Misperceptions and management of LDL-cholesterol in secondary prevention of patients with familial hypercholesterolemia in cardiology practice: Real-life evidence from the EPHESUS registry.

BACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is a common inherited disease, leading to premature atherosclerotic cardiovascular disease (ASCVD) due to elevated low-density lipoprotein cholesterol (LDL-C) levels. Achieving LDL-C goals is extremely important for preventing the complications of this fatal disease. We evaluated the management of FH patients with ASCVD in cardiology practice. METHODS: We analyzed patients with ASCVD from the nationwide EPHESUS registry, which was conducted in 40 cardiology outpatient clinics, and compared those with and without FH. RESULTS: Of the 1482 consecutively enrolled patients with ASCVD, 618 (41.7%) had FH, among which 455 were categorized as 'Possible FH' and 163 as 'Probable or Definite FH'. Proposed LDL-C goals were not attained in more than 90% of the patients with FH. The proportion of those on statin therapy was 77% for possible and 91% for probable or definite FH, whereas 34.2 % and 59.4% were in use of high-intensity statins, respectively. None of the patients were on PCSK-9 inhibitors, and only 2 used ezetimibe. Adverse media coverage was the most common cause of statin discontinuation (32.5% in 'possible FH' and 45.7% in 'probable/definite FH'). The negative impact of media in the decision to stop lipid lowering therapy (LLT) was increasing with education level. CONCLUSIONS: In real life most of the FH patients with ASCVD are undertreated in cardiology practice regarding statin dosing and combined LLT. Drug discontinuation rates are notably high and are mostly media-related, and side effects very rarely cause cessation of LLT. Urgent measures are needed to increase the awareness of FH among healthcare providers and patients and to develop improved treatment strategies aimed at preventing the complications of FH.

The relation of endocan and galectin-3 with ST-segment resolution in patients with ST-segment elevation myocardial infarction.

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality around the world. In patients with STEMI undergoing primary percutaneous coronary intervention (PPCI), electrocardiographic measures of ST-segment resolution (STR) may give information about the myocardial perfusion and poor prognosis. OBJECTIVES: To investigate the relation of endocan and galectin-3 levels with STR in STEMI patients. MATERIAL AND METHODS: In this cross-sectional study, 98 consecutive patients undergoing PPCI for STEMI were enrolled. Synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) scores were recorded. Electrocardiograms were assessed at baseline and 60 min after PPCI. According to STR levels, patients undergoing PPCI (n = 98) were divided into complete STR group (≥70%, n = 53) and incomplete STR group (<70%, n = 45). RESULTS: Serum glucose, total cholesterol, low-density lipoprotein cholesterol, SYNTAX score, endocan and galectin-3 levels were significantly higher and ejection fraction was significantly lower in the incomplete STR (<70%) group (p < 0.05 for all). Body mass index (BMI) (p = 0.046) and galectin-3 (p = 0.037) were independently associated with the SYNTAX score. Endocan (p = 0.044) and galectin-3 (p = 0.017) were independent predictors of incomplete STR. CONCLUSIONS: In patients with STEMI, the levels of endocan and galectin-3 may be helpful in identifying patients with a higher risk of insufficient myocardial perfusion and worse clinical outcome after PPCI.

Acute effects of electronic cigarette smoking on ventricular repolarization in adults.

BACKGROUND: Electronic cigarette (e-cigarette) use is constantly increasing. However, the association between e-cigarette use and ventricular arrhythmia is unknown. Thus, in this study, we aimed to evaluate the markers of ventricular repolarization such as QT interval, corrected QT (QTc), QT dispersion (QTd), peak-to-end interval of the T wave (Tp-e), corrected Tp-e and Tp-e/QT ratios in e-cigarette users. METHODS: The study population consisted 36 e-cigarette users and 40 healthy subjects. Ventricular repolarization parameters were obtained from 12-lead resting electrocardiogram. Ventricular repolarization parameters of the groups were compared. RESULTS: Basal demographic and laboratory data were similar in both groups. According to the electrocardiographic parameters, the Tp-e interval, corrected Tp-e, and Tp-e/QT ratio were significantly higher in individuals using e-cigarettes than in control subjects [74.9±6.4 milliseconds (ms) vs. 80.1±4.1ms, <0.001; 82.9±7.5 ms vs. 87.8±6.3 ms, p=0.003; 0.20±0.01 vs. 0.21±0.01, p=0.002; respectively]. CONCLUSION: This is the first study to show the disruption of ventricular repolarization properties in e-cigarette users. E-cigarette use in terms of public health leads to augmentation of transmural dispersion of repolarization, which may be potential indicator of ventricular arrhythmogenesis.

