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    Independent prediction of metabolic syndrome by plasma fibrinogen in men, and predictors of elevated levels
    (Elsevier Ireland Ltd, 2009) Onat, Altan; Ozhan, Hakan; Erbilen, Enver; Albayrak, Sinan; Kucukdurmaz, Zekeriya; Can, Guenay; Keles, Ibrahim
    The role of plasma fibrinogen levels in predicting metabolic syndrome (MetS) and assessment of determinants of these levels were investigated. A total of 2234 men and women, aged 49 +/- 12 years, representative of Turkish adults who had plasma fibrinogen determinations, were prospectively evaluated and followed for a mean of 6.6 years. The modified Clauss method was used for assays. MetS was defined by ATPIII criteria modified for male abdominal obesity. MetS cases at baseline were excluded in prospective analyses. Median (interquartile range) fibrinogen values were 2.87 (2.29; 3.56) g/L. Fibrinogen levels predicted significantly newly developing MetS in men (RR 1.40 [95%CI 1.07; 1.83] for a 2-fold increment), after adjustment for age and smoking status, and (RR 1.32 [95%CI 0.95; 1.83] again for doubling), after additional adjustment for all 5 components of MetS. MetS was not significantly predicted by fibrinogen levels in women in either multivariable model. By regression analysis of eight covariates, not waist circumference, but systolic blood pressure, current smoking and C-reactive protein (CRP) in men, and age in women were predictors of elevated (>3.0 g/L) fibrinogen at follow-up (p<0.05 in all). Conclusions: Plasma fibrinogen predicts MetS independently of its components in men, in contradistinction to women, and, hence, is likely one of its components. Hyperfibrinogenemia representing an inflammatory state is postulated as the underlying mechanism. Central obesity is linked to elevation in fibrinogen mainly through the mediation of blood pressure, CRP, and via being affected by cigarette smoking. Crown Copyright (C) 2008 Published by Elsevier Ireland Ltd. All rights reserved.
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    Serum apolipoprotein B is superior to LDL-cholesterol level in predicting incident coronary disease among Turks
    (Kare Publ, 2007) Onat, Altan; Ozhan, Hakan; Can, Guenay; Hergenc, Guelay; Karabulut, Ahmet; Albayrak, Sinan
    Objective: To investigate the relative roles of serum apolipoprotein (apo) B and low density lipoprotein (LDL)-cholesterol levels in predicting incident coronary heart disease (CHID). Whether apo B/apo A-I ratio has advantage over apo B in this prediction constitutes a secondary aim. Methods: Prospective evaluation of 1138 men and 1210 women, aged 28-74 years participating in the TEKHARF survey 1997/98 with a mean 5.9-years' follow-up in whom serum apo B was determined. Tertiles of LDL-cholesterol were formed by cut points of 130 and 100 mg/dl, and of apo B by 120 and 95 mg/dl. Metabolic syndrome was defined by modified ATPIII criteria. Nonfatal CHD diagnosis was based on history of angina and myocardial revascularization, physical examination of the cardiovascular system and Minnesota coding of resting electrocardiograms. Results: Apolipoprotein B showed significant correlations with a greater number of parameters than did LDL-cholesterol. Incident CHID was not significantly predicted in age-adjusted logistic regression by LDL-cholesterol but by apo B concentrations in men with a relative risk (RR) 1.005. Apolipoprotein B level >120 vs <95 mg/dl retained significance in both genders combined, even after adjustment for waist girth and log C-reactive protein. The top (>1.02) compared with the bottom bracket of apo B/A-I ratio, though not reaching significantly predictive values among women, did significantly predict in men incident CHID with a RR 1.89. Conclusions: Apolipoprotein B, which marks small, dense LDL particles in plasma is a better predictor of incident CHID than LDL-cholesterol among Turkish adults. While in the prediction of CHID apo B level should be preferred in women, an apo B/A-I ratio >11.02 has advantages over the latter in men. It is time to create the environment (at least in our cities) for measuring in equipped laboratories apo B, which has advantages over measurements that permit calculation of LDL-cholesterol.