazard ratio for MetS for the primary outcome was 2.12 (95% confidence interval 1.59-2.81, p<0.001), and the discriminative ability (c-statistics) of the models with MetS and the components was similar. Conclusion: MetS increases the risk of CV events more than two-fold. High blood pressure, high fasting plasma glucose, and low HDL-cholesterol are the top three components of MetS for CV risk. MetS and its components have a similar discriminative ability for CV events. [ABSTRACT FROM AUTHOR]

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