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Öğe Associations of TSH levels with blood lipids, coronary heart disease, and metabolic syndrome in Turkish adults(Amer Assoc Clinical Chemistry, 2005) Hergenç, Gülay; Onat, Altan; Albayrak, S.; Karabulut, A.; Türkmen, S.; Sarı, İbrahim; Can, GünayÖğe Associations of TSH levels with blood lipids, metabolic syndrome, coronary risk factors, coronary heart disease in Turkish adult(Blackwell Publishing, 2006) Hergenç, Gülay; Onat, Altan; Albayrak, S.; Karabulut, A.; Türkmen, S.; Sarı, İbrahim; Can, GünayÖğe Coğrafi bölgelerimizde risk değişkenlerinin ve global koroner riskin dağılımı(2003) Onat, Altan; Uzunlar, Bülent; Hergenç, Gülay; Yazıcı, Mehmet; Uyarel, HüseyinBu çalışma, TEKHARF 2001/02 kohortu verilerine göre, coğrafi bölgelerimizdeki global koroner risk ve bellibaşlı risk faktörlerinin farklılaşmasını kesitsel biçimde incelemeyi amaçlamaktadır. Global koroner risk bireyin TEKHARF puanına dayanılarak değerlendirildi; başlıca risk faktörleri olarak da sistolik kan basıncı, total kolesterol ve sigara gibi majör risk faktörlerinin yanısıra, HDL-kolesterol, bel çevresi, C-reaktif protein (CRP), açlık insülin düzeyleri ve, ayrıca, metabolik sendrom (MS) ve koroner kalp hastalığı (KKH) sıklığı ele alındı. Ferdin ortalama risk puanı çeşitli bölgelerde 15.7 ile 17.7 arasında değişti. İki uç bölge arasındaki mutlak riskte fark %28-30 dolayındaydı. Marmara bölgesi hem erkek, hem kadınlarda en yüksek riske sahipken, en düşük risk erkeklerde Doğu Anadolu, kadınlarda Karadeniz bölgesinde bulundu. Düşük risk (erkekte 18, kadında 21'den az) puanlı bireylerdeki KKH olasılığına kıyasla, yüksek risk puanlı fertlerde KKH olasılığı 13 kat yüksekti. Nüfusun %18.5'unu temsil eden 6.5-7 milyon kişinin yüksek risk taşıdığı tahmin edildi. Bilfiil KKH tanısı prevalansı en yüksek olan bölge Marmara bölgesiydi; en düşük prevalans ise Doğu Anadolu'da kaydedildi. MS'a Akdeniz bölgesinde en sık (%48), Doğu Anadolu'da en düşük sıklıkla (%23) rastlandı. Her iki cinsiyet birarada tutulunca, en fazla sigara İç Anadolu'da içiliyorken, en yüksek sistolik basınç ile total kolesterol Marmara bölgesinde, en geniş bel, en düşük HDL-kolesterol ve en yüksek CRP düzeyi Akdeniz bölgesinde saptandı. Koroner risk yönünden bölgelerarası farklar azsa da, en yüksek riske sahip olan Marmara bölgesi sakinlerini, Akdeniz bölgesi izlemektedir. Akdenizlilerde insülin direnci sendromu ve komponentlerinin riskin ana unsurlarını oluşturduğu, Marmara bölgesi oturanlarında ise riskin, kökenini genelde kan basıncı ve LDL-kolesterol düzeyinden aldığı sonucuna varıldı.Öğe Complement C3 and other acute phase proteins: comparative associations with risk factors and relation to coronary risk(W B Saunders Co Ltd, 2004) Onat, Altan; Hergenç, Gülay; Sansoy, V.; Uzunlar, B.; Yazıcı, Mehmet; Sarı, İbrahim; Uyarel, H.Öğe Cross-sectional study of complement C3 as a coronary risk factor among men and women(Portland Press Ltd, 2005) Onat, Altan; Uzunlar, Bülent; Hergenç, Gülay; Yazıcı, Mehmet; Sarı, İbrahim; Uyarel, Hüseyin; Can, GünayIn the present study, we examined (i) whether C3 (complement 0) was an independent marker of prevalent CHID (coronary heart disease), and (ii) which preferential associations existed between C3 and some cardiovascular risk factors when jointly analysed with CRP (C-reactive protein) and fibrinogen. In a cohort of 756 unselected adults, 39% of whom had the metabolic syndrome, C3 and other risk variables were evaluated in a cross-sectional manner. In a logistic regression model for the likelihood of CHID, a significant OR (odds ratio) of 3.5 [95% Cl (confidence intervals), 1.27 and 9.62)] for C3 was obtained