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Öğe 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, Sinan; Karabulut, Ahmet; Türkmen, Şule; Sari, Ita Puspita; Can, Günay…Öğe Clustering of risk factors for abdominal obesity in Turkish adults and its demographic distribution [Halkimizda abdominal obezitede risk faktörü kümelenmeleri ve demografik da?ilimi](2005) Onat, Altan; Uyarel, Hüseyin; Karabulut, Ahmet; Albayrak, Sinan; Doğan, Yüksel; Can, Günay; Sansoy, VedatObjectives: We investigated the distribution of abdominal obesity among Turkish adults, according to age groups and geographic regions, and the prevalence and type of its clustering with traditional risk factors including high total and low HDL cholesterol levels, smoking, hypertension, and diabetes. Study design: The study included a cohort of 3267 individuals (1607 men, 1660 women; mean age 52±12 years) whose waist circumferences were measured at least one time in the past three surveys of the Turkish Adult Risk Factor Study from 2000 to 2004. Cardiovascular disease was diagnosed on the basis of the presence of angina history, the Minnesota coding of resting electrocardiograms, and a history of stroke. Criteria of the NCEP ATP III guidelines proposed for metabolic syndrome were adopted for defining abdominal obesity and hypertension. Results: Out of every four adults aged 50 years or above, one man and three women had abdominal obesity. The prevalence of abdominal obesity did not exhibit marked changes among geographic regions. Coexistence of 3-5 risk factors in subjects with abdominal obesity showed a significantly higher proportion than other clusters of risk factors (p<0.001). All of the six risk factors studied exhibited significant and independent associations with abdominal obesity in women, whereas in men, only smoking, low HDL-C levels, and hypertension were independent factors. In contradistinction to men, there was an over three-fold adjusted likelihood of diabetes to accompany abdominal obesity in women, with hypercholesterolemia significantly clustering with both. While abdominal obesity conferred an increased likelihood of coronary heart disease through mediation of five risk factors in women, it was found as a residual independent component in men. Conclusion: According to the NCEP ATP III criteria, abdominal obesity is three times more prevalent among Turkish women than in men. The female-specific combination of abdominal obesity, diabetes, and hypercholesterolemia may partly contribute to the comparatively high risk for cardiovascular disease in Turkish women. This study needs a re-evaluation of the role of abdominal obesity in Turkish men with a threshold of ?96 cm, which was previously proposed by the authors.Öğe Hiperkalemiye bağlı atriyoventriküler tam bloklarda potasyum düzeyinden çok kreatinin düzeyi mortalite ile ilişkilidir(2010) Karabulut, Ahmet; Erden, İsmail; Erden, Emine; Çakmak, Mahmut…Öğe Outcome of Primary Percutaneous Intervention in Patients With Infarct-Related Coronary Artery Ectasia(Sage Publications Inc, 2010) Erden, İsmail; Erden, Emine Çakcak; Özhan, Hakan; Karabulut, Ahmet; Ordu, Serkan; Yazıcı, MehmetData related to the incidence and clinical outcome of acute myocardial infarction (AMI) in patients with preexisting coronary artery ectasia (CAE) are limited. We assessed whether infarct-related artery ectasia (EIRA) indicates an untoward clinical outcome in patients with AMI undergoing primary percutaneous coronary intervention (pPCI). Consecutive patients (n = 643) who presented with AMI and were treated with pPCI were analyzed retrospectively; 3 I patients (4.8%) had EIRA. Patients who had EIRA were significantly younger and had higher incidence of hypertension, previous stroke, smoking, inferior wall AMI, and Killip score >1. Infarct-related artery ectasia was more frequent in the right coronary artery (RCA). Impaired epicardial arterial flow, thrombus burden score of infarct-related artery (IRA), impaired Thrombolysis in Myocardial Infarction (TIMI) Myocardial Perfusion Grade, and distal embolization were significantly higher whereas ST-segment resolution and collateral vascular development were significantly lower in patients with EIRA. Infarct-related artery ectasia was an independent predictor of adverse outcome (odds ratio: 0.197; 95% confidence interval [CI]: 0.062-0.633; P = .006).