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Analysis of all-cause mortality and coronary events in the Turkish Adult Risk Factor Survey 2005
(Turkish Soc Cardiology, 2006) Onat, Altan; Karabulut, Ahmet; Esen, Ali Metin; Uyarel, Huseyin; Ozhan, Hakan; Albayrak, Sinan; Keles, Ibrahim
Objectives: To analyze all-cause and coronary mortality as well as newly diagnosed coronary heart disease (CHD) in the cohort of the Turkish Adult Risk Factor Study which was surveyed in the summer of 2005 and included individuals residing essentially in the regions of Marmara and Central Anatolia. Study design: Information on the mode of death was obtained from first-degree relatives and/or health personnel of local health offices. Diagnosis of coronary heart disease was based on history, physical examination, and 12-lead electrocardiograms. New coronary events were defined as those that developed after the last survey, including fatal or nonfatal myocardial infarction, stable angina and/or myocardial ischemia. Results: Of 1646 participants, 1078 subjects (mean age 54.8 +/- 11.8 years) were examined; information alone was gathered for 507 subjects; 43 subjects (28 men, 15 women) had died, and 18 subjects were lost to follow-up. Incorporation of 3104 person-years of follow-up raised the total follow-up of the survey to 42,600 personyears. Twenty-three deaths were classified as CHD-related. New coronary events were identified in 37 participants. Annual mortality and coronary mortality rates were 13.9 and 7.4 per 1000 adults, respectively. Overall mortality per 1000 person-years was 16.3 in rural areas and 12.0 in urban areas. The high share of coronary deaths among all deaths persisted. In the age bracket of 45 to 74 years, overall mortality declined to 10.6 (p= 0.09) and coronary mortality to 5.5 per 1000 person-years, thus supporting the presence of a consistently decreasing trend of all-cause mortality and coronary mortality. Estimated fatal and nonfatal new coronary events appeared to be high with 18 per 1000 person-years. Conclusion: A rising trend persists in the incidence of coronary mortality and its share in overall mortality as well as in new coronary events. The occurrence of coronary deaths among women seems to be gradually shifting to older ages.
Association between mild renal dysfunction and insulin resistance or metabolic syndrome in a random nondiabetic population sample
(Karger, 2007) Onat, Altan; Hergenc, Gulay; Uyarel, Huseyin; Ozhan, Hakan; Esen, A. Metin; Karabulut, Ahmet; Albayrak, Sinan
Aims: The association of mild renal dysfunction (estimated glomerular filtration rate [eGFR] 60-89.9 ml/min/1.73 m(2)) with insulin resistance (IR) or metabolic syndrome (MS) needs be investigated in a population in which MS prevails. Methods: After excluding subjects with diabetes mellitus, 1,678 subjects from a representative cohort (median age 52 years) were studied cross sectionally. eGFR was based on serum creatinine concentrations using the quadratic GFR equation and categorized by 90 and 60 ml/min/1.73 m(2) as limits. MS was identified using the modified criteria of the Adult Treatment Panel-III. Results: In men, whereas MS was not significantly associated with a reduced eGFR category when controlled for homeostatic model assessment (HOMA), HOMA adjusted for MS or for its components was significantly associated with the likelihood of a reduced eGFR. This likelihood was increased by 14% with a doubling of HOMA in men. Age was the dominant correlate of reduced eGFR in women, whereby an association with HOMA was not significant. Conclusion: Mildly impaired kidney function is common in nondiabetic adults among whom MS prevails, and in men it is mainly associated with IR but not with central obesity and MS-related dyslipidemia. The quadratic GFR equation enables an acceptable estimation of GFR in a general population. Copyright (c) 2007 S. Karger AG, Basel.
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, Günay
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, Günay
Coğrafi bölgelerimizde risk değişkenlerinin ve global koroner riskin dağılımı
(2003) Onat, Altan; Uzunlar, Bülent; Hergenç, Gülay; Yazıcı, Mehmet; Uyarel, Hüseyin
Bu 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.
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.
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, Günay
In 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.