Electrocardiographic changes in right ventricular metastatic cardiac tumor mimicking acute ST elevation myocardial infarction: A case of misdiagnosis.

INTRODUCTION: In patients with ST elevation myocardial infarction (STEMI), minimizing the reperfusion time is the goal of therapy worldwide. However, the differential diagnosis is critical and when a patient is encountered with chest pain and ST elevation, STEMI should not be the only diagnosis considered. By detailed history and focused physical examination, it is possible to avoid a mistaken diagnosis. CASE PRESENTATION: In this report, we present a case of a male patient with tongue cancer and accompanying myocardial metastasis that causes electrocardiographic changes, who was initially misdiagnosed with ST elevation myocardial infarction. CONCLUSION: Here, we reported a case of metastatic cancer in the heart which was initially diagnosed as acute myocardial infarction. Echocardiography, computed tomography and magnetic resonance imaging of the heart were used accordingly to confirm the myocardial metastasis.

Design and rationale for the ASSOS study: Appropriateness of aspirin use in medical outpatients a multicenter and observational study.

OBJECTIVE: The aim of this study was to describe the current status of aspirin use and the demographic characteristics of patients on aspirin for primary and secondary prevention of cardiovascular diseases. METHODS: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) trial was a multicenter, cross-sectional, and observational study conducted in Turkey. The study was planned to include 5000 patients from 14 cities in Turkey. The data were collected at one visit, and the current clinical practice regarding aspirin use was evaluated (ClinicalTrials.gov number NCT03387384). RESULTS: The study enrolled all consecutive patients who were admitted to the outpatient cardiology clinics from March 2018 until June 2018. Patients should be at least 18 years old, have signed written informed consent, and on aspirin (80-325 mg) therapy within the last 30 days. Cardiologists from the hospital participates in the study. Patients were divided into 2 categories according to presence or absence of atherosclerotic cardiovascular disease, namely secondary prevention group and primary prevention group, respectively. The appropriate use of aspirin in the primary and secondary prevention groups was assessed according to the European Society of Cardiology guidelines and US Preventive Services Task Force. The patients' gastrointestinal bleeding risk factors and colorectal cancer risk were evaluated. CONCLUSION: The ASSOS registry will be the most comprehensive and largest study in Turkey evaluating the appropriateness of aspirin use. The results of this study help understand the potential misuse of aspirin in a real-world setting.

Evaluation of the neutrophil-lymphocyte ratio in newly diagnosed nondiabetic hypertensive patients with ascending aortic dilatation.

BACKGROUND: Ascending aortic dilatation (AAD), more often encountered in hypertensive individuals compared with normotensive individuals, is an important cause of mortality in adults. Neutrophil-to-lymphocyte ratio (NLR), as an oxidative stress and proinflammatory marker, has recently emerged as a useful indicator to predict cardiovascular risk and adverse outcomes. The aim of our study was to investigate the relationship between NLR and AAD in patients with hypertension. METHODS: A total of 135 newly diagnosed and untreated hypertensive patients were enrolled in this study. Ninety-three consecutive hypertensive patients with AAD and 42 consecutive hypertensive patients with normal ascending aortic diameter were recruited into the study by comprehensive transthoracic echocardiography. NLR was calculated using the complete blood count. RESULTS: In the comparison of laboratory parameters between the hypertensive patients with AAD and hypertensive patients with normal ascending aortic diameter, NLR was found to be statistically significantly higher in the aortic dilatation group than in the control group (2.72±1.1 vs. 1.87±0.5, P<0.001). There was a statistically significant positive correlation between the ascending aortic diameter and NLR (r=0.524, P<0.001). According to multiple logistic regression analysis (ascending aortic diameter set as the dependent variable), smoking [odds ratio (OR): 1.57, 95% confidence interval (CI): 1.14-1.98, P=0.008], NLR (OR: 2.01, 95% CI: 1.57-3.25, P<0.001), and γ-glutamyl transferase (OR: 1.98, 95% CI: 1.59-2.74, P=0.001) were found to be independent predictors of AAD. CONCLUSION: NLR as a marker of chronic low-grade inflammation may play a role in the pathogenesis of aneurysm of the ascending aorta in hypertensive patients.