Objectives: We investigated the distribution of abdominal obesity among Turkish adults, according to age groups and geographic regions, and the prevalence and type of its clustering with traditional risk factors including high total and low HDL cholesterol levels, smoking, hypertension, and diabetes. Study design: The study included a cohort of 3267 individuals (1607 men, 1660 women; mean age 52±12 years) whose waist circumferences were measured at least one time in the past three surveys of the Turkish Adult Risk Factor Study from 2000 to 2004. Cardiovascular disease was diagnosed on the basis of the presence of angina history, the Minnesota coding of resting electrocardiograms, and a history of stroke. Criteria of the NCEP ATP III guidelines proposed for metabolic syndrome were adopted for defining abdominal obesity and hypertension. Results: Out of every four adults aged 50 years or above, one man and three women had abdominal obesity. The prevalence of abdominal obesity did not exhibit marked changes among geographic regions. Coexistence of 3-5 risk factors in subjects with abdominal obesity showed a significantly higher proportion than other clusters of risk factors (p<0.001). All of the six risk factors studied exhibited significant and independent associations with abdominal obesity in women, whereas in men, only smoking, low HDL-C levels, and hypertension were independent factors. In contradistinction to men, there was an over three-fold adjusted likelihood of diabetes to accompany abdominal obesity in women, with hypercholesterolemia significantly clustering with both. While abdominal obesity conferred an increased likelihood of coronary heart disease through mediation of five risk factors in women, it was found as a residual independent component in men. Conclusion: According to the NCEP ATP III criteria, abdominal obesity is three times more prevalent among Turkish women than in men. The female-specific combination of abdominal obesity, diabetes, and hypercholesterolemia may partly contribute to the comparatively high risk for cardiovascular disease in Turkish women. This study needs a re-evaluation of the role of abdominal obesity in Turkish men with a threshold of ?96 cm, which was previously proposed by the authors.

Objectives: We evaluated the effect of glycoprotein (GP) IIb/IIIa receptor inhibition on ST-segment resolution in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (MI). Study design: We retrospectively analyzed 115 patients (96 males, 19 females; mean age 57.7 years; range 39 to 82 years) who presented with ST-segment elevation acute MI and treated within 12 hours with successful primary PCI (TIMI III flow). Of these, a GP IIb/IIIa receptor blocker (tirofiban) was used in 64 patients. The arithmetic sum of ST-segments was obtained in millimeters on electrocardiograms immediately before angioplasty and after 60 minutes of TIMI III flow restoration. The difference between the two measurements was accepted as resolution of the sum of ST-segment elevation and expressed as ?STR. Results: There were no significant differences between the two treatment groups regarding age, gender, cardiovascular risk factors, laboratory parameters, duration from angina onset to emergency service and from door to angioplasty. Patients who received tirofiban had a greater ?STR than those who did not (7.2±2.8 mm vs 4.2±2.6 mm, respectively; p<0.001). A significant and positive correlation was seen between GP IIb/IIIa inhibition and ?STR (r=0.336, p<0.001). In a multivariate linear regression model including nine variables, GP IIb/IIIa inhibition was found as the only independent determinant of ?STR (p<0.001). Conclusion: Glycoprotein IIb/IIIa inhibition helps preserve microvascular perfusion in patients with TIMI III flow after primary PCI.

Objectives: Although aspirin is widely used for secondary prevention of cardiovascular disease, its effect is not standard in all patients. We aimed to evaluate the frequency of aspirin resistance (AR) in patients taking aspirin for stable coronary artery disease (CAD) and the effect of AR on platelet sensitivity to adenosine diphosphate (ADP). Study design: The study consisted of 100 patients (28 females, 72 males; mean age 56 years; range 30 to 75 years) who had been on aspirin treatment at least for the past seven days for stable CAD. Thirty healthy volunteers (10 females, 20 males; mean age 54 years) without a history of aspirin ingestion within the past seven days comprised the control group. Platelet function was measured by the PFA-100 system and the 95th percentile (170 sec) of the control group was defined as the cut-off value of the closure time at the collagen/epinephrine cartridge to determine AR. Results: Twenty-seven patients (27%) were found to have AR. Seventeen patients (17%) showed a prolonged closure time (range 171 sec to 212 sec) with a maximum increase by 25%, while 34 patients (34%) had no closure at the end of 300 sec. Patients with AR also showed an increased platelet sensitivity to ADP as shown by a significantly shorter closure time (70.0 sec) at the collagen/ADP cartridge compared to that of patients without AR (100.4 sec; p=0.007) or controls (79.0 sec; p=0.03). Patients with and without AR did not differ significantly with regard to age, sex, history of hypertension, diabetes mellitus, hyperlipidemia, smoking, family history of CAD, platelet count and mean platelet volume, and blood levels of urea and creatinine (p>0.05). The duration of aspirin usage and its formulation (enteric-coated or not) were not related with AR. Conclusion: The effect of aspirin is not always desirable and the sensitivity of platelets to ADP is increased in patients with AR, requiring to individualize the antiplatelet treatment.

