Women, lipids, and atherosclerotic cardiovascular disease:a call to action from the European Atherosclerosis Society

Cardiovascular disease is the leading cause of death in women and men globally, with most due to atherosclerotic cardiovascular disease (ASCVD). Despite progress during the last 30 years, ASCVD mortality is now increasing, with the fastest relative increase in middle-aged women. Missed or delayed diagnosis and undertreatment do not fully explain this burden of disease. Sex-specific factors, such as hypertensive disorders of pregnancy, premature menopause (especially primary ovarian insufficiency), and polycystic ovary syndrome are also relevant, with good evidence that these are associated with greater cardiovascular risk. This position statement from the European Atherosclerosis Society focuses on these factors, as well as sex-specific effects on lipids, including lipoprotein(a), over the life course in women which impact ASCVD risk. Women are also disproportionately impacted (in relative terms) by diabetes, chronic kidney disease, and auto-immune inflammatory disease. All these effects are compounded by sociocultural components related to gender. This panel stresses the need to identify and treat modifiable cardiovascular risk factors earlier in women, especially for those at risk due to sex-specific conditions, to reduce the unacceptably high burden of ASCVD in women.</p

European Society of Cardiology: Cardiovascular Disease Statistics 2019

Aims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods and results In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest

The etiopathogenesis of pulmonary hypertension: Inflammation, vascular remodeling [Pulmoner hipertansiyonda etiyopatogenez: İnflamasyon, vasküler yeniden şekillenme]

PubMed ID: 20819761Pulmonary arterial hypertension (PAH) is a progressive disease marked by increased pulmonary artery resistance leading to right heart failure with a high mortality. PAH is histologically characterized by endothelial and smooth muscle cell proliferation, medial hypertrophy, inflammation, and thrombosis in situ. Elevated pulmonary vascular resistance is the result of an imbalance between locally produced vasodilators and vasoconstrictors, in addition to vascular wall remodeling. Recent evidence demonstrates that inflammatory processes are involved in the generation of pulmonary vascular remodeling leading to PAH. Viral infections or similar immune-modulators trigger auto-antibody generation by endothelial injury and indirectly lead to PAH. All these immune-modulators associated with PAH, are also known to decrease the regulatory subgroups (CD4) of T cells. With a recognition of important role of inflammation in the development of PAH, anti-inflammatory agents and anti-cancer drugs are accepted as potential specific targets for PAH treatment. Though clinical studies are not enough, anti-inflammatory agents seem to be promising in the treatment of this devastating disease. © 2009 by AVES Yayİncİlİk Ltd

Editorial [Editörden]

PubMed ID: 28952469[No abstract available

Dyslipidemia prevalence in nonobese, nondiabetic patients with obstructive sleep apnea: does sex matter?

STUDY OBJECTIVES: Dyslipidemia in obstructive sleep apnea (OSA) has been attributed to confounding obesity and/or diabetes. This study aimed to examine lipid profiles in nondiabetic, nonobese patients with OSA and identify the possible effects of age and sex. METHODS: We retrospectively evaluated the lipid parameters of 3,050 adults who underwent polysomnography. A total of 2,168 patients were excluded due to obesity (body mass index ≥ 30 kg/m2), diabetes, alcoholism, untreated hypothyroidism, lipid-lowering drug use, missing sleep data, or treatment for suspected OSA. RESULTS: Of 882 patients (75% males, aged 46.8 ± 12.2 years) included in the study, 88.4% had OSA. Levels of total cholesterol (P = .003), low-density-lipoprotein (LDL) cholesterol (P = .005), non-high-density-lipoprotein (non-HDL) cholesterol (P = .001), and triglycerides (P = .007) were significantly higher in patients with OSA than in those without, whereas HDL-cholesterol levels did not differ. The proportion of patients with hypercholesterolemia and/or elevated non-HDL cholesterol (>  160 mg/dL) was significantly higher in OSA than in non-OSA. Correlation analyses by sex revealed stronger and more significant relationships between lipid parameters and apnea-hypopnea index in women than in men (r = .135, P .001, vs r = .080, P = .043 for total cholesterol; r = .111, P .001, vs r = .080, P = .046 for non-HDL cholesterol; r = .122, P .001, vs r = .061, P = .107 for LDL cholesterol, respectively). In regression analysis, the rate of hypercholesterolemia increased with age (P .001 for women and P = .031 for men); non-HDL- and LDL-cholesterol levels significantly increased with OSA severity (P = .035 and P = .023, respectively) and age (P = .004 and P = .001, respectively) in women. CONCLUSIONS: After excluding confounding obesity and diabetes, patients with OSA have an impaired lipid profile including total cholesterol, LDL cholesterol, non-HDL cholesterol, and triglycerides. A significant association between dyslipidemia and OSA severity was observed in women but not in men. CITATION: Basoglu OK, Tasbakan MS, Kayikcioglu M. Dyslipidemia prevalence in nonobese, nondiabetic patients with obstructive sleep apnea: does sex matter? J Clin Sleep Med. 2023;19(5):889-898. © 2023 American Academy of Sleep Medicine

