Effect of insulin resistance on left ventricular structural changes in hypertensive patients

Both left ventricular (LV) hypertrophy and insulin resistance (IR) have often been demonstrated in patients with essential hypertension (EH). Insulin may exert a direct growth promoting effect on cardiomyocytes rather than affecting the LV internal diameter. The purpose of this study was to examine the effect of IR on LV geometry. We enrolled 105 patients (71 females, mean age, 49.2 ± 13.6 years) with recently diagnosed and untreated hypertension (blood press > 140 and/or 90 mmHg, fasting glucose < 110 mg/dL), and grouped them as normal (N) (39 patients, 26 females, mean age, 48.5 ± 14.7 years) if all M-mode echocardiographic measurements were within normal limits, concentric remodeling (CR) (22 patients, 15 females, mean age, 50.5 ± 14.8 years) if relative wall thickness was increased but left ventricular mass index (LVMI) was normal, concentric hypertrophy (CH) (13 patients, 9 females, mean age, 50.3 ± 10.8 years) if both ventricular thicknesses and the LVMI were increased, and eccentric hypertrophy (EH) (31 patients, 21 females, mean age, 48.6 ± 12.9 years) if ventricular thicknesses were normal, but LVMI was increased. Transthoracic echocardiography was performed in all subjects, and interventricular septal thickness (IVS), posterior wall thickness (PWT), sum of wall thickness (SWT), left ventricular end-diastolic internal diameter (LVED), relative wall thickness (RWT), and LVMI were recorded. Blood samples for routine biochemical examination and fasting insulin levels were obtained and then the homeostasis model assessment (HOMA) index was calculated by the formula: HOMA Index = Fasting Blood Glucose (mg/dL) × Immunoreactive Insulin (μU/mL)/405, for the assessment of IR. There were no significant differences among the groups with respect to age, blood pressure (BP) levels, fasting blood glucose (FBG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), total cholesterol (TC), or triglyceride (TG) levels. Insulin levels were significantly higher in the CR and CH groups in comparison with the N group (P = 0.004), and the HOMA index was higher in the CH group compared to the N group (P = 0.024). In Pearson's correlation analysis, insulin was found to be directly correlated with IVS (r = 0.29, P = 0.002), SWT (r = 0.25, P = 0.009), and RWT (r = 0.33, P = 0.0001). The HOMA index was also directly correlated with IVS (r = 0.33, P = 0.001), SWT (r = 0.29, P = 0.002), and RWT (r = 0.29, P = 0.003). Cardiac changes in hypertensive patients include increased LVMI and altered LV geometry. The concentric LV geometry seen in hypertensive patients might be mediated, at least in part, by increased insulin levels and the HOMA index. Copyright © 2006 by the International Heart Journal Association

KARAPAPAKLARIN ANADOLU'YA GÖÇÜ (1877-1914)

19. yüzyılın ilk yarısında yaşanan siyasi gelişmeler, Karapapakların Kafkasya, İran ve Osmanlı toprakları dâhilinde göç hareketlerine sebep olmuştur. 1826-28 Rus-İran Harbi sonrası imzalanan Türkmençay Antlaşması gereğince Revanzın Rusyazya bırakılması bu bölgede yaşayan Karapapakların göçüne neden olmuştur. Karapapaklar yoğun olarak Anadoluzya göç etmişlerdir. Bu göçler Kafkasyazdan Anadoluzya doğru gerçekleştirilen yüzyılın ilk göç hareketidir. Bu ve bunu takip eden diğer göçler Türk-Rus savaşları ve onun getirdiği değişimin sonuçları olarak karşımıza çıkmaktadır. Karapapak göçleri, 1877-78 Osmanlı-Rus Harbi sonrasında kitlesel bir boyut kazanmıştır. Bunun en önemli sebebi Rusyaznın savaştan galip çıkması, kurulması muhtemel bir Ermeni devleti ve Kars, Ardahan ve Batumzun Rus işgali altında kalmasıdır. Rus işgali altında yaşamaktansa Osmanlı topraklarına göç etmeyi tercih eden Karapapaklar Anadoluznun iç kesimlerine doğru yoğun bir göç hareketi gerçekleştirmişlerdir. Sonuç olarak, 1877-1878 Osmanlı-Rus Harbizne kadar Kafkasyazda ve Elviye-i Selasezde yaşayan Karapapaklar bu tarihten sonra Anadoluznun iç kesimlerinde yerleşmeye başlamışlardır.Political developments in the first half of the 19th Century caused Karapapaks to migrate across Caucasia, Persia and Ottoman lands. Karapapaks migrated from Revan following Iranzs leaving Revan to Russia in accordance with the Turkmenchay Treaty signed after the 1826-28 Russian-Persian War. These were the centuryzs first migration movements from Caucasia to Anatolia. This and other migrations were the results of Russo-Turkish wars. Karapapak migration gained a massive dimension following 1877-78 Russo-Turkish War. This was because following triumph in the war Russia occupied Kars, Ardahan and Batum and of the threat posed by potential Armenian Government. Karapapaks preferred to migrate to Ottoman lands than living under Russian occupation and they migrated in great numbers towards inner parts of Anatolia. In conclusion, Karapapaks, who had lived in Caucasia and Elviye-i Selase (Kars, Batum and Ardahan) till 1877-78 Russo-Turkish War, began to settle in the inner parts of Anatolia after the war