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Öğe Atypical antipsychotic use is an independent predictor for the increased mean platelet volume in patients with schizophrenia: A preliminary study(2013) Semiz, Murat; Yücel, Hasan; Kavakçi, Önder; Yildirim, Osman; Zorlu, Ali; Yilmaz, Mehmet Birhan; Küçükdurmaz, ZekeriyaBackground: Cardiovascular diseases, cardiovascular risk factors, and mortality due to these situations are more frequently encountered in schizophrenic patients when compared with the general population. The mean platelet volume (MPV) is a surrogate biomarker of the platelet activity and an useful prognostic test in cardiometabolic diseases. The aim of this study was to investigate what influenced MPV levels in patients with schizophrenia. Materials and Methods: We evaluated hospital records of 60 hospitalized schizophrenia patients. Thirty age- and sex-matched healthy control subjects were also included as a control group. Results: MPV levels were significantly higher in patients who were on atypical antipsychotic drugs than in patients who were not using any drug (9.2 ± 0.8 vs. 8.6 ± 0.8 fL, P = 0.016) and also higher than control group (9.2 ± 0.8 vs. 8.1 ± 0.9 fL, P < 0.001). Furthermore, patients who were not using antipsychotics had higher MPV than control group (8.6 ± 0.8 vs. 8.1 ± 0.9 fL, P = 0.036). Atypical antipsychotic use [Odds ratio (OR) =6.152, 95% confidence interval (CI,) P = 0.003)] and platelet distribution width (OR = 0.989, 95% CI, P = 0.032) were associated with high MPV levels in univariate analysis. In multivariate logistic regression model, only atypical antipsychotics use (OR = 6.152, 95% CI, P = 0.003) was found to be independent predictor of high MPV levels after adjustment of other potential confounders (age, gender, presence of hypertension, diabetes mellitus, hyperlipidemia, and smoking). Conclusion: MPV seems to be influenced not only by schizophrenia itself but also by atypical antipsychotic drugs. It might be concluded that schizophrenic patients are under increased risk for cardiometabolic diseases and risk factors and this risk is higher in patients on atypical antipsychotic treatment.Öğe Cardiac autonomic function in metabolic syndrome: a comparison of ethnic Turkish and Japanese patients(Springer, 2012) Erdem, Alim; Uenishi, Masahiro; Matsumoto, Kazuo; Küçükdurmaz, Zekeriya; Kato, Ritsushi; Şahin, Şafak; Yazıcı, MehmetMetabolic syndrome (MetS) prevalence shows some differences at various regions of the world in terms of race and ethnicity. The cardiac autonomic functions between Turkish and Japanese MetS patients with heart rate turbulence (HRT) and heart rate variability (HRV) were compared as the aim of this study. This study consists of 149 nondiabetic subjects with MetS. All patients were further classified into subgroups based on ethnicity (76 from Turkey, 73 from Japan). Twenty-four-hour ambulatory Holter ECG recording was applied to all subjects whose HRV and HRT (total onset (TO), total slope (TS)) parameters were analyzed. The waist circumference was the only demographic parameter that was significantly different between the Turkish and Japanese patients with MetS (99.31 +/- 6.12 vs 91.12 +/- 6.89 for men and 91.48 +/- 7.45 vs 86.26 +/- 5.78 for woman; p < 0.001 and < 0.001). There was a significant difference between Turkish and Japanese patients with MetS in terms of the HRT values. (TO Turkish, 0.77 +/- 0.19 %; TO Japanese, 0.49 +/- 1.03 %, p = 0.031; TS Turkish, 1.93 +/- 1.26; TS Japanese, 2.44 +/- 1.37, p = 0.041, respectively). As for HRV parameters, standard deviation of all NN intervals index was only different between Turkish and Japanese patients with MetS (90.79 +/- 58.94, 128.18 +/- 105.30; p = 0.034, respectively). HRT and some HRV scores of ethnic Turkish MetS patients are worse than the scores of ethnic Japan MetS patients. We think that these differences are related to the central obesity.