Incidence of cardiovascular diseases in the patients having chronic kidney disease (CKD) is between 25% and 60%. This increased rate is proposed to be associated with "accelerated atherosclerosis." Increased carotid intima-media thickness (CIMT) is a subclinical atherosclerosis marker. Small-dense low-density lipoprotein particles are a strong risk factor for atherosclerosis. It was shown that atherogenic index of plasma (AIP = log(TG/HDL-c)) is correlated with size of the lipoprotein particles. We investigated the correlation between AIP and CIMT which is a subclinical atherosclerosis marker, in hemodialysis (HD) patients. A total of 62 persons with 31 patients under HD therapy and 31 volunteers were included in the study. In all the participants, CIMT was measured and AIP were calculated. AIP and CIMT values of the participants were compared with blood pressures, lipid profiles and the other risk factors. AIP (0.39 ± 0.32) and CIMT (0.57 ± 0.13) were found significantly higher in the patient group than in the controls (0.04 ± 0.36 and 0.45 ± 0.119, respectively); (P = 0.0001 and 0.0001, respectively). There was a significant correlation between AIP and increased CIMT in the patient group (P = 0.0001, r = 0.430). Among the lipid parameters, the strongest correlation was found between CIMT and AIP. We demonstrated the significant increase of AIP and CIMT in HD patients. A correlation was found between AIP and CIMT. AIP was found to show a correlation with a greater number of risk factors, both classical and CKD specific, than CIMT. These data suggest that AIP might be a method which can be used both in diagnosis of subclinical atherosclerosis and in deceleration processes of its progression.

IntroductionChronic inflammation is a major risk factor in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in healthy subjects and ESRD patients. In the present study we aimed to investigate the relationship between EAT and inflammation parameters including neutrophil-to-lymphocyte ratio (NLR) in hemodialysis (HD) patients.Material and methodsForty-three HD patients (25 females, 18 males; mean age: 64.1 ±11.9 years) receiving HD and 30 healthy subjects (15 females, 15 males; mean age: 59.1 ±10.8 years) were enrolled in the study. Epicardial adipose tissue measurements were performed by echocardiography.ResultsNeutrophil-to-lymphocyte ratio levels were significantly higher in HD patients than in the healthy control group. Hemodialysis patients were separated into two groups according to their median value of NLR (group 1, NLR < 3.07 (n = 21) and group 2, NLR ≥ 3.07 (n = 22)). Group 2 patients had significantly higher EAT, C-reactive protein and ferritin levels, while albumin levels were significantly lower in this group. In the bivariate correlation analysis, EAT was positively correlated with NLR (r = 0.600, p < 0.001) and ferritin (r = 0.485, p = 0.001) levels.ConclusionsNeutrophil-to-lymphocyte ratio was found to be an independent predictor of EAT in HD patients (odds ratio = 3.178; p = 0.008). We concluded that this relationship might be attributed to increased inflammation in uremic patients.

