Knowledge and experience of cardiopulmonary resuscitation among cardiologists in clinical practice: A multicenter cross-sectional study.

OBJECTIVE: This study aimed to investigate the theoretical knowledge and clinical experience of cardiopulmonary resuscitation (CPR) among Turkish cardiologists according to the recommendations of the 2015 European Resuscitation Council (ERC) guidelines. METHODS: A total of 120 cardiologists from 14 different medical centers (six university and eight research-education hospitals) in Istanbul were included in the study. The questionnaire consisting of 29 open-ended and multiple choice questions on CPR was used and validated based on the ERC guidelines published in 2015. The percentage of correct answers was calculated for each participant. RESULTS: Of the 120 cardiologists included in this study, 108 (90%) accepted the participation, and the median percentage of correct answers for theoretical questions was 53% (38-72). The percentage of correct answers for interventional cardiologists (48%, n=52) was significantly higher [60% (50-66) vs. 46% (38-52), p<0.001]. Regarding the type of medical centers, no statictical difference was found in terms of theoretical knowledge on CPR [57% (50-72) university hospitals vs. 49% (41-57) research-education hospitals, p=0.160). Peri-arrest transthoracic echocardiography was used in 71% of cases. The ratio of participants who had received an advanced cardiac life support course in the preceding year was only 19% (n=20), and those participants had a significantly higher score regarding the CPR theoretical knowledge questions [68% (54-70) vs. 46% (38-51), p<0.001]. CONCLUSION: The theoretical knowledge of cardiologists on CPR is not satisfactory according to the 2015 ERC guidelines. An increased frequency of CPR training courses may improve this result.

A descriptive analysis of abstracts presented at the Turkish National Cardiology Congresses between 2011 and 2015.

OBJECTIVE: The aim of this study was to investigate the scientific publication performance of the abstracts presented at the annual Turkish National Cardiology Congress (TNCC) between 2011 and 2015 and to analyze the variables associated with publication. METHODS: The accepted abstracts of five congresses (2011-2015) were screened using the title and names of all authors in English via PubMed and Google Scholar databases. The parameters recorded included presentation type, publication rate, time to publication, affiliated institution, journal name and average impact factor, and average citation number per year for each publication. RESULTS: A total of 2897 abstracts (966 oral presentations and 1931 poster presentations) were accepted in five meetings and 23.4% (n=680) of these were published in national or international peer-reviewed journals. Of the published articles, 32.6% (n=222) were oral presentations and 67.4% (n=458) were poster presentations. The mean time to publication of oral and poster presentations were similar [9 (0-58) vs. 8 (0-62) months, p = 0.150]. According to the type of institution, university hospitals had the highest ratio of publication (58.6%) (p<0.001). All publications were published in 148 journals from 37 different countries. The average citation number of publications was significantly higher than the average impact factor of the journals [1.4 (0-30.1) vs. 1.29 (0.11-19.8), p<0.001]. CONCLUSION: Compared with other national-based literature in other medical fields, the overall publication rate was found to be similar while the time to publication was shorter. The significant difference between citation number and impact factor may be interpreted as positive indicator in terms of high level scientific value for cardiology publications presented in the TNCC.

[The efficacy and safety of pitavastatin]. / Pitavastatinin etkinligi ve güvenligi.

