Controversy is not resolved whether plasma insulin levels serve as a risk indicator for coronary risk in the general population. The purpose of this cross-sectional study was to evaluate the role of insulin concentrations with respect to prevalent coronary heart disease (CHD) in the Turkish population sample. In 761 men and women (>30 years of age) residing in two large regions of the Turkish Adult Risk Factor Survey in 2001 plasma insulin levels, in addition to other risk parameters, were assessed. Diagnosis of CHD was based on clinical findings and Minnesota coding of resting ECGs. The chemiluminescent immunometric method was used to determine insulin values. Fasting log insulin concentrations in 688 nondiabetic persons averaged 9 in men and 8.8 mlU/L in women (p>0.05); they increased modestly with age. Best determinants of fasting insulin on multivariate analysis were waist circumference (and body mass index). In addition, triglycerides, blood pressure and, inversely, HDL-cholesterol values displayed strong correlations with insulin. In a logistic regression model controlling for age and obesity, the odds ratio (OR) for CHD in the quartle with hyperinsulinemia (≥10 mU/L) as opposed to the lowest quartile was 2-fold in both genders (p<0.05). Adjustment for dyslipidemia, blood pressure, glucose intolerance, physical activity and smoking status did not attenuate the OR, nor did adding C-reactive protein into the model (which was correlated with fasting insulin only in women). Thus, hyperinsulinemia may not only add useful information on CHD likelihood to that provided by the other risk factors, it may also contribute to the coronary risk independent of the latter factors.

Growth hormone deficiency can increase cardiovascular mortality and morbidity, negatively affecting some risk factors, like lipid profile known to predispose to coronary artery disease. The aim of this study was to investigate the effects of growth hormone replacement therapy (GHRT) on impaired lipid profile, blood pressure and body composition. Method: Twenty patients (13 females, mean age: 51±6 years; 7 males, mean age: 46±13 years) who were followed-up at the Endocrinology clinic due to hypopituitarism with no cardiac involvement (normal ECG, echo, and holter monitoring) were included in the study. The diagnosis was based on the insulin tolerance test. The patients, who were on the replacement therapy also for other pituitary hormone deficiencies, were planned to receive GHRT for 2 years in doses recommended by the Growth Hormone Society Workshop. Data from 20 patients, who received GHRT for 6 months were assessed in this study. At baseline, third and sixth months after GHRT, total cholesterol, triglycerides, HDL- and LDL- cholesterol and fasting blood glucose levels were measured; systolic and diastolic blood pressures, body mass index (BMI), waist-hip-ratio (WHR) were also evaluated. Results: Before treatment, cardiological findings were normal in all patients. While BMI of the patients did not change during the treatment, WHR decreased significantly (p<0.05). Blood pressures at baseline, were normal and remained so after the treatment. Total and LDL-cholesterol levels dropped significantly (p<0.05). There was a significant increase in HDL levels (p<0.05). Although triglycerides and fasting glucose levels showed an increasing tendency, the difference from baseline did not reach a significant level. Conclusion: With a 6-month GHRT, an improvement in cardiovascular risk factors has been observed; an improvement in lipid profile and a decrease in abdominal obesity. However, it is questionable whether these favorable effects will continue in the long-term. Therefore, it is obvious that there is a need for long-term prospective studies with GHRT.

Aim: This study aims to evaluate the elastic properties of the aorta and its relation with the left ventricular diastolic function in patients with hypertension (HT) and/or diabetes mellitus (DM) by using routine echocardiographic methods and Schieken's method. Methods: Study groups were composed of 2 1 normal subject, 21 patients with HT, 21 with DM, and 15 with HT +DM. The aortic strain, be ta index, distensibility and Schieken index were evaluated as aortic elasticity parameters. Aortic elasticity parameters of normal and patient groups were compared. The correl ations of Schieken index with three other parameters were evaluated by simple linear regress ion analysis. Multivariate analysis was performed for deterıninants of the left ventricular diastolic fu nction. Findings: There were signi ficant differences between normal and patient groups (HT, DM, HT +DM) for acıtic strain (21.62±6.26 vs. 8.93±3.16, 11.48±3.78 and 7 .1 7±2.74 %, p

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Aim: This study was planned to evaluate the relationsh ip of th e change in the myocardial performance index (MPI) obtained by low dose dobutamine stress echocardiography (DSE) with the myocardial improveınent after revascularization and its value in ident ify ing the significant viable myocardial tissue in patients with acute myocardial infaretion (AMI). Methods: Forty patients (mean age 57±9 years, 6 female) with Q-AMI, who had no prior myocardial infarction, were enrolled. The wall motion score index (WMSI) and MPI we re obtained echocardiographically in basal and low dose DSE in all patients and in the second month after revascularization in 24 revascularized patients. The WMSI was assessed qualitatively by seering normal to dyskinesia (1-4 points) according to 16- segınents model. Results: The MPI and WMSI obtained by low dose DSE were similar to those after revascularization (0.5±0.14 and 1.24±0.24 vs. 0.52±0. 15 and 1.28±0.22, p

