Mentholated cigarette smoking and brachial artery, carotid artery, and aortic vascular function.

OBJECTIVES: We investigated possible acute effects of mentholated versus nonmentholated cigarette smoking on vascular functions and left ventricular diastolic functions in otherwise healthy young smokers. STUDY DESIGN: The study included 20 otherwise healthy smokers (6 women, 14 men; mean age 25.6 years) and 22 healthy nonsmokers (12 women, 10 men; mean age 25.1 years). Ultrasound and echocardiographic examinations were performed to determine baseline characteristics for the brachial artery, aorta, and carotid artery, including brachial flow-mediated dilation (FMD), aortic and carotid stiffness index (SI), distensibility, and elastic modulus (EM). On day 2, each subject smoked either two mentholated or nonmentholated cigarettes and ultrasound and echocardiographic examinations were repeated. The procedure was repeated 15 days later with each subject smoking the other type of cigarette. RESULTS: From the baseline level of 14.0+/-9.0%, FMD decreased significantly to 8.3+/-3.2% (p=0.012) and to 9.8+/-5.5% (p=0.025) after smoking mentholated and nonmentholated cigarettes, respectively. Increase in systolic blood pressure was significant only with mentholated cigarettes (p=0.003). Increases in heart rate and rate-pressure product were significant in both groups, being more prominent with mentholated cigarettes. Both types of cigarettes resulted in significant prolongation of mitral E deceleration time and decrease in mitral E/A ratio. Changes in aortic SI and EM were significant only with mentholated cigarettes, while changes in carotid SI and EM were significant in both groups. Menthol-associated changes in systolic blood pressure, heart rate, rate-pressure product, carotid strain, and carotid SI parameters differed significantly from those seen after nonmentholated cigarette smoking (p=0.027, p<0.001, p<0.001, p=0.037, and p<0.001, respectively). CONCLUSION: Our findings show that mentholated cigarettes are not safer than nonmentholated cigarettes and that menthol-associated acute impairment is more severe in many parameters of elasticity and stiffness.

Acute effects of smoking light cigarettes on coronary microvascular functions.

BACKGROUND: To date, there has been no study comparing the possible acute effects on coronary microvascular functions of smoking light cigarettes (those with low tar and nicotine yield) and regular cigarettes. METHODS: Twenty healthy volunteers (8 women and 12 men; mean age, 25.8 +/- 5.8 years) were included in a single-blind, open-label, cross-over study to compare the effects of smoking light cigarettes (containing 0.6 mg nicotine, 8 mg tar, 9 mg carbon monoxide) and smoking regular cigarettes (containing 0.9 mg nicotine, 12 mg tar, 12 mg carbon monoxide) on coronary flow reserve (CFR). For each participant, CFR values were measured at baseline, after smoking 2 regular or light cigarettes, and 15 days later after smoking 2 cigarettes of the other kind. RESULTS: After smoking 2 cigarettes, CFR values declined from 2.8 +/- 0.56 (baseline) to 2.31 +/- 0.51 after smoking light cigarettes (P = .003), and from 2.8 +/- 0.56 (baseline) to 2.21 +/- 0.45 after smoking regular cigarettes (P < .001). After smoking light and regular cigarettes, CFR values were similar (P = .678). CONCLUSIONS: Light cigarette smoking has similar acute detrimental effects on coronary microvascular function and CFR as does regular cigarette smoking.

Smoking mentholated cigarettes impairs coronary microvascular function as severely as does smoking regular cigarettes.

OBJECTIVE: Smoking mentholated cigarettes inhibits the metabolism of nicotine and increases systemic exposure to cigarette smoke toxins. However, the possible effects of smoking mentholated cigarettes on coronary microvascular functions are unknown. We sought to investigate whether smoking mentholated cigarettes impairs coronary flow reserve (CFR) more so than smoking regular cigarettes. METHODS: Twenty otherwise healthy smokers of regular cigarettes (6 women, 14 men; mean age, 25.6 +/- 6.4 years) and 22 non-smoking control subjects were included in the study. To compare the acute effects of mentholated (0.9 mg nicotine, 11 mg tar, 12 mg carbon monoxide) and regular (0.9 mg nicotine, 12 mg tar, 12 mg carbon monoxide) cigarettes on CFR, all subjects underwent an echocardiographic examination that included CFR measurements at baseline. Twenty to 30 minutes after subjects had smoked 2 regular cigarettes and 2 mentholated cigarettes, CFR was again measured in subjects in the smoking group. RESULTS: In response to smoking 2 regular and 2 mentholated cigarettes, CFR values declined from 2.56 +/- 0.60 to 2.06 +/- 0.38 (P < 0.004) and from 2.56 +/- 0.60 to 2.14 +/- 0.30 (P < 0.005), respectively. Smoking mentholated and regular cigarettes impaired CFR to the same degree (P = 0.547). CONCLUSIONS: When compared with smoking regular cigarettes, smoking mentholated cigarettes has similar acute detrimental effects on coronary microvascular functions.

