Burak Akcay

The correlation of thrombolysis in myocardial infarction frame count with insulin resistance in patients with slow coronary flow

BackgroundIt has been reported that coronary endothelial dysfunction plays an important pathogenetic role in patients with slow coronary flow (SCF). Insulin resistance is defined as impairment of insulin-stimulated glucose and/or lipid metabolism, while endothelial dysfunction is defined as paradoxical or inadequate endothelial-mediated vasodilation. In this study, we aimed to evaluate insulin resistance in patients with SCF. MethodsThe study population included 25 patients with SCF and 28 healthy controls. Insulin resistance was estimated via homeostasis model assessment insulin resistance index (HOMA-IR). ResultsPatients with SCF had higher high-sensitive C-reactive protein (hs-CRP) and HOMA-IR scores (P<0.05) than controls. Mean thrombolysis in myocardial infarction frame count had significant correlation with hs-CRP, fasting plasma insulin levels and HOMA-IR score (r=0.566, P<0.05; r=0.883, P<0.05; r=0.884, P<0.05, respectively). ConclusionIn patients with SCF, thrombolysis in myocardial infarction frame counts and hs-CRP are correlated with increased insulin resistance and thus, it can be suggested that insulin resistance and inflammation may, in part, have a role in the pathogenesis of SCF.

Does atorvastatin affect androgen levels in men in the era of very-low LDL targeting therapy?

BACKGROUND An adequate pool of free intracellular cholesterol is essential for steroidogenesis in gonads and LDL is the major source of cholesterol used in this pathway. Effect of peripheral LDL on the synthesis of steroids is dose dependent and although LDL levels around 100 mg/dl is demonstrated to be safe in terms of steroidogenesis, effect of LDL levels <70 mg/dl with higher doses of statins on steroidogenesis remains controversial. MATERIAL AND METHODS Androgen and gonadotropin levels are prospectively evaluated at baseline and after 12 weeks of treatment in 77 male coronary heart disease patients receiving high doses of atorvastatin (40-80 mg daily) targeting serum LDL levels <70 mg/dl and in 83 male coronary heart disease patients receiving regular doses of atorvastatin (10-20 mg daily) targeting serum LDL levels <100 mg/dl. RESULTS At the end of the study, mean LDL levels of the high and regular dose atorvastatin groups were 77+/-9 mg/dl and 98+/-10 mg/dl respectively. After twelve weeks of treatment, there were no significant alterations in serum total testosterone, free testosterone, sex hormone binding globulin, luteinizing hormone and follicle stimulating hormone levels between two groups. CONCLUSION High dose atorvastatin in order to reach serum LDL levels around 70 mg/dl seems to be as safe as regular doses in order to reach serum LDL levels around 100 mg/dl, in terms of gonadal steroidogenesis in men with coronary heart disease.

Is there any relation between coronary atherosclerosis and tympanosclerosis

OBJECTIVE Atherosclerosis is a chronic inflammatory disease of medium and large-sized arteries. Tympanosclerosis is the hyalinization and calcification of the connective tissue in the middle ear, including the tympanic membrane. The etiology and pathogenesis of tympanosclerosis are still controversial. There are some reports about the possible relationship between development of tympanosclerosis and atherosclerosis. Therefore, we aimed a cross-sectional study to investigate relationship between tympanosclerosis and atherosclerosis in patients referred for coronary angiography. METHODS The study population consisted of 203 consecutive patients (145 men, mean age 59+/-11 years) who underwent coronary angiography. Otoscopic examination was performed in all patients. All angiographies were examined to calculate coronary artery vessel stenosis and extent scores. Mann-Whitney U test was used to compare the angiographic scores with existence of tympanosclerosis. RESULTS Among the 203 patients, 35 (17%) patients had angiographically normal coronary arteries without any atheroma plaque and 168 (83%) had coronary atherosclerosis. In the otoscopic examination, tympanosclerosis was found in 14 patients (6.9%). No significant differences in distribution of clinical atherosclerotic risk factors (age, gender, body mass index, hypertension, diabetes mellitus, cigarette smoking and cholesterol levels) were found between groups with and without tympanosclerosis. Tympanosclerosis was found in 4 patients with normal coronary arteries (11.4%). In the group of coronary atherosclerosis, 10 patients have tympanosclerosis (5.9%). In addition, there was no statistically significant association of coronary artery vessel, stenosis or extent scores of atherosclerosis with tympanosclerosis (p>0.05). CONCLUSIONS We could not find any association between tympanosclerosis and angiographic extent and severity of atherosclerosis, contrary to other studies. More studies are needed to understand etiological mechanisms and association between them.