In short-term, phase III or IV studies in Asian and European patients, pitavastatin 1, 2 and 4 mg once daily reduced LDL-Cholesterol (LDL-C) 34%, 42% and 47%, respectively. Pitavastatin provided sustained LDL-C-lowering efficacy over up to 60 weeks' therapy in extension studies. In comparative studies pitavastatin 4 mg and simvastatin 40 mg reduced LDL-C similarly, reduction in triglycerides and increase in HDL-Cholesterol (HDL-C) was more prominent with pitavastatin. In comparative studies with atorvastatin, pitavastatin 4mg was found to be more effective than 20 mg of atorvastatin, and a little less effective than 40 mg of atorvastatin. The increase in HDL-C demonstrated in short term studies sustained in long term, whereas with atorvastatin the increase in HDL-C was less prominent. Pitavastatin was generally well tolerated in these studies and most treatment emergent adverse events were mild or moderate and their frequency was not different from other statins. Pitavastatin did not appear to adversely affect glucose metabolism parameters (e.g. fasting blood glucose, fasting plasma insulin, glycated hemoglobin) in short- and longer-term prospective and post-marketing surveillance studies in adults. In conclusion, pitavastatin is an effective treatment option in adults with primary hypercholesterolemia and combined (mixed) dyslipidemia, including those at risk of developing type 2 diabetes.

[Familial hypercholesterolemia: epidemiology, genetics, diagnosis, and screening]. / Ailevi hiperkolesterolemi: Epidemiyoloji, genetik, tani ve tarama.

Familial hypercholesterolaemia (FH) is an autosomal dominant genetic disorder characterized by el- evated plasma levels of low-density lipoprotein-cholesterol (LDL-C) and increased risk of premature coronary heart disease. There are two types of FH, namely homozygous and heterozygous FH. FH is most commonly (85%) attributable to mutations in the LDL receptor (LDL-R) gene. Other rare causes are the mutations of genes encoding apolipoprotein B (Apo B), pro-protein convertase subtilisin/ kexin type 9 (PCSK9) and LDL adaptor protein 1 (LDLRAP 1). FH is both underdiagnosed and undertreated, particu- larly among children. Approximately 20% of patients are diagnosed and, of those, only a small minority receive ap- propriate treatment. The risk of premature coronary heart disease (CHD) is elevated about 20-fold in untreated FH patients. Early diagnosis of FH enables prompt treatment and prevention of consequent morbidity and mortality from premature CHD. There is no single internationally accepted set of criteria for the clinical diagnosis of FH. The most commonly used are the US (Make Early Diagnosis to Prevent Early Death) MEDPED, the UK (Simon Broome), and the Dutch Lipid Clinic sets of criteria that have been statistically and genetically validated. For early diagnosis and prevention of CVD, testing lipid levels in all first-degree relatives of diagnosed FH patients is necessary. Genetic screening for FH is generally not needed for diagnosis or clinical management, but may be useful when the diagnosis is uncertain.

Abdominal obesity with hypertriglyceridaemia, lipoprotein(a) and apolipoprotein A-I determine marked cardiometabolic risk.

BACKGROUND: Risks for coronary heart disease (CHD) and diabetes (T2DM) of the 'hypertriglyceridemic waist' phenotype (HtgW) warrant further investigation. We studied this issue and whether partial proinflammatory conversion of apolipoprotein (apo) A-I by lipoprotein(a) [Lp(a)] is a codeterminant. MATERIALS AND METHODS: In a population-based prospective study, 1328 Turkish adults were analysed in four groups by the presence of abdominal obesity and elevated triglycerides (Htg). RESULTS: LDL-cholesterol levels, significantly elevated in isolated Htg, were lower in HtgW, yet significantly higher apoB and complement C3 values existed in women with HtgW in whom also the lowest Lp(a) values prevailed. Lp(a) was linearly associated, more strongly in HtgW than in the remaining groups, with apoB and, in women inversely, with gamma-glutamyltransferase. Incident HtgW was predicted, not in men, but in women inversely by Lp(a) (OR 0.80 [95%CI 0.65; 0.97]), regardless of adjustment for relevant confounders. After adjustment for conventional risk factors, HtgW (OR 2.84) and high apoA-I/HDL-C ratio (OR 1.50) were significantly and additively associated with combined prevalent and incident CHD risk. High apoA-I and low HDL-cholesterol levels interacted therein in women. Type-2 diabetes was strongly predicted by HtgW, mediated in men by high apoA-I/HDL-C ratio. CONCLUSION: HtgW is associated with excess inflammatory markers, is predicted in women paradoxically by lower circulating Lp(a) and is associated in both sexes with marked excess cardiometabolic risk to which high apoA-I/HDL-C ratio contributes additively. These findings are consistent in women with apoA-I being oxidized via aggregation to Lp(a).