Impaired coronary microvascular function and increased intima-media thickness in rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is associated with excessive cardiovascular mortality. Recently, some studies have shown endothelial dysfunction in RA patients with high inflammatory activity. In addition, it has been suggested that the chronic inflammatory state of RA contributes to accelerated atherosclerosis. Therefore, we aimed to evaluate whether coronary microvascular dysfunction and increased carotid artery intima-media thickness exist in patients with a long history and well controlled disease activity of RA lacking traditional cardiovascular risk factors. METHODS: Thirty RA patients (22 women; mean age 43.7+/-9.0) and 52 healthy volunteers (38 women; mean age 45.3+/-5.4) were included into the study. Using transthoracic echocardiography, each subject underwent echocardiographic examination including coronary flow reserve (CFR) and carotid intima-media thickness (IMT) measurement. RESULTS: CFR values were statistically reduced for RA patients as compared to controls (2.4+/-0.5 vs. 2.7+/-0.4, P=0.002) whereas IMT values were significantly increased (0.6+/-0.1 vs. 0.5+/-0.1, P=0.001). In RA patients, CFR positively correlated with lateral Em/Am ratio (r=0.399, P=0.029), and negatively correlated with lateral isovolumic relaxation time (IVRT) (r=-0.744, P=0.005), IMT (r=-0.542, P=0.002) and RA disease duration (r=-0.495, P=0.005). Reflecting LV diastolic function, mitral E-wave deceleration time and isovolumic relaxation time were borderline significant between the groups, however lateral Em/Am ratio and lateral IVRT were statistically different. CONCLUSIONS: Patients with RA had impaired CFR and increased carotid IMT, and these injurious effects correlated significantly with disease duration.

Intima-media thickness in patients with rheumatic mitral stenosis.

The aim of the study was to determine carotid artery intima-media thickness (IMT) in patients with rheumatic mitral stenosis (RMS). Between January 2001 and December 2003, 112 consecutive patients who had been diagnosed with RMS were screened. Patients with known cerebrovascular disease, coronary artery disease, diabetes, hypertension, left ventricular hypertrophy, hyperlipidemia, abnormal laboratory results, smoking, or age over 50 years were excluded. Forty-eight patients (43 women, 5 men, mean age 39.7 +/-8.3 years) with RMS without risk factors were enrolled in the study. Age- and sex-matched healthy individuals (n = 48; 43 women, 5 men, mean age 39.6 +/-8.6 years) with normal echocardiographic findings constituted the control group. Carotid IMT was determined by using a high-resolution ultrasound system equipped with a 7-MHz imaging probe (Acuson 128 XP CI) with a computer measurement software. The mean common carotid artery IMT thicknesses both in the right (0.604 +/-0.112 mm vs 0.521 +/-0.072 mm) and in the left side (0.581 +/-0.097 mm vs 0.516 +/-0.065 mm) were significantly higher in patients with RMS than in the control group (p < 0.001). Backward stepwise logistic regression analysis identified RMS as independent predictors of increased IMT (OR, 17.25 (CI, 3.99 to 76.28), p <0.001). The present study demonstrated that RMS is associated with increased IMT. The findings indicate that in patients with RMS not only valvular but also systemic endothelium is damaged.

Effects of atorvastatin on coronary flow reserve in patients with slow coronary flow.