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ÖZETAmaç: Tip 2 diyabetes mellituslu (tip 2 DM) hastalarda noktürnal kan basıncındaki (NKB) düşüş normalden daha azdır. L-karnitin eksikliği tip 2 DM olgularında hiperglisemi, insülin direnci ve endotel disfonksiyonuna yol açarak NKB değişikliklerine neden olabilmektedir. Bu çalışmada; tip 2 DM'li "dipper" ve "non-dipper" olgularda L-karnitin düzeyinde farklılık olup olmadığının araştırılması amaçlanmıştır. Yöntemler: Bu bir enine-kesitli gözlemsel kohort çalışmasıdır. Çalışmada tip 2 DM'li 50 (33 kadın, 17 erkek) olguyu ve kontrol grubu olarak sağ-lıklı 35 (18 kadın, 17 erkek) kişiyi karşılaştırdık. Tüm olgularda ambulatuvar kan basıncı izlemi (ABPM) yapıldı ve L-karnitin ölçüldü. Verilerin değerlendirilmesinde iki ortalama arasındaki farkın önemlilik testi, Ki-kare testi, Mann-Whitney U testi ve Pearson korelasyon analizi kullanıldı. Bulgular: Tip 2 DM'lerin %72'sinde "non-dipper" örnek saptadık. Tip 2 DM'lerde L-karnitin düzeyi (52.77±12.34 μmol/L) kontrol grubuna göre (79.18±10.59 μmol/L) istatistiksel olarak anlamlı derecede düşük saptandı (p<0.05). "Non-dipper" olgularda L-karnitin düzeyleri (50.02±16.30 μmol/L) "dipper" olgulara (53.83±10.50 μmol/L) göre daha düşüktü, ancak bu farklılık anlamlı değildi (p=0.125). Sonuç: Tip 2 DM' lu hastalarda "non-dipper" örnek sık görülmektedir. "Non-dipper" örnek hedef organ hasarı ile ilişkilidir. Bu yüzden ABPM ile saptanacak olan "non-dipper" örnek çok önemlidir. Hasta grubunda L-karnitin düzeyleri düşük saptanmıştır. Tip 2 DM'li "non-dipper" olgularda L-karnitin, "dipper" olgulara göre daha düşük saptanmıştır. Bu farklılık istatistiksel olarak anlamlı olmamakla birlikte, tip 2 DM'li olgularda "nondipper" sıklığı ve L-karnitin ile ilişkisini araştıracak daha geniş ölçekli ve detaylı araştırmalara gereksinim olduğu sonucuna varılmıştır. (Anadolu Kardiyol Derg 2011 1: 57-63) Anahtar kelimeler: Tip 2 diyabetes mellitus, L-karnitin, noktürnal kan basıncı, "non-dipper" örnek ABSTRACT Objective: The nocturnal blood pressure (NBP) reduction is less than normal in the patients with type 2 diabetes mellitus (type 2 DM). L-carnitine deficiency may cause changes of NBP by leading to hyperglycemia, insulin resistance and endothelial dysfunction in patients with type-2 DM. The purpose of the study was to investigate whether there is a difference in levels of L-carnitine in dipper and nondippers patients with type 2 DM. Methods: This is a cross-sectional observational cohort study. We compared the 50 (33 females, 17 males) patients with type 2 DM and the 35 healthy persons (18 females, 17 males) as a control group. In all cases, ambulatory blood pressure monitoring (ABPM) was performed and L-carnitine was measured. The independent samples t test, Chi-square test, Mann-Whitney U test and Pearson correlation analysis were used in the statistical evaluation of data. Results: We found that the percentage of nondipper pattern was 72% in patients with type 2 DM. L-carnitine levels were lower in patients with type 2 DM (52.77±12.34 μmol/L) than those of control group (79.18±10.59 μmol/L...

Background/AimsMany systems including the cardiovascular system (ischemic heart diseases, heart failure, and hypertension) may act as comorbidities that can be seen during the course of chronic obstructive pulmonary disease (COPD). Comorbidities affect the severity and prognosis of COPD negatively. Nearly 25% of patients with COPD die due to cardiovascular diseases. In this study, we aimed to evaluate the relationship between the blood pressure, inflammation, hypoxia, hypercapnia, and the severity of airway obstruction.MethodsWe included 75 COPD patients in the study with 45 control cases. We evaluated age, sex, body mass index, smoking history, C-reactive protein levels, 24-hour ambulatory blood pressure Holter monitoring, arterial blood gas, and respiratory function tests of the patient and the control groups.ResultsIn COPD patients, the night time systolic, diastolic blood pressures and pulse per minute and the mean blood pressures readings were significantly elevated compared to the control group (p < 0.05). In the correlation analysis, night time systolic pressure was associated with all the parameters except forced expiratory volume in 1 second (FEV1%). Diastolic blood pressure was associated with pH and HCO3 levels. The mean night time, day time pulse pressures and 24- hour pulse per minute values were also associated with all the parameters except FEV1%.ConclusionsIn this study we found that parameters of systolic and diastolic blood pressures and pulse pressures were significantly elevated in COPD patients compared to the control groups. Blood pressure was associated blood gas parameters and inflammation parameters in COPD patients. This, in turn, may cause understanding of the pathophysiology of COPD and its complications.