Nuri Köse

Serum vitamin D levels are independently associated with severity of coronary artery disease.

Background and Objectives Low-serum vitamin D levels have been associated with increased cardiovascular risk in the general population. We hypothesized that serum vitamin D levels would be inversely associated with inflammation and with severity of coronary atherosclerosis. We therefore investigated the link between serum vitamin D levels and (1) the extent of coronary artery disease (CAD) assessed by the Gensini score and (2) inflammatory parameters, including C-reactive protein and fibrinogen. Materials and Methods We measured 25-hydroxyvitamin D (25[OH]D) and inflammatory markers in 239 patients who underwent coronary angiography. We analyzed the relation between serum levels of 25(OH)D and inflammatory markers and angiographic severity of CAD. The Gensini lesion severity score was used for assessing the severity of coronary atherosclerosis. Results Vitamin D insufficiency was very common among our study population: 83% of the study population had levels less than 30 ng/mL. The Gensini score was negatively associated with serum vitamin D levels (r = −0.416, P < 0.001), and positively correlated with age (r = 0.209, P = 0.001), blood pressure (r = 0.379, P < 0.001), diabetes (r = 0.335, P < 0.001), hyperlipidemia (r = 0.150, P = 0,021), and C-reactive protein levels (r = 0.214, P = 0,001). After adjustments for traditional and nontraditional cardiovascular risk factors, vitamin D (B = −0,345, P < 0,001) remained a significant predictor for the severity of CAD. Conclusions Low-serum 25(OH)D levels are associated with the severity of coronary artery stenosis. Further studies are warranted to determine whether vitamin D supplementation could prevent progression of CAD.

Effect of atorvastatin on hematologic parameters in patients with hypercholesterolemia.

Hematologic parameters such as mean platelet volume (MPV), red cell distribution width (RDW), and neutrophil to lymphocyte (N/L) ratio are associated with increased cardiovascular risk. We investigated the effect of atorvastatin on hematologic parameters in patients with hypercholesterolemia. A total of 79 patients with hypercholesterolemia and 47 normocholesterolemic healthy participants were included. Patients with hypercholesterolemia received 10 to 80 mg/d atorvastatin during a 24-week period. Hematologic parameters were measured at baseline and after 6 months. Atorvastatin treatment produced a significant decrease in MPV levels (9.3 ± 1.3 vs 9.1 ± 1.2 fL, P = .008) and platelet count (259 ± 61 vs 248 ± 51 109/L, P = .005). The N/L ratio decreased significantly after atorvastatin treatment from 2.9 ± 1.2 to 2.6 ± 1.1, (P = .014). The RDW and platelet distribution width levels were not different among the study groups, before and after treatment. Atorvastatin may beneficially reduce MPV levels and N/L ratio. This antiplatelet and anti-inflammatory effect of atorvastatin treatment could play a role in reducing cardiovascular risk.

Serum Vitamin D and C-Reactive Protein Levels Are Independently Associated With Diastolic Dysfunction

Background and Aim Vitamin D deficiency is common and may contribute to cardiovascular diseases. We hypothesized that serum 25-hydroxyvitamin D [25(OH)D] levels would be inversely associated with inflammation and with diastolic dysfunction. We therefore investigated the link between serum vitamin D levels (i) echocardiographic measures and (ii) inflammatory parameters. Methods The cross-sectional study included 281 patients who were referred to coronary angiography for stable angina pectoris. Patients were recruited between December 2010 and November 2011. Patients with established congestive heart failure, gout, chronic kidney disease (estimated glomeruler filtration rate <60 mL/min per 1.73 m2), and acute infection were not included. We measured serum 25(OH)D levels, C-reactive protein and fibrinogen levels. A radioimmunoassay procedure was used to measure 25(OH)D (DiaSorin, Stillwater, MN). We also performed standardized left ventricular (LV) echocardiograms, and echocardiographic data were used for classification of systolic and diastolic dysfunction. We analyzed the relation between serum levels of 25(OH)D and inflammatory markers and echocardiographic measures of LV mass and diastolic dysfunction. Results At baseline, subjects had a mean age of 59.5 ± 10 years, and 43.4% were women. Left ventricular mass index, left atrial diameter, isovolumic relaxation time, and E/E′ ratio were significantly higher in patients with lower 25(OH)D levels. In ordinal logistic regression analysis, higher 25(OH)D was negatively associated only with LV mass index (odds ratio [OR], 0.965; 95% confidence interval [95% CI], 0.939–0.992; P = 0.015), isovolumic relaxation time (OR, 0.962; 95% CI, 0.939–0.985; P = 0.001), E/E′ ratio (OR, 0.874; 95% CI, 0.811–0.942; P = 0.008), and C-reactive protein (OR, 0.802; 95% CI, 0.668–0.962; P = 0.021). Conclusions Serum levels of 25(OH)D are significantly associated with LV diastolic dysfunction and LV mass index, although the effect size is rather small. Longitudinal studies in larger populations are needed to establish firmly or refute a causal relationship between vitamin D levels and diastolic dysfunction and LV mass index.