BACKGROUND: Statins improve endothelial functioning in patients with coronary artery disease and hypercholesterolemia, while substantially little is known about induced changes in myocardial microcirculation. However, although previous studies have suggested that microvascular abnormalities and endothelial dysfunction is responsible for slow coronary flow (SCF), there is no study investigating possible effects of statins on coronary microvascular function in patients with SCF. HYPOTHESIS: We prospectively investigated the effects of short-term lipid-lowering therapy with atorvastatin on coronary flow reserve (CFR) reflecting coronary microvascular function in patients with SCF assessed by transthoracic Doppler echocardiography (TTDE). METHODS: In an open clinical trial, CFR was studied in 20 subjects with SCF. TTDE was used to assess CFR at baseline as well as after 8 weeks of atorvastatin therapy. Coronary flow was quantified according to TIMI frame count (TFC). Coronary diastolic peak flow velocities were measured at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak velocities. RESULTS: CFR was independently correlated with TFC. After 8 weeks of atorvastatin therapy, CFR values increased significantly (1.95 +/- 0.38 vs. 2.54 +/- 0.56, (p < 0.001). No change in hemodynamic parameters was noted during the entire study. The improvement in CFR was not correlated to the amount of lipid-lowering effect of atorvastatin. CONCLUSIONS: These findings suggest that short-term lipid-lowering therapy with atorvastatin improved CFR, which reflects coronary microvascular functioning in patients with SCF.

Impaired coronary microvascular function in familial Mediterranean fever.

BACKGROUND: Patients with inflammatory rheumatic diseases have an increased risk of developing atherosclerosis. However, the question of whether patients with familial Mediterranean fever (FMF) are at risk of atherosclerosis and related diseases remains controversial. OBJECTIVE: We aimed to use transthoracic Doppler echocardiography to investigate coronary flow reserve (CFR) and left ventricular (LV) diastolic function in patients with FMF. METHODS: CFR and LV diastolic function were studied in 33 patients with FMF (16 men, 17 women; mean age, 36.7+/-12.0 years) and 35 healthy volunteers (20 men, 15 women; mean age, 36.8+/-5.2 years). Coronary diastolic peak flow velocities (DPFV) were measured at baseline and after dipyridamole infusion. LV diastolic function was assessed by standard and tissue Doppler imaging. RESULTS: CFR was significantly lower in the FMF group than in the control group (2.27+/-0.38 versus 3.02+/-0.50, P<0.0001). Significant between-group differences were found regarding LV diastolic function mitral E/A ratio, mitral E-wave deceleration time, and lateral A(m). Serum high sensitivity C-reactive protein (hsCRP) levels were significantly higher in the patients with FMF, and hsCRP values independently correlated with CFR. CONCLUSIONS: Coronary microvascular function and LV diastolic function are impaired in patients with FMF. The severity of these impairments is correlated with hsCRP. Impaired CFR may be an early manifestation of cardiac involvement in patients with FMF.

Light cigarette smoking impairs coronary microvascular functions as severely as smoking regular cigarettes.

BACKGROUND: Smoking is the most prevalent and most preventable risk factor for cardiovascular diseases. Smoking low-tar, low-nicotine cigarettes (light cigarettes) would be expected to be less hazardous than smoking regular cigarettes owing to the lower nicotine and tar yield. OBJECTIVE: To compare the chronic and acute effects of light cigarette and regular cigarette smoking on coronary flow velocity reserve (CFVR). METHODS: 20 regular cigarette smokers (mean (SD) age 24.8 (5.0)), 20 light cigarette smokers (mean age 25.6 (6.4)), and 22 non-smoker healthy volunteers (mean age 25.1 (4.2)) were included. First, each subject underwent echocardiographic examination, including CFVR measurement, after a 12 hour fasting and smokeless period. Two days later, each subject smoked two of their normal cigarettes in a closed room within 15 minutes. Finally, within 20-30 minutes, each subject underwent an echocardiographic examination, including CFVR measurement. RESULTS: Mean (SD) CFVR values were similar in light cigarette and regular cigarette smokers and significantly lower than in the controls (2.68 (0.50), 2.65 (0.61), 3.11 (0.53), p = 0.013). Before and after smoking a paired t test showed that smoking two light cigarettes acutely decreased the CFVR from 2.68 (0.50) to 2.05 (0.43) (p = 0.001), and smoking of two regular cigarettes acutely decreased CFVR from 2.65 (0.61) to 2.18 (0.48) (p = 0.001). CONCLUSION: Smoking low-tar, low-nicotine cigarettes impairs the CFVR as severely as smoking regular cigarettes. CFVR values are similar in light cigarette and regular cigarette smokers and significantly lower than in controls.

Patients with Behcet's disease carry a higher risk for microvascular involvement in active disease period.

