The prognostic impact of insulin resistance surrogates in patients with acute myocardial infarction with and without type 2 diabetes.

BACKGROUND: Cardiovascular disease is the major cause of morbidity and mortality, particularly in type 2 diabetes mellitus (T2DM). Novel markers of insulin resistance and progression of atherosclerosis include the triglycerides and glucose index (TyG index), the triglycerides and body mass index (Tyg-BMI) and the metabolic score for insulin resistance (METS-IR). Establishing independent risk factors for in-hospital death and major adverse cardiac and cerebrovascular events (MACCE) in patients with myocardial infarction (MI) remains critical. The aim of the study was to assess the risk of in-hospital death and MACCE within 12 months after ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) in patients with and without T2DM based on TyG index, Tyg-BMI and METS-IR. METHODS: Retrospective analysis included 1706 patients with STEMI and NSTEMI hospitalized between 2013 and 2021. We analyzed prognostic value of TyG index, Tyg-BMI and METS-IR for in-hospital death and MACCE as its components (death from any cause, MI, stroke, revascularization) within 12 months after STEMI or NSTEMI in patients with and without T2DM. RESULTS: Of 1706 patients, 58 in-hospital deaths were reported (29 patients [4.3%] in the group with T2DM and 29 patients [2.8%] in the group without T2DM; p = 0.1). MACCE occurred in 18.9% of the total study population (25.8% in the group with T2DM and 14.4% in the group without T2DM; p < 0.001). TyG index, Tyg-BMI and METS-IR were significantly higher in the group of patients with T2DM compared to those without T2DM (p < 0.001). Long-term MACCE were more prevalent in patients with T2DM (p < 0.001). The area under the ROC curve (AUC-ROC) for the prediction of in-hospital death and the TyG index was 0.69 (p < 0.001). The ROC curve for predicting in-hospital death based on METS-IR was 0.682 (p < 0.001). The AUC-ROC values for MACCE prediction based on the TyG index and METS-IR were 0.582 (p < 0.001) and 0.57 (p < 0.001), respectively. CONCLUSIONS: TyG index was an independent risk factor for in-hospital death in patients with STEMI or NSTEMI. TyG index, TyG-BMI and METS-IR were not independent risk factors for MACCE at 12 month follow-up. TyG index and METS-IR have low predictive value in predicting MACCE within 12 months after STEMI and NSTEMI.

Mean platelet volume is associated with serum 25-hydroxyvitamin D concentrations in patients with stable coronary artery disease.

There is little published data on the association of platelet function and 25(OH)D concentration. We investigated the associations between mean platelet volume (MPV) and 25(OH)D concentration in patients with stable coronary artery disease. Study population was divided into three groups: group 1-25(OH)D < 10 ng/mL (N = 22), group 2-25(OH)D 10-20 ng/mL (N = 42), and group 3-25(OH)D > 20 ng/mL (N = 14). Study groups shared similar demographics. MPV values were the highest in group 1, moderate in group 2, and the lowest in group 3 (11.1 vs 10.4 vs 9.8 fL P < 0.001). There was a negative correlation between MPV and 25(OH)D (R = - 0.38, P = 0.001). ROC analysis demonstrated a moderate predictive value (AUC 0.70) in identifying the discrimination thresholds of MPV (> 10.5 fL) for vitamin D deficiency and a weak predictive value (AUC 0.65) in identifying the discrimination thresholds of 25(OH)D concentration (≤ 15.5 ng/mL) for the presence of large platelets (MPV over the upper limit of normal). In conclusion, even though the effect of vitamin D on platelet size and function is probably multifactorial, our study provides further evidence linking vitamin D to thrombosis and hemostasis. Platelets are another potential element through which vitamin D deficiency could exert adverse cardiovascular outcomes.

Sudden unexplained cardiac deaths in young adults: a call for multidisciplinary approach.

