Systolic and diastolic blood pressure related to six other risk parameters in Turkish adults: strong correlation with relative weight

The association between fasting serum insulin, apo-lipoproteins level, and severity of coronary artery involvement in non-diabetic patients

BACKGROUND

In the previous studies, fasting insulin and apo-lipoproteins are considered as one of the risk-factor of coronary artery disease (CAD) but did not have the same results. In this study, we attempted to define the association of high fasting insulin and apo-lipoproteins of serum in non-diabetic patients who were afflicted with coronary arteries disease with severity of coronary arteries involvement.

MATERIALS AND METHODS

This study was conducted between September 2011 and February 2012 on three groups, each one consisting of 100 members while using angiographic scores of Gensini with three equal groups with low, medium, and high stenosis of coronary arteries. The evaluation of non-diabetic patients afflicted with CADs, included the fasting glucose level less than 126 mg/dl or non-consumption of blood glucose reduction drugs or negativity history of diabetes.

RESULTS

In this study, there were 300 non-diabetic patients afflicted with CAD in three groups of low, medium, and high extremity. Due to attained results, the patients afflicted with high CAD had a higher level of insulin (18.3 ± 0.8) in relation with low and medium groups (P < 0.001). As it was observed, the level of serum apo-lipoproteins of A1 (APO-A1) in low group of CAD (175 ± 36.4) is meaningfully higher than its quantity in high-CAD group (158 ± 42.4, P < 0.001). Furthermore, the quantity of serum apo-lipoproteins of B (APO-B) in mild CAD group (139 ± 30.4) is meaningfully less than severe CAD group (155.21 ± 29.7, P < 0.001).

CONCLUSION

Our findings show that insulin, APO-A1, APO-B, and total cholesterol measurement is a good case for defining the severity of coronary artery involvement, while high-density lipoprotein, low-density lipoprotein, and triglyceride are not important risk-factors.

Atherosclerotic vascular disease and risk factors in Turkey: from past to present

The prevalence of atherosclerotic vascular disease is unexpectedly high in Turkey despite its young population, with a median age of 29. The mean total cholesterol is lower than in Western European countries; however, smoking is very prevalent, the incidence of metabolic syndrome high and obesity, diabetes and hypertension are becoming a major problem, especially in women. Having these risk factors as well as lower HDL levels leads to high cardiovascular morbidity and mortality at younger ages. This problem is expected to become worse with increasing industrialisation, adaptation to Western diets, a sedentary lifestyle and increasing obesity. A National Heart Health Policy has been developed to overcome this epidemic and combat the risk factors and reduce the burden of atherosclerotic vascular disease.

Antihypertensive drug utilization at health centres in a district of Istanbul

OBJECTIVE

Since irrational use of antihypertensives has considerable clinical and economical consequences, this study was conducted to evaluate antihypertensive drug utilization in hypertension at seven State Health Centres in Istanbul.

METHOD

A total of 297 hypertensive patients who accepted to participate in the study were evaluated by a face-to-face questionnaire and a copy of their prescriptions were collected for prescription analysis.

RESULTS

Angiotensin-converting enzyme (ACE) inhibitors (31.7%), calcium channel blockers (28.8%), diuretics (16.2%), beta blockers (7.5%) and others (15.8%) have been prescribed. There were no statistically significant relation between prescribed antihypertensive drug groups and gender, age, and NSAIDs co-prescribing. The most frequent comorbidity in hypertensive patients was diabetes mellitus (10.4%) and calcium channel blockers (35.5%) have been prescribed to them as a first antihypertensive medication. Average cost per prescription was $42.7 +/- 38.1. According to the patients' self-reporting, the majority of them (85%) were prescribed without a physical examination. The physicians failed to write the prescriptions appropriately; only 5% of the scripts contained all information about the drug(s) and use instructions in full format.