after adjustment for smoking status, TC (total cholesterol) and usage of statins. A similar model, also comprising systolic blood pressure, with a cut-off point of greater than or equal to 1.6 g/l C3 exhibited a 1.9-fold risk (95 % Cl, 1.01 and 3.58) compared with individuals below the cut-off point. Both analyses displayed an adjusted OR of 1.37 for each S.D. increment in C3. The significant relationship of Q with a likelihood of CHD also proved to be independent of CRP. In multiple linear regression models, associations were tested for each acute-phase protein with measures of obesity, fasting insulin, triacylglycerols (triglycerides), TC, HDL (high-density lipoprotein)-cholesterol, physical activity, smoking status, diagnosis of metabolic syndrome and family income. When both genders were combined, C3 was independently associated with serum triacylglycerols, waist circumference, BMI (body mass index) and TC. CRP was independently associated with waist circumference, TC, family income (inversely) and physical activity, and fibrinogen with BMI, TC, smoking status and metabolic syndrome. In summary, elevated levels of complement C3 are associated with an increased likelihood of CHID independent of standard risk factors and regardless of the presence of acute coronary events, suggesting that C3 might be actively involved in coronary atherothrombosis. Unlike CRP and fibrinogen, C3 was preferentially associated with waist girth and serum triacylglycerols.Öğe Determinants of serum total phospholipid levels(Amer Assoc Clinical Chemistry, 2005) Hergenç, Gülay; Onat, Altan; Sarı, İbrahim; Türkmen, S.; Yazıcı, Mehmet; Keleş, İ.Öğe Discordance between insulin resistance and metabolic syndrome(Elsevier Ireland Ltd, 2006) Onat, Altan; Hergenç, Gülay; Türkmen, Serdar; Yazıcı, Mehmet; Sarı, İbrahim; Can, GünayThe aims of this study were to investigate the extent of concordance between metabolic syndrome (MS) and insulin resistance (IR), the features of discordance, and the magnitude of their independent association with cardiovascular disease (CVD) risk. After exclusion of individuals with diabetes and impaired fasting glucose, the population sample of 1534 men and women, representative of Turkish adults (mean age, 52.2 years), were evaluated cross-sectionally and at a mean 2 years' follow-up. Metabolic syndrome was identified by criteria of the Adult Treatment Panel III, except for male waist circumference (>94 cm). Insulin resistance was defined by the upper quartile in the sample (>2.245) of the homeostatic model assessment (HOMA) index. Clinical fatal and nonfatal CVD existed or developed in 165 subjects. Waist circumference proved to be by far the strongest significant determinant of HOMA in both sexes, followed by triglycerides. The cohort was categorized into 4 by the presence or absence of MS and IR. Each of the latter represented 34% and 25%, but together constituted 45% of the sample, thus disclosing concordance in a third of the conditions combined. The nonconcordant IR/NoMS group was less common than the MS/NoIR group and was distinct from the latter in having significantly lower waist girth, blood pressure, apolipoprotein B and triglyceride levels, and higher high-density lipoprotein cholesterol, glucose, and insulin levels and physical activity in both sexes. When adjusted for 5 important risk factors, although the excess risk in men with MS failed to attain significance, men with IR were associated with a significant 1.9-fold CVD risk. The IR/NoMS group had a 2.2-fold (95% confidence interval, 0.97-5.11) CVD likelihood compared with the large insulin-sensitive group, after adjustment for age, sex, log C-reactive