Öğe Serum apolipoprotein B is superior to LDL-cholesterol level in predicting incident coronary disease among Turks(2007) Onat, Altan; Özhan, Hakan; Can, Günay; Hergenç, Gülay; Karabulut, Ahmet; Albayrak, SinanObjective: To investigate the relative roles of serum apolipoprotein (apo) B and low density lipoprotein (LDL)-cholesterol levels in predicting incident coronary heart disease (CHD). Whether apo B/apo A-I ratio has advantage over apo B in this prediction constitutes a secondary aim. Methods: Prospective evaluation of 1138 men and 1210 women, aged 28-74 years participating in the TEKHARF survey 1997/98 with a mean 5.9-years' follow-up in whom serum apo B was determined, Tertiles of LDL-cholesterol were formed by cut points of 130 and 100 mg/dl, and of apo B by 120 and 95 mg/dl. Metabolic syndrome was defined by modified ATPIII criteria. Nonfatal CHD diagnosis was based on history of angina and myocardial revascularization, physical examination of the cardiovascular system and Minnesota coding of resting electrocardiograms. Results: Apolipoprotein B showed significant correlations with a greater number of parameters than did LDL-cholesterol. Incident CHD was not significantly predicted in age-adjusted logistic regression by LDL-cholesterol but by apo B concentrations in men with a relative risk (RR) 1.005. Apolipoprotein B level >120 vs <95 mg/dl retained significance in both genders combined, even after adjustment for waist girth and log C-reactive protein. The top (>1.02) compared with the bottom bracket of apo B/A-I ratio, though not reaching significantly predictive values among women, did significantly predict in men incident CHD with a RR 1.89. Conclusions: Apolipoprotein B, which marks small, dense LDL particles in plasma is a better predictor of incident CHD than LDL-cholesterol among Turkish adults. While in the prediction of CHD apo B level should be preferred in women, an apo B/A-I ratio >1.02 has advantages over the latter in men. It is time to create the environment (at least in our cities) for measuring in equipped laboratories apo B, which has advantages over measurements that permit calculation of LDL-cholesterol.Öğe Serum apolipoprotein B predicts dyslipidemia, metabolic syndrome and, in women, hypertension and diabetes, independent of markers of central obesity and inflammation(Nature Publishing Group, 2007) Onat, Altan; Can, Günay; Hergenç, Gülay; Yazıcı, Mehmet; Karabulut, Ahmet; Albayrak, SinanObjectives: To investigate the role of serum apolipoprotein (apo) B levels in predicting metabolic syndrome (MS), hypertension, atherogenic dyslipidemia and type II diabetes. Methods: Prospective evaluation of 1125 men and 1223 women, aged 28-74 years, participating in the survey 1997/1998 who had serum apo B determinations and were followed-up for a mean 5.9 years. Tertiles of apo B were formed by cut points by 120 and 95 mg/dl. MS was defined by modified ATPIII criteria. Results: Apo B values exhibited no significant difference among sexes. Low-density lipoprotein (LDL)-cholesterol and triglycerides were their leading determinants on linear regression analysis. By logistic regression analyses, the top versus bottom apo B tertile predicted significantly newly developing MS in both sexes separately with two-fold relative risks (RRs) (P<0.02) and the development of high triglyceride/low high-density lipoprotein-cholesterol dyslipidemia with nearly threefold RRs (P=0.001), after adjustment for waist circumference, C-reactive protein (CRP), physical activity grade and family income category. Development of hypertension was predicted only in women by the apo B top tertile (fully adjusted RR 1.71 [95% CI 1.001; 2.92]), while the significance of the prediction regarding age-adjusted diabetes in women (RR 1.86 [95% CI 1.04; 3.36]) attenuated after adjustment for the stated confounding factors. Conclusions: Apo B concentrations, which reflect the number of small, dense LDL particles in plasma, are a significant predictor of cardiometabolic risk among adults with a high prevalence of MS, independent of waist circumference and CRP.