Aydogan Aydogdu

Relationship of cystatin C with coronary artery disease and its severity.

ObjectiveCystatin C, which is an endogenous marker for renal function, is reported to be a novel marker for coronary atherosclerosis. In this study, we aimed to evaluate its role in determining the presence and also the severity of coronary atherosclerosis in patients with coronary artery disease (CAD). Materials and methodsEighty-eight patients who underwent elective coronary angiography were enrolled in the study. Patients with heart failure, renal failure, diabetes, and thyroid disease were excluded from the study. The study population was divided into three groups: individuals with normal coronary arteries, patients with critical CAD, and patients with noncritical CAD. We also analyzed the relationship of cystatin C levels with the presence and the severity of CAD and the number of vessels involved. ResultsThe mean age of the study group was 51.73±9.21 years, and the majority were men (n=71, 80.7%). Cystatin C levels were significantly lower in patients with CAD (1334.86±93.45 vs. 836.49±411.29, P<0.001). It was significantly lower in patients with critical CAD compared with those with noncritical CAD and normal individuals (656.60±346.35, 1016.38±396.54, and 1334.86±393.45, P<0.001, respectively). Serum levels of cystatin C according to the numbers of coronary vessels such as none, single-vessel, two-vessel, three-vessel, and four-vessel disease were as follows: 1334.86±393.45, 801.67±418.70, 993.90±457.34, 744.09±354.53, and 682.30±294.43, respectively. ConclusionLower cystatin C levels may be associated with increased severity of CAD in clinically stable patients, whereas higher levels may indicate the presence of any vulnerable plaque. It may also guide the diagnostic and therapeutic options for the clinical scene on the presentation.

Metabolic syndrome and the effect of testosterone treatment in young men with congenital hypogonadotropic hypogonadism

OBJECTIVE The relationship between metabolic syndrome (MS) and hypogonadism has always been investigated in study groups confounded with aging, obesity or chronic metabolic disorders. So far, there has been no data about the presence of MS in young hypogonadal patients. Also, there is controversial data about the metabolic effects of testosterone replacement therapy. We investigated the frequency of MS in treatment-naïve, young men with congenital hypogonadal hypogonadism (CHH). We also searched for the effect of testosterone replacement on the metabolic profiles of this specific patient group. DESIGN Retrospective analysis. METHODS A total of 332 patients (age 21.68 ± 2.09 years) were enrolled. The control group included 395 age- and body mass index (BMI)-matched healthy young men (age 21.39 ± 1.49 years). Standard regimen of testosterone esters (250 mg/3 weeks) was given to 208 patients. RESULTS MS was more prevalent in CHH (P<0.001) according to healthy controls. The patients had higher arterial blood pressure, waist circumference (WC), triglyceride (P<0.001 for all), fasting glucose (P=0.02), fasting insulin (P=0.004), homeostatic model assessment of insulin resistance (HOMA-IR) (P=0.002) and lower high density lipoprotein (HDL) cholesterol (P<0.001) levels. After 5.63±2.6 months of testosterone treatment, the BMI, WC (P<0.001 for both), systolic blood pressure (P=0.002) and triglyceride level (P=0.04) were increased and the total and HDL cholesterol levels were decreased (P=0.02 and P<0.001 respectively). CONCLUSIONS This study shows increased prevalence of MS and unfavorable effects of testosterone replacement in young patients with CHH. Long-term follow-up studies are warranted to investigate the cardiovascular safety of testosterone treatment in this specific population.

High plasma level of long Pentraxin 3 is associated with insulin resistance in women with polycystic ovary syndrome

Objectives: Polycystic ovary syndrome (PCOS) is characterized by insulin resistance. Chronic low-grade inflammation has been anticipated to play role in the pathogenesis of both insulin resistance and atherosclerosis. Pentraxin 3 (PTX3) is an inflammatory mediator synthesized in a variety of cells and tissues including heart, vascular endothelial cells, macrophages and adipocytes. In the present study, serum PTX3 level and its relationship with insulin resistance were investigated in patients with PCOS. Materials and Methods: Forty patients with PCOS and 40 age- and body mass index (BMI)-matched healthy controls were enrolled in the study. PTX3 and high-sensitivity C-reactive protein (hs-CRP) levels were determined by enzyme immunoassay (EIA). Insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR) formula. Results: Plasma levels of PTX3, hs-CRP and HOMA-IR scores were all significantly higher (p = 0.021, p = 0.002 and p = 0.0001, respectively) in women with PCOS compared with healthy controls. Blood PTX3 level correlated positively with hs-CRP, BMI, waist-to-hip ratio (WHR), HOMA-IR and negatively with high-density lipoprotein cholesterol level (p < 0.05, for all). After adjustment for age and BMI, PTX3, total testosterone levels and BMI remained as independent predictors of HOMA-IR scores (p < 0.05, for all). Conclusion: PTX3 level is increased in patients with PCOS in concordance with insulin resistance.