Association of glomerular filtration rate with slow coronary flow in patients with normal to mildly impaired renal function.

We evaluated the association between estimated glomerular filtration rate (eGFR) and slow coronary flow (SCF) in patients with normal to mildly impaired renal function; 211 patients with angiographically proven SCF and 219 controls were studied. Patients were categorized based on the angiographic findings as with or without SCF. We used the Modification of Diet in Renal Disease equation to calculate eGFR. The frequency of mildly decreased eGFR, serum uric acid levels, and eGFR was higher in the SCF group. Patients with mildly impaired renal function had higher thrombolysis in myocardial infarction frame counts in 3 major coronary arteries. In logistic regression analysis, uric acid (odds ratio [OR] = 1.323, 95% confidence interval [CI] = 1.109-1.572, P = .002) and eGFR (OR = 0.972, 95% CI = 0.957-0.987, P < .001) were independent correlates of SCF. In conclusion, eGFR was significantly correlated with SCF in patients with normal to mildly impaired renal function.

Hematologic parameters in patients with sarcoidosis

We have read with a great interest the article entitled “The clinical significance of hematologic parameters in patients with sarcoidosis” by Dirican et al. (1). The authors reported that neutrophilto-lymphocyte ratio (NLR) an inexpensive and easily measurable laboratory variable, was elevated in patients with sarcoidosis as compared to those without sarkoidosis. Interestingly, no difference was found in the levels of red-cell distribution width (RDW) and C-reactive protein between groups. Their study is interesting, however, we have some questions. In their study, blood samples were collected in ethylenediaminetetraacetic acid (EDTA) anticoagulant for the measurement of hematological parameters. The platelet indices such as mean platelet volume (MPV) and platelet crit increases with the delay in time between blood sample collection and measurement in EDTA-anticoagulated samples (2). It was reported that, mean MPV measured from EDTA samples was 0.66 fL (9%) higher than citrate (3). The optimal recommended time for measurement of platelet indices is 2 h after venipuncture (4). In their cohort, they did not provide details regarding measurement time of platelet indices. Sarcoidosis can involve hematologic organs such as spleen and bone marrow (5). Hematologic abnormalities such as anemia, lymphopenia, leukopenia, eosinophilia and monocytosis have been reported previously in patients with sarcoidosis. In sarcoidosis, the presence of bone marrow involvement usually approximates 10%–15% (5). The bone marrow involvement should be considered in patients with sarcoidosis. The authors did not mention about the bone morrow involvement. Our another concern is about renal involvement. Renal involvement occurs at a rate of 35% to 50% in sarcoidosis (6). The authors did not provide details regarding measurement of renal function. It was previously shown that, there is a significant association between glomerular filtration rate (GFR) and NLR (7). NLR increases as the GFR declines. GFR can influence NLR and platelet parameters. Lastly, the authors did not mention about cardiovascular disease. Cardiovascular disorders can affect hematologic parameters. Several studies suggest a possible relationship between cardiovascular disorders and hematologic parameters such as NLR, RDW and MPV (8, 9). These confounding factors should be considered in determining the utility of NLR, RDW and MPV for prediction of sarcoidosis.

A Rare Congenital Cardiac Anomaly Presenting with Amaurosis Fugax: Quadricuspid Aortic Valve

Kuadrikuspid aort kapak, aort yetersizliginin nadir bir nedenidir. Vakalarin cogu ekokardiyografi, otopsi veya cerrahi sirasinda rastlantisal olarak saptanir. Bu anomali diger dogustan kalp anomalileri ile birlikte olabilmektedir. Yirmi yedi yasindaki hasta amarozis fugaks etyolojisinin degerlendirilmesi amaciyla servisimize yatirildi. Fizik muayenesinde kan basinci 125/85 mmhg olup sol 3. interkostal aralikta 2/6 diyastolik ufurum mevcuttu. Bakilan elektrokardiyografi ve akciger grafisi normal saptandi. Hastaya yapilan transtorasik ve transozofajiyal ekokardiyografide kuadrikuspid aort kapak ve hafif aort yetersizligi saptandi. Kuadrikuspid aort kapagi olan hastalarin %50’sinden fazlasinda besinci veya altinci dekatta aort yetersizliginin kotulesmesine bagli aort kapak replasmani gerektirdiginden taninmasi onemlidir. (Ha se ki T›p Bul te ni 2014; 52: 302-3)