Apolipoprotein B assessment for evaluating lipid goals.

OBJECTIVE: It is suggested that the apolipoprotein (Apo) B levels are more valuable than LDL cholesterol (LDL-C) levels in assessing cardiovascular risk associated with hyperlipidaemia. However, although non-HDL cholesterol (non-HDL-C) levels are accepted as a secondary objective after achieving LDL-C levels in the guidelines, Apo B has not been recommended as a therapeutic goal yet. The objective of this study was to determine how many of the patients who achieved the LDL-C and non-HDL-C target recommended by the guidelines with a statin therapy achieved the Apo B target. METHODS: The study included a total of 182 consecutive hypercholesterolaemic (119 male, 63 female) patients who were over 18 years of age (mean age: 54.96 +/- 9.27 y) and on statin therapy. Apo B and non-HDL-C levels were determined for the patients who achieved or did not achieve the LDL-C target according to the cardiovascular risk categories defined in the Adult Treatment Panel-III report. Serum Apo B levels were assessed using the nephelometric method. RESULTS: The prevalence of patients who achieved the LDL-C, non-HDL-C and Apo B target was 63.2%, 79.7% and 72.5%, respectively. All of the patients who achieved the LDL-C target also achieved the non-HDL-C target. It was found that 6 of 115 patients (5.2%) who achieved the LDL-C and non-HDL-C target failed to achieve the Apo B target, whereas 23 of 132 patients (17.4%) who achieved the Apo B target failed to achieve the LDL-C target. CONCLUSIONS: These results showed that 95% of patients who received a statin therapy, and achieved LDL-C and non-HDL-C targets also achieved the Apo B target.

Frequency of abdominal obesity and metabolic syndrome in healthcare workers and their awareness levels about these entities.

OBJECTIVES: We investigated the frequency of metabolic syndrome (MetS) and abdominal obesity and evaluated the level of awareness about these two conditions in healthcare workers. STUDY DESIGN: A total of 723 healthcare workers (372 physicians, 247 nurses, 104 other healthcare staff; mean age 32.8+/-8.2 years) from four centers were included. Demographic, anthropometric, and biochemical data were recorded, lifestyle features were inquired, and the levels of awareness about abdominal obesity and MetS were surveyed. The criteria recommended by the Adult Treatment Panel (ATP) III were used for the diagnosis of abdominal obesity and MetS. The presence of MetS was evaluated in 178 subjects. Univariate and multivariate analyses were performed to evaluate the association between lifestyle features and abdominal obesity. RESULTS: The frequency of abdominal obesity was 13.8% and it was significantly higher in males than in females (19.1% vs 10.6%; p=0.002). Metabolic syndrome was diagnosed in 14 participants (7.9%), and there was no significant difference between men and women in this respect (p>0.05). The cut-off values for abdominal obesity and at least three criteria of MetS were correctly listed by 47 participants (6.5%) and 240 participants (33.2%), respectively, with physicians showing significantly higher awareness levels (p=0.001). In multivariate analysis, age =or>40 years and male gender were significantly associated with abdominal obesity. CONCLUSION: Our results demonstrate that only a minority of healthcare workers are cognizant of MetS as a clinical syndrome and the definition of abdominal obesity.

[The efficacy and prognostic value of heart rate variability in 24-hour and short time recordings for determining cardiac autonomic dysfunction in congestive heart failure]. / Kalp yetersizliginde uzun ve kisa süreli kayitlarda kalp hizi degiskenliginin kardiyak otonomik disfonksiyonu belirlemede etkinligi ve prognostik degeri.

OBJECTIVE: The heart rate variability (HRV) has been used in patients with heart failure as a non-invasive method and provided neuro-cardiovascular evaluation. This study was planned to determine the efficacy and prognostic value of 24-hour and short time HRV in autonomic dysfunction in patients with congestive heart failure. METHODS: Forty-six patients with symptomatic or asymptomatic left ventricular dysfunction (ejection fraction <40%) were included to the study. In the study group, 16 patients were in NYHA class I (35%), 19 - were in NYHA class II (41%) and 11 - were in NYHA class III (24%). In the first day, HRV was evaluated from the 24-hour Holter recordings. Following day; we assessed the HRV during: (1) 10 min of supine resting, (2) 10 min of regular breathing at a frequency of 20 acts/min, and (3) 10 min of passive orthostatism after tilting 80 degrees with tilt table. RESULTS: Twenty-four hour and short time recordings of HRV showed significant decrease in long-term LF/HF24 (LF- low frequency, HF- high frequency), and short-term LF/HFsupine, LF/HFbreathing and LF/HFtilt ratios in patients with NYHA class III when compared with the patients in NYHA class I-II (p=0.0001, p=0.01, p=0.03, p=0.0001, respectively). During 446+/-186 days of follow-up, cardiovascular end-points occurred in 20 patients. In Cox multivariate analysis, significant predictors of cardiac mortality and morbidity were, reduced LF/HF ratio (HR=0.4, 95% CI 0.31-0.73, p=0.001) in the 24-hour recordings and low left ventricular ejection fraction (HR=0.9, 95% CI 0.83-0.99, p=0.03). CONCLUSION: Our study demonstrated that both of the methods were useful for assessment of cardiac autonomic dysfunction and only 24-hour recordings of HRV had a prognostic value.