Obezite Polikliniğine Başvuran Hastalarda Hematoljik ve Biyokimyasal Parametrelerle Kardiyovasküler Risk Skorlarının Karşılaştırılması

Abstract

Amaç: Bu çalışmada, obezite polikliniğine başvuran hastalarda; hematolojik ve biyokimyasal parametreler ile kardiyovasküler risk skorlamasının karşılaştırmalı değerlendirilmesi amaçlanmıştır. Yöntem: Tanımlayıcı-kesitsel olarak planlanan bu araştırmada, Düzce Üniversitesi Araştırma ve Uygulama Hastanesinin Obezite Polikliniğine 2017-2018 yılları arasında başvuran hastaların, dosya verileri retrospektif olarak değerlendirildi. Hastaların yaş, cinsiyet, sigara kullanımları, DM tanılarının varlığı, BKİ değerleri kaydedildi; kardiyovasküler risk faktörleri Avrupa ve Türkiye Kardiyoloji Dernekleri risk skorlamasına göre değerlendirildi. Bulgular: Çalışmaya %75,1’i kadın, %24,9’u erkek, 631 katılımcı dahil edilmiştir. Yaş ortalaması 38,9±12,1 (min=21-maks=65) olarak bulunmuştur. Hastaların %19,2’sinin sigara kullandığı, %4,6’sında DM ve %36,9’unda insülin direnci olduğu görülmüştür. Katılımcıların %3,3’ü zayıf, %7,3’ü normal kilolu, %22,5’i fazla kilolu ve %66,9’u obezdir. Türkiye Kardiyoloji Derneği risk skorlamasına göre hastaların %51,4’i düşük , %20,5’i orta ve %28,1’i yüksek risklidir. Avrupa Kardiyoloji Derneği risk skorlamasına göre ise hastaların %83,5’i düşük, %10,9’u orta ve %5,5’i yüksek risklidir. Her iki risk skorlamasına göre risk grupları arasında yaş, cinsiyet, beden kitle indeksi ve DM varlığı açısından anlamlı farklılık görüldü (p<0,001). Türkiye Kardiyoloji Derneği risk skorlamasına göre; yüksek risk grubunda olanların daha düşük trombosit/lenfosit oranına ve daha yüksek total kolesterol/HDL oranına sahip olduğu görüldü. Her iki skorda da kardiyovasküler risk ile RDW, MPV, lökosit sayısı, nötrofil/lenfosit oranı değerlerinde ilişki saptanmadı. Sonuç: Birinci basamak sağlık hizmetlerine obezite danışmanlığı için başvuran hastalara risk değerlendirmesi yapılması önemlidir. Yapılan kardiyovasküler risk değerlendirmesi ile bazı önlemlerin erkenden alınması sağlanabilir. Riskin erken saptanması amacıyla klinisyenlerin kolay ulaşabilecekleri parametreleri ortaya çıkaracak daha çok çalışmaya ihtiyaç vardır.

Keywords

• Obezite
• BKI
• NLR
• PLR
• Kardiyovasküler risk skorları
• hematolojik parametreler

Comparison of Hematological and Biochemical Parameters and Cardiovascular Risk Scores in Patients Applying to the Obesity Outpatient Clinic

Abstract

Objective: The aim of this study was to compare hematological and biochemical parameters and cardiovascular risk scoring in patients admitted to the obesity outpatient clinic. Method: In this descriptive cross-sectional study, data of the patients who admitted to the Obesity Outpatient Clinic of Duzce University Research and Application Hospital between 2017 and 2018 were evaluated retrospectively. Age, gender, smoking status, presence of Diabetes Mellitus (DM), and body mass index (BMI) were recorded and the cardiovascular risk of the patients was calculated by using the scoring system of the European Society of Cardiology (ESC) and Turkish Society of Cardiology (TSC). Results: A total of 631 participants were included in the study. The mean age was 38.9±12.1 (min=21, max=65) and 75.1% of the patients were female and 24.9% were male. It was observed that 19.2% of the patients were smokers, 4.6% had DM and 36.9% had insulin resistance. When the patients were evaluated according to the BMI scores, it was found that 3.3% of them were underweight, 7.3% were normal weight, 22.5% were overweight and 66.9% were obese. According to TSC risk scoring system, 51.4% of the patients were in low risk, 20.5% were in medium risk and 28.1% were in high risk category. According to the ESC risk scoring system, 83.5% of the patients were in low risk, 10.9% were in medium risk and 5.5% were in high risk category. According to both risk scoring systems, there were significant differences between the risk groups in terms of age, gender, BMI, and presence of DM (p<0.001). When evaluated according to the TSC risk score, it was seen that the patients in the high-risk category had a lower platelet/lymphocyte ratio and a higher total cholesterol/HDL ratio. According to both risk scoring systems, no correlation was found between cardiovascular risk and RDW, MPV, leukocyte count, and NLR(Neutrophil-Lymphocyte ratio). Conclusion: Conducting a cardiovascular risk assessment for patients who admit to primary health care services for obesity counseling is important. A cardiovascular risk assessment conducted at admission may help some precautions to be taken earlier. There is a need for more studies to determine easily accessible parameters that can predict cardiovascular risk.