Minor allele of the APOA4 gene T347S polymorphism predisposes to obesity in postmenopausal Turkish women.

The aim of this study was to examine the relationship between APOA4 gene T347S polymorphism with obesity measures and serum lipids in Turkish adults. Randomly selected sample of 1,554 adults (754 men, mean age 50.4 ± 11.9 years and 800 women, mean age 49.6 ± 11.8 years) were included in the study. 346 Women (43.2 %) were postmenopausal. Genotyping was performed by using hybridization probes in real-time PCR. Not men but postmenopausal women, carrying the S347 allele, were associated with 1.5 kg/m(2) higher BMI (P = 0.016) and 3.6 cm wider waist circumference (P = 0.005) than postmenopausal T347 homozygotes, controlled for covariates. Logistic regression analyses of this polymorphism, adjusted for age, fasting triglyceride, smoking status, alcohol consumption and physical activity disclosed the rare allele to be associated with obesity in postmenopausal women at an odds of 1.80 (95 % CI 1.09-2.97; P = 0.021). Serum apoB level was lower in S347 allele carriers (110.9 ± 2.9 mg/dL) than in T347 homozygotes (119.0 ± 2.4 mg/dL; P = 0.035) in men but not women. APOA4 T347S polymorphism was unrelated to lipids and other lipoproteins in either gender. The APOA4 S347 allele predisposes to obesity and high waist circumference in Turkish postmenopausal women. ApoB levels are lower only in men in S347 allele carriers.

[Conflict of interest policies and disclosure requirements among European Society of Cardiology national cardiovascular journals]. / Políticas de conflictos de intereses y requisitos para su declaración en las revistas cardiovasculares nacionales de la Sociedad Europea de Cardiología.

Disclosure of potential conflicts of interest is used by biomedical journals to guarantee credibility and transparency of the scientific process. Conflict of interest disclosure, however, is not systematically nor consistently dealt with by journals. Recent joint editorial efforts paved the way towards the implementation of uniform vehicles for conflicts of interest disclosure. This paper provides a comprehensive editorial perspective on classical conflict of interest-related issues. New insights into current conflicts of interest policies and practices among European Society of Cardiology national cardiovascular journals, as derived from a cross-sectional survey using a standardized questionnaire, are discussed.

Políticas de conflictos de intereses y requisitos para su declaración en las revistas cardiovasculares nacionales de la Sociedad Europea de Cardiología / Conflict of interest policies and disclosure requirements among european society of cardiology national cardiovascular journals

Las revistas biomédicas utilizan la declaración de posibles conflictos de intereses para garantizar la credibilidad y la transparencia del proceso científico. Sin embargo, las revistas no abordan la declaración de conflictos de intereses de manera sistemática ni uniforme. Recientes esfuerzos editoriales conjuntos han abierto el camino a la aplicación de herramientas uniformes para la declaración de conflictos de intereses. En este artículo se presenta una visión integral sobre cuestiones clásicas relacionadas con los conflictos de intereses desde un punto de vista editorial. Además, a partir de los datos de un estudio transversal basado en el empleo de un cuestionario estandarizado, se comentan nuevas apreciaciones sobre las políticas y los actuales procedimientos editoriales relativos a los conflictos de intereses en las diversas revistas cardiovasculares nacionales de la Sociedad Europea de Cardiología.