Öğe Cardiac autonomic function measured by heart rate variability and turbulence in pre-hypertensive subjects(Taylor & Francis Inc, 2013) Erdem, Alim; Uenishi, Masahiro; Küçükdurmaz, Zekeriya; Matsumoto, Kazuo; Kato, Ritsushi; Hara, Motoki; Yazıcı, MehmetNon-dipping blood pressure pattern was shown to be associated with increased cardiovascular events. In addition, cardiac autonomic dysfunction was found to be associated with non-dipper phenomenon. In this study, we aimed to evaluate the cardiac autonomic functions in dipper and non-dipper pre-hypertensive subjects. A total of 65 pre-hypertensive subjects were enrolled in this study. They were divided into two groups as non-dippers (40 subjects, 52% female) and dippers (25 subjects, 52.5% female). Cardiac autonomic functions of the two groups were compared with the aid of heart rate variability, heart rate turbulence (HRT), atrial premature contractions (APCs), ventricular premature contractions (VPCs), and mean heart rate (MHR). There was no significant difference between non-dippers and dippers in basal characteristics. The two parameters of HRT, turbulence onset and turbulence slope, were found to be significantly abnormal in non-dippers than in dippers (P < .011 and P < .002, respectively). Heart rate variability parameters, including SDNN, SDANN, RMSSD, and pNN50, were found to be similar in dipper and non-dipper pre-hypertensive subjects (P < .998, P < .453, P < .205, and P < .788, respectively). APCs, VPCs, and MHR were compared, and there were statistical differences between the groups (APCs 5.80 + 4.55, 9.14 + 7.33, P < .024; VPCs 8.48 + 8.83, 13.23 + 9.68, P < .044; and MHR 70.16 +/- 11.08, 76.26 +/- 11.31, P < .035; respectively). This study demonstrated a possible cardiac autonomic dysfunction in pre-hypertensive subjects with non-dipper pattern. This may be a basis for future studies related to pre-hypertension and non-dipping BP pattern.Öğe The effect of metabolic syndrome on heart rate turbulence in non-diabetic patients(Via Medica, 2012) Erdem, Alim; Uenishi, Masahiro; Küçükdurmaz, Zekeriya; Matsumoto, Kazuo; Kato, Ritsushi; Hara, Motoki; Yazıcı, MehmetBackground: Metabolic syndrome (MetS), which includes a cluster of risk factors, is being increasingly recognized as a new risk factor for cardiovascular disease. Heart rate turbulence (HRT) is a Holter-based non-invasive method for detecting cardiac autonomic imbalance and is an independent, powoful predictor of cardiac arrhythmias and sudden cardiac death in different patient groups. This study evaluated the effect of MetS on HRT in non-diabetic patients. Methods: This study included 80 non-diabetic MetS subjects and 50 healthy subjects. All 130 subjects underwent a 24-h ambulatory Holter electrocardiogram recording. Two indices of HRT were analyzed: turbulence onset (TO) and turbulence slope (TS). HRT values were classified into 3 categories for risk stratification: 1) Category 0, TO and TS were normal; 2) Category 1, either TO or TS was abnormal; 3) Category 2, both TO and TS were abnormal. Results: When we compared MetS rates in the HRT risk stratification groups, there were significant differences for all groups as compared with the controls (Category 0 = MetS 28.8%, n = 15, Control 71.2%, n = 37, p < 0.001; Category 1 = MetS 80.8%, n = 42, Control 19.2%, n = 10, p <0.001; Category 2 = MetS 88.5%, n = 23, Control 11.5%, n =3, p <0.001). In addition, TO and TS abnormalities were correlated with the number of MetS components (r = 0.608, p <0.001; r = -0.388, p <0.001, respectively). Conclusions: To our knowledge, this is the first study to establish a relationship between HRT and MetS. These findings suggest that MetS adversely affects HRT scores. In addition, the number of MetS components is related to impaired HRT scores. (Cardiol J 2012; 19,5: 507-512)Öğe Relationship between metabolic syndrome and non-dipping blood pressure pattern in obese patient(2013) Yılmaz, Ahmet; Erdem, Alim; Karapınar, Hekim; Küçükdurmaz, Zekeriya; Gül, İbrahim; Yontar, Osman CanAmaç: Metabolik sendrom ve non -dipper kan basıncı paterni kardiyovasküler hastalıklarla ilişkilidir. Bu klinik durumların ortak patofizyolojik mekanizmalarıyla ilişkili olabilir. Metab olik sendrom ile non -dipper kan basıncı arasındaki ilişkiyi araştırmayı amaçladık. Yöntem: 24 saatlik ambulatuar kan basıncı takibi yapılan yeni tanı almış 118 obez metabolik sendromlu hasta çalışmamıza dahil edildi. Bunlar dipper (n = 46) ve non -dipper (n = 72) olmak üzere iki gruba ayrıldı. Gece non -dipper kan basıncı, gece ortalama sistolik ve/veya diastolic kan basıncı azalması %10 dan daha az azalma oluşu olarak tanımlandı. Bulgular: Ça lışma gurubumuzun ortalama 24 saatlik kan basıncı ortalaması 146/96 mmHg idi. İki grubun temel karakteristik özellikleri benzer olmasına rağmen, non -dipper tansiyon paterni olan grupta metabolik sendrom sıklığı a nlamlı derecede daha fazla idi (p=0.038). Sonuç: Bu çalışmada non -dipper kan basıncı paterni olan hastalarda metabolik sendromun daha fazla bulunduğu saptandı . Bu durum, obez hastalarda metabolik sendrom ile non-dipper kan basıncının ortak bir patofizyolojik mekanizma içerdiğini belirtebilir.Öğe TEKHARF 2006 taramasında ölüm ve koroner olaylar: Kadınlarda mortalitede azalma, koroner kalp hastalığı genel prevalansında artma(2007) Onat, Altan; Albayrak, Sinan; Karabulut, Ahmet; Ayhan, Erkan; Kaya, Zekeriya; Küçükdurmaz, Zekeriya; Bulur, SerkanAmaç: TEKHARF Çalışması’nın temelde Marmara ve İç Anadolu dışındaki bölgelerde oturan ve 2006 yazında taranan kohortunda tüm-nedenli, koroner kökenli ölüm ve koroner kalp hastalığına (KKH) ait insidans ve prevalans verileri incelendi. Çalışma planı: Taramada toplam 1585 kişi (776 erkek, 809 kadın; ort. yaş 55.3±11.8) izlendi; bunlar ülke genelinde hayattaki TEKHARF kohortunun %49’unu oluşturuyordu. Ölüm konusunda birinci derece akraba ve/veya sağlık ocağı personelinden bilgi alındı; yaşayanlarda bilgi edinmekten başka, fizik muayene ve 12 derivasyonlu EKG kaydı yapıldı. Yeni koroner olay, son taramadan beri gelişen, ölüme yol açan veya açmayan miyokard infarktüsü, yeni stabil angina ve/veya miyokard iskemisi şeklinde tanımlandı.Bulgular: Örneklemden 946’sı muayene edildi, 599 kişi hakkında bilgi edinildi ve 27 erkek ile 13 kadının öldüğü belirlendi. Yeni takip olarak eklenen 2842 kişi-yılı ile, 1990 yılından beri izlemede 45490 kişi-yılına ulaşıldı. Ölümlerden 15’i KKH kökenli sayıldı. Son tarama döneminde yıllık tüm ölüm oranı bin yetişkinde 14.1, koroner mortalite binde 5.1 düzeyinde bulundu. Kırk beş ile 74 yaş arası kesimde toplam yıllık mortalite son Türkiye taramasında binde 10.9’a (p=0.09), KKH’den ölüm prevalansı binde 5.6’ya geriledi. Gerilemeler kadınlarda belirgindi. Ortalama ölüm yaşının erkeklerde 67.1’ye, kadınlarda 75.9’a uzadığı görüldü. Koroner kalp hastalığı prevalansı 39-49 yaş grubunda %3, 50-59 yaş grubunda %11, 60 yaş ve üzerinde %27 bulundu. Bu prevalansın ülkede 2.75 milyon erkek ve kadını kapsadığı tahminine varıldı. Sonuç: Kırk beş ile 74 yaş arası kesimde tüm ölümler ile koroner kökenli ölümlerin özellikle kadınlarda azalma eğilimi içinde olduğu ve ortalama ölüm yaşının uzadığı görülmektedir. Buna karşılık, yaş gruplarına özgü KKH prevalansı hızla artma eğilimindedir.