The investigation of death in young (<35 years), previously fit individuals, calls for a detailed autopsy with emphasis placed upon the examination of the heart. In most instances, the cause of cardiac death can be identified during autopsy. However, a large percentage of sudden deaths remain unexplained even after comprehensive medicolegal investigation, including autopsy, and are labelled as autopsy-negative sudden unexplained cardiac death (SUD). Still, when you look to the law, an autopsy, a much needed truth-finding-instrument, usually is not mandatory and is left up to the discretion of various medical or legal authorities, which when making a decision, balance various, often conflicting interests of the state and society on the one hand and of the deceased and his family on the other. Cardiac molecular autopsy calls for a close cooperation between medical examiner, pathologist, family physician, cardiologist, geneticist, and the relatives. Multidisciplinary approach and the identification of genetic cause of SUD enable proper genetic counselling for surviving relatives as well as for implementing specific preventive/therapeutic strategies, e.g. implantable cardioverter-defibrillator (ICD) implantation.

[The role of medical dispatchers in the prehospital management of patients with ST-segment elevation myocardial infarction].

OBJECTIVE: Introduction: Cardiovascular diseases are the leading cause of mortality worldwide. Acute coronary syndromes are diagnosed in 1.5 million patients, in Poland about 140,000 patients per year. A medical dispatcher who has first contact with the patient or a witness of the accident plays a very important role. The aim: To analyze the quality indicators of the State Emergency Medical System, including the role of the medical dispatcher diling with patients with STEMI. PATIENTS AND METHODS: Material and methods: The medical documentation of the Voivodeship Emergency Medical Service in Katowice for the years 2013-2016 (n =915345)was analized a retrospective analysis. The study included those causes that ended with the diagnosed STEMI (870 cases). The final diagnosis was based on the data of the Polish Registry of Acute Coronary Syndromes PL-ACS and AMI-PL. RESULTS: Results: STEMI was diagnosed in 870 visits (0.095%) causes. More often in men than in women (63.8% vs. 36.2%, p <0.001). The average age of the patients was 65 years ± 11.3. Most frequent STEMI occurred during the day (p <0.001). Patients either smoke or smoked in the past, a small proportion never smoked (78.3% vs 31.7%, p <0.001). The most frequent place occurrence of STEMI was the victim's home (p <0.001). The average time in the emergency code (K-1) was 6 min 29 seconds. It is worth noting that changing the code causes a dramatic increase in the time of a team reaching the place of an accident (p <0.001). The time of giving help is related to the time of day and the light of a conversation (p <0.001). CONCLUSION: Conclusions: Medical dispatcher and Emergency Medical Teams play a key role diling with patients with STEMI. Conducting activities in accordance with the current medical knowledge leads to much lower mortality and results in a better quality of life for the patient and his family.

[The influence of type 2 diabetes mellitus on early and late results of percutaneous coronary intervention for non-st segment elevation myocardial infarction].

OBJECTIVE: The aim: We aimed at assessing the prognostic significance of diabetes mellitus in patients with NSTEMI treated with PCI as well as determining the independent predictors of worse prognosis. PATIENTS AND METHODS: Materials and methods: We performed a retrospective analysis of 830 patients hospitalized between January 2006 and December 2012 with diagnoses of NSTEMI and undergoing angiography and percutaneous coronary interventions. Patients were divided into two groups: with diabetes mellitus (246 patients) and without diabetes mellitus (584 patients). All patients were followed up at 30 days, 12 months, and 24 months. RESULTS: Results: Diabetes mellitus was an independent risk factor for the occurrence of complex endpoints (HR, 1.64) at the 24-month follow-up visit: myocardial infarction not ending with death analyzed alone (HR, 1.82), death analyzed together with myocardial infarction not ending with death (HR, 1.65), and repeated revascularization performed due to the presence of ischemia (HR, 1.63) Moreover, diabetes mellitus was one of the factors influencing 24-month mortality, but its independent influence was at the threshold of significance (HR, 1.46; p=0.08). In the multiple factor analysis the independent risk factors for death at the 24-month follow-up were: creatinine concentration on admission, LVEF, age, and cardiogenic shock during hospitalization. CONCLUSION: Conclusions: Despite similar efficacy of percutaneous coronary intervention, diabetes mellitus was associated with a worse in-hospital and long-term outcomes. Diabetes mellitus did not affect long-term mortality.

Superficial herpes simplex virus wound infection following lung transplantation.

Surgical site infections (SSIs) are infections of tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure. SSIs are classified into superficial, which are limited to skin and subcutaneous tissues, and deep. The incidence of deep SSIs in lung transplant (LTx) patients is estimated at 5%. No reports have been published as to the incidence of superficial SSIs specifically in LTx patients. Common sense would dictate that the majority of superficial SSIs would be bacterial. Uncommonly, fungal SSIs may occur, and we believe that no reports exist as to the incidence of viral wound infections in LTx patients, or in any solid organ transplant patients. We report a de novo superficial wound infection with herpes simplex virus following lung transplantation, its possible source, treatment, and resolution.

