Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE) / 대한뇌졸중학회지

Background@#and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes. @*Methods@#Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH). @*Results@#Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (P<0.0001). @*Conclusions@#The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.

Frequency of ABO/Rhesus blood groups in patients with diabetes mellitus

The correlation between ABO/Rh blood groups and diabetes mellitus is still controversial. The aim of this study was to determine the relationship between ABO/Rhesus blood groups and diabetes in Turkish population. This cross-sectional study was conducted in Istanbul Medeniyet University Goztepe Education and Training Hospital's Diabetes Units. The study group was composed of 421 patients with type-1 diabetes, 484 patients with type-2 diabetes and 432 controls. Blood samples were collected and tested for ABO/Rhesus blood groups. Data was analyzed by SPSS version 17.0. A significant association was found between blood groups and diabetes mellitus. The frequency of AB blood group was significantly higher in type-1 diabetics; and A blood group was significantly higher in type-2 diabetics. Furthermore, Rh negativity were significantly more frequent in type-2 diabetics

Prevalence of celiac disease in adult type 1 patients with diabetes

Celiac disease, an autoimmune disease, is related to immune mediated intolerance to gluten. Some studies suggest that Celiac Disease was 20 times more frequent in type 1 patients with diabetes. The objective of our study was to evaluate the prevalence of celiac disease in hospital based type 1 diabetic adults. Our study was carried out retrospectively in Medeniyet University Goztepe Training and Educational Hospital in Istanbul between 2012-2013. The cohort comprised 482 type 1 patients with diabetes attending the diabetes outpatient clinic. The data were analyzed by SPSS 10.5 package program. Student's t tests is used for comparative analyses. A p-value less than 0.05 was considered statistically significant. The cohort included 482 type 1 patients with diabetes. Fifty seven of them were not evaluated for Endomysium antibody positivity. Fifteen of the remaining 425 patients were positive for anti endomysial antibody [3.5%]. The prevalence of biopsy proven celiac disease was 2.3% [10/425]. There was no significant difference between Endomysial antibody positive and negative groups in regard of age, sex, or duration of the disease. This study confirms that the celiac disease is common in type 1 diabetic patients. Since a small proportion of celiac patients are symptomatic this disorder should be screened in all adult type 1 patients with diabetes by antiendomysium antibody

effect of education and consultancy provided by nurse on main components of metabolic syndrome in women

The prevalence of metabolic syndrome is increasing day by day throughout the world. Cardiovascular disease are the primary clinical outcome of metabolic syndrome. Most individuals who develop cardiovascular disease have multiple risk factors. To evaluate the effects of education and consultancy provided by the nurses to the women suffering from metabolic syndrome. Randomised single blind controlled study, conducted in an obesity outpatient clinic in the department of endocrinology and metabolism, Istanbul from November, 2010 to October, 2011. A total 120 women with metabolic syndrome were randomly assigned to the intervention and control group. An education and consultancy program was given to the intervention group which comprised of reading materials and power-point presentations for three days. Individual consultancy was provided at the request of the patient. Data was collected using biochemical markers like fasting blood glucose, HbA1c, cholesterol, systolic and diastolic blood pressure and body composition measurements such as body weight, body fat and body mass index. Data was collected twice for ten months in the intervention and the control group and analyzed using Student t-tests, Mann Whitney U test, Wilcoxon and Chi-square test. In the intervention group, significant decrease was observed in fasting blood glucose, HbA1c, triglyceride, systolic and diastolic blood pressure, body weight, body mass index, visceral fat, total body fat and muscle, waist circumference, hip circumference, while an increase was observed in HDL-cholesterol. Individual consultancy was provided at the request of the patient. In the control group no significant change was seen between pre-assessment and pos- assessment parameters. Education and consultancy provided by the nurses was effective in improving the basic parameters of metabolic syndrome in women

Effect of intended fasting on serum leptin, adiponectin and ghrelin levels

Physiology of gastrointestinal system including its hormones is in strong interaction with the brain. During Ramadan, "intention" to fast may act on this physiology. We aimed to find out if there was a difference between the effects of Ramadan fasting and non-Ramadan fasting on serum levels of some gastrointestinal hormones i.e.; leptin, adiponectin and ghrelin. Forty two healthy subjects were included in the study. Blood samples were obtained in the morning in two different days. The first day was during the last week of the Ramadan when they were fasting, and the second day was during the first week after the Ramadan with the same duration of fasting. The comparison of the leptin, adiponectin and ghrelin levels in this two measurements did not reveal any statistically significant differences [12.25 vs.11.56 ng/ml, 485.19 vs. 286.52 pg/ml, and 15.18 vs. 24.07 ng/ml; p=0.317, p=0.282, p=0.604 respectively]. Although it was not statistically significant, approximately fifty percent higher adiponectin and fifty percent lower ghrelin levels with Ramadan fasting suggests that there could be a different fasting physiology with intended fasting during Ramadan, which needs to be further investigated.

Are all fixed dose combinations equally effective in blood pressure control? the analysis of four different fixed dose antihypertensive combinations

Hypertension guidelines recommend the use of fixed dose combinations as the first step treatment in patients with stage 2 and 3 hypertension. The aim of this study was to compare the antihypertensive effects of four different fixed-dose preparations containing beta blocker [BB]-diuretic, ACE inhibitor [ACEI]-diuretic, angiotensin receptor blocker [ARB]-diuretic, and calcium channel blocker [CCB]-ACEI. Eighty patients with newly diagnosed hypertension whose sitting blood pressure [BP] >/= 160/100 mmHg were randomized to receive either of those four fixed dose antihypertensive preparations: atenolol 50 mg-hydrochlorotiazide [HCTZ] 12.5 mg, or lisinopril 20 mg-HCTZ 12.5 mg, or telmisartan 80 mg-HCTZ 12.5 mg or verapamil 180 mg- trandolapril 2 mg. All the patients were followed up for six months. Both systolic BP [SBP] and diastolic BP [DBP] were reduced similarly in all groups [45.7/22.4 mmHg in BB-diuretic group, 45.8/18.1 mmHg in ACEI-diuretic group, 54.6/17.6 mmHg in ARB-diuretic group and 38.9/16 mmHg in ACEI-CCB group. For SBP p=0.19 and for DBP p=0.43]. All investigated fixed dose antihypertensive combinations were found similarly effective in reducing blood pressure

Relationship between uric acid levels and impaired glucose tolerance in subjects with metabolic syndrome

Metabolic syndrome [MetS] is a clustering of cardio-metabolic risk factors. Elevated serum uric acid levels are frequent in cases with cardiovascular disease carrying many attributes of MetS. The role of uric acid in the MetS pathogenesis and the development of Type 2 Diabetes Mellitus [DM] was not fully understood. In this study, the relationship between serum uric acid levels and MetS criteria and oral glucose tolerance test [OGTT] results was studied. This study was carried out in 83 patients having at least three MetS diagnosis criteria recommended by National Cholesterol Education Program Adult Treatment Panel III. After collecting 12-hour fasting venous blood samples of subjects, 2-hour OGTT was performed with 75 g oral glucose. A glucose level between 140 and 199 mg/dl at hour 2 was defined as impaired glucose tolerance. The 2-hour glucose value of 25 cases [31%] out of 83 cases was determined to be 140 mg/dl and over. In the multiple linear regression analysis, it was found that uric acid level and waist circumference, and body mass index and 2-hour OGTT levels were significantly related. In this study, in cases having high risk for type 2 DM, it was found that uric acid levels were related by some MetS components. Uric acid concentrations did not effect basal glycemia and insulin sensitivity