The Accuracy of Home Glucose Meters in Hypoglycemia

BACKGROUND Home glucose meters (HGMs) may not be accurate enough to sense hypoglycemia. We evaluated the accuracy and the capillary and venous comparability of five different HGMs (Optium Xceed [Abbott Diabetes Care, Alameda, CA, USA], Contour TS [Bayer Diabetes Care, Basel, Switzerland], Accu-Chek Go [Roche Ltd., Basel, Switzerland], OneTouch Select [Lifescan, Milpitas, CA, USA], and EZ Smart [Tyson Bioresearch Inc., Chu-Nan, Taiwan]) in an adult population. METHODS The insulin hypoglycemia test was performed to 59 subjects (56 males; 23.6 +/- 3.2 years old). Glucose was measured from forearm venous blood and finger capillary samples both before and after regular insulin (0.1 U/kg) was injected. Venous samples were analyzed in the reference laboratory by the hexokinase method. In vitro tests for method comparison and precision analyses were also performed by spiking the glucose-depleted venous blood. RESULTS All HGMs failed to sense hypoglycemia to some extend. EZ Smart was significantly inferior in critical error Zone D, and OneTouch Select was significantly inferior in the clinically unimportant error Zone B. Accu-Chek Go, Optium Xceed, and Contour TS had similar performances and were significantly better than the other two HGMs according to error grid analysis or International Organization for Standardization criteria. The in vitro tests were consistent with the above clinical data. The capillary and venous consistencies of Accu-Chek Go and OneTouch Select were better than the other HGMs. CONCLUSIONS The present results show that not all the HGMs are accurate enough in low blood glucose levels. The patients and the caregivers should be aware of these restrictions of the HGMs and give more credit to the symptoms of hypoglycemia than the values obtained by the HGMs. Finally, these results indicate that there is a need for the revision of the accuracy standards of HGMs in low blood glucose levels.

The relationship between severity of coronary artery disease and plasma level of vascular endothelial growth factor.

OBJECTIVE It has been known that ischemia or occlusion of coronary arteries in animal models increases the production of vascular endothelial growth factor (VEGF); however, little is known about the relationship between coronary artery disease and VEGF in humans. In this study, our aim was to evaluate the relationships between the degree of coronary occlusion and plasma VEGF level as well as other risk factors, including age, weight, arterial blood pressure, cholesterol, triglyceride, blood glucose, and high-sensitive C-reactive protein (hsCRP) in patients with established coronary artery disease. MATERIALS AND METHODS Our study group consisted of 77 patients. Of these, 38 patients had normal coronary angiography (control group; group C) and 39 had abnormal angiography (17 critical lesion; group CL, 22 noncritical lesion; non-CL group). RESULTS Plasma VEGF level was 116.95+/-30.12 pg/ml in the control group, 212.47+/-75.28 pg/ml in group CL, and 138.89+/-45.18 pg/ml in the non-CL group. Plasma VEGF level of group C was found to be lower than that of group CL (P<.05), but the difference between groups C and non-CL was insignificant (P>.05). However, logistic regression analysis showed that VEGF level of group CL was significantly higher (P<.001). There was a negative correlation between VEGF and haemoglobin (r=-0.58, P<.01), and positive correlation between VEGF and age (r=0.29, P<.04). There was no relationship between plasma VEGF level and other cardiac risk parameters. Group CL had a higher level of total and LDL-cholesterol levels. CONCLUSION Increased plasma VEGF levels in patients with coronary artery disease may point that the coronary lesion is critical, and VEGF increase in patients with established coronary artery disease may be used as an indicator of the need for revascularization.

Cognitive and functional influences of vildagliptin, a DPP-4 inhibitor, added to ongoing metformin therapy in elderly with type 2 diabetes.

INTRODUCTION Diabetes mellitus has been linked to cognitive decrement faster than usual. Medical management of diabetes can also interfere with the cognitive skills. The purpose of this study was to evaluate the effects of vildagliptin on cognition, as an add-on to metformin therapy in elderly patients with type 2 diabetes mellitus. MATERIALS AND METHODS This was a prospective and observational investigation conducted in 10 elderly type 2 diabetes mellitus patients who were started treatment with vildagliptin 50 mg twice daily to ongoing metformin. All participants underwent detailed clinical cognitive assessment and neuropsychological testing with mini mental state examination (MMSE) and clock drawing test (CDT), along with measurement of functional parameters at entry and study completion. RESULTS Mean follow-up time was 10.9±3.7 months. No subjects reported significant side effects during the study. At follow-up, in accordance with the clinical assessment, neither MMSE nor CDT showed significant changes after addition of vildagliptin to metformin. Basic and instrumental activities of daily living (BADL and IADL), mini nutrition assessment and geriatric depression scale scores also remained unchanged between the two evaluations. DISCUSSION In this pilot study, addition of vildagliptin to ongoing metformin therapy in elderly with diabetes was accompanied by stable cognitive and functional performance after almost one year of follow-up.

