How did the updated 2019 european society of cardiology/european atherosclerosis society risk categorization for patients with diabetes affect the risk perception and lipid goals, a simulated analysis of real-life data from EPHESUS study

Background: The recent 2019 European Society of Cardiology/European Atherosclerosis Society practice guidelines introduced a new risk categorization for patients with diabetes. We aimed to compare the implications of the 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines with regard to the lipid-lowering treatment use, low-density lipoprotein cholesterol goal attainment rates, and the estimated proportion of patients who would be at goal in an ideal setting. Methods: Patients with diabetes were classified into 4 risk categories according to 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidemia guidelines from the database of EPHESUS (cross-sectional, observational, countrywide registry of cardiology outpatient clinics) study. The use of lipid-lowering treatment and low-density lipoprotein cholesterol goal attainment rates were then compared according to previous and new guidelines. Results: This analysis included a total of 873 diabetic adults. Half of the study population (53.8%) were on lipid-lowering treatment and almost one-fifth (19.1%) were on high-intensity statins. While low-density lipoprotein cholesterol goal was achieved in 19.5% and 7.5% of patients, 87.4% and 69.6% would be on target if their lipid-lowering treatment was intensified according to 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society lipid guidelines, respectively. The new target <55 mg/dL could only be achieved in 2.2% and 8.1% of very high-risk primary prevention and secondary prevention patients, respectively. Conclusion: The control of dyslipidemia was extremely poor among patients with diabetes. The use of lipid-lowering treatment was not at the desired level, and high-intensity lipid-lowering treatment use was even lower. Our simulation model showed that the high-dose statin plus ezetimibe therapy would improve goal attainment; however, it would not be possible to get goals with this treatment in more than one-third of the patients

THE INVESTIGATION OF KINESIOPHOBIA , PAIN CATASTROPHIZING, PHYSICAL ACTIVITY, ANXIETY, AND DEPRESSION IN PATIENTS WITH OR WITHOUT MYOCARDIAL INFARCTION

Purpose: The study aimed to investigate kinesiophobia, pain catastrophizing, physical activity, anxiety, and depression in patients with MI.Material and Methods: A cross-sectional study was conducted with 100 participants (50 myocardial infarction, 50 age-sex matched controls). Participants were evaluated with the Tampa Scale of Kinesiophobia for Heart (TSK Heart), Pain Catastrophizing Scale (PCS), International Physical Activity Questionnaire-Short Form (IPAQ-SF), and Hospital Anxiety and Depression Scale (HAD).Results: IPAQ-SF (except sitting time) was higher in the control group (p0.01). PCS score (p0.01), HAD-A (p=0.001) and HAD-D (p=0.006) scores were significantly higher in the MI group. TSK Heart was correlated with Sitting PA (r=0.425), Walking PA (r=-0.574), Moderate PA (r=-0.632), HAD-A (r=0.641) and HAD-D (r=0.827) (p0.01). There was a relationship between HAD-A with Sitting PA, Walking PA and Moderate PA (r1=0.445, r2=-0.485, r3=-0.378, p0.01). Lastly, HAD-D was correlated with Sitting PA, Walking PA and Moderate PA (r1=0.475, r2=-0.520, r3=-0.578, p0.01).Conclusion: The study results showed decreased physical activity, increased kinesiophobia, pain catastrophizing, depression and anxiety in patients with MI. In addition, kinesiophobia was related to mild -moderate physical activity and depression-anxiety

Geographical Variations in Patients with Heart Failure and Preserved Ejection Fraction: A Sub-Group Analysis of the APOLLON Registry

