Objective: To assess the prevalence of obesity and abdominal obesity in Turkish adults.
Methods: This is a nationally representative cross-sectional study. From both urban and rural areas of seven geographical regions of Turkey 2110 men and 2154 women with a mean age of 40.9±14.9 years (range 20-90) were included in this study. Demographic, anthropometric data were collected and biochemical analyses of blood lipids and glucose levels were performed in all participants. Statistical analyses were performed using Chi-square, unpaired t and two-way ANOVA tests. Stepwise logistic regression analysis was applied for the study of association of obesity with cardiometabolic risk factors.
Results: The prevalence of the overweight was 36.0% (41.5% in men and 30.6% in women) and the prevalence of obesity was 30.4% (20.6% in men and 39.9% in women). The prevalence of obesity was similar in rural and urban areas. The prevalence of abdominal obesity and metabolic syndrome were 36.2% and 40.9 % according to American Heart, Lung, and Blood Institute criteria and 58.7% and 42.6% according to International Diabetes Federation criteria, respectively. Abdominal obesity and metabolic syndrome were significantly more prevalent among women. After adjusting for age, sex and other cardiometabolic risk factors, abdominal obesity was significantly associated with increases in body mass index (odds ratio [OR] per 5 kg/m2 increase 1.61, 95% CI 1.52-1.69) and triglycerides (OR per 10 unit increase 1.02, 95% CI 1.01-1.02) and negatively associated with total cholesterol (OR 0.95, 95% CI 0.94-0.96), high-density lipoprotein cholesterol (OR 0.96, 95% CI 0.93-0.99), systolic blood pressure (OR 0.95, 95% CI 0.92-0.98) and diastolic blood pressure (OR 0.94, 95% CI 0.90-0.99).
Conclusion: Obesity and abdominal obesity are major problems for Turkish adults, especially for Turkish women. Our finding is alarming for cardio-metabolic complications and underscores the need for population-based strategies to modify lifestyle related risk factors. (Anadolu Kardiyol Derg 2008; 8: 401-6)

Objective: In this study, we aimed at comparing the effects of standard once daily 20 mg atorvastatin treatment with that of atorvastatin 20 mg administered every other day on serum lipids and high sensitive C-reactive protein (hs-CRP) levels.
Methods: Sixty-one patients with serum total cholesterol levels of above 200 mg/dl and low density lipoprotein (LDL) - cholesterol levels of above 130 mg/dl were included in this prospective, randomized study. The patients were randomized into daily treatment of 20 mg atorvastatin (standard treatment) and 20 mg atorvastatin every other day (every other day treatment) groups. Before the treatment and at each visit, serum lipids and hs-CRP levels of all the patients were measured. Statistical analyses were performed Chi-square, unpaired t and two-way repeated measurements ANOVA tests.
Results: In the every other day treatment group, there was a 36.1% reduction in LDL-cholesterol levels by the end of first month (p<0.01). At the end of three months there was further decrease of 10.2% in LDL-cholesterol levels when compared to 1 month levels (p>0.05). The LDL cholesterol levels of the group receiving 20 mg atorvastatin every day was reduced by %41 by the end of 1 month (p<0.01). At the end of three months, the difference between the changes in the all lipid parameters of the two groups was not found to be of statistical significance. In the group receiving the medication every other day, there was a 21% decrease in hs-CRP levels compared to the basal measurements at the end of first month (p<0.05). In the group, receiving the medication every day the decrease in hs-CRP levels at the end of one month was more striking (37%, p<0.05). However, the effects of both treatment arms on hs-CRP levels, did not differ significantly (p>0.05).
Conclusions: Alternate-day dosing of atorvastatin causes a significant lipid-lowering and antiinflammatory effects similar to that of daily administration and yet may provide some cost savings. (Anadolu Kardiyol Derg 2008; 8: 407-12)

