sek Cardiovascular Surgery Center

İstanbul, Turkey

sek Cardiovascular Surgery Center

İstanbul, Turkey
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Onat A.,Turkish Society of Cardiology | Can G.,Istanbul University | Hergenc G.,Yildiz Technical University | Kucukdurmaz Z.,Gaziantep Teaching Hospital | Ugur M.,sek Cardiovascular Surgery Center
Cardiology | Year: 2010

Objectives:To confirm previous findings on excess absolute coronary heart disease (CHD) risk among Turks. Methods: The observed incident CHD risk of a representative population sample was compared with that anticipated by Fra- mingham risk scores (FRS). At 7.4 years of follow-up of 3,027 participants free of CHD at baseline, risk estimation was contrasted in the 398 cases of newly developed fatal and nonfatal CHD. Results:CHD developed at a rate 2.2 times higher than the anticipated risk. In sex-specific quintiles of FRS, the 10-year incidence of CHD events in males in the 2 highest quintiles was 2 times the anticipated levels. In women, the 3 highest quintiles displayed an incidence 2.7 times the anticipated risk. Such individuals typically had abdominal obesity and evidence of dysfunctional apolipoprotein (apo) A-I. Men had high levels of non-high-density lipoprotein (HDL) cholesterol, total apoC-III, apoB and triglycerides. In Cox proportional hazard regression analyses, the 10-year probability of remaining free of CHD was low (81.1% in men, 84.2% in women). Women exhibited C-reactive protein as an independent predictor of CHD, lack of protection by HDL cholesterol and no conferred risk from current smoking. The observed excess CHD risk was primarily attributed to central obesity and related dysfunction of HDL, apoC-III and apoA-I. Conclusion: Dysfunction of protective serum proteins associated with metabolic syndrome impacts on CHD events, in addition to conventional risk factors. © 2010 S. Karger AG, Basel.


Onat A.,Istanbul University | Can G.,Istanbul University | Cicek G.,sek Cardiovascular Surgery Center | Dogan Y.,Bakirkoy Dr Sadi Konuk Educational Hospital | And 3 more authors.
Clinical Biochemistry | Year: 2012

Objectives: We determined in non-diabetic persons the associations of current smoking with future glucose and insulin concentrations. Design and methods: Middle-aged non-diabetic adults (n= 1071) were studied in whom these values were measured at baseline and 5.2-years later. Results: Age-adjusted fasting insulin concentrations in 137 smoking men remained lower than never smokers at both surveys. While age-adjusted fasting glucose values in male never smokers declined at follow-up (p= 0.037), they rose in male smokers. In 94 female smokers, age-adjusted fasting insulin values marginally declined, and fasting glucose was reduced (by 0.09. mmol/L, p= 0.055) during follow-up. In contrast in never-smoking women, insulin and glucose concentrations rose (p<0.001 in both). Age-adjusted insulin levels in former smokers exhibited similar trends as never smokers. Trends were essentially unchanged when adjustment included body mass index. Current male smokers demonstrated evidence of reduced insulin sensitivity, female smokers of improved one, as assessed by QUICKI. Conclusion: Smoking among Turks induces at long-term lower fasting insulin levels which represent improved insulin sensitivity in women, yet a reduced one in men. © 2011 The Canadian Society of Clinical Chemists.


Dogan Y.,Bakirky Sadi Konuk Education and Research Hospital | Onat A.,Istanbul University | Kaya H.,Kartal Kosuyolu Hospital | Ayhan E.,sek Cardiovascular Surgery Center | Can G.,Istanbul University
Cardiology Research and Practice | Year: 2011

To determine whether obesity, inflammation, or conventional risk factors are related to depressive symptoms (DeprSy) in the general population. Responses to 3 questions served to assess sense of depression. Body mass index (BMI), C-reactive protein (CRP), and other epidemiologic data of participants were available. In 1940, individuals who consulted a psychiatrist in the preceding year, or felt depressed (together DeprSy), 248 were female. Logistic regressions for adjusted associations of BMI with DeprSy were not significant as was serum CRP level. Diabetes and, in men, fasting glucose concentrations were associated with DeprSy. Systolic blood pressure (SBP) was robustly inversely associated with DeprSy in diverse models at ORs of 0.74 (95%CI 0.63; 0.89) independent of confounders, including antihypertensive and lipid-lowering medication. The use of antidepressants could not explain the reduced BP. Women are predisposed to depression with which, not BMI and CRP, but SBP is inversely associated. Anti-inflammatory substances produced in depressed persons might explain the slightly lower BP. Copyright © 2011 Yksel Doan et al.