Background: Clinical characteristics of patients with heart failure may vary geographically. However, limited data are available regarding the geographical differences of patients with heart failure and preserved ejection fraction.Aims: The present subgroup analysis aims to investigate the geographical differences in clinical characteristics, management, and primary etiology of patients with heart failure and preserved ejection fraction in Turkey.Study Design: A cross-sectional study.Methods: A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON (APOLLON) is a multicenter and observational study conducted in seven regions of Turkey (NCT03026114). The present study is a post-hoc analysis of the APOLLON registry. In this substudy, we compared the clinical characteristics of 819 consecutive patients with heart failure and preserved ejection fraction (mean age, 67 years; 57.8% women) admitted to cardiology outpatient units in different geographical regions.Results: Based on the geographical distribution of the entire Turkish population, the highest number of patients enrolled were from Marmara (271 patients, 33.1%). All demographical characteristics, clinical and laboratory findings, comorbidities, primary etiology, and medications prescribed were significantly different between the regions. Furthermore, inter-regional gender differences were identified. Comparatively, the Aegean and Mediterranean regions had older patients with heart failure and preserved ejection fraction (p0.001), and the Black Sea, Southeast, and East Anatolia regions had predominantly male patients (51.2, 54.5, and 56.9%, respectively; p0.002). Notably, the Mediterranean and Southeast Anatolia had more symptomatic patients, and history of hospitalization for heart failure was more prevalent in Southeast Anatolia (33.3%, p0.001). Prevalence of atrial fibrillation was higher in the Mediterranean and Southeast Anatolia regions (51 and 48.5%, p0.001), and patients with heart failure and preserved ejection fraction had a higher prevalence of hypertension in the Mediterranean, Southeast Anatolia, and Black Sea regions (p0.002). Angiotensin-converting enzyme inhibitors were more frequently prescribed in East Anatolia (52.3%, p0.001), and the prevalence of patients with heart failure and preserved ejection fraction using loop diuretics (48.8%, p0.003) was higher in the Black Sea region.Conclusion: This study was the first to show geographical differences in clinical characteristics of patients with heart failure and preserved ejection fraction in Turkey. Determination of the clinical characteristics of the heart failure and preserved ejection fraction population based on the geographical region may enables physicians to adopt a region-specific clinical approach toward heart failure and preserved ejection fraction

EPHESUS (Kılavuzlara Uyumun, Bilgi ve Algı Düzeylerinin Gerçek Yaşamda Saptanması) çalışmasının temel, tasarım ve metodolojisi

Objective: A wide gap exists between dyslipidemia guidelines and their implementation in the real world, which is primarily attributed to physician and patient compliance. the aim of this study is to determine physician and patient adherence to dyslipidemia guidelines and various influential factors. Methods: the Evaluation of Perceptions, Knowledge, and Compliance with the Guidelines in Real Life Practice: A Survey on the Under-treatment of Hypercholesterolemia (EPHESUS) trial (ClinicalTrials.gov number NCT02608645) will be an observational, multicenter, non-interventional study. the study targets enrollment of 2000 patients from 50 locations across Turkey. All of the data will be collected in a single visit and current clinical practice will be evaluated. A cross-sectional survey of public perception and knowledge of cholesterol treatment among Turkish adults will be performed. All consecutive patients admitted to cardiology clinics who are in the secondary prevention group (coronary heart disease, peripheral artery disease, atherosclerotic cerebrovascular disease) and who are in the high-risk primary prevention group (type 2 diabetes mellitus with no prior known coronary heart disease; patients who had markedly elevated single risk factors, in particular, cholesterol >8 mmol/L [>310 mg/dL], blood pressure ?180/110 mmHg, a calculated Systematic Coronary Risk Evaluation [SCORE] ?5%, or 8 mmol/L (>310 mg/dL) veya kan basıncı ?180/110 mmHg veya hesaplanmış SCORE değeri 10 yıl için ölümcül kardiyovasküler hastalık riski ?%5 ve <10% olanlar) olan tüm hastalar dahil edilecektir. Demografik, yaşam tarzı, tıbbi ve terapötik veriler bu özel anketle toplanacaktır. Sonuç: EPHESUS kayıtları, hem ikincil korunma, hem de yüksek riskli hastalarda birincil korunmada dislipidemi kılavuzlarına uyumu değerlendiren en büyük çalışma olacaktır