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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 Clinical Characteristics and Outcome of Cardiovascular Implantable Electronic Device Infections in Turkey(Sage Publications Inc, 2016) Aydın, Mesut; Yıldız, Abdülkadir; Kaya, Zeynettin; Kaya, Zekeriya; Başarır, Ahmet Özgür; Çakmak, Nazmiye; Özhan, HakanInfection is one of the most devastating outcomes of cardiovascular implantable electronic device (CIED) implantation and is related to significant morbidity and mortality. In our country, there is no evaluation about CIED infection. Therefore, our aim was to investigate clinical characteristics and outcome of patients who had infection related to CIED implantation or replacement. The study included 144 consecutive patients with CIED infection treated at 11 major hospitals in Turkey from 2005 to 2014 retrospectively. We analyzed the medical files of all patients hospitalized with the diagnosis of CIED infection. Inclusion criteria were definite infection related to CIED implantation, replacement, or revision. Generator pocket infection, with or without bacteremia, was the most common clinical presentation, followed by CIED-related endocarditis. Coagulase-negative staphylococci and Staphylococcus aureus were the leading causative agents of CIED infection. Multivariate analysis showed that infective endocarditis and ejection fraction were the strongest predictors of in-hospital mortality.Öğe Epidemiology of atrial fibrillation in Turkey: Preliminary results of the multicenter AFTER study(Turkish Anaesthesiology and Intensive Care Society, 2013) Ertaş, Faruk; Kaya, Hasan; Kaya, Zekeriya; Bulur, Serkan; Köse, Nuri; Gül, Mehmet; Ülgen, Mehmet S.Objectives: Although atrial fibrillation (AF) is one of the most common rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. Study design: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency departments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. Results: The mean age of the patients was determined as 66.8±12.3 years with female patients representing 60% of the study population. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common comorbidity in patients with AF. While a stroke or transient ischemic attack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspirin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. Conclusion: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy. © 2013 Turkish Society of Cardiology.Öğe Fizik aktivitenin Türk yetişkinlerini metabolik bozukluklardan koruduğuna ilişkin ileriye dönük kanıt(2007) Onat, Altan; Hergenç, Gülay; Küçükdurmaz, Zekeriya; Bulur, Serkan; Kaya, Zekeriya; Can, GünayAmaç: Yeni gelişen koroner kalp hastalığı (KKH) ile belirli metabolik bozuklukları öngörmede fizik aktivite derecesinin rolü ve abdominal obezitenin olası aracılığı araştırıldı. Çalışma planı: TEKHARF çalışması 1997/98 ve 2002/03 taramalarında izlenen ve başlangıçta KKH tanısı bulunmayan, 28 yaş ve üzerindeki 3248 katılımcı (1601 erkek, 1647 kadın; ort. yaş 4812) sekiz yıl süresince ileriye dönük olarak incelendi. Fizik aktivite derecesi aktif ve oturgan biçiminde sınıflandırıldı. Metabolik sendrom (MetS) tanımında erkekte abdominal obezite için modifikasyonlu ATP-III ölçütlerine uyuldu. Ölümlü olmayan KKH tanısı öykü, kardiyovasküler sistemin fizik muayenesi ve dinlenme EKG’lerinin Minnesota kodlamasına dayandırıldı. Ortalama izleme süresi 6.8 yıldı. Bulgular: Yeni hipertansiyon, diyabet ve MetS gelişme oranları sırasıyla %39, %8.6 ve %25.4 bulundu. Cinsiyet, yaş ve bel çevresi için ayarlı fizik aktivite örnekleminde, aktif grubun oturgan gruba kıyasla nispi riskleri anlamlı biçimde düşük bulundu: Hipertansiyon için 0.76 (%95 GA 0.63; 0.91), diyabet için 0.66 (%95 GA 0.49; 0.89), MetS için 0.76 (%95 GA 0.60; 0.97). Fizik aktivitenin bu durumlardan koruması, bel çevresi ya da C-reaktif protein aracılığı dışında görüldü; çünkü, abdominal obezite riskinden koruması anlamlı düzeye ulaşmadı. Fiziksel aktivite derecesinin aterojen dislipidemi ile LDL-kolesterol yüksekliği ve KKH gelişme riskinde etkili olduğuna ilişkin kanıt ortaya çıkmadı. Egzersiz sayesinde erkeklerin diyabetten, kadınların hipertansiyondan anlamlı biçimde korunduğu görüldü. Metabolik bozukluklar bütününde ise, egzersizin sağladığı koruma iki cinste benzer bulundu. Sonuç: Cinsiyet ve yaş için ayarlanan fizik aktivite, Türk yetişkinlerini yeni gelişen hipertansiyon, diyabet ve MetS’den korumaktadır. Bu korumanın, abdominal obezite ve inflamasyon sürecinin dışında esas olarak kan basıncındaki iyileşme üzerinden gerçekleştiği düşünüldü.