CONCLUSION

The present study indicates that GPs working at primary healthcare centres were rational in terms of antihypertensive drug choice. However, they poorly applied rational pharmacotherapy principles such as (a) writing a "good" prescription which is easily readable by the pharmacist and the patient and that contains full essential information; (b) a medical examination of the patient to assess her/his current clinical condition; and (c) taking care of not prescribing drugs with potential interaction like antihypertensives and NSAIDs together.

Which anthropometric measurements is most closely related to elevated blood pressure?

BACKGROUND

Epidemiological studies find a progressive increase in the prevalence of elevated blood pressure with increasing adipose tissue. But there is no common opinion about which effectiveness of the anthropometric measurement tools indicating general or android obesity are most important to follow up in patients with elevated blood pressures.

OBJECTIVES

To identify which anthropometric measurements are most closely related to blood pressure elevation.

METHODS

A cross-sectional descriptive study of 1727 subjects [894 (50.6%) men and 833 (48.2%) women, aged 18-65 years old] was held in Edirne, Turkey. Each subject's weight, height, waist and hip circumference, triceps skin fold and blood pressures was measured; waist to hip ratio and body mass index were calculated. The relations between blood pressure and different anthropometric variables in both genders were investigated in linear regression models.

RESULTS

The mean systolic and diastolic blood pressures were 123.49 +/- 17.60 and 78.79 +/- 10.37 mmHg. According to body mass index 23.7% of the subjects were obese (.29.9 kg/m(2)). When waist circumference cut-off points were compared with waist to hip ratio the android obesity ratio was doubled (32.3% versus 16.6%). 119 subjects (6.8%) were not obese according to body mass index but nonetheless had waist circumference measurements above the cut-off points suggesting a high cardiovascular risk. In the linear regression models waist circumference was found to be an independent risk factor for blood pressure in men; however body mass was more important index and waist circumference somewhat less so for women.

CONCLUSION

In primary care waist circumference should be a useful tool screening for and following android obesity in patients with elevated blood pressure.

Endocrine and cardiovascular responses to corticotropin-releasing hormone in patients with posttraumatic stress disorder: a role for atrial natriuretic peptide?

Hypothalamic-pituitary-adrenocortical (HPA) axis data, such as low plasma cortisol concentrations in spite of increased corticotropin-releasing hormone (CRH) levels in patients with posttraumatic stress disorder (PTSD), are difficult to interpret. Atrial natriuretic peptide (ANP) may be an explanatory link in the neuroendocrine pathophysiology of the disorder, since it is a neuromodulator with antianxiety effects that inhibits HPA activity at multiple levels. Seventeen patients with chronic PTSD and 17 healthy control subjects were given 100 microg of human CRH at 3 p.m. ANP, adrenocorticotropic hormone (ACTH), and cortisol levels in plasma as well as blood pressure and heart rate were measured during basal conditions and after CRH stimulation. Basal ANP levels were significantly lower in PTSD patients in comparison with normal controls, but the response to CRH was undistinguishable. In contrast to our expectation, no significant differences in basal or CRH-stimulated ACTH or cortisol parameters could be observed. Systolic and diastolic blood pressures at baseline and after CRH were significantly elevated in PTSD patients. All group differences remained significant after controlling for basal blood pressure and/or body mass index. Our data do not support a role of ANP in abnormal HPA axis regulation in PTSD. However, the persistently low ANP plasma levels in PTSD patients despite elevated blood pressure may serve to facilitate anxiety behavior and have adverse long-term cardiovascular consequences. Further studies to assess ANP secretion in PTSD patients and to clarify its pathophysiological impact are needed.