Objective: We aimed in this study to investigate the differences in left ventricular (LV) structure, function and elastance parameters in the patients with normotensive blood pressure (BP) levels.
Methods: A total of 294 normotensive patients (<140/90 mmHg) (135 males, mean age: 45±11 years; 159 females, mean age 38±10 years) were enrolled into the present cross-sectional study. Patients were categorized into three groups according to their BP levels as optimal BP (<120/80 mmHg), normal BP (120-129 / 80-84 mmHg) and high normal BP (129-139 / 84-89 mmHg) groups. We evaluated LV structure and functions byusing Doppler echocardiography in all participants. Afterwards we compared the measurements for revealing the echocardiographic differences among the BP groups. In this study, one-way ANOVA Kruskal-Wallis, one-way ANCOVA and partial correlation analysis tests were used for the statistically evaluation of the data. In addition, relative risk ratios (RR) were also calculated for determination of the effects of BP levels to echocardiographic parameters.
Results: There were significant statistical differences in left atrial diameter (LA) (p=0.002), transmitral A wave velocity (A) (p=0.002), meridional wall stress (MWS) (p<0.001), pulmonary capillary wedge pressure (PCW) (p=0.029) among BP groups. After the correction of the data for anthropometric measurements, multiple comparisons have shown that only end-systolic (Es) and end-diastolic elastance (Ed) were different between the normal and high-normal BP groups (for Es, p=0.013; for Ed, p=0.007). But it was found that optimal BP group had significant differences in LV structure and function parameters when compared to high normal BP group (for LA, p=0.028; for A, p=0.035; for MWS, p=0.002; for Es, p<0.001; for Ed, p<0.001). Besides, increased RR were detected for increased left atrial diameter index and pulmonary capillary wedge pressure values in high-normal BP group (RR: 1.537, 95% CI (1.197-1.974), p=0.005 and RR: 1.272, 95% CI (1.089-1.485), p=0.032, respectively).
Conclusion: Pathologic changes in LV due to increasing BP begin at below-hypertensive BP levels. It could be possible that normal BP stage is the beginning level of these changes. (Anadolu Kardiyol Derg 2008; 8: 413-21)

Amaç: Sigara ve kolesterol düzeyleri aterosklerozun iki önemli bileşenidir. Ortalama trombosit hacmi (OTH), trombosit aktivasyonunun bir göstergesidir. Sigara içiminin trombosit fonksiyonları ve lipitler üzerine etkisi olduğunu gösteren az sayıda çalışma bulunmaktadır. Sağlıklı genç yaş grubunda daha azdır. Çalışmamızda sağlıklı genç yaşlardaki kişilerde sigaranın ortalama trombosit hacmi ve lipit düzeylerine etkisini araştırdık.
Yöntemler: Enine-kesitli çalışmamıza toplam 102 (sigara içen 56, içmeyen 46, yaş ortalamaları 22.8) sağlıklı genç erkek olgu alındı. Hipertansiyon, diyabet, obezite, koroner arter hastalığı, bilinen lipit metabolizma bozukluğu, kronik seyirli diğer hastalıkları olanlar ve ilaç kullananlar çalışmaya alınmadı. Olguların bel çevresi, kan basıncı, vücut kitle indeksi (VKİ), kan lipid değerleri ve ortalama trombosit hacimlerine baktık. İstatistiksel inceme için Student’s t testini ve Pearson korelasyon analizini kullandık.
Bulgular: Sigara içen grupta yüksek yoğunluklu lipoprotein (HDL)-kolesterol 44.1±8.7 mg/dl, içmeyen grupta 49.7±7.6 mg/dl (p=0.013) idi. Trigliserid(TG) değerleri sigara içenlerde 98.6±53.0 mg/dl, içmeyenlerde 71.5±43.0 mg/dl (p=0.041) idi. Çok düşük-yoğunluklu lipoprotein (VLDL)-kolesterol sigara içenlerde 19.7±10.8 mg/dl, içmeyenlerde 14.2±8.6 mg/dl (p=0.038). Ortalama trombosit hacmi sigara içenlerde 8.57±0.8 fl, içmeyenlerde 8.67±0.8 fl. (p=0.66) olarak saptadık.
Sonuç: Çalışmamızda aterosklerozun erken dönemi olan genç yaşlarda sigara içimi ile HDL-kolesterolün azaldığı, TG değerlerinin arttığını saptarken, OTH’nin değişmediğini gözledik. (Anadolu Kardiyol Derg 2008; 8: 422-5)