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 Predictive value of prehypertension for metabolic syndrome, diabetes, and coronary heart disease among Turks(Oxford Univ Press, 2008) Onat, Altan; Yazıcı, Mehmet; Can, Günay; Kaya, Zekeriya; Bulur, Serkan; Hergenç, GülayBACKGROUND Predictors of prehypertension and the latter's significance in predicting metabolic syndrome (MetS), type 2 diabetes (DM), and incident coronary heart disease (CHD) need further exploration. METHODS Individuals with or without prehypertension (blood pressure (BP) 120-139 systolic or 80-89 mm Hg diastolic) were studied prospectively in a representative sample of Turkish adults. RESULTS Mean age of 1,501 men and 1,533 women was 48 12 years at baseline. Prehypertension, identified in 32.8% of the sample, differed from the normotensive group mainly by age-adjusted obesity measures and C-reactive protein (CRP) and progressed to hypertension at more than twofold annual incidence as normotension did. In logistic regression analysis, adjusted for sex, age, heart rate, and smoking status, prehypertension waspredictive for risk of MetS in both genders (relative risk (RR) 1.55 (95% confidence interval (CI) 1.21; 1.99)) compared with normotensives. However, DM and CHD were significantly predicted by prehypertension only in women (RR 2.06 and 1.98, respectively, for outcomes). Cardiometabolic risks in women were largely independent of obesity. Body mass index (BMI) at baseline predicted significantly subsequent development of new prehypertension in both genders (hazard ratio 1.39 (95% Cl 1.17; 1.65)) and CRP tended to contribute to this risk. CONCLUSIONS Prehypertension, compared with normotension, approximately doubles the risk for DM, MetS, and CHD in women without conferring substantial risk in Turkish men, except toward MetS. Excess cardiometabolic risk of prehypertension in women is independent of obesity. BMI is a determinant of prehypertension.Öğe Prospective evidence for physical activity protecting Turkish adults from metabolic disorders(2007) Onat, Altan; Hergenç, Gülay; Küçükdurmaz, Zekeriya; Bulur, Serkan; Kaya, Zekeriya; Can, GünayObjectives: We investigated the role of physical activity levels in predicting incident coronary heart disease (CHD) and certain metabolic disorders and the possible mediation of abdominal obesity. Study design: A total of 3248 participants (1601 men, 1647 women; age ?28 years; mean age 48±12 years) who were enrolled, without a previous diagnosis of CHD, into the Turkish Adult Risk Factor Survey in 1997/98 and 2002/03 were prospectively studied over an eight-year period. Physical activity levels of the participants were categorized as active or sedentary. Metabolic syndrome (MetS) was defined with the ATP-III criteria with modification for male abdominal obesity. Diagnosis of non-fatal CHD was based on history, physical examination, and the Minnesota coding of resting electrocardiograms. The mean follow-up was 6.8 years. Results: The rates of incident hypertension, diabetes, and MetS were 39%, 8.6%, and 25.4%, respectively. After adjustment for gender, age, and waist circumference, the relative risks (RR) calculated for hypertension (RR 0.76; 95% CI 0.63; 0.91), diabetes (RR 0.66; 95% CI 0.49; 0.89), and MetS (RR 0.76; 95% CI 0.60; 0.97) were significantly lower in the physically active group. Protection offered by physical activity was not mainly mediated by waist circumference or C-reactive protein, since protection from abdominal obesity risk did not reach significance. No influence of physical activity was observed on the risks for developing atherogenic dyslipidemia, elevated LDL-cholesterol, and CHD. Exercise significantly protected men from diabetes, and women from hypertension. Overall, protection from metabolic disorders was similar in both sexes. Conclusion: Physical activity, adjusted for gender and age, protects Turkish adults from incident hypertension, diabetes, and MetS. This protection is considered to operate mainly through improvements in blood pressure, beyond the mediation of abdominal obesity and low-grade inflammation.