Effects of trimetazidine on interleukin-2 and interleukin-8 concentrations in patients with coronary artery disease.

Trimetazidine (TMZ) exhibits metabolic and cardioprotective effects. The aim of this study was to assess the effects of TMZ on interleukin-2 (IL-2) and interleukin-8 (IL-8) serum concentrations in 156 patients with stable coronary artery disease. They underwent a treadmill exercise test (TET) before and after 3 months of TMZ treatment. IL-2 and IL-8 concentrations were determined before and after each TET. Before treatment, TET did not influence IL-2 concentrations, whereas IL-8 concentrations increased. TMZ treatment led to a decrease in IL-2 concentrations before TET, as well as it prevented the increase of IL-8 following the second TET. Obtained results confirmed the improvement in TET performance during TMZ treatment and they revealed a significant influence of TMZ on IL-2 and IL-8 concentrations both before and after TET. These changes may reflect potential anti-inflammatory effects of TMZ.

Antithyroid drugs during breastfeeding.

Antithyroid drugs (ATDs) are widely used for the treatment of Graves' disease (GD) in the general population. Over the past decade, there has been an increasing awareness that several disturbances of thyroid function may occur in mothers after delivery which may be more prevalent than previously appreciated. Exacerbation of immune reactions occurs 3-12 month following delivery. Management of hyperthyroidism during lactation requires special considerations and should be implemented to prevent any adverse outcomes in mother and neonate. Continuation of breastfeeding is safe and should be encouraged in hyperthyroid mothers taking ATDs, whether these are ATDs being continued after gestation or indeed ATD treatment initiated in the postpartum period. Given PTU hepatotoxicity concerns, experts currently recommend using low-to-moderate MMI doses as a first-line therapy in lactating mothers. PTU should be reserved only as a second-line agent for cases of severe hyperthyroidism (thyroid storm) and allergic reactions to previous MMI treatment. ATD should be administered in divided doses immediately following each feeding. Evaluation of thyroid function tests is advisable at least 3-4 weeks after the initiation of breastfeeding.

Radiocontrast-induced thyroid dysfunction: is it common and what should we do about it?

There has been a substantial increase in the use of radiocontrast-enhanced imaging studies in the past two decades (particularly computed tomography and coronary angiography). Sudden exposure to high levels of iodide may result in thyroid dysfunction (hyperthyroidism and hypothyroidism alike). Although the adverse-event rate is not very high, the condition is notable considering the large number of contrast-enhanced radiographic studies performed. Clinicians often have to decide on the most suitable diagnostic modality and the safest contrast medium when it comes to certain patients. In this study, we stress that the thyroid function of the patients should also be taken into consideration while making such decisions. We discuss in detail the prevalence and types (hypothyroidism and hyperthyroidism) of radiocontrast-induced thyroid dysfunction. We list the subsets of the population that are at a higher risk of radiocontrast-induced thyroid dysfunction and summarize the necessary prophylaxis and possible treatment. The presented principles apply to intravenous, intra-arterial and enteral (endoscopic retrograde cholangiopancreatography) routes of iodinated contrast medium administration.

The obesity paradox in acute coronary syndrome: a meta-analysis.

In the general population, the lowest mortality risk is considered to be for the body mass index (BMI) range of 20-24.9 kg/m(2). In chronic diseases (chronic kidney disease, chronic heart failure or chronic obstructive pulmonary disease) the best survival is observed in overweight or obese patients. Recently above-mentioned phenomenon, called obesity paradox, has been described in patients with coronary artery disease. Our aim was to analyze the relationship between BMI and total mortality in patients after acute coronary syndrome (ACS) in the context of obesity paradox. We searched scientific databases for studies describing relation in body mass index with mortality in patients with ACS. The study selection process was performed according to PRISMA statement. Crude mortality rates, odds ratio or risk ratio for all-cause mortality were extracted from articles and included into meta-analysis. 26 studies and 218,532 patients with ACS were included into meta-analysis. The highest risk of mortality was found in Low BMI patients--RR 1.47 (95 % CI 1.24-1.74). Overweight, obese and severely obese patients had lower mortality compared with those with normal BMI-RR 0.70 (95 % CI 0.64-0.76), RR 0.60, (95 % CI 0.53-0.68) and RR 0.70 (95 % CI 0.58-0.86), respectively. The obesity paradox in patients with ACS has been confirmed. Although it seems to be clear and quite obvious, outcomes should be interpreted with caution. It is remarkable that obese patients had more often diabetes mellitus and/or hypertension, but they were younger and had less bleeding complications, which could have influence on their survival.