protein, low-density lipoprotein cholesterol, smoking status, physical activity, and the 2 groups of MS with or without IR. Overlapping between MS and IR is limited in either sex, and MS/NoIR is more common than IR/NoMS. Overall, IR is more significantly associated with CVD risk than MS in men and in both sexes after adjustment for important confounders. Insulin resistance without MS tends to implicate in middle-aged and elderly Turkish men roughly a 2-fold CVD risk, corresponding to 50% excess risk per 1 SD in HOMA index, independent of MS and important covariates.Öğe Discordance between insulin resistance and metabolic syndrome: features and associated cardiovascular risk in adults with normal glucose regulation(W B Saunders Co-Elsevier Inc, 2006) Onat, Altan; Hergenç, Gülay; Türkmen, Serdar; Yazıcı, Mehmet; Sarı, İbrahim; Can, GünayThe aims of this study were to investigate the extent of concordance between metabolic syndrome (MS) and insulin resistance (IR), the features of discordance, and the magnitude of their independent association with cardiovascular disease (CVD) risk. After exclusion of individuals with diabetes and impaired fasting glucose, the population sample of 1534 men and women, representative of Turkish adults (mean age, 52.2 years), were evaluated cross-sectionally and at a mean 2 years' follow-Lip. Metabolic syndrome was identified by criteria of the Adult Treatment Panel III, except for male waist circumference (> 94 cm). Insulin resistance was defined by the upper quartile in the sample (> 2.245) of the homeostatic model assessment (HOMA) index. Clinical fatal and nonfatal CVD existed or developed in 165 subjects. Waist circumference proved to be by far the strongest significant determinant of HOMA in both sexes, followed by triglycerides. The cohort was categorized into 4 by the presence or absence of MS and IR. Each of the latter represented 34% and 25%, but together constituted 45% of the sample, thus disclosing concordance in a third of the conditions combined. The nonconcordant IR/NoMS group was less common than the MS/NoIR group and was distinct front the latter in having significantly lower waist girth, blood pressure, apolipoprotein B and triglyceride levels, and higher high-density lipoprotein cholesterol, glucose, and insulin levels and physical activity in both sexes. When adjusted for 5 important risk factors, although the excess risk in men with MS failed to attain significance, men with IR were associated with a significant 1.9-fold CVD risk. The IR/NoMS group had a 2.2-fold (95% confidence interval, 0.97-5.11) CVD likelihood compared with the large iusulin-sensitive group, after adjustment for age, sex, log C-reactive protein, low-density lipoprotein cholesterol, smoking status, physical activity, and the 2 groups of MS with or without IR. Overlapping between MS and IR is limited in either sex, and MS/NoIR is more common than IR/NoMS. Overall, IR is more significantly associated with CVD risk than MS in men and in both sexes after adjustment for important confounders. Insulin resistance without MS tends to implicate in middle-aged and elderly Turkish men roughly a 2-fold CVD risk, corresponding to 50% excess risk per 1 SD in HOMA index, independent of MS and important covariates.