Determinants and definition of abdominal obesity as related to risk of diabetes, metabolic syndrome and coronary disease in Turkish men
(Elsevier Ireland Ltd, 2007) Onat, Altan; Uyarel, Huseyin; Hergenc, Gulay; Karabulut, Ahmet; Albayrak, Sinan; Can, Gunay
We aimed to investigate determinants of abdominal obesity and its clinical impact on metabolic syndrome (MS), diabetes (DM) and coronary heart disease (CHD) in men. Methods: Prospective evaluation of 1638 male participants (aged 48.5 +/- 12.3), representative of Turkey's men who have a high prevalence of MS. For components of MS, criteria of NCEP guidelines were adopted, modified for abdominal obesity. Follow-up constituted 9650 person-years. Results: Insulin level (relative risk [RR] 1.40 for doubling), C-reactive protein (CRP) and heavy smoking (protective) were independent predictors of newly developing abdominal obesity. High triglyceride and low HDL-cholesterol were significantly associated already with waist girth quartile II, apolipoprotein B with quartile III. Waist girth significantly predicted future MS from quartile II on, independent of insulin resistance (IR) by homeostatic model assessment, whereby its hazard ratio (HR, 2.6) exceeded double that of HOMA. CRP independently predicted MS. Age-adjusted HR of waist girth (1.59) was significant in predicting DM. Age- and smoking-adjusted top waist quartile conferred significant risk for incident CHD (RR 1.71) but not for overall mortality. As judged by sensitivity and specificity rates for future CHD, DM and MS, abdominal obesity was most appropriately defined with a waist girth of >= 95 cm, and an action level 1 of >= 87 cm was proposed for MS in this population. Conclusions: Serum insulin, CRP levels and (inversely) heavy smoking are predictors for abdominal obesity in Turkish men. Atherogenic dyslipidemia and elevated blood pressure are associated significantly already with modest rises in waist girth adjusted for age and smoking. Abdominal obesity shows substantial independence of IR in the development of MS. Increasing waist girth was predictive of MS, more strongly than of DM. Risk for CHD imparted by abdominal obesity is essentially mediated by risk factors it induces. (c) 2006 Elsevier Ireland Ltd. All rights reserved.
Determinants of serum total phospholipid levels
(Amer Assoc Clinical Chemistry, 2005) Hergenç, Gülay; Onat, Altan; Sarı, İbrahim; Türkmen, S.; Yazıcı, Mehmet; Keleş, İ.
Discordance between insulin resistance and metabolic syndrome
(Elsevier Ireland Ltd, 2006) Onat, Altan; Hergenç, Gülay; Türkmen, Serdar; Yazıcı, Mehmet; Sarı, İbrahim; Can, Günay
The 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.
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, Günay
The 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.
Evidence for a complex risk profile in obese postmenopausal Turkish women with hypertriglyceridaemia and elevated apolipoprotein B
(Portland Press Ltd, 2004) Onat, Altan; Yazıcı, Mehmet; Can, Günay; Sniderman, Allan
The aim of the present study was to examine possible pathophysiological relationships among a wide array of proatherogenic risk factors in postmenopausal women. Fasting lipids, apoB (apolipoprotein B), BMI (body mass index) and waist circumference were measured in 178 women (59.4 +/- 7.2 years) from the Turkish Adult Risk Factor Study. Fasting levels of complement C3, insulin, SHBG (sex hormone-binding globulin), cortisol, oestradiol, testosterone and DHEA-S (dehydroepiandrosterone sulphate) were also determined. This is the first study to examine the relationships of all these variables with apoB. In the first of two different approaches, three groups of obese women were compared. Group 1 comprised women who were normolipidaemic with normal apoB; group 2, women who were hypertriglyceridaemic, but with normal apoB; and group 3, women who were hypertriglyceridaemic with elevated apoB. Complement C3, fasting insulin and glucose were significantly higher and HDL-C (high-density lipoprotein-cholesterol) and SHBG levels were significantly lower in group 3 than in group 1. In the former group, the testosterone/SHBG ratio tended to be higher, indicating more free testosterone, than in group 1. The mean risk score in group 3 and the odds ratio for coronary disease by logistic regression analysis were significantly higher, 2.56 (confidence intervals, 1.12-5.85; P = 0.026), compared with the two other groups combined. In examining the whole group, apoB levels correlated significantly with a wider array of pro-atherogenic risk factors than did LDL-C (low-density lipoprotein-cholesterol), particularly being linked to complement C3 and glucose, as well as the risk score. Complement C3 demonstrated the widest associations and was significantly linked with BMI, waist circumference, insulin, glucose, fibrinogen, triacylglycerols (triglycerides) and apoB and was inversely correlated with HDL-C and SHBG. SHBG was also correlated inversely with a wide spectrum of risk variables. In summary, in Turkish women, apoB was linked with a complex array of proatherogenic risk factors, and hypertriglyceridaemia with elevated apoB was associated with a higher risk of coronary disease.
