Yusuf Selcoki

Effect of treatment of hyperuricemia with allopurinol on blood pressure, creatinine clearence, and proteinuria in patients with normal renal functions.

BackgroundHyperuricemia has been associated with the development of hypertension, cardiovascular, and renal disease. However, there is no data about the effect of lowering uric acid level on hypertension, renal function, and proteinuria in patients with glomerular filtration rate (GFR) >60xa0ml/min. We therefore conducted a prospective study to investigate the benefits of allopurinol treatment in hyperuricemic patients with normal renal function.Materials and methodsForty-eight hyperuricemic and 21 normouricemic patients were included in the study. Hyperuricemic patients received 300xa0mg/day allopurinol for threexa0months. All patients’ serum creatinine level, 24-h urine protein level, glomerular filtration rate, and blood pressure levels were measured at baseline and after threexa0months of treatment.ResultsA total of 59 patients completed the three-month follow-up period of observation. In the allopurinol group, serum uric acid levels, GFR, systolic and diastolic blood pressure, and C-reactive protein (CRP) levels significantly improved (Pxa0<xa00.05). However, urine protein excretion remained unchanged (Pxa0>xa00.05). No correlation was observed between changes in GFR and changes in CRP, or blood pressure in the allopurinol group. No significant changes were observed in the control group (Pxa0>xa00.05).ConclusionWe bring indirect evidence that hyperuricemia increases blood pressure, and decreases GFR. Hence, management of hyperuricemia may prevent the progression of renal disease, even in patients with normal renal function, suggesting that early treatment with allopurinol should be an important part of the management of chronic kidney disease (CKD) patients. Long-term follow-up studies are warranted to identify the benefits of uric acid management on renal function and hypertension.

Fibroblast Growth Factor 23 and Fetuin A are Independent Predictors for the Coronary Artery Disease Extent in Mild Chronic Kidney Disease

BACKGROUND AND OBJECTIVESnCardiovascular disease in chronic kidney disease (CKD) is explained in part by traditional cardiovascular risk factors; by uremia-specific factors; and by abnormalities of mineral metabolism, factors involved in its regulation, and in the vascular calcification process.nnnDESIGN, SETTING, PARTICIPANTS, & MEASUREMENTSnIn an unselected population of 177 patients with calculated GFR (eGFR) between 90 and 30 ml/min per 1.73 m(2), the link between the mineral metabolism abnormalities (calcium, phosphorus, calcium-phosphorus product), regulatory factors (parathyroid hormone [PTH], intact PTH [iPTH], vitamin D, fibroblast growth factor 23 [FGF 23], and fetuin A), and the severity of coronary artery disease (CAD) assessed by coronary angiography were evaluated in three subgroups defined by tertiles of Gensini lesion severity score.nnnRESULTSnThe mean serum values for FGF 23 in the entire study population was 28.1 ± 17.3 RU/ml and for fetuin A was 473.1 ± 156.2 μg/ml. Patients with eGFR < 60 ml/min per 1.73 m(2) had significantly higher values of FGF 23 compared with patients with eGFR > 60 ml/min per 1.73 m(2). The Gensini score values significantly correlated with gender; arterial hypertension; and HDL cholesterol, eGFR, iPTH, FGF 23, and fetuin A levels. After the adjustments for traditional and uremia-related cardiovascular risk factors, the FGF 23 and fetuin A remained significant predictors of the Gensini score.nnnCONCLUSIONSnThis study suggests that in a relatively young population with mild-to-moderate alteration of kidney function and with less traditional cardiovascular risk factors, anomalies of the serum FGF 23 and fetuin A levels appear early in the course of disease and are independent major predictors for extent of CAD.