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, Ahmet; Albayrak, Sinan…Öğe Serum bilirubin levels in Turkish adults show inverse relation with insulin resistance and overall obesity, without association with metabolic syndrome(2007) Onat, Altan; Özhan, Hakan; Karabulut, Ahmet; Albayrak, Sinan; Can, Günay; Hergenç, GülayObjectives: We investigated serum bilirubin levels and their association with insulin resistance (IR), metabolic syndrome (MS) or its components, and coronary heart disease (CHD) among Turkish adults. Study design: Serum bilirubin concentrations were measured in 1,052 male and female participants of a representative cross-sectional Turkish cohort living in the Marmara and Middle Anatolia regions. Metabolic syndrome was defined by modified criteria of the Adult Treatment Panel III. Results: The median age of the cohort was 53 years. Metabolic syndrome was identified in 235 males (46%) and 253 females (46.8%). The mean serum bilirubin concentration was 0.59±0.34 mg/dl in males, and 0.53±0.34 mg/dl in females (p=0.004). Serum bilirubin levels showed significant positive correlations with serum protein, albumin, testosterone, age, diastolic blood pressure, creatinine, and folic acid, and inverse correlations with smoking, body mass index, and IR. Serum bilirubin was correlated with HDL-cholesterol only in males. Of these factors, obesity, IR (inversely), and diastolic blood pressure were the main independent covariates of serum bilirubin. Logistic regression analysis showed that IR was significantly associated with the bottom quartile of bilirubin (?0.34 mg/dl) (OR: 1.91; 95% CI: 1.14-3.18), with a stronger association only in females (OR: 2.43; 95% CI 1.21-4.88). Bilirubin levels were not in significant association with CHD and MS. Conclusion: Insulin resistance, but not MS components related with central obesity, was associated with low levels of serum bilirubin in Turkish adults. This relation is more prominent among females and supports the hypothesis that serum bilirubin possesses antioxidant function.Öğe Serum sex hormone-binding globulin, a determinant of cardiometabolic disorders independent of abdominal obesity and insulin resistance in elderly men and women(W B Saunders Co-Elsevier Inc, 2007) Onat, Altan; Hergenç, Gülay; Karabulut, Ahmet; Albayrak, Sinan; Can, Günay; Kaya, ZekeriyaSerum sex hormone-binding globulin (SHBG) is related to cardiometabolic disorders; but whether or not this relationship is purely secondary to hyperinsulinemia and/or obesity, which down-regulates SHBG, is unknown. The aim of the study was to investigate the association of SHBG and total testosterone with atherogenic dyslipidemias, metabolic syndrome (MS), and diabetes among predominantly elderly Turkish adults. After appropriate exclusions, 777 randomly selected male and female subjects with available measurements of both variables were eligible and were analyzed cross-sectionally, with diabetic subjects analyzed separately. Free testosterone was calculated. Metabolic syndrome was identified by the modified criteria of the Adult Treatment Panel III. Metabolic syndrome was identified in half the sample,,which had a median age of 58 years. The odds of low SHBG concentrations (<45 nmol/L in men, <55 nmol/L in women) for the likelihood of 2 types of dyslipidemias, MS, and diabetes were examined by regression analyses in standard models including age, smoking status, presence of abdominal obesity, and insulin resistance (homeostasis model assessment of insulin resistance). In both sexes, low SHBG was associated independently with high triglyceride/low high-density lipoprotein dyslipidemia and with MS, at significant 2.2- to 4.5-fold odds ratios, independent of waist circumference or homeostasis model assessment of insulin resistance index. Low SHBG among women was additionally associated with the likelihood of hypertriglyceridemia with elevated apolipoprotein B and-at borderline significance-with that of diabetes, again when adjusted for the same confounders. In an elderly population with prevalent MS, low SHBG levels significantly associate with high triglyceride/low high-density lipoprotein dyslipidemia, MS, and, in women alone, diabetes and a dyslipidemia marking small dense low-density lipoprotein particles, all independent of abdominal obesity and insulin resistance. Low SHBG may be an important independent factor for cardiometabolic risk, particularly in women. (c) 2007 Elsevier Inc. All rights reserved.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; Keleş, İbrahimBackground: 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.
