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Publisher's version (útgefin grein), Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied. Methods and results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at 'high' 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29-39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22-24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44-51 such individuals using original algorithms, in contrast to 37-39 individuals with recalibrated algorithms. Conclusion: Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need., The work of the co-ordinating centre was funded by the UK Medical Research Council (G0800270), British Heart Foundation (SP/09/ 002), British Heart Foundation Cambridge Cardiovascular Centre of Excellence, UK National Institute for Health Research Cambridge Biomedical Research Centre, European Research Council (268834), and European Commission Framework Programme 7 (HEALTH-F2-2012-279233). The Emerging Risk Factor Collaboration’s website https://www.phpc.cam.ac.uk/ceu/erfc/list-of-studies/ has compiled a list provided by investigators of some of the funders of the component studies in this analysis. I.W. was supported by the Medical Research Council Unit Programme MC_UU_12023/21. M.K. is supported by the Netherlands Organization for Scientific Research (NWO) Veni grant (Veni, 91616079). J.P. is supported by Erasmus Mundus Western Balkans (ERAWEB), a project funded by the European Commission.

Comparative sex distribution of the proportions in the three adiposity categories is shown. Though men prevail in “normal weight” and overweight categories, women predominate in obesity by over two-fold. (DOCX 15 kb)

Amaç: Bu çalışmada, Türk toplumunda kronik atriyal fibrilasyonun (AF) prevalansı, insidansı ve mortalitesi araştırıldı. Ça lış ma pla nı: Türk Erişkinlerinde Kalp Hastalığı ve Risk Faktörleri (TEKHARF) Çalışması’nın son olarak 2006/07 taramasına kadar izlenen kohortu öne dönük ve kesitsel olarak analiz edildi. Katılımcı sayısı 3450 (1707 erkek, 1743 kadın; ort. yaş 5213) idi. Atriyal fibrilasyon prevalansı için ölen katılımcılar, insidansı için başlangıçta AF bulunan bireyler dışlandı. Bul gu lar: Altmış yedi kişide AF belirlendi. Toplam takip süresi 34 100 kişi-yılı (ortalama 9.9 yıl) idi. Prevalan AF 43, insidan AF 46 katılımcıda saptandı. Genel prevalans %1.25 idi ve dağılımı 32-59, 60-69 ve 70 yaş gruplarında sırasıyla %0.46, %2.09 ve %2.49 idi. Genel insidans 1000 kişi-yılı başına 1.35 bulundu ve aynı yaş gruplarına dağılımı sırasıyla 0.31, 1.98 ve 3.50 idi. Prevalans ve insidans oranları tüm yaş gruplarında kadınlarda erkeklerden daha yüksek idi (kadın/erkek oranı, prevalans için 1.69, insidans için 1.19). İnsidan olgularda sağkalım iki cinsiyette de 5-9 yıl arasındaydı. Toplam mortalite 100 kişi-yılı başına 6.8 bulundu. Hipertansiyon AF için en önemli etken iken, bunu ileri yaş takip etmekteydi. Atriyal fibrilasyonlu erkeklerin bel çevresi, beklenenin aksine kadınlara göre 1.9 cm daha dardı. C-reaktif protein düzeyleri AF’li erkeklerde ortalama 1.21 mg/l ile, hem AF’li kadınlara (ort. 2.62 mg/l), hem de AF bulunmayan erkeklere (ort. 1.78 mg/l) göre anlamlı derecede düşüktü. So nuç: Türk yetişkinlerinde, kronik AF insidansının yılda 35 bin (22 bini kadın), prevalansının ise halen 310 bin (200 bini kadın) olduğu tahmin edilmektedir. İnflamasyon sürecinin erkeklerimizde bu aritminin patogenezinde daha az önemle yer alması olasılığının AF’nin daha sık gelişmemesinde rolü olabilir. Objectives: We investigated the incidence, prevalence, and mortality of chronic atrial fibrillation (AF) in Turkish adults. Study design: In a prospective and cross-sectional design, we analyzed 3,450 eligible participants (1707 men, 1743 women; mean age 52±13 years) of the Turkish Adult Risk Factor Study, who had been surveyed until 2006/07. Those who were