The Association between Circulating Cytokines and Body Composition in Frail Patients with Cardiovascular Disease.

The burden of cardiovascular disease and the percentage of frail patients in the aging population will increase. This study aims to assess the circulating levels of several cytokines in frail patients. This is an ancillary analysis of the FRAPICA trial. The ratio of men/women changed from robust through frail groups from 3:1 to 1:2. The groups are comparable in terms of age and body measurements analysis (weight, height, and BMI), yet the frail patients have significantly reduced fat-free mass, and more often have been diagnosed with diabetes. Frail patients have higher fibroblast growth factor basic (FGF basic) and follistatin levels (borderline significance). In multiple linear regression modeling of fat-free mass, we identified FGF basic, osteopontin, stem cell factor, soluble suppression of tumorigenicity 2, soluble epidermal growth factor receptor, soluble human epidermal growth factor receptor 2, follistatin, prolactin, soluble interleukin 6 receptor alfa, platelet endothelial cell adhesion molecule 1, soluble vascular endothelial cell growth factor receptor 1, leptin, soluble angiopoietin/tyrosine kinase 2, and granulocyte colony-stimulating factor. We have identified a few cytokines that correlate with fat-free mass, a hallmark of frailty. They comprise the kinins implicated in bone and muscle metabolism, fibrosis, vascular wall function, inflammation, endocrine function, or regulation of bone marrow integrity.

Could vitamin D concentration be a marker of a long hospital stay in older adults patients?

Background and aims: Vitamin D plays a pleiotropic role in the human body. Some studies have suggested that hypovitaminosis D may serve as a marker of comorbidity severity and length of hospital stay. Hospitalized older adults patients with a higher comorbidity burden tend to have lower vitamin D status, which negatively impacts the length of their hospital stay. Vitamin D deficiency has been identified as a significant risk factor for a prolonged hospital stay. This study aimed to investigate the link between vitamin D status and prolonged hospital stays, focusing on geriatric patients, and to assess the variation in hospitalization duration among geriatric patients with different vitamin D statuses. Methods: The study sample comprised of 422 patients aged over 60 years admitted to the geriatric department. Blood samples were collected in the morning on the day of admission. According to the diagnostic threshold defining serum 25(OH)D concentration approved for Central Europe, patients were divided into two groups (deficiency group and suboptimal group). Patients were divided into two groups based on hospitalization duration: the first, "shorter hospitalization," included stays up to 11 days, whereas the second, "longer hospitalization," encompassed stays of 12 days and above. Results: In total, 242 Caucasian patients, primarily women (172 women and 70 men), were recruited in the study. Patients with vitamin D deficiency had extended hospital stays compared with those with vitamin D levels below 49.92 nmol/L: 10.0 (8.00-13.00) days vs. 9.00 (8.00-11.00) days, P = 0.044. Hospitalization length (in days) had a negative correlation with vitamin D blood status (nmol/L) (P = 0.0005; R = -0.2243). ROC analysis indicated that patients with vitamin D levels below 31.2 nmol/L had a 47% higher chance of extended hospitalization, whereas those with levels above 31.2 nmol/L had a 77% higher chance of avoiding it. A significant majority of patients with suboptimal 25(OH)D levels experienced shorter hospital stays (≤11 days) than those with vitamin D deficiency (64.6%), P = 0.045. Conclusion: The study findings indicate that lower serum levels of 25(OH)D in hospitalized patients within the geriatric department are linked to extended hospital stays. Vitamin D holds potential as a predictor of hospitalization duration in geriatric patients. Nonetheless, further research is imperative to account for additional factors affecting health status and hospitalization duration in older adults individuals.