BACKGROUND: Behcet's disease (BD) is characterized with remissions and exacerbations. However, to date, there is no study to investigate a possible association of disease activity (active versus inactive disease period) with cardiovascular complications. METHODS: Forty patients with BD were evaluated in both active and in inactive disease period. For the control group 45 healthy volunteers, age and sex matched, were registered. Subjects with at least a 15-day lesion-free period were regarded in inactive disease period, and subjects with any oral, skin, and/or genital lesion was regarded as in active disease period. In each subject coronary diastolic peak flow velocities (DPFV) were measured at baseline and after dipyridamole infusion (0.84 mg/kg over 6 minutes) using an Acuson Sequoia C256 echocardiography system. Coronary flow reserve (CFR) was defined as the ratio of hyperemic to baseline DPFV. RESULTS: CFR values were significantly lower in BD patients compared to the controls (2.57+/-0.50 versus 2.87+/-0.53, P = 0.006). In active disease period, basal DPFV (24.6+/-7.5 versus 27.3+/-6.6, P = 0.019) was significantly higher than in the inactive disease period. In the active disease period hyperemic DPFV (61.7+/-14.9 versus 56.8+/-16.7, P = 0.015) values decreased significantly. Therefore, in the active disease period CFR significantly decreased from 2.57+/-0.50 to 2.09+/-0.46, P<0.001. The only independent predictor of CFR within the active disease period was the disease duration (beta = -0.384, P = 0.012). CONCLUSION: Within the active disease period, coronary microvascular function is more prominently impaired in BD patients. Therefore, BD patients are possibly more vulnerable to cardiovascular manifestations when they are in an active disease period.

Metformin therapy improves coronary microvascular function in patients with polycystic ovary syndrome and insulin resistance.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) are thought to have increased cardiovascular risk. Metformin therapy reduces whole-body insulin resistance (IR) in patients with type-2 diabetes mellitus (DM). OBJECTIVE: As insulin resistance accompanying PCOS may be reversed by metformin therapy, we hypothesized that metformin therapy might improve coronary microvascular functions in women with PCOS and IR. PATIENTS AND METHODS: We treated 16 women with PCOS and IR with metformin, and measured coronary flow reserve (CFR) at the beginning and after 6 months of metformin therapy using transthoracic second-harmonic Doppler echocardiography. RESULTS: At the end of the 6 months of metformin therapy, baseline coronary diastolic peak flow velocity (DPFV) did not change significantly (from 24.6 +/- 4.3 to 23.0 +/- 3.1, P = 0.106); however, hyperaemic coronary DPFV (from 68.2 +/- 12.7 to 74.5 +/- 9.7, P = 0.08), and CFR (from 2.75 +/- 0.48 to 3.3 +/- 0.5, P = 0.016) was significantly improved by metformin therapy. CONCLUSION: In women with PCOS, coronary microvascular function and CFR are significantly improved by 6 months of therapy with metformin.

Do women with polycystic ovary syndrome really have predisposition to atherosclerosis?

The elastic properties of the aorta were studied in 28 women with polycystic ovary syndrome (PCOS) and in 26 regularly menstruating healthy women. In PCOS and control groups, systolic and diastolic blood pressure, aortic systolic diameter, aortic diastolic diameter, aortic distensibility, aortic stiffness index, and aortic elastic modulus were similar. It is likely that PCOS does not have any innate adverse effects on the cardiovascular system if its undesirable metabolic consequences are successfully controlled.

Do young women with polycystic ovary syndrome show early evidence of preclinical coronary artery disease?

BACKGROUND: It is thought that women with polycystic ovary syndrome (PCOS) are at increased risk of developing cardiovascular diseases. METHODS: In this study, we used transthoracic echocardiography to measure coronary flow reserve (CFR) in 28 women with PCOS and in 26 healthy women. RESULTS: The PCOS and the control groups were similar in terms of age (27.1 +/- 4.5 versus 28.8 +/- 4.4 years) and BMI (26.6 +/- 5.7 versus 24.7 +/- 4.4 kg/m2). Fasting insulin levels and homeostasis model assessment insulin resistance index were higher in the PCOS group. LH, the LH/FSH ratio, total testosterone, free testosterone and androstenedione were higher in the PCOS group. FSH, estradiol, prolactin, progesterone, cholesterol, triglyceride and high-sensitive C-reactive protein were similar between the two groups, but homocysteine levels were higher in the PCOS group. Baseline diastolic peak f low velocity (DPFV) (25.0 +/- 4.6 versus 23.3 +/- 2.7 cm/s, P > 0.05), hyperaemic DPFV (71.2 +/- 12.8 versus 73.0 +/- 12.9 cm/s, P > 0.05) and CFR (2.8 +/- 0.8 versus 3.2 +/- 0.8 cm/s, P > 0.05) of the left anterior descending coronary artery were similar between the two groups. CONCLUSION: We conclude that in young women with PCOS and without cardiovascular risk factors, CFR is preserved.