The rationale and design of the national peripartum cardiomyopathy registries in Turkey: The ARTEMIS-I and ARTEMIS-II studies [Türkiye’deki peripartum kardiyomiyopati kayıt çalışmalarının temeli ve tasarımı: ARTEMIS-I ve ARTEMIS-II çalışmaları]

PubMed ID: 29339690Objective: Peripartum cardiomyopathy (PPCM) is left ventricular (LV) systolic dysfunction with an ejection fraction of ?45% occurring in the later stages of pregnancy or soon after delivery. Although various risk factors have been identified, the exact cause of the disease is unknown. Unlike most countries in the European region, Turkey has yet to determine the current PPCM burden. A registry for this purpose does not exist. To close this gap, the A RegisTry of pEripartuM cardIomyopathy in Turkish patientS (ARTEMIS-I and ARTEMIS-II), was planned and endorsed by the Turkish Society of Cardiology. The aim of this manuscript is to describe the rationale and design of the ARTEMIS-I and ARTEMIS-II registries. Methods:ARTEMIS was designed to be the nationwide PPCM registry of Turkey, with the goal of identifying problems and opportunities while improving quality and consistency in the medical care of PPCM patients. A second goal is to determine the clinical characteristics pertinent to patients in this region. The ARTEMIS registry will consist of 2 arms. All secondary and tertiary cardiology centers have been electronically invited to participate in ARTEMIS-I, which will be conducted to assess the current standard of care and outcome measures. Centers will be asked to enroll PPCM patients admitted to their clinic in last 5 years retrospectively. Eligibility criteria will consist of pregnant or early postpartum woman without a previous history of heart failure (HF) or known pathology associated with HF, LV ejection fraction ?45%, and exclusion of other causes of LV systolic dysfunction. ARTEMIS-II will consist of the prospective enrollment of patients. Conclusion: The nationwide PPCM registries, ARTEMIS-I and ARTEMIS-II, are designed to determine the current status of medical care, provide insights into nature of the disease, and suggest solutions on how to improve care and outcomes in these patients. © 2018 Turkish Society of Cardiology

Baseline clinical characteristics and patient profile of the TURKMI registry: Results of a nation-wide acute myocardial infarction registry in Turkey