dead and were found to have AF at baseline were excluded in the estimation of AF prevalence and incidence, respectively. Results: Atrial fibrillation was determined in 67 participants. The total follow-up was 34,100 person-years (mean 9.9 years). There were 43 prevalent and 46 incident cases, which corresponded to 1.25% and 1.35 per 1000 personyears, respectively. For age brackets of 32-59, 60-69, and ≥70 years, the prevalence rates were 0.46%, 2.09%, and 2.49%, and the incidence rates were 0.31, 1.98, and 3.50 per 1000 person-years, respectively. Both were higher in women of all age groups, with female-to-male ratios for overall prevalence and incidence being 1.69 and 1.19, respectively. Survival after onset of AF was 5 to 9 years and overall mortality was 6.8 per 100 person-years. Hypertension was the most common cause of AF, followed by advanced age. Contrary to expectations, waist circumference of men with AF was smaller by 1.9 cm than that of women. Serum C-reactive protein levels in men with AF (mean 1.21 mg/l) were significantly lower than women with AF (mean 2.62 mg/l) and than males without AF (mean 1.78 mg/l). Conclusion: In Turkish adults, the current incidence and prevalence of chronic AF can be extrapolated to be 35,000 per year (22,000 in women) and 310,000 (200,000 in women), respectively. Considering the low incidence in males, it seems that inflammatory processes may play a minor role in the development of AF in Turkish men.

Objective: The aim of this study was to delineate in detail the longitudinal association of total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) levels with overall mortality in middle-aged partici pants of the biennial Turkish Adult Risk Factor study.Methods: Baseline lipid variables were analyzed in sex-specific deciles. A baseline age of 45 to 84 years as an inclusion criterion led to the enrollment of 2121 men and women. Cox regression analyses were performed. Results: Deaths were recorded in 237 and 306 women and men, respectively, during a mean 8.85 +/- 4.4 years of follow-up. Afte r adjustment for age, smoking status, lipid-lowering and antihypertensive drug usage, prevalent diabetes, and coronary heart disease, and using the lowest decile as referent, neither TC (p trend=0.94 and 0.96, respectively), nor HDL-C categories (p trend=0.20 and 0.31, respectively) were significantly predictive of mortality in either gender. TC deciles exhibited a gender difference insofar as hazard ratios in females tended to be reciprocal to those in males in deciles 2 through 5. Conclusion: The findings on TC deciles may be attributed to a comparatively higher death rate in the female (compared with male) bottom decile, reflecting the autoimmune process-induced elevated risk in the lowest decile. Observations on HDLC confirmed presumed pro-inflammatory conversion in levels >50 mg/dL. These results have important clinical implications., TOFAS; Turkish Society of Cardiology

Objective: This study is an examination of 1) overall mortality trend in the Turkish Adult Risk Factor (TARF) study stratified by sex and place of residence, and 2) brief report on main aspects of the 2016 survey. Methods: The period of last 18 years was divided into 2 for trend analysis of data. Required information on deaths was obtained. Baseline age >= 40 years at the beginning of each period was the inclusion criterion. Cox regression analyses were performed. Results: Among over 2500 participants in each, deaths were recorded in 281 and 334 individuals in Periods 1 and 2, respectively, and baseline mean age was 54.6 years and 56.4 years, respectively, in each period. Age-adjusted hazard ratio for mortality in Period 2 remained virtually the same for rural males, rose to borderline significance for urban males and rural females (p=0.06, p=0.09), and increased 1.72-fold for urban females (p=0.006), as compared