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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.


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 | Yuksel H.,Istanbul University | Ayhan E.,sek Cardiovascular Surgery Center | And 2 more authors.
Journal of Endocrinological Investigation | Year: 2011

Background and aim: An algorithm for predicting Type 2 diabetes (DM) risk in a population with prevalent metabolic syndrome (MetS) is needed since ethnicity influences the pathogenesis of DM. Material and methods: The 8-yr risk of DM was estimated in 2261 middle-aged Turkish adults free of DM at baseline who were followed for over 7.6 yr. DM newly developed in 212 subjects. Cox proportional hazard regression and 15 variables were used to predict DM. Discrimination was assessed with area under receiver operating characteristics curve (AROC). Results: In multivariable analysis, height, family income brackets, systolic blood pressure, smoking status, alcohol usage, and HDL-cholesterol levels were not predictive in either sex. In addition to sex, family history of DM, fasting glucose, and waist circumference were predictors, in men, age and non-HDL-cholesterol, while in women physical inactivity and serum C-reactive protein were so. AROC of the final model was 0.783 in men, 0.772 in women (p<0.001 each). An algorithm using the stated 7 variables was developed separately for each sex. Men and women in the top quintile of risk score were, respectively, 20 and 50 times and significantly more likely to develop DM than those in the bottom quintile. The predictive value of the algorithm was validated in 2 split samples. Conclusions: A marker of low grade inflammation provides useful predictive ability beyond other simple predictors in a female population with MetS prevailing. The derived simple algorithm may be useful in estimating the 8-yr risk of DM among middle-aged Turkish men and women. ©2011, Editrice Kurtis.


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.

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