Objective: Smoking and cholesterol levels are two significant causes of atherosclerosis. Mean platelet volume (MPV) is an index of platelet activation. Only limited numbers of studies showing the effect of smoking on platelet function are published. Even less studies exists regarding the effect of smoking on platelet function in young healthy population. The current study investigated the effects of smoking on the MPV of the young healthy male population.
Methods: A total of 102 (smoking 56, nonsmoking 46, medium ages: 22.8) healthy young male individuals were included into this crosssectional study. The subjects with hypertension, diabetes, obesity, coroner arterial diseases, lipid metabolism disorders, other chronic diseases were excluded. Subjects’ waist circumference, blood pressure, body mass index (BMI) serum lipid profile and mean platelet volume were recorded. Statistical analyses were performed with student t test and Pearson correlation analysis.
Results: High density lipoprotein(HDL) cholesterol levels were lower in smoking group (44.1±8.7 mg/dl) compared with nonsmoking group (49.7±7.6 mg/dl) (p=0.013). Triglyceride levels were higher in smoking group (98.6±53.0 mg/dl) compared with nonsmoking group (71.5±43.0 mg/dl) (p=0.041). Very low-density lipoprotein (VLDL) cholesterol levels were also found to be higher in smoking group (smoking group: 19.7±10.8 mg/dl; nonsmoking group: 14.2±8.6 mg/dl; p=0.038). However, no significant difference was found for MPV between the groups (smoking: 8.57±0.8 fl; nonsmoking: 8.67±0.8 fl; p=0.66)
Conclusion: The results of the current study revealed higher VLDL-cholesterol and triglyceride levels and lower HDL-cholesterol levels in smoking group and no significant difference was observed for MPV between the smoking and nonsmoking young aged healthy male subjects possibly in the early period of atherosclerosis. (Anadolu Kardiyol Derg 2008; 8: 422-5)

Objective: Non-invasive mechanical ventilation (NIMV) has the potential to improve sympathovagal control of heart rate. The aim of this study was to investigate the acute effects of NIMV on heart rate variability (HRV) in chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure (HRF).
Methods: In this prospective study 28 COPD patients (64±10 years) with HRF underwent electrocardiographic Holter monitorization. Both time domain (TD) and frequency domain (FD) means of HRV analysis were measured for two hours before and during NIMV application. For the TD, mean-RR, SDNN, SDANN, SDNN index, RMSSD, pNN50 and HRV triangular index were measured. For FD, high frequency (HF) and low frequency (LF) were detected. To compare HRV parameters before and during bi-level positive airway pressure (BiPAP) application; paired sample t test was used for normally distributed variables and Wilcoxon signed rank test was used for the variables that were not normally distributed. Pearson correlation test was used to analyze the correlation between HRV and blood gas parameters during BiPAP application.
Results: High frequency power of HRV (39 (18-65) ms2 vs. 28 (12-50) ms2, p<0.05), HRV triangular index (9 (3-17) units vs. 6 (2-13) units, p<0.05) and pNN50 (59% (13-110) vs. 42% (5-84), p<0.05), were higher during NIMV than before noninvasive mechanical ventilation.
Conclusions: We think that NIMV may improve heart rate variability indices of parasympathetic modulation of heart rate in COPD cases with HRF and decrease arrhythmic potential. (Anadolu Kardiyol Derg 2008; 8: 426-30)