Onat A.,Istanbul University | Can G.,Istanbul University | Cicek G.,sek Cardiovascular Surgery Center | Ayhan E.,sek Cardiovascular Surgery Center | And 2 more authors.
Acta Diabetologica | Year: 2013

We determined in non-diabetic persons the risk of fasting and non-fasting glucose levels for pre-diabetes, diabetes, and coronary heart disease (CHD), including the roles of serum C-reactive protein (CRP) and HDL cholesterol, and delineated risk profiles of the pre-diabetic states. Over 7Â years, 2,619 middle-aged Turkish adults free of diabetes and CHD were studied prospectively. Using different serum glucose categories including impaired fasting glucose (IFG, 6.1-6.97 mmol/L) and impaired glucose tolerance (IGT), outcomes were analyzed by Cox regression. IFG was identified at baseline in 112 and IGT in 33 participants. Metabolic syndrome components distinguished individuals with IFG from those with normoglycemia. Participants with IGT tended to differ from adults in normal postprandial glucose categories in regard to high levels of triglycerides, apoA-I, and CRP. Diabetes risk, adjusted for sex, age, waist circumference, CRP, and HDL cholesterol, commenced at a fasting 5.6-6.1 mmol/L threshold, was fourfold at levels 6.1-6.97 mmol/L. Optimal glucose values regarding CHD risk were 5.0-6.1 mmol/L. Fasting and postprandial glucose values were not related to CHD risk in men; IGT alone predicted risk in women (HR 3.74 [1.16;12.0]), independent of age, systolic blood pressure, non-HDL cholesterol, waist circumference, smoking status, and CRP. HDL cholesterol was unrelated to the development of IFG, IGT, and diabetes, while CRP elevation independently predicted the development of diabetes. IGT independently predicts CHD risk, especially in women. HDL dysfunction associated with low-grade inflammation is a co-determinant of pre-diabetic states and their progression to diabetes. © 2011 Springer-Verlag.


Onat A.,Istanbul University | Can G.,Istanbul University | Cicek G.,sek Cardiovascular Surgery Center | Dogan Y.,Bakirkoy Dr Sadi Konuk Educational Hospital | Yuksel H.,Istanbul University
Diabetes Research and Clinical Practice | Year: 2011

We addressed whether or not the risk of coronary heart disease (CHD) in non-diabetic persons is linear at the lower end of fasting glucose levels. Middle-aged Turkish adults (n= 2893) free from diabetes and CHD at baseline were studied prospectively over a 7.6-year follow-up. Participants with fasting glucose measurements were analyzed in 3 groups separated by 90. mg/dl and 110. mg/dl limits. Outcomes were analyzed by Cox regression.Cox regression for CHD incidence (n= 374) showed an increased age-adjusted risk in the <90. mg/dl fasting glucose group (n= 788) [HR 1.32 (1.03; 1.68)], compared with the 90-110. mg/dl group after adjustment for sex, age and the glucose groups. Further adjustment for waist circumference, C-reactive protein and conventional risk factors attenuated the HR to 1.27 (p= 0.077). The risk profile in the low-glucose group could not be accounted for by age, smoking status, systolic blood pressure or fasting insulin levels but tended to show higher levels of circulating C-reactive protein.The increased CHD risk observed in individuals with lower compared with higher normal glucose concentrations is likely to be related to an associated pro-inflammatory state. © 2010 Elsevier Ireland Ltd.


Onat A.,Istanbul University | Hergenc G.,Yildiz Technical University | Bulur S.,Duzce University | Ugur M.,sek Cardiovascular Surgery Center | And 2 more authors.
International Journal of Cardiology | Year: 2010

Background: Predictive value of apolipoprotein (apo) A-I for incident hypertension, metabolic syndrome (MetS), type 2 diabetes (DM) and coronary heart disease (CHD) needs further exploration. Methods: A representative sample of Turkish adults was studied with this purpose prospectively. Sex-specific apoA-I tertiles were examined regarding cardiometabolic risk. Results and conclusions: A total of 1044 men and 1067 women (aged 49 ± 12 years at baseline) were followed up over 7.4 years. High serum apoA-I levels were significantly associated in multivariable analysis with female sex, aging, alcohol intake, (inversely) cigarette smoking and, in women, with systolic blood pressure. Risk of diabetes was predicted in logistic regression in both genders by top versus bottom apoA-I tertile (RR 1.98; [95%CI 1.31; 3.0]), additive to age, body mass index (BMI), C-reactive protein (CRP), HDL-cholesterol and lipid lowering drugs. By adding sex hormone-binding globulin to the model in a subset of the sample, the association between high apoA-I and incident diabetes was attenuated only in women. ApoA-I tertiles tended to be positively associated also with hypertension and CHD only in women but this did not reach significance. High compared with low serum apoA-I levels nearly double the risk for incident diabetes, additively to age, BMI, CRP, HDL-cholesterol among Turks. Systemic inflammation concomitant with prevailing MetS might turn apoA-I into proinflammatory particles. © 2008 Elsevier Ireland Ltd. All rights reserved.