Öğe Kardiyometabolik risk profilini şekillendirmede aile geliri: Cinsiyete bağlı farklılıkların da incelendiği prospektif bir çalışma(2006) Onat, Altan; Özhan, Hakan; Can, Günay; Hergenç, Gülay; Karabulut, Ahmet; Albayrak, SinanAmaç: Aile gelirinin sigara içiciliği, metabolik sendrom (MS) ve bileşenleri, hiperapo B, yüksek C-reaktif protein (CRP) ile yeni gelişen koroner kalp hastalığı (KKH) bakımlarından öngördürücülüğü, cinsiyet farkları da gözetilerek araştırıldı. Çalışma planı: TEKHARF çalışması 1997/98 ve 2002/03 taramalarında yer alan ve 2004/05 taramasına kadar izlenen, 28 yaş veya üzerindeki 3273 katılımcı (1610 erkek, 1630 kadın; ort. yaş 48.3±12; ortalama izlem 5.9 yıl) prospektif biçimde incelendi. Aylık aile geliri, katılımcıların bildirimine göre, dört dilimde gruplandırıldı. Yüksek apo B için 120 mg/dl, yüksek CRP için 3.0 mg/l sınır olarak alındı; MS için TEKHARF modifikasyonlu ATP III tanısına uyuldu; KKH tanısı, öykü, kardiyovasküler sistem fizik muayenesi ve istirahat EKG’lerinin Minnesota kodlamasına dayandırıldı. Bulgular: Lojistik regresyon analiziyle yaş ayarlamasından sonra, erkeklerde gelir dilimi artışıyla diyabet, hipertansiyon ve hiperapo B’de artış öngörüldü. Kadınlarda ise, sigara içiciliği ile hiperapo B gelirle doğrusal; obezite, abdominal obezite ve - anlamlılığa erişmese de - trigliserid/HDL dislipidemi gelişmesi ters ilişki içindeydi; diyabet ve hipertansiyon gelirle öngörülemedi. Her iki cinsiyette de, yüksek CRP düzeyi riski gelir azlığında (dilim 1-3, <910 YTL) artıyordu (nispi risk 1.47, p<0.002). Ölümlü olan ve olmayan KKH gelirle anlamlılığa ulaşmayan bir nispi risk (1.27) sergiledi. Sonuç: Türk yetişkinlerinde refah düzeyi, sakıncalı bir risk profilinin gelişmesine anlamlı katkı yapmaktadır. Kadınlarımızda refahla artan sigara içiciliğinin (abdominal) obezite üzerindeki olumlu etkileri nedeniyle, yüksek aile geliri, bazı kardiyometabolik durumların riskinde iyileşmeyi öngördürmektedir.Öğe Obstructive sleep apnea syndrome in Turkish adults(Elsevier Ireland Ltd, 2007) Hergenç, Gülay; Onat, Altan; Uyarel, H.; Yazıcı, Mehmet; Tuncer, M.; Doğan, Y.; Rasche, K.Öğe Obstructive sleep apnea syndrome is associated with metabolic syndrome rather than insulin resistance(Springer Heidelberg, 2007) Onat, Altan; Hergenç, Gülay; Uyarel, Hüseyin; Yazıcı, Mehmet; Tuncer, Mustafa; Doğan, Yüksel; Can, GünayThe aim of this study was to investigate crosssectionally the prevalence and covariates of obstructive sleep apnea syndrome (OSAS) and its relationship to metabolic syndrome (MS), insulin resistance (IR), and coronary heart disease (CHD) in a population sample of 1,946 men and women representative of Turkish adults. OSAS was identified when habitual snoring and episodes of apnea were combined with another relevant symptom. MS was diagnosed based on modified criteria of the Adult Treatment Panel III and IR by homeostatic model assessment (HOMA). OSAS was identified in 61 men (6.4%) and 58 women (5.8%), at a similar prevalence, after adjusting for covariates. Among individuals with OSAS, significantly higher odds ratios (ORs), adjusted for age, body mass index (BMI), and waist girth, were observed for MS, hypertension, and prevalent CHD, but not for HOMA or menopause. Significantly higher C-reactive protein existed only in women with OSAS who were also more frequent smokers. In logistic regression models, waist circumference, but not BMI nor hypertension, was significantly associated with OSAS among men. In women, by contrast, current cigarette smoking and hypertension were the significant independent covariates. Regression models controlling for sex, age, and smoking revealed that MS (and not IR per se) was associated significantly with OSAS (OR 1.94) in nondiabetic individuals. To conclude, abdominal rather than overall obesity in men and smoking among women are significant independent determinants of OSAS in Turkish adults. OSAS is associated with MS rather than IR per se. Relatively high prevalence of OSAS is observed in Turkish women in whom it is significantly associated with CHD.