Disclosure of potential conflicts of interest is used by biomedical journals to guarantee credibility and transparency of the scientific process. Conflict of interest disclosure, however, is not systematically nor consistently dealt with by journals. Recent joint editorial efforts paved the way towards the implementation of uniform vehicles for conflicts of interest disclosure. This paper provides a comprehensive editorial perspective on classical conflict of interest-related issues. New insights into current conflicts of interest policies and practices among European Society of Cardiology national cardiovascular journals, as derived from a cross-sectional survey using a standardized questionnaire, are discussed.

Gender- and obesity-specific effect of apolipoprotein C3 gene (APOC3) -482C>T polymorphism on triglyceride concentration in Turkish adults.

BACKGROUND: Apolipoprotein C3 (APOC3) gene polymorphisms are associated with cardiometabolic risk factors, varying in ethnicities. This study aimed to investigate such association between the APOC3 -482C>T polymorphism and cardiometabolic risk factors in the turkish adult risk factor (TARF) study cohort, stratifying by gender and obesity. METHODS: Randomly selected 1548 individuals (757 male and 791 female, mean age 49.9±11.8 years) were genotyped for -482C>T polymorphism using hybridization probes in a Real-Time PCR LC480 device. RESULTS: The -482TT genotype prevailed 9.9% in men and 11.5% in women. Association between 482C>T polymorphism and dyslipidemia (p=0.036, OR=1.42, 95%Cl=1.02-1.97) was found only in men. Analysis of variance showed that anthropometric and metabolic variables were not differently distributed in APOC3 -482C>T genotypes in the study population. In relation to dyslipidemia and obesity, the -482C>T polymorphism showed significant gender-by-genotype interactions (p<0.01). When the study population was stratified according to gender and obesity, homozygotes for the T allele were associated strongly with (by 45%) elevated fasting triglyceride concentrations in obese men (p=0.009) and homeostatic model assessment (HOMA) index in non-obese women (p=0.013). Furthermore, in the same subgroups, the associations of the fasting triglyceride concentrations and HOMA index with the TT genotype remained after adjustment for risk factors (p<0.05). CONCLUSIONS: APOC3 -482TT genotype is independently associated with elevated fasting triglyceride concentrations in obese men. Presence of obesity seems to be required for this genotype to induce markedly elevated triglycerides. Furthermore, it is associated with the dyslipidemia in men, without requirement of obesity.

Centralized Pan-European survey on the under-treatment of hypercholesterolaemia (CEPHEUS): overall findings from eight countries.

BACKGROUND: Surveys evaluating plasma lipid goal attainment in patients with coronary heart disease have shown that hypercholesterolaemia is inadequately treated. Limited data account for the reasons behind this. The aim of the CEntralized Pan-European survey on tHE Under-treatment of hypercholeSterolaemia (CEPHEUS) survey was to evaluate the current use and efficacy of lipid-lowering drugs (LLD), and to identify possible patient/physician characteristics associated with failure to achieve low-density lipoprotein cholesterol (LDL-C) targets recommended by the 2003 European guidelines (Third Joint Task Force). METHODS: CEPHEUS was a European, multi-centre, cross-sectional survey conducted in eight countries and involved patients on LLD for >3 months (stable medication >6 weeks). One visit was scheduled for data collection, including fasting lipids. In all but one country, physicians and patients filled in a questionnaire about aspects of hypercholesterolaemia and treatment. RESULTS: Of the 15 199 patients recruited, 14 478 were included in the final analyses. The mean age was 63.2 years, and 45% of patients were female. Overall, 55.3% of the patients achieved their LDL-C target. In multivariate analyses, the factors identified as positive predictors for achieving LDL-C goals included normal body mass index, not smoking, not having metabolic syndrome, being on statin therapy and good treatment adherence. LIMITATIONS: The population was a selected group of subjects treated with LLD, and the results cannot be extrapolated to the general population. Patient consent was obtained, which may have selected more motivated patients and induced a positive bias. The physician and patient questionnaires were not validated, but were only used for exploratory purposes. CONCLUSION: Only 55.3% of patients using LLD achieved the LDL-C target recommended in the 2003 European guidelines.