Metabolic Deregulations in Patients with Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) contributes to endocrine and metabolic complications for women worldwide. The aim of this study was to establish the usefulness of new anthropometric indices and atherogenic indices in the evaluation of metabolic disorders, in particular, glucose and insulin abnormalities in the profiles of women with polycystic ovary syndrome (PCOS). In the study, a total of 49 women with PCOS aged between 18 and 39 years were recruited. All patients were tested for fasting glucose and insulin, lipid parameters, oral-glucose administration, and biochemical parameters. All of them underwent anthropometric measurements, such as BMI (body mass index), WHR (waist-to-hip ratio), WHtR (waist-to-height ratio), BAI (body adiposity index), VAI (visceral adiposity index), LAP (lipid accumulation product), BRI (body roundness index), ABSI (A body shape index), AIP (atherogenic risk of plasma), AC (atherogenic coefficient), Castelli risk index-I, Castelli risk index-II and (LCI) lipoprotein combine index, TG/HDL-C ratio, METS-IR (The metabolic score of insulin resistance), triglyceride glucose index (TyG index), triglyceride glucose-body mass index (TyG-BMI index) and triglyceride glucose-waist circumference index (TyG-WC index) were calculated. The analyzed anthropometric measurements/indices and atherogenic indices demonstrated significant correlations in PCOS women. T A strong relationship was found between fasting glucose, fasting insulin, glucose after 60 min, HOMA-IR index in the patients with PCOS. There was no significant relationship between HbA1c and other analyzed parameters and indices. Most of the analyzed anthropometric and atherogenic indices may be useful tools in evaluating metabolic disorders, and, in particular, glucose and insulin abnormalities in PCOS women.

Anticoagulation for Atrial Fibrillation in Acute Coronary Syndrome Survivors Reduces Major Cardiovascular Events and Mortality.

The prevalence of atrial fibrillation (AF) in acute coronary syndrome (ACS) patients is increasing. Data on outcomes of anticoagulation in ACS patients with AF are lacking.The aim of our study was to investigate the prevalence of stroke, myocardial infarction, bleeding complications, and all-cause mortality in this population.PL-ACS and AMI-PL registries gather an all-comer population of ACS patients in Poland, exceeding half a million records. We have selected ACS survivors with concomitant AF on admission, divided them into subgroups with regard to the administered anticoagulation, and followed up with them for a 12-month period (n = 13,973). Subsequently, groups were propensity score matched for age, sex, ejection fraction, diabetes, heart failure, renal impairment, and type of ACS.The study population was divided with regard to the administration of anticoagulation. Anticoagulation was prescribed in 2,466 patients (17.6%). The (D)OAC+ patients were younger; however, comorbidities were more prevalent in this group. The 12-month follow-up showed that the (D)OAC+ patients had significantly lower rates of all-cause mortality, myocardial infarction, and ischemic stroke, with no significant increase in bleeding events. After matching, the study groups consisted of 2,194 patients each and showed no differences in baseline characteristics. The outcomes of the 12-month observation were similar to the findings before matching.This all-comer national registry analysis shows that the use of guideline-recommended therapy and anticoagulation in ACS survivors with AF is associated with a lower rate of all-cause mortality, recurrent myocardial infarction, and ischemic stroke.

Incidentally found situs inversus with dextrocardia: inferior myocardial infarction in an 86-year-old woman.

Situs inversus with dextrocardia is a rare condition. Yet, the incidence of atheroclerosis and myocardial infarction in patients with dextrocardia is similar to that in general population. The diagnosis of acute myocardial infarction is somewhat tricky and difficult if the dextrocardia is not recognized. We present the electrocardiogram, coronary angiograms, and chest radiogram of a patient with incidentally found situs inversus with dextrocardia.

Transradial Interventions at the Forefront of Innovation.

Interventional cardiology has witnessed tremendous changes over the years from a mainly diagnostic approach in an elective population to therapeutic strategies in critically ill patients. Currently, we can treat a broad spectrum of coronary artery, peripheral artery, and structural heart diseases with less invasive, percutaneous approaches that we did not anticipate to be possible just a decade ago. It is certain that the interventional techniques will see further development and we will be able to treat by percutaneous methods more conditions previously thought beyond our reach. Regardless of the advances in catheter-based diagnostic and therapeutic techniques, one thing remains constant. They all require vascular access. And, vascular access is the first technical part of any percutaneous cardiovascular procedure that can determine its overall success. High-quality data together with the availability of training courses for interventional cardiologists and fellows-in-training ensure systematic use of the transradial approach (TRA) which has demonstrated a considerable benefit compared to transfemoral approach both in chronic and acute coronary syndromes. Constant improvement of TRA techniques will further facilitate transradial endovascular and structural interventions, and the growing use for high-risk and complex percutaneous coronary interventions. A continuously growing body of evidence is focused on surpassing current TRA limitations (specifically radial artery occlusion) and expanding alternative vascular accesses such as transulnar approach or distal TRA ("snuff-box" technique). Should this downsizing trend continue, we could see a further paradigm shift toward using the snuff-box technique.