Öğe Popülasyona dayalı bir çalışmada lipoprotein (a): Klinik önemi kadınlarımızda daha mı fazla?(2005) Onat, Altan; Yazıcı, Mehmet; Hergenç, Gülay; Doğan, Yüksel; Karabulut, Ahmet; Sarı, İbrahim; Türkmen, SerdarAmaç: TEKHARF Çalışması 2003/04 kohortunda serumda lipoprotein (a)’nın (Lp (a)) belirlendiği 665 kişide dağılımı, kardiyovasküler risk faktörleri, metabolik sendrom (MS) ve koroner kalp hastalığı (KKH) ile ilişkisi incelendi. Yöntemler: Metabolik sendrom tanısı Adult Treatment Panel III kriterlerine, KKH tanısı anamnezde angina varlığı ve 12-derivasyonlu istirahat elektrokradiyogramlarının Minnesota kodlamasına dayanılarak kondu. Örneklemin %44’ünde MS, %14’ünde KKH mevcuttu. Behring nefelometresiyle ölçülen Lp(a) değerleri normal dağılım sergilemediğinden, analizler log-transformasyonla yapıldı. Bulgular: Ortalama yaşı 55.5 ±12.0 yıl olan 286 erkek ve 379 kadında, geometrik ortalama değer sırasıyla 9.46 ±2.90 mg/dL ve 10.46 ±3.00 mg/dL (p>0.2) olup yaşla hafif artıyordu (r =0.08). Başta apolipoprotein A-I ve B ile düşük yoğunluklu lipoprotein kolesterol (LDL-K) (r =0.15) olmak üzere, total kolesterol, yüksek yoğunluklu lipoprotein kolesterol (HDL-K), sistolik kan basıncı ve log C-reaktif protein ile anlamlı doğrusal, erkeklerde tiroid uyarıcı hormon (r =-0.25), kadınlarda log gama glutamiltransferaz ile anlamlı ters korelasyonlar kaydedildi. Log insülin dahil olmak üzere, Lp(a)’nın 10 parametre ile iki cinsiyette de anlamlı ilişkisi görülmedi. Bağımsız belirleyicileri için lineer regresyon analizinde serum total kolesterol ve sistolik kan basıncı ile Lp(a) arasında pozitif, bel çevresi ile her iki cinsiyette, gama glutamiltransferaz ile Lp(a) arasında yalnız kadınlarda ters anlamlı ilişki kaydedildi. Lojistik regresyon analizlerinde erkeklerde Lp(a) ne MS, ne de KKH olasılığı için ilgi çekici bir ilişki gösterdi. Kadınlarda Lp(a) ile MS arasında yaştan bağımsız sınırda anlamlı bir ters ilişki bulunduğu gibi, Lp(a) >30 mg/dl düzeyi yaş ve MS’ten bağımsız şekilde prevalan KKH için (anlamlılığa yaklaşmadıysa da) 1.62’lik odds oranı (OR) sergiledi. Lipoprotein(a) >30 mg/dl ile LDL-K >150 mg/dl birlikteliği tüm erişkinlerde yaş, MS, sigara içimi ve LDL-K kategorileri için ayarlandıktan sonra, 1.92’lik OR (p<0.19) kaydedildi. Sonuç: Değişkenliğinin ezici bir oranda apo(a) genine bağlı olduğu bilinen Lp(a), bu çalışmada en çok abdominal obezite ölçütü ile anlamlı bağımsız (ters) ilişki içindeydi. Kadınlarda yüksek Lp(a) düzeylerinin MS’in daha az geliştiği bir ortamla eşlik ettiğine dair, KKH olasılığı için ise MS’ten bağımsız bir risk eğilimi gösterdiği yolunda ipuçları elde edildi. Daha geniş incelemelere ihtiyaç olduğu açıktır.Öğe Predictors of abdominal obesity and high susceptibility of cardiometabolic risk to its increments among Turkish women: a prospective population-based study(W B Saunders Co-Elsevier Inc, 2007) Onat, Altan; Sarı, İbrahim; Hergenç, Gülay; Yazıcı, Mehmet; Uyarel, Hüseyin; Can, Günay; Şansoy, VedatTo investigate determinants of abdominal obesity and its metabolic and clinical consequences relative to its degree in women, a prospective evaluation of 1682 female participants (aged 28-79 years at baseline), representative of Turkey's women, was performed. For components of metabolic syndrome (MS), criteria of National Cholesterol Education Program guidelines were adopted, modified for cut point of 91 cm or greater for abdominal obesity and less than 45 mg/dL for low high-density lipoprotein (HDL) cholesterol. Fasting insulin and C-reactive protein concentrations and (inversely) smoking more than 10 cigarettes daily were significant predictors of newly developed abdominal obesity at a follow-up