Onat A.,Istanbul University | Can G.,Istanbul University | Cicek G.,sek Cardiovascular Surgery Center | Ayhan E.,sek Cardiovascular Surgery Center | Dogan Y.,Bakirkoy Sadi Konuk Educ Hospital
Clinical Biochemistry | Year: 2010

Objectives: We determined the independent predictive value of serum apolipoprotein (apo) B/LDL-cholesterol ratio for the risk of diabetes, metabolic syndrome (MetS) and coronary heart disease (CHD). Design and methods: Prediction of incident cases was assessed in 2466 adults at 7. years' follow-up. Results: ApoB/LDL ratio was independently associated log-linearly with waist circumference, and, only in men, with HDL-cholesterol in a multivariable regression model. Positive partial correlations existed with fasting insulin, fibrinogen and apo A-I and, only in women, with CRP. Cox regression analyses revealed the two highest apoB/LDL quartiles to be significant determinants of diabetes, at 2-fold RRs, independently of waist circumference, fasting glucose and other confounders. However, apoB/LDL quartiles were not independently associated with CHD in either gender. Only the highest apoB/LDL quartile was associated (RR 1.46) with the development of MetS. Serum apoB/LDL-cholesterol ratio, determined by insulin resistance and in women additionally by pro-inflammatory state, is of independent predictive value for incident diabetes and weakly for MetS, but not for CHD. © 2010 The Canadian Society of Clinical Chemists.


Onat A.,Istanbul University | Can G.,Istanbul University | Hergenc G.,Yildiz Technical University | Ugur M.,sek Cardiovascular Surgery Center | Yuksel H.,Istanbul University
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2012

Background and aim: An algorithm is needed for predicting coronary heart disease (CHD) risk in Turkish adults who have a high prevalence of metabolic syndrome (MetS). Methods and results: Ten-year risk of CHD was estimated in 2232 middle-aged adults free of CHD at baseline, followed over 7.6-years. Cox proportional hazard regression was used to predict CHD. Discrimination was assessed with area under receiver operating characteristics curve (AROC). CHD developed in 302 subjects. In multivariable analysis, high-density lipoprotein (HDL)-cholesterol levels were borderline predictive in men; smoking status and HDL-and low-density lipoprotein (LDL)-cholesterol levels were not predictive in women. Age, presence of diabetes, systolic blood pressure and C-reactive protein (CRP) were predictors in both sexes, while smoking status and LDL-cholesterol were so in men only. AROC of the model was 0.789 in men, and 0.806 in women (p < 0.001 each). An algorithm using the stated seven variables was derived separately for each sex. After age adjustment, men and women in the highest quintile of risk score were significantly and 20-27-fold more likely to develop CHD than those in the lowest quintile. Conclusions: In a population with prevalent MetS, low-grade inflammation is independently relevant for CHD, as are serum lipoproteins and smoking status. The derived algorithm is effective in estimating CHD risk among Turkish adults. © 2010 Elsevier B.V.


Onat A.,Istanbul University | Can G.,Istanbul University | Ornek E.,Etlik Educational and Research Hospital | Cicek G.,sek Cardiovascular Surgery Center | And 2 more authors.
Obesity | Year: 2012

Serum γ-glutamyltransferase (GGT) is associated with oxidative stress and hepatic steatosis. The extent to which its value in determining incident cardiometabolic risk (coronary heart disease (CHD), metabolic syndrome (MetS), hypertension and type 2 diabetes) is independent of obesity needs to be further explored in ethnicities. After appropriate exclusions, a cohort of 1,667 adults of a general population (age 52 11 years) was evaluated prospectively at 4 year's follow-up using partly Cox proportional hazard regressions. GGT activity was measured kinetically, and values were log-transformed for analyses. MetS was identified by Adult Treatment Panel-III criteria modified for male abdominal obesity. Median (interquartile range) GGT activity was 24.9 (17.0; 35.05) U/l in men, 17.0 (12.3; 24.0) U/l in women. In linear regression analysis, while smoking status was not associated, (male) sex, sex-dependent age, alcohol usage, BMI, fasting triglycerides and C-reactive protein (CRP) were significant independent determinants of circulating GGT. Each 1-s.d. increment in (= 0.53 ln GGT) GGT activity significantly predicted in each sex incident hypertension (hazard ratio (HR) 1.20 (95% confidence interval (CI) 1.10; 1.31)), and similarly MetS, after adjustment for age, alcohol usage, smoking status, BMI and menopause. Strongest independent association existed with diabetes (HR 1.3 (95% CI 1.1; 1.5)) whereas GGT activity tended to marginally predict CHD independent of total bilirubin but not of BMI. Higher serum total bilirubin levels were protective against CHD risk in women. We conclude that elevated serum GGT confers, additively to BMI, risk of hypertension, MetS, and type 2 diabetes but only mediates adiposity against CHD risk. © 2011 The Obesity Society.

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