Summary of the European Society of Cardiology guidelines on dual antiplatelet therapy in patients after percutaneous coronary interventions.

This review is a summary of the European Society of Cardiology (ESC) guidelines focused on dual antiplatelet therapy in patients after percutaneous coronary interventions (PCI). Given a large number of recommendations concerning antiplatelet therapy published in various ESC guidelines, the main goal of this paper was to compile these separate recommendations into one document. In addition, we set out to present the current state of knowledge and create an algorithm that would be based on all of these guidelines in hope that it would allow quick navigation when selecting the type and duration of dual antiplatelet therapy (DAPT) depending on the clinical scenario with a special emphasis on evaluating both ischemic and bleeding risks. The review is based on the ESC guidelines on the diagnosis and management of chronic coronary syndromes (2019), revascularization (2018), acute myocardial infarction in patients presenting with ST-segment elevation myocardial infarction (STEMI) (2017), DAPT (2017), and acute coronary syndromes in patients presenting without persistent ST-segment elevation (NSTE-ACS) (2020). The review also provides brief information on the most important studies and meta-analyses in this area, as well as practical pointers for management in the case of bleeding complications and before urgent surgery in patients on DAPT.

Fetuin-A and Its Association with Anthropometric, Atherogenic, and Biochemical Parameters and Indices among Women with Polycystic Ovary Syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) contributes to metabolic and endocrine complications for women of reproductive age. We set out to assess the relationship between fetuin-A and anthropometric parameters, anthropometric indices, body composition, and atherogenic indices, as well as carbohydrate and lipid profile in women with polycystic ovary syndrome (PCOS). METHODS: The study included 49 women with PCOS, aged between 18 and 39 years. All patients were tested for fetuin-A, fasting glucose and insulin, and lipid parameters, after oral-glucose administration were done. All of them underwent anthropometric measurements and body composition analyses such as BMI (Body Mass Index), WHR (Waist to Hip Ratio), WHtR (Waist to Height Ratio), BAI (Body Adiposity Index), VAI (Visceral Adiposity Index), LAP (Lipid Accumulation Product), BRI (Body Roundness Index), ABSI (A Body Shape Index), ABSI z-core (ABSI with added mortality risk in correlation with age and gender), AIP (Atherogenic Risk of Plasma), AC (Atherogenic Coefficient), Castelli risk index-I, and Castelli risk index-II. RESULTS: Obesity was diagnosed in 18 patients (36.7%) based on BMI index and 7 patients (14.3%) based on BAI index. Significantly increased risk of metabolic complications was observed among 26 patients (53.1%) based on waist circumferences. Based on VAI index, risk of metabolic disease was observed among 17 women (34.7%). Dyslipidemia such as hypercholesterolemia, hypertriglyceridemia, and mixed hyperlipidemia was detected among 14 patients (28.6%), and insulin resistance was observed among 29 (59.2%). There was a positive correlation between fetuin-A and total cholesterol (r = 0.30, p = 0.0034). There was no statistically significant correlation between fetuin-A and all of the anthropometric measurements and anthropometric indices, atherogenic indices, and other biochemical parameters. CONCLUSION: Fetuin-A correlates with hypercholesterolemia. It is necessary to conduct further research regarding the relationship between fetuin-A concentrations and body composition, anthropometric indices, and metabolic disorders in women with PCOS. Surprisingly, the effects of concentration of fetuin-A and anthropometric indices (BAI, VAI, LAP, ABSI, ABSI z-core) in woman with PCOS have not been closely examined. Future studies that take these variables into account will need to be undertaken. More information on the relationship between fetuin-A concentrations and anthropometric indices would aid us in establishing a greater degree of accuracy on this matter.