of mean 5.9 years. In the prediction of high triglyceride-low HDL dyslipidemia, elevated blood pressure (BP) or MS and doubling of baseline fasting insulin level contributed approximately 25% to the hazard ratio (HR), whereas waist circumference exhibited independent HRs of 1.30, 1.62, and 2.22, respectively. Waist girth (or body mass index) quartiles was the major predictor (HR, 1.72) of diabetes mellitus (DM), followed by physical inactivity and total cholesterol and insulin levels, all independent of each other. Waist girth quartiles in women conferred excess risk of incident coronary heart disease from quartile II onward, independent of age, DM, and elevated BP. Fasting insulin and C-reactive protein levels and (inversely) heavy smoking are main predictors in Turkish women of abdominal obesity. Across waist girth quartiles, multiadjusted relative risks for dyslipidemia, elevated BP, MS, and coronary heart disease rise sharply and asymptotically from quartile II (>= 83 cm) onward, whereas risk of DM emerges in the top quartile. A waist girth of 83 cm or greater should be regarded as abdominal obesity among Turkish women. (c) 2007 Elsevier Inc. All rights reserved.Öğe Predictors of abdominal obesity and high susceptibility of cardiometabolic risk to its increments among Turkish women: A prospective population-based study(Elsevier Ireland Ltd, 2007) Onat, Altan; Sarı, İbrahim; Hergenç, Gülay; Yazıcı, Mehmet; Uyarel, H.; Can, Günay; Sansoy, V.Öğe Prevalence, incidence, predictors and outcome of type 2 diabetes in Turkey(2006) Onat, Altan; Hergenç, Gülay; Uyarel, Hüseyin; Can, Günay; Özhan, HakanAmaç: Türk erkek ve kadınlarını temsil eden bir örneklemde, tip 2 diyabetin insidansı, bazı öngördürücüleri ile akıbetini prospektif biçimde, prevalansını da kesitsel olarak araştırmak. Yöntemler: Ortalama yaşı 48 (±12) olan 3401 kişilik bir örneklem 19,050 kişi-yılı tutan bir izlemede öne dönük olarak değerlendirildi. Diyabetes mellitüs'lü (DM) bireylerin tanısı Amerikan Diyabet Cemiyeti kriterlerine göre kondu. Fatal ve fatal olmayan koroner kalp hastalığı (KKH) klinik bulgu ve istirahat elektrokardiyografisinin Minnesota kodlarıyla belirlendi. Abdominal obezite için erkekte ?95 cm, kadında ?91 cm'lik sınırlar uygulandı. Öne dönük değerlendirmelerde, başlangıçtaki DM ve KKH vakaları dışlandı. Bulgular: Nüfusu ?35 yaş olan kesim için %11.0'e karşılık gelen bir DM prevalansı (tahminen 2.89 milyon) saptandı. Ortalama 5.9 yıllık takipte 223 kişide yeni DM gelişmesi karşılığında, 1000 kişi-yılında kadında 11.0, erkekte 12.4'lük bir insidans hesaplandı; bu da ülke bazında yılda 300 bin kişilik insidans ifade eder. Geri kalanlara kıyasla, yeni gelişen diyabetli kişilerde başlangıçtaki HDL-kolesterol benzer olup şu risk değişkenleri anlamlı farklıydı: Yaş (5 yıl), bel çevresi (7 cm), kan basıncı (12/6 mmHg), apolipoprotein B (7 mg/dl), total kolesterol (14 mg/dl), açlık trigliseridleri (yalnız kadında, 52 mg/dl). Diyabetes mellitüs'ün anlamlı bağımsız öngördürücüleri olarak abdominal obezite (RR 2.61 [%95GA 1.87; 3.63]) ile yaş her iki cinsiyette, erkekte ise hipertansiyon (RR 1.81 [%95GA 1.10; 2.98]) ve düşük HDL-kolesterol ortaya çıktı. Cinsiyet, yaş, hipertansiyon, bel çevresi, total kolesterol ve sigara içimi için ayarlandıktan sonra, DM 1.81'lik (%95GA 1.19; 2.75) bir nisbi risk ile fatal ve fatal olmayan KKH'nın anlamlı bağımsız bir öngördürücüsüydü. Sonuçlar: Halkımızda halen 305 bin olan DM insidansı hızla artmakta, prevalansı da benzer şekilde yükselmektedir. Diyabetin kadınlarda esas belirleyicisi abdominal obezite iken, insülin direnci bu bağlamda daha zayıf görünmektedir. Çok değişkenli ayarlamada DM, fatal ve fatal olmayan KKH'nın anlamlı bağımsız öngördürücüsüdür. Bu gözlemler, göbeklilik “salgını”nı durdurucu veya tersine dönüştürücü önlemlere şiddetle ihtiyaç olduğunun altını çizmektedir.