Family income in shaping cardiometabolic risk profile: a prospective analysis including gender-related differences
(Turkish Soc Cardiology, 2006) Onat, Altan; Ozhan, Hakan; Can, Guay; Hergenc, Gulay; Karabulut, Ahmet; Albayrak, Sinan
Objectives: We investigated the extent to which family income predicts smoking, metabolic syndrome (MS) and its components, elevated levels of apolipoprotein (hyperapo) B and C-reactive protein (CRP), and incident coronary heart disease (CHD), with reference to gender-related differences. Study design: A total of 3,273 participants (1610 males, 1630 females; mean age 48.3 +/- 12 years, minimum age 28 years) of the TEKHARF surveys 1997/98 and 2002/03 were prospectively evaluated during a mean of 5.9 years. Monthly family incomes were grouped into four categories. Elevated apoB and CRP levels were based on the cutoff values of 120 mg/dl and 3 mg/l, respectively. Identification of MS was made according to the Adult Treatment Panel III criteria modified by the TEKHARF study. Diagnosis of CHD was based on history, physical examination, and the Minnesota coding of resting electrocardiograms. Results: In age-adjusted logistic regression analyses, men with higher income brackets had an increased incidence of diabetes, hypertension, and elevated hyperapo B. In women, income was positively associated with smoking and elevated hyperapo B, and inversely related with obesity, abdominal obesity, and - at borderline significance - triglyceride/HDL dyslipidemia; diabetes and hypertension were not predicted by income. Lower income brackets (<910 NTL) predicted elevated CRP levels in both genders (relative risk 1.47, p<0.002). Income exhibited an insignificant relative risk (1.27) for incident CHD. Conclusion: The level of family income contributes to the development of an adverse risk profile in Turks. Given increased smoking in women and its inhibitory effect on (abdominal) obesity, rising income seems to predict improvement in some elements of the cardiometabolic risk profile.
Halkımızda abdominal obezitede risk faktörü kümelenmeleri ve demografik dağılımı
(2005) Onat, Altan; Uyarel, Hüseyin; Karabulut, Ahmet; Albayrak, Sinan; Doğan, Yüksel
Amaç: Türk erişkinlerinde abdominal obezitenin yaş gruplarına ve coğrafi bölgelerimize göre dağılımı; abdominal obezitenin yüksek total ve düşük HDL kolesterol düzeyleri, sigara içimi, hipertansiyon ve diyabet gibi başlıca risk faktörleriyle kümelenme sıklığı ve tipleri araştırıldı. Çalışma planı: Çalışmaya, Türk Erişkinlerinde Kalp Hastalığı ve Risk Faktörleri (TEKHARF) çalışmasının son üç taramasında bel çevresi ölçülmüş olan 3267 kişi (1607 erkek, 1660 kadın; ort. yaş 52±12) alındı. Kardioyovasküler hastalık tanısı anamnezde angina varlığı, istirahat elektrokardiyografisinin Minnesota kodlamasına ve inme öyküsüne dayanılarak kondu. NCEP ATP III tarafından metabolik sendrom çerçevesinde önerilen bel çevresi ölçütlerine ve hipertansiyon tanımına uyuldu. Bulgular: Elli yaş ve üzerindeki her dört erkekten biri, her dört kadından üçü abdominal obeziteli bulundu. Abdominal obezite prevalansı bölgelerimize göre büyük farklılıklar sergilemedi. Abdominal obezitelilerde 3-5 risk faktörünün birlikteliği diğer kümelenmelere göre daha fazlaydı (p<0.001). İncelenen altı risk faktörü de kadında abdominal obeziteyle anlamlı bağımsız ilişki gösterirken, erkekte yalnız sigara, HDL-kolesterol düşüklüğü ve hipertansiyon bağımsız ilişki sergiledi. Erkeklerden farklı olarak, kadınlarda diyabet abdominal obeziteye üç kattan fazla eşlik etmekte ve bu ikisi hiperkolesterolemi ile anlamlı derecede fazla kümeleşmekteydi. Abdominal obezite, kadında koroner kalp hastalığı olasılığını diğer beş risk faktörü aracılığıyla belirlerken, erkekte anılan etmenlerin dışında bağımsız bir belirleyici niteliğine sahipti. Sonuç: Batıda türetilmiş ölçütler kullanıldığında, abdominal obezite Türk kadınında erkeğe kıyasla üç kat daha sık görülmektedir. Cinsiyete özgü önemli bir farkı açığa vuran abdominal obezite-diyabet-hiperkolesterolemi kombinasyonu Türk kadınındaki yüksek koroner kalp hastalığı riskine muhtemelen katkıda bulunmaktadır. Buna benzer bir çalışmanın Türk erkeği için daha önce önerdiğimiz ≥96 cm ölçütüyle tekrarlanmasında yarar vardır.