Uric Acid and Pentraxin-3 Levels Are Independently Associated with Coronary Artery Disease Risk in Patients with Stage 2 and 3 Kidney Disease

Background and Objectives: Cardiovascular disease is prevalent in chronic kidney disease (CKD). Uric acid is increased in subjects with CKD and has been linked with cardiovascular mortality in this population. However, no study has evaluated the relationship of uric acid with angiographically proven coronary artery disease (CAD) in this population. We therefore investigated the link between serum uric acid (SUA) levels and (i) extent of CAD assessed by the Gensini score and (ii) inflammatory parameters, including C-reactive protein (CRP) and pentraxin-3, in patients with mild-to-moderate CKD. Material and Methods: In an unselected population of 130 patients with estimated glomerular filtration rate (eGFR) between 90 and 30 ml/min/1.73 m2, we measured SUA, serum pentraxin-3, CRP, urinary protein-to-creatinine ratio, lipid parameters and the severity of CAD as assessed by coronary angiography and quantified by the Gensini lesion severity score. Results: The mean serum values for SUA, pentraxin-3 and CRP in the entire study population were 5.5 ± 1.5 mg/dl, 6.4 ± 3.4 ng/ml and 3.5 ± 2.6 mg/dl, respectively. The Gensini scores significantly correlated in univariate analysis with gender (R = –0.379, p = 0.02), uric acid (R = 0.42, p = 0.001), pentraxin-3 (R = 0.54, p = 0.001), CRP (R = 0.29, p = 0.006) levels, eGFR (R = –0.33, p = 0.02), proteinuria (R = 0.21, p = 0.01), and presence of hypertension (R = 0.37, p = 0.001), but not with smoking status, diabetes mellitus, and lipid parameters. After adjustments for traditional cardiovascular risk factors, only uric acid (R = 0.21, p = 0.02) and pentraxin-3 (R = 0.28, p = 0.01) remained significant predictors of the Gensini score. Conclusions: SUA and pentraxin-3 levels are independent determinants of severity of CAD in patients with mild-to-moderate CKD. We recommend a clinical trial to determine whether lowering uric acid could prevent progression of CAD in patients with CKD.

Association between gamma-glutamyltransferase and coronary artery calcification

BACKGROUNDnThe exact mechanisms behind the association between atherosclerosis and gamma-glutamyltransferase (GGT) are unclear. Coronary artery calcification (CAC) detected by computerized tomography is an important marker of atherosclerosis and its severity correlates with coronary plaque burden. The aim of this study was to investigate if serum GGT levels are associated with CAC in patients without known coronary heart disease (CHD) who had low-intermediate risk for CHD.nnnMETHODSnTwo hundred and seventy two patients who had low-intermediate risk for coronary artery disease were included in the study. Serum GGT levels were measured spectrophotometrically. CACS (Agatston method) were performed using a 64-slice computerized tomography scanner. The patients were grouped according to their GGT values in four quartiles.nnnRESULTSnPatients in higher GGT quartiles had elevated CAC score (P<0.001). Patients in higher GGT quartiles were predominantly males (P<0.001) and were more likely to be smoking (P=0.004), and have elevated uric acid (P<0.001), fasting blood glucose (P<0.001), CRP levels (P=0.003) and 10-year total cardiovascular risk (P=0.007) and low HDL levels (P<0.001). Positive correlations were found between log GGT and CAC (r=0.233, P<0.001). In the multivariate analysis GGT, age, smoking and serum uric acid levels appeared as independent factors predictive of presence of CAC.nnnCONCLUSIONSnWe demonstrated a significant correlation between serum GGT levels and CAC and CHD risk factors. Serum GGT level was an independent marker of CAC.

Increased thrombin-activatable fibrinolysis inhibitor antigen levels as a clue for prothrombotic state in polycystic ovary syndrome

Objectives. Our study was undertaken to evaluate the levels of thrombin-activatable fibrinolysis inhibitor (TAFI) antigen and also its relationship with other hemostasis markers in a group of patients affected with polycystic ovary syndrome (PCOS)–under Diane-35 (ethinyl estradiol 0.035 mg/cyproterone acetate 2 mg) treatment or not–as compared with a group of healthy controls. Methods. Forty-two women with PCOS and 30 age-matched healthy controls were involved in the study. Group A were on Diane-35 for at least 6 months; group B did not take any drug; group C served as a control group. Results. TAFI antigen levels of groups A and B were significantly higher than in controls, but no difference was observed between them. All of the other coagulation and fibrinolysis parameters (including prothrombin time, activated partial thromboplastin time, fibrinogen and D-dimer) were comparable between the three groups. Conclusion. The evidence presented herein suggests that women with PCOS have impaired fibrinolysis, as reflected by increased TAFI. This impairment can contribute to the risk of cardiovascular disease in PCOS. Elucidation of the modifiable mechanisms in PCOS can represent an opportunity for preventive therapy of the cardiovascular risks associated with PCOS.