Effects of three different medications on metabolic parameters and testicular volume in patients with hypogonadotropic hypogonadism: 3‐year experience

The aim of this study was to demonstrate the influences of three different treatment strategies on biochemical parameters and testicular volume (TV) in patients with idiopathic hypogonadotropic hypogonadism (IHH).

Serum Pentraxin-3 Level in Patients Who Underwent Coronary Angiography and Relationship with Coronary Atherosclerosis

Objectives: To evaluate the role of pentraxin-3 (PTX-3) in determining the presence and severity of coronary atherosclerosis in patients with coronary artery disease (CAD). Subjects and Methods: Ninety-five patients (77 males and 18 females) who underwent elective coronary angiography were enrolled in this study. Patients with heart failure, renal failure, diabetes and thyroid disease were excluded. The study population was divided into 3 groups: individuals with normal coronary arteries, patients with critical CAD (n = 35) and patients with noncritical CAD (n = 36). The association of PTX-3 levels with the presence and severity of CAD and the number of involved vessels were analyzed. Results: The mean age was 53.40 ± 10.25 years. The PTX-3 levels were significantly higher in patients with CAD than without CAD (146.48 ± 48.52 vs. 109.83 ± 49.06 pg/ml, p < 0.001). A statistically significant difference was found among the 3 groups regarding the severity of CAD (165.66 ± 49.10, 127.83 ± 40.51 and 109.83 ± 49.06 pg/ml, p < 0.001, respectively). The serum PTX-3 levels in normal arteries were 110.4 ± 48.11 pg/ml, in single-vessel disease 132.35 ± 32.96 pg/ml, in 2-vessel disease 142.57 ± 55.88 pg/ml, in 3-vessel disease 156.07 ± 50.53 pg/ml, and in 3-vessel disease 160.50 ± 30.41 pg/ml. After adjusting for baseline confounders, older age (OR = 1.107, 95% CI = 1.027-1.193, p = 0.008) and higher PTX-3 levels (OR = 1.017, 95% CI = 1.003-1.032, p = 0.021) were detected as significant predictors for the presence of CAD. Conclusions: Higher PTX-3 levels were associated with the presence of CAD and its increased severity in clinically stable patients. Higher PTX-3 levels may be regarded as a novel diagnostic predictor and may offer therapeutic options in the clinic.

Osteoprotegerin, Fibroblast Growth Factor 23, and Vitamin D3 Levels in Male Patients with Hypogonadism

Cardiometabolic disorders and osteoporosis are prevalent in patients with hypogonadism. Osteoprotegerin (OPG) and fibroblast growth factor-23 (FGF-23), are co-secreted from bones and vascular endothelium, regulating bone mineral metabolism and vascular functions. Vitamin D is another hormone with dual effects on bone and vascular metabolism. The aim of this study was to search for any difference between the serum levels of OPG, FGF-23, and vitamin D in patients with hypogonadism and the healthy controls. We also aimed to search for any relationship between these parameters and endothelial dysfunction or insulin resistance. Forty-nine male patients with congenital hypogonadotropic hypogonadism (CHH) (mean age 20.71 ± 1.75 years) and 43 BMI matched healthy male subjects (mean age 21.37 ± 1.04 years) were enrolled. OPG, FGF-23, vitamin D, and asymmetric dimethylarginine (ADMA) levels were measured from the fasting serum samples. The insulin sensitivity was estimated by homeostatic model assessment-insulin resistance (HOMA-IR) formula. Triglycerides, insulin, HOMA-IR, and ADMA levels in the patient group were significantly higher than the values of the control group (p = 0.014, p = 0.002, p = 0.003, p < 0.001, respectively). The OPG, FGF-23, and vitamin D levels of the patients were not significantly different from the healthy controls. In addition, these markers were not correlated to ADMA or HOMA-IR levels. The results show that young and treatment naive subjects with CHH have endothelial dysfunction and insulin resistance when compared to their healthy counterparts. However, the OPG, FGF-23, and vitamin D levels were similar in the 2 groups. In addition, these parameters are not significantly related to the endothelial functions or insulin resistance in these subjects.

Brain derived neurotrophic factor (BDNF) in cardiometabolic physiology and diseases

Important advances in our understanding of the relationships between adipose tissue derived peptides, namely adipokines, and their effects on cardiovascular functions have been achieved in recent years. Growing knowledge of adipokine biology is revealing the complexity of these proteins. Adipose tissue releases some other proteins called neurotrophins that are mainly active in central and peripheral nervous system. However, secretion and activity of these hormones are not only limited to neuronal cells and tissues, but they also take part in adipose tissue development, energy metabolism, glucose utilization, insulin sensitivity, inflammation, lipoprotein synthesis, and atherosclerosis. In this review, we describe the most recent advances in the functions of brain derived nerve growth factor (BDNF), a major type of neurotrophins, focusing primarily on cardiovascular and metabolic diseases.