Objective: The purpose of this study was to compare treatment of saphenous vein graft (SVG) lesions with paclitaxel-eluting (PES) and sirolimus-eluting stents (SES) in daily practice with regard to short- and long-term clinical outcomes.
Methods: Between August 2002 and September 2006, a total of 71 patients with SVG lesions who were implanted PES or SES with percutaneous coronary intervention in our center were evaluated retrospectively. Forty-six patients with PES (PES group) were compared to twenty-five patients treated with SES (SES group) in terms of in-hospital, 30-day, six-months and 1-year clinical outcomes. Statistical analyses were performed using Chi-Square statistics or Fisher’s exact and independent sample t test. Survival analysis was done using Kaplan-Meier method and log-rank test.
Results: Baseline clinical characteristics were similar in both groups except for a tendency toward a lower age in the SES group. No statistically significant difference was found between two groups by means of lesion and procedural characteristics. All clinical outcomes at 30-day, 6-month and 1-year after the interventions were similar in both groups. Early stent thrombosis was detected in one patient (2.2%) of PES group (p=0.65). Late stent thrombosis was not observed in both groups. The rate of major adverse cardiac events at 1-year was 8.7% in the PES group and 16% in the SES group (p=0.44).
Conclusion: Short- and long-term clinical outcomes of PES and SES in the treatment of SVG lesions are similar. The results of our study showed that both drug-eluting stents are effective and safe in real-world patient with diseased SVGs. (Anadolu Kardiyol Derg 2008; 8: 431-6)

Objective: We aimed to evaluate the efficacy of low dose N-acetylcysteine (NAC) against myocardial ischemia-reperfusion damage in coronary artery bypass surgery accompanied by cardiopulmonary bypass (CPB).
Methods: Thirty patients operated due to triple coronary artery disease were enrolled into this prospective randomized study (control groupn= 15 and NAC group - n=15). N-acetylcysteine was added to induction cardioplegia solution in dose of 4 mmol/l and in dose of 2 mmol/l to maintenance cardioplegia solution in the NAC group. Hemodynamic measurements were performed before and after anesthesia with different intervals. Creatine kinase-MB (CK-MB) levels were analyzed during 24 hours postoperatively. Blood samples were obtained from coronary sinus before CPB (T1), just before the cross-clamp removed (T2) and 30 minutes later (T3). Malondialdehyde (MDA), glutathione peroxidase (GSH-Px), nitric oxide (NO) levels and neutrophil percentage were determined. Statistical analysis was performed using student’s t test, Chi-square and two-way ANOVA tests.
Results: There were no significant differences between the two groups with regard to the hemodynamic parameters, and CK-MB levels. The MDA levels were significantly lower in NAC group than in control group during reperfusion period (0.75 nmol/l vs 0.88 nmol/l, p<0.05). Neutrophil percentage in coronary sinus blood was significantly lower in NAC group than in control group during the reperfusion period (77.6% vs 82.7%, p<0.05). The GSH-Px and NO levels were also not statistically different between groups.
Conclusion: Low dose NAC as an adjunct to cardioplegic solutions effectively reduces myocardial oxidative stress in coronary bypass surgery with cardiopulmonary bypass, but may not restore the myocardial injury. (Anadolu Kardiyol Derg 2008; 8: 437-43)