PubMed: 32628144Objective: The TURKMI registry is designed to provide insight into the characteristics, management from symptom onset to hospital discharge, and outcome of patients with acute myocardial infarction (MI) in Turkey. We report the baseline and clinical characteristics of the TURKMI population. Methods: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of percutaneous coronary intervention selected from each EuroStat NUTS region in Turkey according to population sampling weight, prioritized by the number of hospitals in each region. All consecutive patients with acute MI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018 and November 16, 2018. Results: A total of 1930 consecutive patients (mean age, 62.0±13.2 years; 26.1% female) with a diagnosis of acute MI were prospectively enrolled. More than half of the patients were diagnosed with non-ST elevation MI (61.9%), and 38.1% were diagnosed with ST elevation MI. Coronary angiography was performed in 93.7% and, percutaneous coronary intervention was performed in 73.2% of the study population. Fibrinolytic therapy was administered to 13 patients (0.018%). Aspirin was prescribed in 99.3% of the patients, and 94% were on dual antiplatelet therapy at the time of discharge. Beta blockers were prescribed in 85.0%, anti-lipid drugs in 96.3%, angiotensin converting enzyme inhibitors in 58.4%, and angiotensin receptor blockers in 7.9%. Comparison with European countries revealed that TURKMI patients experienced MI at younger ages compared with patients in France, Switzerland, and the United Kingdom. The most prevalent risk factors in the TURKMI population were hypercholesterolemia (60.2%), hypertension (49.5%), smoking (48.8%), and diabetes (37.9%). Conclusion: The nation-wide TURKMI registry revealed that hypercholesterolemia, hypertension, and smoking were the most prevalent risk factors. TURKMI patients were younger compared with patients in European Countries. The TURKMI registry also confirmed that current treatment guidelines are largely adopted into clinical cardiology practice in Turkey in terms of antiplatelet, anti-ischemic, and anti-lipid therapy. ©Copyright 2020 by Turkish Society of CardiologyAcknowledgments: TURKMI is an investigator-initiated study sponsored by the Turkish Society of Cardiology that receives major funding from Astra-Zeneca Company for this project

Sekonder Önlem Hastalarında Kardiyovasküler Riski Azaltmada PCSK9 İnhibitör Gereksinimine Özel Vurgu ile Lipit Modifikasyonu: Delphi Panel Yaklaşımına Dayalı Bir Analiz

Objective: The aim of this study is to analyze the low-density lipoprotein cholesterol-lowering therapies in secondary prevention patients by analyzing their plasma low-density lipoprotein cholesterol levels, current treatment, considering their inadequate response to medications (as defined in current guidelines), and the requirement for a protein convertase subtilisin/kexin type 9 inhibitor. Methods: Delphi panel is used to seek expert consensus of experienced 12 cardiologists. A questionnaire consisting of 6 main questions is used to reflect the opinion of the expert panelists on the practices of low-density lipoprotein cholesterol-lowering therapies of patients with high and very high cardiovascular risk. Patients with atherosclerotic cardiovascular disease are covered in this present analysis. Results: According to expert opinion data, 18.6% of the patient population with atherosclerotic cardiovascular disease is estimated to have experienced recurrent vascular events. The current treatment of the patient population is 39.7% on high dose, 36.9% on low/moderate dose of statin, 13.1% on maximum tolerated dose statin + ezetimibe, and 1.2% on maximum tolerated dose statin + ezetimibe + protein convertase subtilisin/kexin type 9 inhibitor. The percentage of atherosclerotic cardiovascular disease patients with inadequate treatment response is estimated to be 20.2% in those using “maximum tolerated dose statin + ezetimibe.” The proportion of patients who will need to be treated with a protein convertase subtilisin/kexin type 9 inhibitor increases as their low-density lipoprotein cholesterol levels rises from 9.1% in 70-99 mg/dL to 50.8% in ?160 mg/dL for these patients. Conclusion: According to expert opinion, although a substantial proportion of patients with secondary prevention have not achieved low-density lipoprotein cholesterol goals, the use of protein convertase subtilisin/kexin type 9 inhibitors is very low. Since the questionnaire subject to panel discussion did not include any question elaborating the issue, the discrepancy between the recommendation of the related guidelines and Turkish practice needs further studies for the explanation. © 2022 Turkish Society of Cardiology. All rights reserved.Funding: This study was supported by Amgen Turkey

Rationale, design, and methodology of the evaluation of perceptions, knowledge, and compliance with the guidelines in real life practice: A survey on the under-treatment of hypercholesterolemia [EPHESUS (Kılavuzlara uyumun, bilgi ve algı düzeylerinin gerçek yaşamda saptanması) çalışmasının temel, tasarım ve metodolojisi]

PubMed: 293396912-s2.0-85040780102Objective: 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 <10% 10-year risk of fatal cardiovascular disease) will be included. Demographic, lifestyle, medical, and therapeutic data will be collected with a survey designed for the study. Conclusion: The EPHESUS registry will be the largest study conducted in Turkey evaluating the adherence to dyslipidemia guidelines both in secondary and high-risk primary prevention patients. © 2018 Turkish Society of Cardiology