to Period 1. Whereas males gained an average of 3.8 years of survival in the later period compared with the earlier period, females gained only 1.8 years. This narrowed the difference in mean age at death in favor of women from 2.5 years to 0.5 year. Of 1144 participants to be surveyed in the TARF 2016, 48 were lost to follow-up, 695 were examined, and 39 participants were ascertained to be deceased. In 362 cases, verbal information was obtained regarding health status. Conclusion: Gain in survival in Turkish women has distinctly stagnated compared with men, and hazard of death has risen significantly for women and urban residents in the past decade, suggesting interaction between female sex and urban residence. Both phenomena require recognition and adoption of appropriate measures., TOFAS; Turkish Society of Cardiology

Amaç: Mitral anulus kalsifikasyonu (MAK) yaşla artış gösteren mitral kapağın fibröz iskeletinin kronik dejeneratif kalsifikasyonudur. Patolojik çalışmalar MAK'ın ateroskleroza benzer etyolojiye sahip olduğunu göstermiştir. Bu çalışmanın amacı MAK ile kardiyovasküler risk faktörleri ve kardiyovasküler risk skorları arasındaki ilişkiyi değerlendirmektir.Metod: Çalışmamızda Cerrrahpaşa Tıp Fakültesi Kardiyoloji Anabilim Dalın'da Nisan 2010 - Nisan 2012 tarihleri arasında takip edilen 2075 hastanın tıbbi kayıtları retrospektif olarak incelendi, 2075 hastadan ekokardiyografi ile MAK olan 400 hastadan oluşan özel bir çalışma grubu seçildi. Bu 400 hasta, klasik kardiyovasküler risk faktörleri ve kardiyovasküler risk skorları (Türk Kardiyoloji Derneği risk skoru, Framingham risk skoru ve Amerikan Kalp Derneği ACC/AHA 2013 risk skoru) yönünden incelenip, yaş ve cinsiyet özellikleri benzer olan MAK olmayan 400 hastadan oluşan bir kontrol grubu ile karşılaştırıldı.Dört yüz MAK olan hastanın arasında, akut koroner sendromu tanısıyla (AKS) hastaneye başvuran ve daha önceden kardiyak hastalığı olmayan 83 hasta alt grubu oluşturdu. AKS alt grubu ile diğer gruplar arasında aynı yönlerden karşılaştırmalar yapıldı.Bulgular: Kardiyovasküler aile öyküsü MAK ve kontrol grupları arasında anlamlı farklılık göstermedi (p>0,05). Diğer kardiyovasküler risk faktörleri ise dislipidemi, hipertansiyon, sigara kullanımı ve diyabet MAK grubunda kontrol grubuna göre istatistiksel olarak anlamlı (p0,05). The other cardiovascular risk factors dislipidemia, hipertension, smoking and diabetes mellitus were significantly higher in the MAC group (p

Giriş ve Amaç: Vitronektin (VN) bir plazma glikoproteini olup ateroskleroz patogenezindeki rolü aratırılmaktadır. Çalımamızın amacı tek ölçümle akut koroner sendromda (AKS) tanı belirteci olarak kullanılabilirliini, hastane içi ve altı aylık takipte major kardiyovasküler olay (MACE) öngörü deerini belirlemektir. Materyal ve Metod: Çalıma popülasyonu ST elevasyonlu akut miyokard infarktüslü (STEM) 30, non-ST elevasyonlu akut koroner sendromlu (NSTE-AKS) 32 hasta ve koroner arterleri anjiyografik olarak normal 18 bireyden olutu. Bavuruda VN serum düzeyi ELISA yöntemi ile belirlendi. Hasta özellikleri, yapılan tedavi ve kardiyovasküler olaylar, prognostik risk belirteçleri kaydedildi. Hastalar 6 ay takip edildi. Ölüm, tekrarlayan AM, kalp yetersizlii, major ventriküler aritmi ve inme MACE olarak belirlendi. AKS?lerdeki VN düzeyleri normal grup ile kıyaslanarak tanı deeri aratırıldı. Bulgular: VN düzeyleri AKS?li hastalarda kontrol grubuna kıyasla yüksekti (p=0,001). AKS tanısı için ROC analizinde elde edilen 1.59 µg/ml?lik kestirim deeri %64 duyarlılık, %83 özgüllük gösterdi (p=0,004). 