Ventricular diverticula are usually asymptomatic and associated with other cardiac abnormalities. They are generally diagnosed during early childhood. A 73-year-old woman presented with chest pain with a history of eight years, occurring on physical exertion. Both echocardiography and left ventriculography revealed a true contractile isolated left ventricular diverticulum. The coronary arteries were normal and she did not have any congenital anomaly. During three months of medical therapy with a beta-blocker, angiotensin converting enzyme inhibitor, and aspirin, her complaint of chest pain did not appear.

Aortopulmonary window (APW) is a rare cardiac anomaly. It may be present in conjunction with interrupted aortic arch (IAA). A one-month-old female infant was referred to our institution with suspected aortic coarctation. Physical examination revealed a left parasternal systolic ejection murmur and absence of femoral pulses. Arterial blood pressure was 120 mmHg in upper extremities and 65 mmHg in lower extremities. Transthoracic echocardiography showed a 13-mm communication between the main pulmonary artery and ascending aorta in the subcostal long axis view. There was a 67-mmHg gradient of a coarctation flow pattern across the proximal descending aorta. Surgical intervention was delayed until three months of age due to recurrent pulmonary infections. A type A IAA and a proximal type APW was detected during surgery. Under deep hypothermic circulatory arrest, a single-stage total correction was carried out with end-to-end repair of the IAA and intra-aortic Gore-Tex patch closure of the APW. In the postoperative period, the patient developed recurrent pulmonary infections and transthoracic echocardiography showed persistence of pulmonary hypertension. Three months after surgery, pulmonary hypertension decreased and the general condition of the infant improved. To our knowledge, this is the first reported case of a single-stage repair of APW and IAA in Turkey.

Cardiac papillary fibroelastomas are rare, benign tumors that involve the valvular endocardium. They are clinically important because of their propensity to embolize. A 58-year-old woman presented with complaints of palpitation, dizziness, dyspnea, and weariness, all of which she had not experienced before. Electrocardiographic findings of atrial fibrillation and her hemodynamic instability led to the application of electrical cardioversion, after which the patient restored to normal sinus rhythm. Following clinical improvement, transthoracic echocardiography was performed, in which parasternal short-axis views showed a mobile mass in the free edge of the right aortic coronary cuspid. Transesophageal echocardiographic findings were compatible with a diagnosis of papillary fibroelastoma. Fifteen days after cardioversion, a subsequent echocardiographic examination showed no change in the size of the mass. Although the patient was free of any clinical complaints, surgical removal of the mass was decided due to the potential risk for embolism.

The use of antidepressant and antipsychotic drugs is not generally well-appreciated among physicians other than psychiatrists. Like almost all drugs, they are not devoid of cardiovascular effects. Since cardiac disorders and psychiatric diseases may well coexist, implications of this coexistence should be considered. In this article, the use of antidepressant and antipsychotic therapy is reviewed in patients with cardiac diseases in terms of role, safety, adverse effects, and treatment choice

The benefit of lowering blood pressure in hypertension has been clearly demonstrated. However, apart from their role in lowering blood pressure, there is debate as to whether some antihypertensive drugs confer protection from cardiovascular events. Recently, the effectiveness of beta-blockers has been questioned in the treatment of hypertension. Many controlled randomized trials have compared the older (diuretics and beta-blockers) and newer (calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers) antihypertensive agents. Meta-analyses of these trials have shown that both the older and newer agents are associated with similar reductions in cardiovascular end points. Even though beta-blockers, along with diuretics, have recently been shown to be associated with new diabetic cases, they are still effective in reducing cardiac events in diabetic patients. In the comparison of antihypertensive agents, findings of all recent major studies but one do not negate the effectiveness of beta-blockers. On the basis of available data, one class of antihypertensive drug cannot be favored over others on the grounds that it offers specific benefits apart from its inherent use. Therefore, it is still convenient to consider beta-blockers for the initiation and maintenance of antihypertensive therapy in the majority of hypertensive patients.