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.
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, Sinan
Amaç: 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.
Lipoprotein(a) level and MIF gene variant predict incident metabolic syndrome and mortality
(Bmj Publishing Group, 2016) Onat, Altan; Can, Günay; Çoban, Neslihan; Dönmez, İbrahim; Çakır, Hakan
Owing to the scarcity of available information, we aimed to assess the association of migration inhibitory factor (MIF)-173 G/C genotypes and serum lipoprotein(Lp)(a) with incident metabolic syndrome (MetS) and all-cause mortality, respectively. In population based, middle-aged adults (n=1297), stratified by gender and presence of MetS, we used Lp(a) quintiles to identify non-linear associations with outcomes using Cox regression models, adjusted for MIF genotype, age, smoking status, high density lipoprotein cholesterol, and systolic blood pressure. After 5.2years of follow-up, 151 cases of incident MetS and 123 deaths were recorded. For incident MetS, adjusted HRs increased in each gender across four declining quintiles, starting from the highest quintile in men and from quintile 4 in women. The MIF CC-GC genotype appeared to contribute to the risk estimates in men. Similarly adjusted models in the whole sample disclosed that all-cause mortality tended to be inversely associated with Lp(a) quintiles and yielded an HR (2.42 (95% CI 1.03 to 5.81)) in men in quintile 2, whereas the MIF genotype additively predicted mortality (HR 1.79 (95% CI 1.01 to 3.18)) only in men. Excess risk of death was additively conferred on Turkish men by the MIF CC-GC genotype and by apparently reduced circulating Lp(a) assays, supporting the notion that low' serum Lp(a), mediating autoimmune activation, is a major determinant of metabolic disease risk and death. Damaged MIF protein and more complex autoimmune activation in women may be responsible from lack of relationship to MetS/mortality.
Mild Renal Dysfunction Among Turkish Adults: Prevalence and Its Association With Insulin Resistance
(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2006) Onat, Altan; Yazici, Mehmet; Hergenc, Gulay; Uyarel, Huseyin; Esen, A. Metin; Karabulut, Ahmet; Can, Gunay
Objectives: To investigate the prevalence of mild renal dysfunction and its association with insulin resistance (IR), metabolic syndrome (MS) or its components among Turkish adults. Methods: Serum creatinine concentrations were measured in 1048 male and female subjects. After excluding cases with diabetes mellitus, 933 participants of a representative cohort were studied cross-sectionally. Glomerular filtration rate (GFR) was estimated based on serum creatinine concentrations using the Modification of Diet in Renal Disease formula. GFR was divided into 3 categories constituting chronic kidney disease stages 2 and 3 3. MS was identified by modified criteria of the Adult Treatment Panel-III. Results: MS existed in 38.7% of the cohort. Mild renal dysfunction (estimated GFR 60 to 89.9 mL/min/1.73 m(2)) existed in 50% of the study sample in both genders. Compared to the group with normal GFR, in category II, age-adjusted estimates of body mass index, homeostatic model assessment (HOMA) index, blood pressures, total, HDL-, LDL-cholesterol and serum proteins were all significantly elevated in both genders, as were apo B and log TSH in women alone. Stated variables were also significantly and inversely correlated with GFR. Whereas MS was not significantly associated with GFR categories, nor with reduced GFR when controlled for HOMA, HOMA D adjusted for MS as well as for sex, age and systolic BP-was significantly associated with likelihood for reduced GFR. Conclusions: Mild impairment of kidney function is very common in nondiabetic middle-aged and elderly adults, is associated mainly with IR and related cardiovascular risk factors, in the absence of MS-related atherogenic dyslipidemia. IR is important even in mild reduction in GFR, an action independent of central obesity-related components of MS.
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.
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, Günay
The 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.

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