1.59 µg/ml üzerindeki deerler %93 pozitif prediktif deere sahipti. VN?nin üst iki kuartilinde alt iki kuartile göre hastane içi ve 6 ay izlemde MACE geliimi fazlaydı (Hastane içi p=0,026, 6 ay izlem p=0,001). Dier prognoz belirleyicileri ile çoklu regresyon analizinde baımsız olarak MACE?yi öngördü (p=0,001). KAH yaygınlıı ile VN kuartilleri arasında anlamlı bir korelasyon gözlendi (p=0.016). Gensini skoru NSTE-AKS kolunda VN düzeyi ile pozitif korelasyon bulundu (p=0,013). Sonuç: Çalımamıza dayanarak VN?nin AKS?lerde klinik ile birlikte deerlendirildiinde tanı testi olarak kullanılabileceini söyleyebiliriz. Ancak yüksek hasta katılımlı çalımalarla desteklenmelidir. AKS?lerde güçlü bir MACE öngörücüsü olduu ve KAH?ın yaygınlıının bir belirteci olduu dier çalımalara benzer ekilde bizim çalımamızla da desteklenmitir. Anahtar kelimeler: Vitronektin, akut koroner sendrom, koroner arter hastalıı, ateroskleroz, major kardiyovasküler olay Background: Vitronectin (VN) is a novel plasma glycoprotein. Its role in the pathogenesis of atherosclerosis is a subject of active investigation. The aim of this study is to determine the utility of single VN measurement in the diagnosis of acute coronary syndromes (ACS), as well as its value in predicting major cardiovascular events (MACE) in-hospital and six month period after ACS. Material and Methods: Study population consisted of 30 ST segment elevation acute myocardial infarction (STEMI), 32 non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients and 18 control cases with documented normal coronary arteries. VN serum level was measured on admission for ACS, using ELISA method. Patient characteristics, administered treatments, and prognostic risk markers for cardiovascular events were recorded. Patients were followed up for six months for MACE including death, ACS, heart failure, ventricular arrhythmias and stroke. VN levels in ACS patients were compared with VN levels in control subjects in order to determine its diagnostic value. VN's predictive value was investigated in comparison with recognized prognostic markers. Findings: VN levels were higher in ACS patients compared to controls (p=0.001). VN's cut-off value was 1.59 µg/ml in the diagnosis of ACS with a sensitivity of 64% and specificity of 83% using ROC analysis (p=0.004). VN levels >1.59 µg/ml had a positive predictive value of 93%. When upper two quartiles were compared to the lower quartiles, in-hospital and 6-month MACE values were found to be significantly higher (p=0.026 and p=0.001 respectively). VN was also able to predict MACE independent of other prognostic markers in multivariate regression analysis (p=0.001). There were significant correlations between CAD severity and VN quartiles (p=0.016). A positive correlation was found between Gensini score and VN levels in the NSTE-ACS group (p=0.013). Conclusion: Based on these data, we can state that VN may be used as a diagnostic test in ACS patients together with clinical evaluation. These findings should be supported with additional studies performed in larger patient groups. The VN's strong predictive value for MACE in ACS, along with its relation with CAD severity was supported with our findings, which were in line with several previous studies. Key words: Vitronectin, acute coronary syndrome, coronary artery disease, atherosclerosis, major cardiovascular event 93

Amaç: Aort sertliği gelisiminde meydana gelen bozukluklardan bir tanesi de vaskülerglikokaliks tabakasındaki değisimlerdir. Yüksek oksidatif stres durumlarında glikokalikstabakası hasar görmektedir ve nitrik oksid (NO) üretimine bağlı akım iliskili vazodilatasyonbozulmaktadır. Bu çalısmada diyabetes mellitus (DM) ve sistemik arter hipertansiyonu (HT)olan hastalarda aort duvarı elastikiyetini gösteren parametrelerin serum hyaluronidaz ve NOdüzeyleri ile iliskisi arastırıldı.Yöntem: Çalısmaya ?stanbul Üniversitesi Cerrahpasa Tıp Fakültesi Hastanesine tip 2DM (21 hasta), HT (30 hasta) ve DM artı HT (50 hasta) tanısı ile basvuran 101 hasta(ortalama yas 56.77±6.78, 35 erkek, 66 kadın) alındı. Çalısmaya alınan hastalaraekokardiyografik olarak aortik strain, aortik strain indeksi ve aort distensibilitesi ölçümleri, vees zamanlı olarak alınan kandan serum hyaluronidaz ve NO düzeyi ölçümleri yapıldı. Aortsertliği parametreleri serum hyaluronidaz ve NO düzeyleriyle karsılastırıldı.Bulgular: Hastalarda serum hyaluronidaz düzeyleri yüksekliği ile aortik strain, aortikstrain indeksi ve aort distensibilitesi artısı arasında anlamlı iliski saptandı (sırasıyla p