Silent cerebral infarct in patients with mitral valve prolapse.

It is still not clear whether mitral valve prolapse (MVP) is a risk factor for ischemic stroke. The aim of this study was to evaluate whether uncomplicated MVP is a risk factor for silent cerebral ischemic events. Fifty-two patients with uncomplicated MVP and 46 control subjects without MVP were included in the study. All subjects were evaluated for silent cerebral infarct (SCI) with a magnetic resonance imaging. Five (9.6%) of the patients who had MVP but no other risk factors for ischemic cerebral events had SCI. The results suggest that uncomplicated MVP is a risk factor for SCI, and that patients with MVP should receive anti-platelet-aggregating drugs.

High serum bilirubin concentrations preserve coronary flow reserve and coronary microvascular functions.

BACKGROUND: Elevated serum bilirubin concentrations protect against atherosclerotic diseases; however, it is not clear whether higher serum bilirubin concentrations in physiological ranges work in favor of the cardiovascular system in younger persons with no cardiovascular risk factors. Accordingly, we investigated the effects of high, intermediate, and low serum bilirubin concentrations on coronary flow reserve (CFR). METHODS AND RESULTS: Fifty-two healthy subjects with hyperbilirubinemia (total bilirubin 1.43+/-0.33 mg/dL; mean age 35.9+/-7.3), 55 subjects with intermediate bilirubin level (total bilirubin: 0.69+/-0.11 mg/dL; mean age: 36.4+/-6.8), and 53 healthy subjects with hypobilirubinemia (total bilirubin 0.37+/-0.08 mg/dL; mean age, 37.6+/-6.6) were studied. Transthoracic second harmonic Doppler echocardiography examination was performed using an Acuson Sequoia C256 Echocardiography System. Coronary diastolic peak flow velocities were measured at baseline and after dipyridamole infusion (0.84 mg/kg over 6 minutes). CFR was calculated as the ratio of hyperemic to baseline diastolic peak velocities. Demographic features, coronary risk factors, echocardiographic measurements, and biochemical measurements were similar among the 3 groups, except high-sensitivity C-reactive protein (hsCRP). CFR values were significantly higher in subjects with high bilirubin concentrations than those were in the intermediate and the low bilirubin groups (3.19+/-0.73; 2.75+/-0.42; 2.56+/-0.52, respectively; P<0.0001), and hsCRP levels were significantly lower in subjects with high bilirubin concentrations than those in both intermediate and low bilirubin groups (1.4+/-1.0, 2.0+/-1.7, 3.0+/-1.9 mg/L, respectively; P<0.001). hsCRP levels correlated with total bilirubin concentration and with CFR. CONCLUSIONS: Elevated serum bilirubin concentrations protect from CFR impairment, coronary microvascular dysfunction, and possibly coronary atherosclerosis.

Impaired coronary flow reserve in hemodialysis patients: a transthoracic Doppler echocardiographic study.

BACKGROUND: Coronary flow reserve (CFR) reflects the functional capacity of microcirculation to adapt to blood demand during increased cardiac work. In this study, CFR of hemodialysis patients with angiographically normal coronary arteries was evaluated using transthoracic second harmonic Doppler echocardiography. METHODS AND RESULTS: Ten hemodialysis patients, and 14 sex-, age- and left ventricular mass index-matched hypertensive controls with angiographically normal coronary arteries underwent transthoracic second harmonic Doppler echocardiographic examination. Coronary basal diastolic peak flow velocities and hyperemic peak flow velocities after dipyridamole infusion (0.56 mg/kg over 4 min) were measured. CFR was defined as the ratio of hyperemic to basal diastolic peak velocities. CFR > or =2.0 was regarded as normal. Additionally, Doppler tissue imaging pulse wave measurements were taken from the lateral and septal corners of the mitral annulus. CFR values were significantly lower in the study group than in the control group (2.03 +/- 0.3 vs. 2.61 +/- 0.5, p = 0.005). In 5 of 10 hemodialysis patients, CFR was <2.0 (50%), however in only 1 of 14 control patients it was <2.0 (5%). CONCLUSIONS: Impairment of coronary microvasculature occurs earlier in patients with chronic renal failure and may be the harbinger of subsequent primary uremic myocardial disease. In patients with chronic renal failure and normal coronary arteries, decreased CFR by transthoracic echocardiography might be regarded as an early finding of an affected coronary vasculature.

