Adnan Duha Cömert

Background: Low admission low-density lipoprotein cholesterol (LDL-C) is paradoxically associated with worse outcomes after acute coronary syndrome, but this may reflect confounding rather than causation. We examined the paradox in statin-naïve patients. Methods: We studied 388 statin-naïve patients with a first ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) and followed for up to five years. Admission LDL-C was analyzed continuously and as three categories (130 mg/dL), with all-cause mortality assessed using Kaplan–Meier, Cox regression, restricted cubic splines, and landmark sensitivity analyses. Results: Crude mortality was highest in the lowest LDL-C group (20.0% vs. 8.3% vs. 10.7%; p = 0.014), and LDL-C < 100 mg/dL predicted higher mortality (hazard ratio 2.03, 95% CI 1.02–4.03). After adjustment, this remained non-significant across the parsimonious and fully adjusted models (adjusted HR 1.27–1.43, all 95% CIs including 1); older age, lower ejection fraction, and diabetes were independent predictors of death. The lowest stratum also had lower albumin and higher CONUT scores, consistent with a frailty phenotype. Conclusions: In statin-naïve STEMI patients undergoing primary PCI, the lipid paradox reflected age- and frailty-related confounding rather than protection; low admission LDL-C marks a higher-risk phenotype and should not discourage guideline-directed lipid-lowering therapy.

The Anatolian Journal of Cardiology - Peer-reviewed cardiology journal publishing original research, reviews, case reports. Impact Factor 1.5. The Anatolian Journal of Cardiology - Leading international cardiology journal with Impact Factor 1.5. Publishing original research, reviews, and case reports in cardiovascular medicine. Indexed in PubMed, Scopus, and Web of Science.

The Anatolian Journal of Cardiology - Peer-reviewed cardiology journal publishing original research, reviews, case reports. Impact Factor 1.5. The Anatolian Journal of Cardiology - Leading international cardiology journal with Impact Factor 1.5. Publishing original research, reviews, and case reports in cardiovascular medicine. Indexed in PubMed, Scopus, and Web of Science.

The Anatolian Journal of Cardiology - Peer-reviewed cardiology journal publishing original research, reviews, case reports. Impact Factor 1.5. The Anatolian Journal of Cardiology - Leading international cardiology journal with Impact Factor 1.5. Publishing original research, reviews, and case reports in cardiovascular medicine. Indexed in PubMed, Scopus, and Web of Science.

Amaç: Hipertansiyon ile aterosklerotik kardiyovasküler hastalıklar arasındaki ilişki daha önce birçok çalışmada gösterilmiştir. Diürnal kan basıncının intima-media kalınlığı üzerine olan etkisi az sayıda makalede araştırılmış ve çelişkili sonuçlar elde edilmiştir. Biz bu çalışmada antihipertansif tedavi almayan dipper, non-dipper ve revers-dipper hipertansiyonlu hastalarda aterosklerotik kardiyovasküler hastalığın göstergelerinden biri olan karotis intima-media kalınlığında farklılık olup olmadığını incelemeyi amaçladık. Gereç ve Yöntemler: Tek merkezli ve kesitsel olan bu çalışmaya, Şubat 2023 ile Mayıs 2023 tarihleri arasında, Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi Kardiyoloji polikliniğine başvuran ve ayaktan kan basıncı ölçüm cihazı ile hipertansiyon tanısı konulan hastalar dahil edildi. Hastaları; dipper, non-dipper ve revers-dipper olarak 3 grup şeklinde tasarladık. 125 hastanın 38'i dipper, 53'ü non-dipper ve 34'ü ise revers-dipper idi. Bulgular: Çok değişkenli lineer regresyon analizinde bilateral ortalama karotis intima–media kalınlığı revers-dipper grubunda dipper grubuna göre istatistiksel olarak anlamlı derecede daha yüksekti [β-coefficient = 0,075, %95 Cl: 0,027-0,123, p = 0,003]. Ayrıca, ileri yaş ile bilateral ortalama karotis intima–media kalınlığı arasında istatistiksel olarak pozitif bir korelasyon vardı [β-coefficient = 0,005, %95 GA: 0,003-0,007, p