Öğe Serum apolipoprotein B predicts hypertension, dyslipidemia, metabolic syndrome and, in women, diabetes(Amer Assoc Clinical Chemistry, 2007) Hergenç, Gülay; Onat, Altan; Can, Günay; Yazıcı, Mehmet; Karabulut, A.; Albayrak, S.Öğe Serum folate and Vit B12 levels in Turkish women: Inverse associations with metabolic syndrome, but none with coronary heart disease(Amer Assoc Clinical Chemistry, 2007) Hergenç, Gülay; Onat, Altan; Albayrak, S.; Özhan, H.; Uyarel, H.; Can, GünayÖğe Serum total and HDL-phospholipid levels in a population based study and relation to risk of metabolic yndrome and coronary disease(Elsevier Ireland Ltd, 2006) Hergenç, Gülay; Onat, Altan; Yazıcı, Mehmet; Sarı, İbrahim; Can, GünayThe aim of study was to investigate the role of serum total (TPL) and high-density lipoprotein phospholipids (HDL-pl) as a risk factor in coronary heart disease (CHD) and metabolic syndrome (MS). In a random sample, total and HDL-pl were measured in 1088 and 642 adults from Turkey, respectively, who have a high prevalence of MS; this was done with an enzymatic method that measures total phosphatidylcholine, sphingomyelin, and lysophosphatidylcholine. Serum TPL and HDL-pl levels were significantly higher in women (TPL, 2.8 mmol/L; HDL-pl, 1.21 mmol/L) than in men. Strong correlations existed between serum TPL levels and nonHDL cholesterol (HDL-C), triglycerides, apolipoprotein (apo) B, complement C3, and γ-glutamyltransferase. Non–HDL-C, HDL triglyceride, and apo A-I were strongly correlated with HDL-pl. Linear regression analyses revealed HDL-C, apo B, triglycerides, diabetes, and female gender as independent significant determinants of TPL levels in adults. HDL-C and impaired glucose regulation were sole significant variables, together contributing one-quarter of serum HDL-pl. Individuals with MS or diabetes had significantly higher TPL concentrations. The gender- and age-adjusted odds ratio (OR) of TPL for MS was 1.73 (95% confidence interval, 1.35-2.21), whereas the multiadjusted OR of HDL-pl per 1 SD increment corresponded to a significantly reduced independent MS likelihood by 26% in women (and 18% in the entire group). The multiadjusted OR of HDL-pl for CHD in men and women combined was 0.32 (P = .057) corresponding to a reduced CHD likelihood by 32% per 1 SD increment of HDL-pl. Plasma TPL levels point to an adverse relationship to MS, whereas their role in CHD risk needs further investigation. HDL-pls, in contrast, mark substantial protection from MS as well as from CHD.Öğe Serum uric acid is a determinant of metabolic syndrome in a population-based study(Oxford Univ Press, 2006) Onat, Altan; Uyarel, Hüseyin; Hergenç, Gülay; Karabulut, Ahmet; Albayrak, Sinan; Sarı, İbrahim; Yazıcı, MehmetBackground: Determination of serum uric acid concentrations and role in risk of metabolic syndrome (MS) were investigated in 1877 participants in a cross-sectional population-based study including a brief follow-up. Methods: The MS was identified by modified criteria of the Adult Treatment Panel III, and coronary heart disease (CHD) by clinical findings and Minnesota coding of resting electrocardiograms. Uric acid concentrations were measured by the uricase method. Results: Metabolic syndrome was present in 39.1% of the cohort. Linear regression analysis of uric acid levels in a model comprising 13 variables identified gender, waist girth, total cholesterol (TC), alcohol usage, triglycerides, log C-reactive protein (CRP), and log gamma-glutamyl