Metabolic syndrome: major impact on coronary risk in a population with low cholesterol levels--a prospective and cross-sectional evaluation

The prevalence and the excess coronary heart disease (CHD) risk of the metabolic syndrome (MS) and its components were investigated in the Turkish Adult Risk Factor Study in both a prospective and a cross-sectional manner. In a population sample, representative of Turkish adults who have low levels of high- and low-density lipoprotein-cholesterol (HDL-C and LDL-C), MS was identified in conformity with the definition used in the recent NCEP guidelines. Prospective analysis was based on 2398 men and women (mean age at baseline 49.1+/-13 years) who had a baseline examination in 1997/98 and were followed-up for a mean of 3 years. CHD was diagnosed based on clinical findings and Minnesota coding of resting electrocardiograms. Fatal and nonfatal CHD developed in 126 subjects. 27% of men and 38.6% of women were found to have MS at baseline examination. When adjusted for age, MS was an independent predictor of subsequent overall fatal and nonfatal CHD in both genders, displaying an RR of 1.71. At the final cross-sectional evaluation, coronary risk associated with MS in men was primarily accounted for by standard MS components (largely inherent in glucose intolerance, hypertension and in a surrogate of small, dense LDL particles), in addition to a minor independent contribution by C-reactive protein (CRP). In women with MS, a substantial residual coronary risk remained after controlling for five components, which was partly accounted for by levels of LDL-C and CRP. It was estimated that MS was the culprit in just over half the cases of CHD in Turkey.

CONCLUSION

MS was the major determinant of CHD risk in a population having generally low levels of HDL-C and LDL-C in middle-aged and elderly adults, extending to three out of every eight adults, and imposing an overall excess CHD risk of approximately 70%. In contrast to men, a substantial residual coronary risk is retained in Turkish women after controlling for five MS components.

Fasting insulin levels independently associated with coronary heart disease in non-diabetic Turkish men and women

BACKGROUND

Levels of plasma insulin have been recognized as a weak risk indicator for coronary or cardiovascular risk in the general population with ethnic background and gender modifying this relationship. We assessed whether insulin concentrations are associated with or would serve as a marker of prevalent coronary heart disease risk in a cross-sectional study of a population having low cholesterol levels (just under 5 mmol/l) but higher prevalence of components of the metabolic syndrome.

METHODS

In 688 participants of the Turkish Adult Risk Factor Survey in 2001, plasma insulin values as well as other risk variables were evaluated, and coronary heart disease was diagnosed based on clinical findings and Minnesota coding of resting electrocardiograms. Nearly equal numbers of men and women (>30 years of age) constituted the population sample from the two largest regions of Turkey. Concentrations of insulin were determined by the chemiluminescent immunometric method.

RESULTS

Geometric mean value was 50 pmol/l (interquartile range 37-68 pmol/l), without revealing a significant difference in genders. Fasting insulin was correlated in both genders with many variables, notably those involving central obesity, triglycerides, blood pressure, physical inactivity and, inversely, with high-density lipoprotein (HDL)-cholesterol. In a regression model, waist circumference and body mass index were strongly associated with log insulin, after controlling for age and presence of coronary heart disease. The age- and obesity-adjusted odds ratio for coronary heart disease in the highest as opposed to the lowest quartile was 2-fold in both genders (P<0.05). Even after adjustment for dyslipidemia, blood pressure, glucose intolerance, physical activity and smoking status, an over 2-fold increased coronary heart disease risk still persisted with regard to hyperinsulinemia (>or=10 mU/l, 69.5 pmol/l). When C-reactive protein which was correlated with fasting insulin only in women, was added to the model, the impact of hyperinsulinemia on coronary heart disease risk remained unchanged.

CONCLUSION

Hyperinsulinemia (i) may provide information on the coronary heart disease likelihood over and above that provided by the other risk factors, including HDL-cholesterol, and (ii) may contribute, within the frame of insulin resistance, to the coronary heart disease risk independently of the classical risk factors.

