Serum endotrophin levels in patients with heart failure with reduced and mid-range ejection fraction.

BACKGROUND: Endotrophin, a type VI collagen cleavage product, has fibrosis, and insulin resistance effects. Type VI collagen also plays a role in cardiac fibrosis. In this study, we aimed to investigate the role of endotrophin in the pathogenesis of cardiac fibrosis by determining its levels in patients with heart failure with reduced and mid-range ejection fraction (EF). We also aimed to determine the possible association between endotrophin and treatment that prevents ventricular fibrosis. METHODS: Sixty patients with heart failure with reduced and mid-range EF and 27 volunteers with no cardiac failure were included in this study. In both groups, biochemical tests, EF, and endotrophin levels were measured. ELISA was performed for the determination of endotrophin levels. RESULTS: When compared with the control group, there was no significant difference for endotrophin levels in the patient group (p = .35). Participants in the study were divided into two groups according to their EFs, 40% and less, and 40-49%. They were classified according to their use of renin-angiotensin-aldosterone system (RAAS) blocking drugs. Endotrophin levels were significantly lower in patients with mid-range EFs between 40 and 49% (p = .03) using RAAS blockers. CONCLUSION: This study is the first to evaluate the relationship between endotrophin and heart failure. Endotrophin levels were found to be low in patients with heart failure with mid-range EF who were using RAAS blockers. This suggests that RAAS blockers may influence endotrophin levels and thus could have a role in the prevention of remodelling.

Choice of treatment based on Turkish hypertension consensus report: Do we follow the recommendations?

OBJECTIVE: The aim of this study was to determine how often the recommendations of the Turkish Hypertension Consensus Report are followed, and to draw attention to the report. METHODS: The demographic information of 1000 patients diagnosed with hypertension and the details of the antihypertensive medications prescribed at the outpatient service of a tertiary care hospital were recorded, and the data were compared with the recommendations of the report. RESULTS: The mean age of the patients was 62±11 years. In all, 623 (62.3%) of the 1000 patients were women, and 377 (37.7%) were men. A combination of an angiotensin II receptor blocker (ARB) and a diuretic was the most frequently observed prescription. A diuretic was the most used antihypertensive drug (58.7%), followed by an ARB (48.8%). However, as a monotherapy, a calcium channel blocker (CCB) was the most commonly used antihypertensive drug (19.2%). The most frequently used antihypertensive drug group in older patients was diuretics (63.6%), as proposed in the report. Beta blockers (49.1%) were used more often than expected. For the diabetic group also, a diuretic (60.7%) was the most frequently used antihypertensive drug, followed by an ARB (51.1%) and a CCB (45.2%). Angiotensin-converting enzyme (ACE) inhibitors (34.6%) were the fifth most preferred antihypertensive drug class. However, when ACE inhibitors and ARBs were considered as a single group, known as renin-angiotensin system (RAS) blockers, these RAS blockers were the most prescribed antihypertensive drug class, followed by diuretics. In the group of patients with coronary artery disease, treatment was found to be generally consistent with the report, but the use of diuretics was greater than expected. Lastly, 124 of 160 patients who had chronic kidney disease were given RAS blocker therapy, which was in line with the consensus report recommendations. CONCLUSION: Antihypertensive therapies were individualized, as suggested by the consensus report. However, there are proposals still to be considered in special patient groups.

The Effects of Blood Glucose Regulation in Omentin-1 Levels among Diabetic Patients.

Objectives: Omentin-1, an adipocytokine that increases the insulin sensitivity, has been determined to be reduced in patients with insulin resistance, impaired glucose tolerance, and Type-2 diabetes mellitus. In this study, we have investigated the alterations in Omentin-1 levels with the blood glucose regulation in diabetic patients having poor glycemic control. By this way, we aimed to determine the role of Omentin-1 as a marker in follow-up and monitoring progression of diabetes. Methods: Totally 58 patients with type 2 diabetes mellitus, older than 18 years of age who were having poor glycemic control (HbA1c≥9) were included in this study. In the first visit, all clinical and biochemical parameters of patients were recorded. After baseline evaluation, the patients were advised life style changes, and their medical treatment was determined individually according to the recommendations of the American Diabetes Association guidelines. At the end of the third month patients were re-evaluated. Serum Omentin-1 levels were measured with ELISA. Results: In patients using only oral antidiabetic agents, after exchanging the treatment with insulin, on 3rd month of treatment, there was a significant decrease in serum C-peptide and Omentin-1 levels compared with the initial results (p=0.034, p=0.048, respectively). On the other hand, in patients using insulin treatment from the beginning of the study, there was not any significant alterations in serum C-peptide or Omentin-1 levels compared with the initial results (p>0.05). Conclusions: Serum Omentin-1 levels may change with insulin and metformin treatments in Type-2 diabetic patients. In patients with poor glycemic control, Omentin-1 levels do not change with the regulation of blood glucose levels. A decrease in Omentin-1 and C-peptide levels has been determined after the initiation of insulin therapy. This suggests that, Omentin-1 levels are closely associated with the endogenous insulin reserve and may be used in follow-up of patients.