GİRİŞ VE AMAÇ: CD40/CD40 ligandı sistemi, hücresel ve humoral immün yanıtın değişik fazlarını düzenleyen bir sistemdir. CD40 ligandının hem membrana bağlı hem de çözünür haldeki formu (sCD40L), reseptörü olan CD40 ile etkileşerek birçok değişik inflamatuvar yanıta sebep olur. sCD40L, özellikle aktif trombositlerden salınmaktadır. Günümüzde aktif trombositlerin aterosklerotik lezyon gelişiminin ve restenoz sürecinin bir parçası olduğu bilinmektedir. Bu bilgilerden yola çıkarak tasarlanan çalışmamızın amacı, sCD40L düzeyleri ile koroner arter hastalığının (KAH) yaygınlığı ve şiddetinin ilişkisini araştırmaktır.YÖNTEM: Çalışmaya alınan 102 hastadan 37'si akut koroner sendrom (AKS), 41'i kararlı angina pektoris (SAP), 24' ü de kontrol grubunda yer aldı. sCD40L ölçümü için kan örnekleri, AKS grubunda hastaneye kabulde, SAP grubu ve kontrol grubunda ise koroner anjiyografi sonrasında alındı. KAH yaygınlığı ve şiddetinin göstergesi olan Gensini skoru, her darlığın derecesi ve bölgesel önemi göz önünde bulundurularak hesaplandı.BULGULAR: Ortalama sCD40L düzeyi, AKS grubunda diğer gruplara göre anlamlı olarak yüksek bulundu (p0.05). AKS alt grupları arasında ortalama sCD40L değerleri arasında anlamlı fark saptanmadı (p>0.05). AKS ve SAP grubunda, Gensini skoru ile sCD40L düzeyleri arasında anlamlı bir ilişki bulunamadı (p>0.05).SONUÇ: Koroner arter hastalığının farklı klinik tiplerinde bakılan sCD40L düzeyleri ile KAH şiddeti ve yaygınlığı arasında ilişki gösterilemedi. AKS grubunda, sCD40L düzeyleri diğer gruplara göre anlamlı olarak yüksek bulundu, ancak AKS grubunun alt grupları arasında anlamlı farklılık gözlenmedi. Bu da artmış sCD40L düzeylerinin, plak rüptürü gelişip, miyokard nekrozu oluşmadan kararsız plağın tespitinde kullanılabileceğini desteklemektedir. BACKGROUND AND OBJECTIVE: The CD40 and CD40 ligand system regulates multiple phases of the humoral and cellular immune response. Both membrane-bound and soluble forms of this ligand may interact with CD40, resulting in various inflammatory responses. Soluble CD40 ligand (sCD40L) especially releases from activated platelets. Platelets are involved in atherosclerotic lesion formation and restenosis processes. According to this knowledge, the aim of our study is to evaluate whether there is a relationship between the level of sCD40L and angiographic extent and severity of coronary artery disease (CAD).METHOD: 102 participants were included to our study (37 patients in acute coronary syndrome (ACS) group, 41 patients in stable angina pectoris group (SAP), 24 patients in control group). Peripheral venous blood samples were drawn at the Coronary Care Unit admission of ACS group patients. From SAP group patients and controls, blood samples collected after coronary angiography. The Gensini score was computed for each patient by assigning the severity score to each coronary stenosis in accordance with the degree of the vessel narrowing and its geographic importance.RESULTS: Mean serum sCD40L level was significantly higher in patients with ACS than the controls and SAP patients (p0.05).CONCLUSION: Our study doesn?t show relation between sCD40L levels and Gensini scores in patients with different clinical sub-types of CAD. In ACS group sCD40L levels were significantly higher than other groups, but there was no significant difference between ACS sub-groups. This finding suggest that increased sCD40L levels can be used as a marker for determining the unstable plaque before ruptured and occuring miyocardial necrosis. 41