Serum uric acid level is an independent risk factor for presence of calcium in coronary arteries: an observational case-controlled study.

OBJECTIVEnA link between uric acid levels and cardiovascular diseases has been previously reported. Coronary artery calcium score (CACS) is a marker of atherosclerotic disease and a predictor of cardiovascular events. We sought to determine if serum uric acid level is an independent risk factor for the presence of calcium in coronary arteries.nnnMETHODSnFour hundred and forty-two patients who were evaluated in the cardiology outpatient clinic for suspected coronary heart disease with a low-moderate risk for coronary artery disease were included in this observational case-controlled study. Serum uric acid levels were measured with colorimetric methods. CACS were performed using a 64-slice CT scanner. Patients were divided to 3 groups according to their CACS value (Group 1: CACS=0, Group 2: CACS 1-100, Group 3: CACS>100).nnnRESULTSnThe demographical characteristics and laboratory findings of 3 groups were similar, except age, fasting glucose levels and serum uric acid levels. Serum uric acid levels were found to increase significantly with increasing CACS (p=0.001). Patients were grouped according to presence CAC (CACS=0 and CACS≥1) and in the multiple regression analysis, age (OR, 1.11, 95% CI, 1.07-1.16), smoking (OR, 3.83, 95% CI, 2.06-7.09), serum uric acid levels (OR, 1.26, 95% CI, 1.04-1.54) and average 10-year total risk of Framingham risk score (OR, 1.13, 95% CI, 1.04-1.09) appeared as independent factors predictive of presence of CAC (p<0.05).nnnCONCLUSIONnSerum uric acid level is an independent risk factor for presence of coronary calcium. Moreover, increasing levels of serum uric acid are associated with increasing CACS.

Epicardial adipose tissue and pericoronary fat thickness measured with 64-multidetector computed tomography: potential predictors of the severity of coronary artery disease

OBJECTIVE: The aim of the present study was to investigate the relationship between pericoronary fat and the severity and extent of atherosclerosis, quantified using 64-multidetector computed tomography, in patients with suspected coronary artery disease. METHODS: The study population consisted of 131 patients who were clinically referred for noninvasive multislice computed tomography coronary angiography for the evaluation of coronary artery disease. Patients were classified as follows: no atherosclerosis, Group 1; nonobstructive atherosclerosis (luminal narrowing <50% in diameter), Group 2; and obstructive atherosclerosis (luminal narrowing ≥50%) in a single vessel or obstructive atherosclerosis in the left main coronary artery and/or multiple vessels, Group 3. Epicardial adipose tissue was defined as the adipose tissue between the surface of the heart and the visceral layer of the pericardium (visceral epicardium). Epicardial adipose tissue thickness (mm) was determined in the right ventricular anterior free wall. The mean thickness of the pericoronary fat surrounding the three coronary arteries was used for the analyses. RESULTS: The average thickness over all three regions was 13.2 ± 2.1 mm. The pericoronary fat thickness was significantly increased in Group 3 compared with Groups 2 and 1. The epicardial adipose tissue thickness was significantly increased in Group 3 compared with Groups 2 and 1. A receiver operating characteristic curve for obstructive coronary artery disease was assessed to verify the optimum cut-off point for pericoronary fat thickness, which was 13.8 mm. A receiver operating characteristic curve for obstructive coronary artery disease was also assessed to verify the optimum cut-off point for epicardial adipose tissue, which was 6.8 cm. CONCLUSION: We showed that the epicardial adipose tissue and pericoronary fat thickness scores were higher in patients with obstructive coronary artery diseases.

Association of serum calcitonin with coronary artery disease in individuals with and without chronic kidney disease.

BackgroundCardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD). Recent data implicate disordered bone and mineral metabolism, including changes in serum levels of calcium, phosphate, parathyroid hormone (PTH), vitamin D, fibroblast growth factor-23 (FGF-23), and fetuin A, as novel risk factors for arterial calcification. The potential role of calcitonin, another hormonal regulator of mineral and bone metabolism, has not been studied in detail.Materials and methodsWe investigated the link between serum calcitonin and the total burden of coronary artery disease (CAD) using the validated Gensini score, in a cross-sectional study of 88 patients with estimated GFR (eGFR) between 46 and 87xa0ml/min/1.73xa0m² who underwent coronary angiography. We evaluated the associations between serum calcitonin, minerals (calcium, phosphate), calciumxa0×xa0phosphate product, and other factors that regulate mineral metabolism (intact PTH, 25-OH-vitamin D, FGF-23, and fetuin A) and the severity of CAD.ResultsThe mean serum calcitonin was 11.5xa0±xa07.8xa0pg/ml. In univariate analysis, the Gensini CAD severity score correlated significantly with male gender, eGFR, and serum levels of 25-OH-vitamin D, iPTH, FGF-23, fetuin A, and calcitonin (Rxa0=xa00.474, Pxa0=xa00.001 for the latter). In multivariate analysis adjusted for calcium, phosphate, 25-OH-vitamin D, iPTH, FGF 23, fetuin A, and calcitonin, only calcitonin (βxa0=xa00.20; Pxa0=xa00.03), FGF-23, fetuin A, and 25-OH-vitamin D emerged as independent predictors of Gensini score. In the second step, we adjusted for the presence of traditional risk factors, proteinuria, and GFR. After these adjustments, the FGF-23 and fetuin A remained statistically significant predictors of the Gensini score, while calcitonin did not.ConclusionsOur study suggests that, in addition to other well-known components of mineral metabolism, increased calcitonin levels are associated with greater severity of CAD. However, this relation was not independent of traditional and nontraditional cardiovascular risk factors. Longitudinal studies in larger populations including patients with more advanced CKD are needed.

Population-based cardiovascular risk factors in the elderly in Turkey: a cross-sectional survey

Hypertension, diabetes, hyperlipidaemia, obesity and smoking are known to be the most important modifiable risk factors for cardiovascular disease (CVD). Because the elderly population has been increasing globally, CVD may become a more important public health problem in the future. This report examines the prevalence of cardiovascular risk factors in the elderly in Ankara, Turkey. This was a cross-sectional survey and included a total of 2720 individuals living in the Ankara district. Trained research staff administered a standard questionnaire in the participants’ homes and worksites. The questionnaire collected information on clinical and demographic characteristics and a self-reported medical history, including past history of hypertension, diabetes, hyperlipidemia, coronary artery disease, coronary artery by-pass graft operation, and cerebrovascular accident. The mean age of the study participants was 69.5 ± 7.2 years. The study identified 1298 women (78.1%) and 753 men (71.2%) with hypertension, and the overall prevalence of hypertension was 75.4%. A total of 739 (27.2%) people had diabetes mellitus, and, of these people, 603 (81.6%) were hypertensive. A total of 1361 people had hyperlipidemia, and 1103 of these patients were also hypertensive. The overall prevalence of obesity was 27.2%. A total of 553 (20.3%) people were smokers. Our findings indicate that cardiovascular risk factors are very common in the elderly. To maximize risk reduction, physicians must take aggressive measures to decrease cardiovascular risk factors.

The major clinical outcomes of diabetic foot infections: One center experience

Diabetes mellitus with its limb and life-threatening complications such as diabetic foot infection and amputation are increasing at epidemic rates all over the world. The objective of this study was to determine the rate of lower extremity amputation, the risk factors and the bacteriologic profile for diabetic foot lesions. The records of all 84 patients with diabetic foot infections of a large general hospital over a 4-year period were retrospectively included. The most commonly isolated pathogens were Staphylococcus aureus (39%), Pseudomonas aeruginosa (14%), Proteus mirabilis (14%), Escherichia coli (14%), Group B streptococci (12%), and Klebsiella pneumonia (8%). The variables, independently associated with higher foot infections, were inadequate diabetic regulation (93%), peripheral neuropathy (88.1%), peripheral vascular disease (73.8%), smoking (56%), past history of ulcer (28.5%), penetrating injury (20.3%), inadequate foot wear (15%) and Charcot osteoartropathy (10.7%). The general amputation rate was 38.1%. Diabetic foot ulcers and its complication rates including infection, gangrene and lower extremity amputation in Turkey are still high. Preventive care of the foot in patients with diabetes mellitus is extremly important. Therefore early diagnosing of risk factors for diabetic foot infections in the primary care setting and their adequate therapy under multidisciplinary approach should not be neglected.