transferase (GGT), and in women diuretic use and elevated blood pressure (BP), as significant independent covariates whereby the largest contribution (1.6 mg/dL) was generated by waist girth. Logistic regression analysis of serum uric acid for MS disclosed for the top versus the bottom tertile an odds ratio (OR) of 1.89 (95% confidence interval [CI]: 1.45-2.46) in men and women combined, after ajustment for sex, age, TC, log CRP, log GGT, alcohol, and diuretic drug use, presence of diabetes/impaired fasting glucose, elevated BP, and smoking status. This corresponded to an increase by 35% in MS likelihood for each 1 SD uric acid increment. This rate declined to a significant 15% by inclusion of waist girth into the model. The OR of uric acid concentrations for prevalent and incident CHD, adjusted for age, MS, smoking, and diuretic use, was not significant among women and only tended toward significance in men. Conclusions: Abdominal obesity is the main determinant of uric acid variance. An increment of 1 SD in serum uric acid levels are associated in both sexes with a 35% higher MS likelihood, independent of 10 risk factors related to MS. After adjustment for waist girth, a more modest but significant likelihood persists, which suggests that serum uric acid is a determinant of MS.Öğe TSH levels in Turkish adults: Prevalences and associations with serum lipids, coronary heart disease and metabolic syndrome(2005) Hergenç, Gülay; Onat, Altan; Albayrak, Sinan; Karabulut, Ahmet; Türkmen, SerdarOvert hypothyroidism is implicated in atherosclerosis through dyslipidemia, hypertension, and hyperhomoscysteinemia. Epidemiological data related to the role of thyroid hormones in the risk of coronary heart disease (CHD) and metabolic syndrome (MS) in Turkish adults are lacking. Thyroid stimulating hormone (TSH) was measured in the 2004 follow-up of the Turkish Adult Risk Factor Study, with the aim of investigating thyroid hormone status as a possible risk factor in CHD and MS in the population sample. To this end, a subgroup of the cohort (512 men and women: mean age 52 ± 11.4) in whom the prevalences for CHD, MS and diabetes (DM) were 8.2%, 42.4% and 10.7%, respectively, were screened for TSH. The cohort was classified as hypo-, hyperor euthyroid according to cutoffs of 4.2 and 0.3 µU/ml for TSH, respectively. No distinction was made between overt and subclinical thyroid states. Total and LDL-cholesterol was lowest, but waist circumference unexpectedly highest in the hyperthyroid group. Women (1.3 µU/ml) had significantly higher (P < 0.001) TSH levels than men (0.95 µU/ml). The prevalence of hypo- and hyperthyoidism in men and women were 1.7%/7% and 4.4%/5%, respectively, and women overwhelmingly predominated the hypothyroid cases. TSH values did not significantly differ among groups diagnosed as or not CHD, MS, or DM. Log TSH was significantly correlated with total and LDL-cholesterol and, inversely, with alcohol usage. Multivariate linear regression analysis revealed total cholesterol as the sole independent covariate of TSH levels in men and both sexes combined. An increase by approximately one-third of the physiological TSH levels was associated with a 40 mg/dl-increase in total cholesterol concentrations. Age- and sex-adjusted TSH did not contribute to the risk of CHD, hypercholesterolemia, MS, or DM in logistic regression analyses. To conclude, TSH levels were independently associated with total cholesterol concentrations but did not appear to be a risk factor for CHD or MS in the cohort studied. Following up the group prospectively may give a better understanding concerning the thyroid status and CHD risk in Turkish adults.