Comparison of carotid intima-media thickness in patients with stable angina pectoris versus patients with acute coronary syndrome.

In this study, we found that carotid intima-media thickness (IMT) was significantly increased and carotid artery atherosclerotic plaques were detected more frequently in patients who had early-onset coronary artery disease compared with control subjects (0.73 +/- 0.10 vs 0.60 +/- 0.10 mm, p <0.001, and 40% vs 11%, p <0.001, respectively). Further, patients who had coronary artery disease and presented with an acute coronary syndrome were found to have significantly increased carotid IMT compared with patients who had stable angina pectoris (0.76 +/- 0.10 vs 0.70 +/- 0.10 mm, p <0.05). The IMT was greater in the patients who had acute coronary syndrome than in those who had stable angina pectoris.

[Metabolic syndrome in patients after coronary bypass surgery: prevalence and compliance with treatment]. / Koroner baypas sonrasi hastalarda metabolik sendrom sikligi ve tedaviye uyum oranlari.

OBJECTIVE: The aim of this study was to evaluate the prevalence of metabolic syndrome (MS) and its components, to determine the patients' compliance with pharmacological therapy and lifestyle modification, and to clarify the association of demographic and socioeconomic factors with the MS in Turkish patients with prior coronary artery bypass surgery (CABG). METHODS: Two hundred and seventy-three patients (age range 35-77, 208 men) were interviewed and examined 1.0-2.2 years after CABG. RESULTS: The prevalence of MS was 44.8% (55.4% among women and 41.3% among men). The most prevalent metabolic risk factor was visceral obesity among females, and elevated blood pressure among males. Rates for regular physical activity were lower in patients with MS, compared with those without MS (36.9% vs. 47.7%, p<0.05). Compared with patients without MS, use of aspirin was lower among patients with MS (84.4% vs. 93.4%, p<0.05). Logistic regression analysis revealed an independent association of age>65 years and low educational level with MS. CONCLUSION: We found a high prevalence of metabolic syndrome and its components among patients with prior CABG. Patients with MS had lower rate of regular physical activity and aspirin use, compared with those without MS.

Prevalence of modifiable cardiovascular risk factors remain high after coronary bypass graft surgery: a multicentre study among Turkish patients.

BACKGROUND: The measures of secondary prevention in patients undergoing coronary bypass graft surgery (CABG) remains largely undetermined in Turkey. DESIGN: We designed a multicentre cross-sectional study to estimate the prevalence of cardiovascular risk factors in patients after CABG and to evaluate the association of demographic-socio-economic factors with secondary prevention in these patients. METHODS: A total of 622 patients who underwent CABG between 1 January 1999 and 15 January 2000 at four centres in Adana, Turkey; 273 (ages 35-77, 208 men) were interviewed and examined 1.0-2.2 years after the procedure. RESULTS: Of 273 patients interviewed, 81.5% were overweight, 65.5% had unhealthy food choices for a lipid-lowering diet, 56.0% were physically inactive, 28.8% were obese and 17.6% were current smokers. Hypercholesterolaemia, elevated blood pressure and fasting blood glucose were found in 65.6, 34.1 and 19.8%, respectively. Of diabetic patients, 63.8% had elevated fasting blood glucose. The use of angiotensin-converting enzyme inhibitors, beta-blockers and statins was low. Women had a higher rate of obesity and physical inactivity; smoking was less prevalent in females. More women were taking antihypertensive and lipid-lowering drugs than men. Logistic regression analysis revealed an association between hypercholesterolaemia and low educational level. CONCLUSION: Turkish patients have a high prevalence of modifiable risk factors related to unhealthy lifestyle and ineffective prophylactic drug use 1 year or more after CABG. Low educational level has a significant influence in this situation.