The relationship between hemoglobin, albumin, lymphocyte, platelet (HALP) score, and various cancers and cardiovascular diseases has been tested previously. However, the relationship between HALP score and non-valvular atrial fibrillation (NVAF) has not been adequately tested. Therefore, our study aimed to investigate the relationship between HALP score and mortality in patients with NVAF. This study included 2,592 NVAF patients from 35 centers in Turkey. Patients were divided into two groups: those with HALP scores ≤ 58.96 (low HALP score group, 1,296 patients) and > 58.96 (high HALP score group, 1,296 patients). The primary outcome measured was all-cause mortality. The mean HALP score was 66 ± 33. Patients in the low HALP score group had higher 1- and 5-year all-cause mortality rates (1-year: 12.9% vs. 5.4%, p < 0.001; 5-year: 38.5% vs. 20.2%, p < 0.001). Cox regression analysis identified the HALP score as an independent predictor of mortality (1-year: HR = 0.987, 95% CI = 0.981-0.992, p < 0.001; 5-year: HR = 0.990, 95% CI = 0.987-0.993, p < 0.001). ROC analysis determined a HALP score 52.3 predicted 1-year mortality with 62.9% sensitivity and 62% specificity (AUC = 0.680); a score of 55 predicted 5-year mortality with 60.3% sensitivity and 62.2% specificity (AUC = 0.657). Kaplan-Meier analysis revealed increasing mortality over time in the low HALP score group (log-rank tests, 1-year = 44.86, p < 0.001; 5-year = 108.54, p < 0.001). The HALP score is a simple, accessible measure, and our findings suggest that lower HALP scores are associated with increased 1-year and 5-year mortality in NVAF patients. This provides a reference for clinicians assessing risk in this vulnerable population.

The triglyceride glucose (TyG) index is a biomarker of insulin resistance and is associated with an increased risk of cardiovascular events. Contrast-induced nephropathy (CIN) is an important complication that causes poor outcomes in patients undergoing percutaneous coronary intervention (PCI). In this study, we aimed to investigate the relationship between the TyG index and CIN and mortality in patients who underwent PCI due to chronic total coronary occlusion (CTO). Two hundred eighteen individuals from three separate medical centers who underwent procedural PCI between February 2010 and April 2012 and had a CTO lesion in at least one coronary artery were recruited. According to the TyG index, patients were divided into two groups. Patients with a TyG index ≥ 8.65 were included in Group 1, and patients with a TyG index < 8.65 were included in Group 2. Patients were followed up for 96 months. The main outcome was the development of CIN and mortality. The mean age of the patients (65.8 ± 10.94 vs. 61.68 ± 11.4, P = 0.009), diabetes mellitus (60 [44.8%] vs. 11 [13.1%], P < 0.001), and dyslipidemia rates (52 [38.8%] vs. 21 [25%], P = 0.036) were higher in group 1. In multivariable logistic regression analysis, it was seen that age (OR = 1.04, 95% CI = 1.01–1.08, P = 0.020), chronic kidney disease (OR = 2.34, 95% CI = 1.02–5.33, P = 0.044), peripheral artery disease (OR = 5.66, 95% CI = 1.24–25.91, p = 0.026), LVEF (OR = 0.95, 95% CI = 0.92–0.99, P = 0.005), LDL cholesterol levels (OR = 1.00, 95%CI = 1.00–1.02, P = 0.024) and TyG index (OR = 2.17, 95% CI = 1.21–3.89, P = 0.009) were independent predictors of the development of CIN. Our study demonstrates a correlation between the TyG index and the prevalence of CIN in patients with CTO undergoing PCI. Adding the TyG index to the routine clinical evaluation of patients with CTO undergoing PCI may help protect patients from the development of CIN.