Sub-optimal drug treatment of diabetes and cardiovascular risk in diabetic patients in Turkey. A countrywide survey

Objectives: The present study is a snapshot of how diabetic patients are treated for diabetes and coexisting cardiovascular risk factors in Turkey. We also adressed the question of what percentage of these patients are treated appropriately according to the current guidelines. Next step will be to determine which pharmacological treatment strategies affect mortality and morbidity in these patients and whether there are regional differences in these outcomes

Short and long term survival of surgical treatment of left ventricular aneurysms - Ten years experience

Although surgical treatment of left ventricular ancurysins has been performed for a long time, it is still a point of debate. in this study, we investigated 159 patients who had undergone surgery for a left ventricular aneurysm in our clinic between 1985 and 1994. Perioperative mortality, long term survival rates, and parameters which probably affect these ratios were evaluated. All of the patients except one were followed by clinical records, mail or phone. Classic linear repair (1 1 1 cases), plication (46 cases), and Dor plasty (2 cases) were performed. Revascularisation procedure was also performed in 140 (88%) cases. The average number of distal anastomosis was 2.6. Twenty cases (12.6%) died in the perioperative period. The most important parameter which affected early mortality was the requirement for an intra-aortic balloon pump in the postoperative period. Mean follow-up duration was 47 35 months. Forty-two late deaths occurred in this period, The overall 5-year survival rate was 71%. Predictors for long term mortality were related to preoperative left ventricular function, presence of congestive heart failure, and poor functional capacity. The type of surgery did not affect short and long term survival. The functional capacity of the survivors was improved

Sub-optimal drug treatment of diabetes and cardiovascular risk in diabetic patients in Turkey. A countrywide survey

PubMed ID: 15525875Objectives: The present study is a snapshot of how diabetic patients are treated for diabetes and coexisting cardiovascular risk factors in Turkey. We also adressed the question of what percentage of these patients are treated appropriately according to the current guidelines. Next step will be to determine which pharmacological treatment strategies affect mortality and morbidity in these patients and whether there are regional differences in these outcomes. Methods: To get a representative picture, Turkey was splitted into four parts with different ethnic and socioeconomic features then centers were randomized within each of these parts. Number of the centers in a region were calculated according to the population of that region. 305 physicians in 11 cities participated in data collection during a period of 3 months. Consecutive 2226 diabetic patients patients who were above 55 years of age were included. Detailed information was obtained about the demographic features and the cardiovascular risk factor and diabetes status of the patients together with relevant drug treatment. Laboratory analyses were done locally and recorded if performed during the last 3 months. Results: Most patients were treated with oral antidiabetic monotherapy regardless of diabetes duration, metabolic control and complication and cardiovascular risk factor status. There was a trend among physicians except for endocrinologists to underprescribe insulin. Monotherapy also was the main mode of treatment for hypertension. Angiotensin converting enzyme inhibitors were generally not used as first line treatment contrary to the recommendations and angiotensin converting enzyme inhibitors and angiotensin receptor blockers are not prescribed for renoprotection in microalbuminuric patients. Statins, fibrates, metformin and aspirin were largely underused. Conclusion: The present study indicates that diabetic patients are undertreated in Turkey. Therefore every effort should be spent to implement current guidelines in diabetic patients in order to prevent macro and microvascular complications of diabetes.Acknowledgements – The study was sponsored by Aventis Pharma Turkey. Aventis had no role in study design, data analysis, data interpretation or in the writing of the report. We are grateful to Drs. Mehmet Yusuf and Sedat Baran for their contribution to this study. -

Five year follow-up of patients with high cardiovascular risk in the Turkish population. What are the predictors of highest cardiovascular risk?

Background: Despite the overwhelming evidence from clinical trials showing that preventive measures recommended by recent guidelines significantly reduce mortality, the implementation rate in patients with high cardiovascular risk is still far from optimal. Methods: A total of 5600 patients with a high cardiovascular risk were invited to participate however 3331 (59%) agreed to a five year follow-up in a multicenter, observational study. Primary end-points included death, myocardial infarction, stroke and optimal medication use over 5 years. Results: Primary end-points including cardiovascular mortality were higher in patients with vascular disease (25.3% vs 15.1%, p < 0.001, and 13.5 vs 6.2%, p < 0.001, respectively) and it was doubled in 5 years. Presence of end organ damage further increased the incidence of primary end-point and cardiovascular mortality (30.6% vs 16.2%, p < 0.001 and 18.1% vs 6.8%, p < 0.001, respectively). The optimal preventive treatment (statin, renin-angiotensin system blocker, beta-blocker and antiplatelet) rate was low and did not change significantly in 5 years, although the consistent use of angiotensin-converting enzyme inhibitor seemed to be a protective predictor of cardiovascular mortality. Conclusion: In this high risk Turkish population, mortality and morbidity in the medium to long term were high and the implementation rate of optimal preventive treatment unacceptably low. The highest risk subgroup was identified to be those with previous vascular disease/event and end organ damage requiring aggressive medical treatment. © 2008 World Heart Federation

Which patients have the highest cardiovascular risk? A follow-up study from Turkey

WOS: 000230511300011PubMed ID: 15942424Background Recent guidelines target individuals at highest risk as a priority. However, implementation of guidelines even in this group is sub-optimal. Design A multicenter, observational follow-up study. Methods A total of 5600 consecutive patients >= 55 year with high risk of vascular events were evaluated for risk factors and medication usage and followed for 1 year for primary end-points (death, myocardial infarction, stroke), and secondary end-points (revascularization, hospitalization). Results The patients were divided into two groups: those without and with vascular disease. In the first group, mortality at 1 year was significantly higher in those with end organ damage (5.8 versus 2.7%, P=0.005). Similarly, the mortality in patients with known vascular disease (CAD, peripheral vascular disease, ischaemic stroke) was higher in the presence of a previous vascular event (78 versus 5.3%, P=0.055, vascular event: non-fatal MI/stroke). The use of antiplatelets, statins, beta-blockers and angiotensin-converting enzyme inhibitors was low and did not improve in the follow-up period. The most important predictors of cardiovascular mortality were the presence of end organ damage [odds ratio (OR) 1.65, P=0.001], pre-existing vascular disease (OR 1.49, P=0.023) and protectively, the consistent use of angiotensin-converting enzyme inhibitors (OR 0,49, P=0.001). Conclusion In a high-risk Turkish population, the early mortality and morbidity due to cardiovascular events was unacceptably high and medical treatment inadequate. The presence of end organ damage and a previous vascular event increased the risk even further and should be vigorously questioned. Aggressive lifestyle modification and medical therapy should be instituted in these patients. (c) 2005 The European Society of Cardiology

Antral/pyloric type hyperplastic polyp with prominent myoglandular features: a distinct subtype of gastric polyps

WOS: 00044341410308

The preliminary results of a residency satisfaction survey: "To love and not to love Pathology"

WOS: 00032390420002