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    Anti-Hyperglycemic Agents for the Treatment of Type 2 Diabetes Mellitus: Role in Cardioprotection During the Last Decade
    (BENTHAM SCIENCE PUBL LTD, 2017) Kocyigit, Duygu; Gurses, Kadri Murat; Yalcin, Muhammed Ulvi; Tokgozoglu, Lale
    Type 2 diabetic patients are known to have a tendency to develop cardiovascular (CV) disease (CVD), and related unfavourable outcomes such as heart failure, myocardial infarction (MI), cerebrovascular events (e.g. stroke), and related mortality. Long-term clinical trials have revealed contradictory findings regarding the relationship between glycemic control and CV benefits due to variations in the key characteristics of the study population. During the last decade, number of pharmacological agents used for glucose-lowering in the treatment of type 2 diabetes mellitus (T2DM) has increased owing to the introduction of dipeptidyl peptidase-IV (DPP-IV) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and sodium-glucose co-transporter 2 (SGLT-2) inhibitors. This review aims to focus on the mechanisms of action of these drugs in the cardiovascular system and the trials evaluating their impact on CVD. Furthermore, trials in the last decade evaluating the impact of traditional glucose-lowering drugs on CVD are included. For this purpose, we searched PubMed for articles in English using the search terms "type 2 diabetes mellitus, glucose-lowering drugs, antidiabetic medications, cardiovascular, cardiovascular disease, cardiovascular system" between inception to September 2016. We also searched separately for each medication in addition to the keyword "cardiovascular disease" on PubMed. To identify further articles, we hand searched related citations in review articles and commentaries.
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    Demographics of patients with heart failure who were over 80 years old and were admitted to the cardiology clinics in Turkey
    (TURKISH SOC CARDIOLOGY, 2019) Gok, Gulay; Zoghi, Mehdi; Sinan, Umit Yasar; Kilic, Salih; Tokgozoglu, Lale; Sumerkan, Mutlu Cagan; Emren, Volkan
    Objective: Heart failure (HF) has a high prevalence and mortality rate in elderly patients; however, there are few studies that have focused on patients older than 80 years. The aim of this study is to describe and compare the age-specific demographics and clinical features of Turkish elderly patients with HF who were admitted to cardiology clinics. Methods: The Epidemiology of Cardiovascular Disease in Elderly Turkish population (ELDER-TURK) study was conducted in 73 centers in Turkey, and it recruited a total of 5694 patients aged 65 years or older. In this study, the clinical profile of the patients who were aged 80 years or older and those between 65 and 79 years with HF were described and compared based on the ejection fraction (EF)-related classification: HFrEF and HFpEF (is considered as EF: >= 50%). Results: A total of 1098 patients (male, 47.5%; mean age, 83.5 +/- 3.1 years) aged 80 years and 4596 patients (male, 50.2 %; mean age, 71.1 +/- 4.31 years) aged 65-79 years were enrolled in this study. The prevalence of HF was 39.8% for patients who were >= 80 years and 27.1% for patients 65-79 years old. For patients aged >= 80 years with HF, the prevalence rate was 67% for hypertension (HT), 25.6% for diabetes mellitus (DM), 54.3% for coronary artery disease (CAD), and 42.3% for atrial fibrilation. Female proportion was lower in the HFrEF group (p=0.019). The prevalence of HT and DM was higher in the HFpEF group (p<0.01), whereas CAD had a higher prevalence in the HFrEF group (p=0.02). Among patients aged 65-79 years, 43.9% (548) had HFpEF, and 56.1% (700) had HFrEF. In this group of patients aged 65-79 years with HFrEF, the prevalence of DM was significantly higher than in patients aged >= 80 years with HFrEF (p<0.01). Conclusion: HF is common in elderly Turkish population, and its frequency increases significantly with age. Females, diabetics, and hypertensives are more likely to have HFpEF, whereas CAD patients are more likely to have HFrEF.
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    Increased myocardial vulnerability and autonomic nervous system imbalance in obstructive sleep apnea syndrome
    (W B SAUNDERS CO LTD, 2007) Aytemir, Kudret; Deniz, Ali; Yavuz, Bunyamin; Demir, Ahmet Ugur; Sahiner, Levent; Ciftci, Orcun; Tokgozoglu, Lale
    Background: Obstructive steep apnea syndrome (OSAS) is characterized by the repeated episodes of upper airway obstruction during steep, leading to significant hypoxia. Noninvasive evaluation of autonomic nervous system (ANS) and myocardial vulnerability may help determination of OSAS patients who are under high risk of malignant cardiac arrhythmias. The aim of this study was to show the effects of OSAS on predictors of arrhythmias by the evaluation of heart rate turbulence (HRT), heart rate variability (HRV) and QT dynamicity reflecting the ANS balance and myocardial vulnerability. Methods: After polysomnographic study, 80 patients with OSAS and 55 age matched OSAS (-) subjects were included in the study. Twenty-four-hour Hotter monitoring was performed in all subjects. HRT, HRV and QT dynamicity parameters were calculated. Results: Turbulence slope was significantly decreased in OSAS patients whereas turbulence onset was increased (P < 0.001). QT/RR slopes were significantly increased for QT end and QTapex (P < 0.001). In HRV analysis, autonomic balance changed in favor of sympathetic system at night in OSAS patients. Furthermore, HRT and QT dynamicity parameters are found to be correlated with Apnea-Hypopnea Index (AHI). Conclusion: OSAS is associated with a significant worsening in HRV, HRT, and QT dynamicity parameters. Our results may indicate that HRV and QT dynamicity parameters can be useful noninvasive methods that may detect autonomic nervous system activity and ventricular vulnerability in OSAS. (c) 2006 Elsevier Ltd. All rights reserved.
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    Management of Blood Pressure and Heart Rate in Acute Decompensated Heart Failure with Volume Overload
    (BENTHAM SCIENCE PUBL LTD, 2017) Kocyigit, Duygu; Gurses, Kadri Murat; Yalcin, Muhammed Ulvi; Tokgozoglu, Lale
    Background: Heart failure (HF) is a global health problem. Like most chronic diseases, HF also courses with acute exacerbations, which have been found to be associated with significant morbidity and mortality. A substantial proportion of acute decompensated heart failure (ADHF) patients clinically present with volume overload. Methods: The goal of this work was to review the current literature and recent guidelines of European Society of Cardiology and American Heart Association/American College of Cardiology regarding the management strategies in patients with ADHF and volume overload. Results: In the setting of ADHF and volume overload, prompt diagnosis of the disease should be made. Underlying pathologies should be identified and corrected if possible. Specific approaches may be necessary depending on the etiology. Discussion: Current guidelines direct clinicians on the appropriate principles of management in this group of patients; however, approach should be individualized.