DGAT1 promoter polymorphism associated with alterations in body mass index, high density lipoprotein levels and blood pressure in Turkish women

Triglyceride synthesis is catalyzed by acyl CoA:diacylglycerol acyltransferases (DGAT), microsomal enzymes that use diacylglycerol and fatty acyl CoAs as substrates. Because DGAT1 expression is up-regulated during adipocyte differentiation and DGAT1 deficiency is associated with leanness in mice, we hypothesized that alterations in DGAT1 expression may affect human body weight. We identified five polymorphisms in the human DGAT1 promoter and 5' non-coding sequence in a random Turkish population. Functional analysis of one common variant, C79T, revealed reduced promoter activity for the 79T allele in cultured cell lines. In 476 Turkish women, the 79T allele was associated with lower body mass index (BMI) (p = 0.004), conferring an odds ratio of 2.0 (95% CI = 1.30-3.07, p = 0.0001) for BMI </= 20. Interestingly, after controlling for the influence of BMI, the 79T allele was also associated with higher plasma HDL cholesterol levels (p = 0.0006) and lower diastolic blood pressure (p = 0.019) in these women. No association was found in Turkish men (n = 846). Our findings suggest that genetic variation at the DGAT1 locus may influence BMI and other metabolic parameters associated with cardiovascular risk in selected human populations.

C-reactive protein and coronary heart disease in western Turkey

C-reactive protein (CRP) has been recognized as a useful marker for coronary or cardiovascular risk in healthy subjects or patients with coronary heart disease (CHD) in industrialized societies. We assessed whether CRP could serve as a marker of prevalent CHD risk in a cross-sectional study of a population with low cholesterol levels (4.61 mmol/L in men and 4.82 mmol/L in women) but higher prevalence of other risk factors. In 1,046 participants of the Turkish Adult Risk Factor Survey in 2000, high-sensitivity CRP as well as other risk variables were evaluated, and CHD was diagnosed, based on clinical findings and Minnesota coding of electrocardiograms at rest. Almost an equal number of men and women > or = 30 years of age constituted the population sample of the western regions of Turkey. Geometric mean value of CRP was 1.9 mg/L (interquartile range 0.8 to 4.3), without revealing a significant difference in gender. CRP was correlated with many variables, notably those involving central obesity, fibrinogen, and apolipoprotein-B, but not with smoking status (regardless of age adjustment). In multiple regression models, blood fibrinogen, waist circumference, total cholesterol, and physical activity grade were independently associated with log CRP concentrations. Among many risk variables, CRP quartiles and systolic blood pressure were, besides age and gender, the only significant independent determinants of CHD. The age-adjusted odds ratio for CHD in the highest as opposed to the lowest quartile was 4.48 (p < 0.001). Even after adjustment for the 5 previously mentioned determinants of CRP, a 4.2-fold increased risk of CHD still persisted between the highest and lowest quartiles. Thus, the observed increased risk was not in large part due to the intermediary effects of fibrinogen, nor were some indicators of insulin resistance, but interaction appeared to be independent of these effects. Thus, CRP values serve as a marker of prevalent CHD risk in populations with low cholesterol levels. This association is independent of, or in addition to, the effects of conventional risk factors, suggesting that the contribution of chronic low-grade inflammation to the atherothrombotic process is present even in the setting of low cholesterol levels.

Obesity and associated factors in a Palestinian West Bank village population

OBJECTIVE

To describe body mass index (BMI), waist circumference and waist-hip ratio in a Palestinian West Bank village population, and to assess the associations of these variables to blood pressure and serum lipids.

DESIGN

Cross-sectional study.

SETTING

Community-based study in a prototypic semi-rural Palestinian village in the central West Bank.

SUBJECTS

All individuals aged 30-65 y in the study village were invited for the study and 500 (85%) participated.

MAIN OUTCOME MEASURES

BMI > or = 30 was used as the measure of obesity.

RESULTS

The prevalence of obesity was 37.5% among women and 18.8% among men. The prevalence of abdominal obesity was 62.5% among women and 14.8% among men. BMI seemed to be the more important correlate of blood pressure whereas waist-hip ratio seemed to be the more important correlate of serum triglycerides, compared to the other obesity measures.