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 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 TEKHARF çalışması 2007 taraması: Mortalite ve koroner mortalitede azalma eğilimi sürüyor(2008) Onat, Altan; Dursunoğlu, Dursun; Bulur, Serkan; Küçükdurmaz, Zekeriya; Kaya, Zekeriya; Ordu, Serkan; Uğur, MuratAmaç: TEKHARF çalışmasının esas olarak Marmara ve İç Anadolu bölgelerinde oturan ve 2007 Ağustos’unda taranan kohortuna ilişkin tüm-nedenli ve koroner kökenli ölüm ve yeni koroner kalp hastalığı (KKH) verileri değerlendirildi. Çalışma planı: Ölüm konusunda birinci derece akraba ve/veya sağlık ocağı personelinden bilgi alındı; yaşayanlarda bilgi edinmekten başka, fizik muayene ve 12-derivasyonlu EKG kaydı yapıldı. Yeni koroner olay tanımına, son taramadan beri gelişen ve ölümle sonuçlanan veya sonuçlanmayan miyokard infarktüsü, yeni stabil angina ve/veya miyokard iskemisi alındı. Bulgular: Taranacak 1618 kişilik örneklemden 961’i muayene edildi, 501 kişi hakkında bilgi edinildi ve 18 erkek ile 12 kadının öldüğü belirlendi. Elli iki kişinin takipten çıktığı kabul edildi. Çalışmaya ayrıca 138 yeni katılımcı alındı. Eklenen 3010 kişi-yılı süreli yeni takip ile birlikte, 17 yılda toplam izleme 48500 kişi-yılını buldu. Ölümlerden sekizi KKH kökenli sayıldı. Katılımcılardan 16’sında yeni koroner olay gelişti. Son tarama döneminde yıllık tüm ölüm oranı bin yetişkinde 10.0, koroner mortalite binde 2.7 bulundu. Şimdiye dek tüm nedenli ölümler orijinal kohortta bin kişi-yılında 11.2 iken, benzer yaştaki 1997/98 kohortunda binde 9.1’e, 2002/03 kohortunda binde 5.9’a geriledi. Kırk beş ile 74 arası yaş kesiminde 1000 kişi-yılına düşen toplam yıllık mortalite 2004 yılında 15.2 iken, son üç yılda 10.2’ye (p0.003), KKH ölüm prevalansı ise 6.0’dan 5.1’e (p0.18) geriledi. Böylece, bu yaş kesiminde tüm ölümler ile koroner kökenli ölümlerin birkaç yıl önce başlayan azalma eğilimi sürdü. Sonuç: Bulgularımız, tüm nedenli ve kardiyovasküler kökenli ölümlerde gerileme eğiliminin sürdüğünü göstermektedir.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.Öğe Turkish adult risk factor survey 2007: Decline in all-cause and coronary mortality continues(2008) Onat, Altan; Dursunoğlu, Dursun; Bulur, Serkan; Küçükdurmaz, Zekeriya; Kaya, Zekeriya; Ordu, Serkan; Uğur, MuratObjectives: We analyzed all-cause and coronary mortality as well as incident coronary heart disease (CHD) among the participants of the Turkish Adult Risk Factor Study, who resided essentially in the Marmara and Central Anatolia regions and were surveyed in the summer of 2007. Study design: Information on the mode of death was obtained from first-degree relatives and/or health personnel of the local heath office. Most of the participants who were alive underwent physical examination and 12-lead electrocardiography. Incident CHD was defined as fatal or nonfatal myocardial infarction that occurred after the previous survey or incident stable angina and/or myocardial ischemia. Results: Of 1,618 participants to be surveyed, 961 were examined, 501 subjects were assessed based on information obtained, 18 men and 12 women were dead, and 52 subjects were lost to follow-up. The number of newly recruited subjects was 138. Addition of 3,010 person-years of follow-up raised the total follow-up of the survey to 48,500 person-years. Eight deaths were attributed to CHD; new coronary events were identified in 16 subjects. Annual mortality was estimated as 10.0 and coronary mortality as 2.7 per 1,000 adults. Overall mortality which was 11.2 per 1,000 person-years in the original cohort declined to 9.1 and 5.9 in more recently recruited 1997/98 and 2002/03 cohorts, respectively. In the age bracket of 45 to 74 years, all-cause mortality which was 15.2 in 2004 decreased to 10.2 per 1,000 person-years in the past three years (p=0.003), with a corresponding decrease in coronary mortality from 6.0 to 5.1 (p<0.18), indicating that the decreasing trend in overall mortality and coronary deaths observed in this age group in the previous years did not level off. Conclusion: Our data show that the incidences of overall and coronary mortality continue to decline.