Keywords

• Obesity
• BMI
• NLR
• PLR
• Cardiovasculer risk scores
• hematologic parameters

References

1. References 1. Wonca Avrupa. Aile Hekimliği Avrupa Tanımı. Ankara, Türkiye Aile Hekimleri Uzmanlık Derneği Yayınları, 2011;11-36.
2. 2. World Health Organization. Facts about overweight and obesity. Ara. 2012. URL:https://www.who.int/news- room/fact- sheets/detail/obesity- and-overweight. adresinden 11.12.2021
3. 3. Bhosale VV, Singh S, Srivastava M, Pathak P, Prakash S, Sonkar S, Misra AK, Misra R, Ghatak A. A case control study of clinical and biochemical parameters of metabolic syndrome with special attention among young and middle aged population. Diabetes Metab Syndr. 2019 Jul-Aug;13(4):2653-9.
4. 4. Faulkner JL. Obesity-associated cardiovascular risk in women: hypertension and heart failure. Clin Sci (Lond). 2021 Jun 25;135(12):1523-44.
5. 5. Bisciglia A, Pasceri V, Irini D, Varveri A, Speciale G. Risk Factors for Ischemic Heart Disease. Rev Recent Clin Trials. 2019;14(2):86-94.,
6. 6. Ural D. Kardiyovasküler risk belirlenmesi ve tabakalandırılmasının kılavuzluğuyla yapılan tedavi yaklaşımı: Öngör, önle ve bireyselleştir. Anadolu Kardiyol Derg. 2011; 11: 551-6.
7. 7. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). Eur Heart J 2007; 28: 2375-414
8. 8. Parums DV. Editorial: The 2021 European Society of Cardiology (ESC) Guidelines on the Real-World Prevention of Atherosclerotic Cardiovascular Disease (ASCVD). Med Sci Monit. 2021;27:e935172.

9. 9. Wilson, PW, et. al. Prediction of Coronary Heart Disease Using Risk Factor Categories. Circulation 1998 97 (18): 1837-47
10. 10. Brady W, de Souza K. The HEART score: A guide to its application in the emergency department. Turk J Emerg Med. 2018;18(2):47-51.
11. 11. Lagergren M, Fratiglioni L, Hallberg IR, Berglund J, Elmståhl S, Hagberg B, et al. A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC). Aging clinical and experimental research. 2004;16(2):158-68.
12. 12. Finegold JA, Asaria P, Francis DP. Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations. International journal of cardiology. 2013;168(2):934-45
13. 13. Savji N, Rockman CB, Skolnick AH, Guo Y, Adelman MA, Riles T, et al. Association between advanced age and vascular disease in different arterial territories: a population database of over 3.6 million subjects. Journal of the American College of Cardiology. 2013;61(16):1736-43.
14. 14. Jousilahti P, Vartiainen E, Tuomilehto J, Puska P. Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland. Circulation. 1999;99(9):1165-72.
15. 15. Uçar C. Aile Hekimliği Polikliniğine Başvuran 45 Yaş ve Üzeri Bireylerde Kardiyovasküler Risklerin Araştırılması ve Risk Skorlaması [tez]. Antalya: Akdeniz Üniversitesi Tıp Fakültesi; 2018
16. 16. Temiz A, Gazi E, Güngör Ö, Barutçu A, Altun B, Bekler A, et al. Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction. Medical science monitor: international medical journal of experimental and clinical research. 2014;20:660.
17. 17. Acanfora D, Gheorghiade M, Trojano L, Furgi G, Pasini E, Picone C, et al. Relative lymphocyte count: a prognostic indicator of mortality in elderly patients with congestive heart failure. American heart journal. 2001;142(1):167-73.
18. 18. Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the blood lymphocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. American Journal of Cardiology. 2000;86(4):449-51.
19. 19. Nikolsky E, Grines CL, Cox DA, Garcia E, Tcheng JE, Sadeghi M, et al. Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC trial). The American journal of cardiology. 2007;99(8):1055-61.
20. 20. Iijima R, Ndrepepa G, Mehilli J, Bruskina O, Schulz S, Schömig A, et al. Relationship between platelet count and 30-day clinical outcomes after percutaneous coronary interventions. Thrombosis and haemostasis. 2007;98(10):852-7.
21. 21. Castelli WP, Garrison RJ, Wilson PW, Abbott RD, Kalousdian S, Kannel WB. Incidence of coronary heart disease and lipoprotein cholesterol levels: the Framingham Study. Jama. 1986;256(20):2835-8.
22. 22. Miller G, Miller N. Plasma-high-density-lipoprotein concentration and development of ischaemic heart-disease. The lancet. 1975;305(7897):16-9.
23. 23. Lemieux I, Lamarche B, Couillard C, Pascot A, Cantin B, Bergeron J, et al. Total cholesterol/HDL cholesterol ratio vs LDL cholesterol/HDL cholesterol ratio as indices of ischemic heart disease risk in men: the Quebec Cardiovascular Study. Archives of internal medicine. 2001;161(22):2685-92.
24. 24. Kinosian B, Glick H, Garland G. Cholesterol and coronary heart disease: predicting risks by levels and ratios. Annals of internal medicine. 1994;121(9):641-7.
25. 25. Onat A, Yıldırım B, Erer B, Başar Ö, Çetinkaya A, Ceyhan K, et al. Total kolesterol/HDL-kolesterol oranı koroner hastalığın en iyi lipid öngördürücüsü: Trigliserid ortalama düzeyimiz yılda 1 mg yükselme gösteriyor. Türk Kardiyoloji Derneği Arşivi. 2001;29(6):334-43.
26. 26. Söğüt E, Avcı E, Üstüner F, Arıkan E. Serum aterojenite indeksi olarak (TG/HDL-K) oranının değerlendirilmesi. Türk Klinik Biyokimya Derg. 2006;4:1-8.