CONCLUSIONS

The prevalence of obesity in the study population was very high compared to most other countries in the world, particularly among women.

SPONSORSHIP

The study was funded by the Norwegian Universities' Committee for Development Research (NUFU). LCM Stene was supported by a grant from the Throne Holst Foundation.

Risk factors and cardiovascular disease in Turkey

Cardiovascular risk factors as well as morbidity and mortality from coronary heart disease among Turkish adults are herein reviewed. Lipids and lipoproteins are in focus, but other relevant risk factors are also discussed. Turks have distinctively low levels of total and high-density lipoprotein (HDL)-cholesterol, associated with high levels of hepatic lipase and fasting triglycerides. In addition, physical inactivity is common in both genders; close to 60% of men have the smoking habit, while obesity is common among Turkish women leading to a high prevalence of hypertension and diabetes in them. These factors probably account for the unanticipated fact that Turkish adults have the pattern of causes of death similar to a developed population, although the process of industrialization is ongoing, the structure of its population is young and overall cholesterol levels are comparatively low. The age-standardized coronary heart disease death rate is estimated to rank among the highest in Europe. The leading independent predictors of coronary events and death [systolic blood pressure, total/HDL-cholesterol ratio, followed by diabetes and (central) obesity] are related to the metabolic syndrome, estimated to prevail in 3-4% of adults aged 30 or over, and to underlie one-eighth of cases of coronary disease. Since several adverse factors exhibit a rising trend, primary and secondary prevention of cardiovascular disease must assume a much higher priority in various issues in Turkey than it currently does.

Waist circumference and waist-to-hip ratio in Turkish adults: interrelation with other risk factors and association with cardiovascular disease

OBJECTIVE

To investigate the distribution of waist circumference (WC) and waist-to-hip ratio (WHR), their relationships with a number of established risk factors and their relevance to cardiovascular morbidity in a random sample of Turkish general adult population.

DESIGN

Cross-sectional population-based study.

SUBJECTS

The subjects comprised 958 men and 1014 women, aged 25-74 years.

MEASUREMENTS

Waist circumference was measured midway between the lower rib and iliac crest while that of the hip at the level of trochanters. Mean of two blood pressure measurements was used for analysis. Plasma total cholesterol (Cho) and triglyceride (Trg) concentrations were measured by the enzymatic dry method with a Reflotron apparatus.

RESULTS

Overall mean WC measured 93+/-12 cm in men, and 88.6+/-13 cm in women. Mean WHR was 0.919+/-0.077 and 0.823+/-0.074, respectively, and a rise by about 0.001 was associated with each year of age. In multiple regression analysis a model was utilized that included age, body mass index (BMI), systolic and diastolic blood pressure (BP), plasma total Cho and Trg and category of smoking. This revealed age, BMI, and Trg as independent determinants of WHR in both genders, and diastolic BP in women alone. Age, BMI, and diastolic BP proved to be independently associated with WC in both genders, while Cho did so in men alone, Trg and systolic BP in women alone. Partial correlation coefficients on univariate analysis between all four variables of blood pressure and plasma lipids and either WC or WHR, controlled for age, were highly significant though moderately weak in both genders. These were stronger in men than in women, and stronger with respect to WC than to WHR. Cigarette smoking men and women had significantly lower WC or WHR than nonsmokers and ex-smokers, though these associations did not prove to be independent. When the relevance of WC and WHR to CHD risk was tested in this cohort (for the age bracket 45-74 years) comprising 138 cases with a clinical diagnosis of CHD, only WHR in women proved to be significantly associated. Odds ratio for a value of >0.845 was 1.6.

CONCLUSION

WC and WHR are strongly associated with BMI and age as well as with parameters reflecting insulin resistance such as diastolic blood pressure and plasma triglycerides. WHR was significantly associated with coronary heart disease in Turkish women.