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Recent studies have shown that elevation in hoınocysteine (Hey) levels is an independent risk factor other than classical risk factors for atherosclerotic coronary artery disease (CAD). In our study, we aimed to investigate the role of Hey in CAD, its association with vitamin B12 (B12), folic acid (FA) and severity of stenotic lesi on. This study was ınade in the Cardiology Department of Uludağ University Medical Faculty between June 1998 and August 1999 among persons in whoın a coronary angiography was perforıned. The coronary angiographies were evaluated quantitatively by two experienced cardiologists who were unaware of the laboratory findings. In order to show lesion severity of CAD, coronary artery lesions were assessed according to the Gensini scoring system. Blood sa ınp les were drawn from patients for serum Hey, B12 and FA levels. Role of hey in atherosclerotic coronary artery disease; and its association with B 12, FA and lesion stenotic severity were examined statistically. Coronary angiography was coınp lete l y normal in 45 of 209 patients. In 164 patients, coronary lesions were detected. In the group with CAD; mean age, male/female ratio, ineidence of smoking and diabetes, levels ofB12, FA, Hey and total cholesterol were higher than the group without CAD and the differences between the groups were statistically significant (p<0.05). In the study group when the binary logistic regression test was used for determination of coronary risk factors, elevated levels of hey were found as an independent risk factor other than classical risk factors and were fo und to increase risk of having CAD 1.6 times (p

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S ince the coronary risk profile of Turkish adults was found to differ significantly from Western populations and international guidel ines on prevention are considered to have shortcomings for Turks, a new approach was sought. W ith the purpose of comprising into a prevention program those individuals at high risk who have thus far not been included in primary and secondary coronary prevention, the thesis is proposed (based on the database of the Turkish Adult Risk Factor Study) that the upper limit of nomıal total cholesterol (TC) levels be reduced to 180 ıng/di. Of the estiınated 5 million adults harboring levels of TC 180-200 ıng/di , about 800,000 are considered to be at high coronary risk. Subjects at high risk were defined by a TC/HDLcholesterol ratio >5 in men aged (50 or women aged (60 years. Even in primary prevention in this group, the benefit of drug therapy should not be withheld, in addition to lifesryle changes, with the aiın of improving the dyslipidemia involving plasma triglycerides and HDL-cholesterol. The hypothesis was suppoıted not only by mathematical and ınetabolic evidences, but also by the British recommendations and the Framinghaın risk function as well as the findings of the Turkish Adult Risk Factor Study. If these criterla are incorporated into the forthcoming g uidelines of the Turkish Society of Cardiology and are iınplemented, a significant proportion of the estimated 45-50,000 new coronary events each year occurring in persons with TC levels of 180-200 mg/d! ınay be prevented.

Congestive heart failure (CHF) is a rather freq uent disease especially in the older population. This disease has a very grave prognosis and death usually comes suddenly. Despite the ratio of sudden death approaches 80% in groups with relatively well functional capacity sudden death rate drops to 5 % in end-stage patient groups. Nevertheless, the cause of sudden death shifts from vent ri cula r tachycardia/ fibrill a tion to bradyarrhythmias when illness becomes grave. Many comprehensible reasons, such as myocardial fibrosis, stretch, increased sympathetic drive, el ectrolyte imbalance, may easily cause ventricular arrhythmia in fa iling hearts. Holter monitoring, signal averaged e lectroca rd iogram, prog rammed ventric ular stimulation procedures are used to find out the population under ri sk. Randemised trials have been designed to seek the most advantageous drug in terrns of reducing the arrhythmic and total mortality. Unfortunately, even amiodarone fa iled to show any impressive benefit to reduce deaths in population at ri sk. Implantable cardioverter defıbrillator devices (ICD) seem to be very promising to reverse the evi) course .

Epidemiologic studies have shown that not only raised low density lipoprotein cholesterol but also dyslipidaeınic syndromes characterized by e levated plasma triglyceride and lo w high dens ity lipoprotein cholesterol are powerful risk factors for coronary heart d isease (CHD). Co ın b i ned hyperlipidemia and atherogenic l ipopro tein phenotype are the most common dyslip idaemia types seen in patients with CHD. An alternative approach is to increase high density lipoprotein cholesterol (HDL-c) level and to decrease plasma triglyceride (TG) level in addi tion to decreasing level of low density lipoprotein cholesterol (LDL-c) to reduce the risk of CHD. It is known that fibrates are useful for the treatment of low HDL-c with or without hypertrigliceridaemia. The recommendation for the use of fibrates in certain types dyslipidaemia has gained additic nal support from Helsinki Heart Study. Fibrates are a broad spectrum lipid lowering drug. They increase the HDL-c level while decreasing plasma TG level and LDL-c cons iderably. F urthe rmore, they change the composition of LDL-c. Highly atherogenic smail , dense LDL particules are converted to less atherogenic large LDL particules. The effects of fibrates are mediated by nuclear hormone recepter termed peroxisÔme proli fe rator activated reseptor (PPAR). Fibrates bi nd to PPAR and initiate a sequence of events that lead to hypolipidaemic effect. It has been supported by the recent data from multicenter large elinical studies that fi brates can be used safely and they can decrease CHD mortality and ın orbidi ty cons iderably by rai s ing HDL-c and lowering TG. In this rev iew, we focused on the mechanism of action of fi brates on the lipid metabolism and elinical studies investigating their effecs on CHD mortality/mo rbidity and elin ical indications.