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Öğe Age at death in the Turkish Adult Risk Factor Study: Temporal trend and regional distribution at 56,700 person-years' follow-up(2009) Onat, Altan; Uğur, Murat; Tuncer, Mustafa; Ayhan, Erkan; Kaya, Zekeriya; Küçükdurmaz, Zekeriya; Kaya, HasanObjectives: We analyzed the temporal trend and regional distribution of age at all-cause death and the sex-specific and age-bracket defined coronary mortality in the 18-year follow-up of the Turkish Adult Risk Factor Study. Study design: The participants of the Turkish Adult Risk Factor Study who have been examined in even years were last surveyed in August 2008. A total of 1,582 individuals were surveyed, which constituted half of the alive participants of the overall cohort. Information on death was obtained from first-degree relatives and/or health personnel of local heath offices. Survivors were evaluated by history, physical examination, and 12-lead electrocardiography. The cumulative follow-up was 56,700 person-years. Results: Of 1582 participants, 868 (431 men, 437 women) were examined, in 604 subjects information was gathered, and 47 participants (26 men, 21 women) were ascertained to have died. Twenty-two deaths were classified as of coronary origin. Cumulative assessment of the entire cohort in the age bracket of 45-74 years disclosed coronary mortality to be 7.64 per 1000 person-years in men and 3.84 in women and persisted to be the highest among 30 European countries, whereas overall mortality declined at a greater proportion. Overall mean ages at death were deferred within a 12-year period by 7.4 years in men and 6 years in women, to 71.9 and 74.8 years, respectively. The extension of this mean survival was similar among urban-rural areas and geographic regions. Conclusion: Coronary mortality declined modestly, but life expectancy of Turkish adults rose by a mean of nearly seven years in the 12 years to 2003-08, without showing major differences in sex, urban-rural dwelling, or geographic regions.Öğe Lipoprotein(a) is associated with coronary heart disease independent of metabolic syndrome(Lippincott Williams & Wilkins, 2008) Onat, Altan; Hergenç, Gülay; Özhan, Hakan; Kaya, Zekeriya; Bulur, Serkan; Ayhan, Erkan; Can, GünayAim To assess (i) the association between lipoprotein(a) [Lp(a)] with the likelihood of coronary heart disease and metabolic syndrome (MS) and (ii) its covariates in Turkish adults. Methods Cross-sectional evaluation of 1309 adults, who had serum Lp(a) determinations by Behring nephelometry, and followed for a mean 1.0 year. MS was defined by ATPIII criteria modified for male abdominal obesity. Results Mean age of the sample was 56.8 +/- 11.3 years. After adjustment for sex, age, and smoking status, log-transformed Lp(a) levels were associated significantly with coronary heart disease likelihood in both sexes combined [odds ratio: 1.53 (95% confidence interval: 1.06; 2.20)]. This association persisted after additional adjustment for MS [odds ratio: 1.57 (95% confidence interval: 1.09; 2.26)]. The Lp(a) mid-tertile (5-17 mg/dl), accompanied by significantly lower serum triglycerides than the two remaining tertiles, was inversely associated significantly with MS in either sex; in women, this association was independent of waist circumference. In a linear regression comprising seven variables, excepting total cholesterol, only gamma-glutamyltransferase in women (P=0.002) and waist circumference (P=0.057) in men were inverse covariates of modest magnitude of Lp(a). Conclusion Coronary heart disease likelihood, significantly associated with Lp(a) concentrations, is independent of MS and insulin resistance. Suggestive evidence was provided that intermediary Lp(a) concentrations, when accompanied by the presence of MS, could accelerate progression of vascular disease, especially in women.Öğe Serum apolipoprotein E concentrations among Turks: Information additive to genotype relative to dyslipidemia and metabolic syndrome(2007) Onat, Altan; Hergenç, Gülay; Ayhan, Erkan; Kaya, Zekeriya; Küçükdurmaz, Zekeriya; Bulur, Serkan; Ünaltuna, N.E.Objectives: We investigated the relationship of serum apolipoprotein E (apoE) levels with dyslipidemia and metabolic syndrome (MS) in the general population and their degree of independence of the apoE genotype. Study design: This cross-sectional study included a random sample of Turkish adults whose serum apoE concentrations were measured. Metabolic syndrome was defined with the ATP-III criteria with modification for male abdominal obesity. Results: Of 454 participants (222 men, 232 women; mean age 54.1±9.6 years), the median serum apoE concentration was 3.93 mg/dl with an interquartile range of 1.75 to 5.82 mg/dl. Higher apoE concentrations were found in male carriers of the 84 allele than homozygous ?3 