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SummaryBackgroundCardiovascular diseases (CVD) account for approximately 50% of the total deaths in Turkey. Most of them are related with atherosclerotic coronary heart disease. Predictive value of endothelial dysfunction markers related with the earliest stage of atherosclerosis has been getting more attention. We hypothesized that differences in endothelial dysfunction biochemical markers among genders would aid to capture proatherogenic activity that was not diagnosed by conventional risk assessment scoring systems.MethodsWe assessed the endothelial dysfuntion markers in 92 Turkish adults who were in the »low CV risk group« according to ESC (European Society of Cardiology)-Score Risk Charts. We compared the males and females.ResultsWe observed higher endothelial dysfunction rates in males, with higher median and mean levels of e-NOS, ox-LDL before and after adjustment for HDL lowness and obesity (P=0.018, P=0.036 for NOS; P=0.000, P=0.004 for ox-LDL, respectively). Men had higher hs-CRP levels than females before adjustment (P=0.021). Decreased e-NOS levels were related with FMD for females before adjustment for confounders (P=0.028). We also found significant correlation between e-NOS and ox-LDL levels both before (r=0.360, P<0.001) and after adjustment (r=0.366, P<0.01) for confounders which pointed out the nitrosative stress. In multivariate regression analyses, after adjusting for other endothelial dysfunction markers which were not included in the ESC-risk scoring system, decreased e-NOS levels were independently asssociated with impaired flow mediated dilatation for females (odds ratio 0.3; P=0.038).ConclusionsOur results underline the importance of gender in evaluating endothelial dysfunction biochemical markers to assess cardiovascular risk for low CV risk indivuals.

Background: Hypertension, dyslipidemia, and other cardiovascular risk factors are linked epidemiologically, clinically, and metabolically. Intensive/Initial Cardiovascular Examination regarding Blood Pressure levels, Evaluation of Risk Groups (ICEBERG) study focuses on the effect of dyslipidemia on cardiovascular risk evaluation and association of lipid profi le with other risk factors. Patients and methods:The ICEBERG study consisted of two sub-protocols: ICEBERG-1, conducted at 20 university hospitals (Referral Group) and ICEBERG-2, conducted at 197 primary healthcare centers (Primary Care Group). Sub-protocol had two patient profi les: patients previously diagnosed with essential hypertension and under medical treatment (Treated Group) and patients with systolic blood pressure Ն130 mmHg or diastolic blood pressure Ն85 mmHg, with no antihypertensive treatment for at least 3 months before inclusion (Untreated Group). Dyslipidemia was evaluated and cardiovascular risk stratifi cation was performed according to ESC/ESH guidelines. Results: More than half of the treated and untreated subjects were classifi ed into high or very high cardiovascular risk groups. In a total of 1817 patients, the percentage of patients in "high" plus "very high" added risk groups increased to 55.2% in Treated Referral Group (p Ͻ 0.001), to 62.6% in Untreated Referral Group (p = 0.25) and to 60.7% in Untreated Primary Care Group (p Ͻ 0.001), by re-evaluation of patients' lipid values. Conclusions: Serum lipid levels are useful in stratifying hypertensive patients into cardiovascular risk groups more accurately, for appropriate antihypertensive treatment.

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The Intensive/Initial Cardiovascular Examination Regarding Blood Pressure Levels: Evaluation of Risk Groups (ICEBERG) study was aimed at evaluating the components of the metabolic syndrome (MS) for cardiovascular risk stratification in hypertensive patients. The ICEBERG study consisted of 2 subprotocols: ICEBERG-1, conducted at 20 university hospitals, and ICEBERG-2, conducted at 197 primary health care centers. Each subprotocol had 2 patient profiles: patients diagnosed with hypertension and receiving medical treatment (treated group) and patients who had not received antihypertensive treatment (untreated group). MS was defined in the Third Report of the National Cholesterol Education Program Adult Treatment Panel as the presence of at least 3 of the following abnormalities: decreased plasma high-density lipoprotein cholesterol level, increased plasma triglyceride level, hypertension, increased fasting glucose level, and obesity. In a total of 4039 patients, 65.0% had MS, 30.2% had 3 components, 15.0% had 2 components, and 24.8% had 4 components. The most common accompanying component to hypertension was abdominal obesity. Therefore, this study underlined the value of questioning metabolic components in patients with high-normal or high blood pressure to identify individuals with high added risk of cardiovascular disease.