Objective: We aimed to investigate whether limb-salvage bypass operation improves outcomes in patients with critical infrapopliteal ischemia and poor or no distal arterial flow on angiography.
Methods: Forty-nine patients with severe tibial and peroneal occlusive disease and poor distal arterial flow on angiography were included in this prospective study. The age ranged from 57 to 82 years in the surgical group and 63 to 80 in the medical group. Patients had class III or IV disease according to Fontaine classification. Preoperative arterial Doppler ultrasonography and arteriography were performed in all patients. The ankle-brachial index (ABI) was calculated preoperatively and postoperatively in all of the cases. Twenty-three patients underwent distal bypass operation. Other 26 patients were followed with medical therapy. The outflow distal anastomoses were performed on posterior tibial, dorsal pedal, anterior tibial, peroneal, and lateral plantar arteries. All patients were followed-up for 3 years and clinical outcomes were recorded. The statistical analyses were performed using unpaired t, Mann Whitney and Wilcoxon tests.
Results: There were 3 early and 2 late graft failures. Limb salvage rates were 84.2%, 84.2%, 73.7% in the surgical group, and 82.8%, 69.9%, 64.3% in the medical group respectively in 6 months, 1 year, and 3 years. According to statistical analysis; the levels of the amputations tend to be lower in the surgical group than in the medical group but it was not significant statistically. Surgical treatment reduced the amputation ratio (p<0.05) but medical therapy did not (p>0.05). The difference between preoperative mean ABI [0.26±0.06] and postoperative mean ABI [0.80±0.24] was significant (p<0.05).
Conclusion: We think that limb-salvage bypass operation may be preferred for patients with critical limb ischemia and poor distal flow on angiography. Infrapopliteal bypass will provide limb salvage and a functional extremity. (Anadolu Kardiyol Derg 2008; 8: 444-8)

Kalp hislerin, tutkuların, aşkın, kaynağı, makarı olarak değerlendirilegelmiş1; ama, XIX. yüzyılın başından itibaren bilim adamlarının, bunların kaynağının başımızdaki beynin olduğunu açıklamaları ile, zaman içersinde kalbin işlevi, fizyolojik boyutu ile sınırlanmıştır. Günümüzde kalbin, organizmanın gereksinimlerini karşılamaya yeterli kanı pompalamak ile görevlendirilmiş bir organ olduğu, bunu miyokardın (miyokard hücrelerinin) içrek özellikleri, Frank-Starling kanunu ve nörohümoral bir katkı ile sağlandığı hepimizce bilinmektedir. Zaman içine gerilimlerin kalp zararlanmalarına veya işlevsel bozukluklara yol açtığı, aritmilerin otonom sinir sistemi ile ilgisi olduğu, müphem olsa da anlaşılmıştır. Kalbin içrek kardiyak sinir sistemi olduğu, afferent, internöron ve efferent sempatik ve parasempatik nöronları ile karmaşık içsel kardiyak gangliyonlarını içeren kalbin kendisinin bir “beyni’”olduğu, günlük kardiyoloji uygulamalarımızda pek dikkate alınmamaktadır. Bu derleme kardiyak regülasyonunun ilk basamağı olarak içrek kardiyak gangliyonların yapı ve fonksiyonlarını aydınlatmaktadır. Bu konu farmakolojik tedavilerin hedefleri ve cerrahi girişim teknikleri (septal defektlerin tamiri, kapak girişimleri, konjental düzeltmeler) açısından önem taşımaktadır. (Anadolu Kardiyol Derg 2008; 8: 451-4)

Heart has been considered as the source and the seat of emotions, passion and love. But from the dawn of XIXth century, scientists have emphasized that the heart, though life depends on its ceaseless activity, is merely a electromechanical pump, pumping oxygenated blood. Nowadays, we all know that heart pumps blood commensurate with the needs of the body and this unending toil, and its regulation depends on the intrinsic properties of the myocardium, Frank-Starling Law and neurohumoral contribution. It has been understood, though not clearly enough, that these time-tensions may cause structural or functional cardiac impairments and arrhythmias are related to the autonomic nervous system. Less well known and less taken in account in daily cardiology practice is the fact that heart has an intrinsic cardiac nervous system, or “heart brain” consisting of complex ganglia, intrinsic cardiac ganglia containing afferent (receiving), local circuit (interneurons) and efferent (transmitting) sympathetic and parasympathetic neurons. This review enlightens structural and functional aspects of intrinsic cardiac ganglia as the very first step in the regulation of cardiac function. This issue is important for targets of pharmacological treatment and techniques of cardiac surgery interventions as repair of septal defects, valvular interventions and congenital corrections. (Anadolu Kardiyol Derg 2008; 8: 451-4)