subjects. Multivariate analysis showed the apoE genotype (grouped into 3) as a determinant of apoE levels, and serum apoB levels as a major covariate. In logistic regression analysis, doubling of the apoE level showed significant associations, independent of the apoE polymorphism, with total cholesterol, elevated apoB (OR 4.54, 95% CI 2.83; 12.3) and triglyceride/HDL-cholesterol dyslipidemia (OR 2.82, 95% CI 1.67; 5.18). Doubling of the apoE level was also associated in both genders with MS (OR 1.72, 95% CI 1.24; 2.38), after adjustment for confounders. Conclusion: ApoE concentrations in Turkish adults are significantly linked to serum total cholesterol, hyperapoB, and atherogenic dyslipidemia, independent of the apoE polymorphism. They are also significantly and independently associated with MS. Male carriers of the ?4 allele have no lower apoE concentrations than homozygous ?3 individuals, suggesting a close link between apoE and apoB levels.Öğe Serum folate is associated with coronary heart disease independently of homocysteine in Turkish men(Churchill Livingstone, 2008) Onat, Altan; Hergenç, Gülay; Küçükdurmaz, Zekeriya; Can, Günay; Ayhan, Erkan; Bulur, SerkanBackground Et aims: Whether serum homocysteine levels are associated with coronary heart disease (CHD) and the metabolic syndrome (MS) needs investigation in different ethnic groups. These associations and the influence of serum folate and vitamin 1312 thereupon were addressed separately in genders. Methods: A random sample of Turkish adults was studied cross-sectionally. Results: Median age of 338 men and 342 women was 55 years. Geometric mean serum homocysteine concentrations were 12.7 +/- 1.5 mu mol/l in men and 9.6 +/- 1.4 mu mol/l in women (p < 0.001). Linear regression analysis among 11 variables revealed mate sex, reduced estimated glomerular filtration rate (eGFR) and vitamin B-12, (in men) reduced folate as significant independent covariates of higher homocysteine levels. Logistic regression analysis disclosed that (sex-specific) top versus bottom homocysteine tertile was borderline significantly and independently associated with CHD in men and both genders combined, after adjustment for gender, age, smoking status, systolic blood pressure, eGFR, folate and vit B-12. Folate revealed significant inverse association with CHD likelihood in men and combined genders (OR 0.73 for doubling [95%CI 0.56; 0.94]), independently of homocysteine levels and even of presence of type-2 diabetes. Serum vit B-12 concentrations were significantly associated with MS likelihood in women atone after adjustment for sex, age, smoking status, folate and antidiabetic medication. Conclusion: High serum homocysteine and tow folate levels are associated in Turkish men independently with CHD, which needs confirmation in a larger sample. In women, vitamin B-12 concentrations are significantly associated with MS likelihood. (C) 2008 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.Öğe TEKHARF taramasında ölüm yaşı: 56700 kişi-yıllık izlemede dönemsel eğilim ve bölgesel dağılım(2009) Onat, Altan; Uğur, Murat; Tuncer, Mustafa; Ayhan, Erkan; Kaya, Zekeriya; Küçükdurmaz, Zekeriya; Kaya, HasanAmaç: TEKHARF Çalışması’nın 18 yıllık takibinde tüm-nedenli ölümdeki yaş verilerinin zaman dilimine ve bölgelere bağlı değişimi ve cinsiyete özgü ve belirli yaş kesimindeki koroner mortalite değerlendirildi. Çalışma planı: TEKHARF Çalışması’nın çift yıllarda taranan kohortu 2008 Ağustos ayında yeniden izlendi. Taramaya giren kohortun toplam sayısı 1582 kişi idi ve ülke genelinde hayatta bulunan izlenecek TEKHARF kohortunun yarısını oluşturuyordu. Ölüm konusunda birinci derece akraba ve/veya sağlık ocağı personelinden bilgi alındı; yaşayanlarda bilgi edinmekten başka, fizik muayene ve 12-derivasyonlu EKG kaydı yapıldı. Toplam takip süresi 56700 kişi-yılıydı. Bulgular: Örneklemin 868’i (431 erkek, 437 kadın) muayene edildi, 604 kişi hakkında bilgi edinildi ve 47 kişinin (26 erkek, 21 kadın) öldüğü belirlendi. Ölümlerin 22’si koroner kalp hastalığı (KKH) kökenli sayıldı. Tüm kohortun 18 yıllık takibinde 45-74 yaş kesiminde KKH kökenli ölümler erkeklerde 1000 kişi-yılında 7.64, kadınlarda 3.84 düzeyinde bulundu ve böylece 30 Avrupa ülkesi içinde en yüksek seviyede süregeldiği gözlemlendi; oysa, genel mortalitedeki gerileme daha yüksek orandaydı. Ortalama ölüm yaşı Türkiye genelinde 12 yıl içerisinde erkeklerde 7.4 yıl, kadınlarda altı yıl ertelenerek, 2003-08 döneminde sırasıyla ortalama 71.9 ve 74.8’e ulaştı. Ortalama ömürdeki bu uzama kentsel ve kırsal kesimler ile coğrafi bölgelerde benzerdi. Sonuç: Yetişkinlerimizde koroner mortalite az gerilemiş, ama ömür süresi son 12 yılda yedi yıla varan belirgin uzama göstermiştir; bu uzamanın erkek-kadın, kent-kır sakinleri ve coğrafi bölgelerde önemli farklar sergilemediği gözlenmiştir.
