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Öğe Abdominal obesity with hypertriglyceridaemia, lipoprotein(a) and apolipoprotein A-I determine marked cardiometabolic risk(Wiley, 2013) Onat, Altan; Can, Günay; Örnek, Ender; Sansoy, Vedat; Aydın, Mesut; Yüksel, HüsniyeBackground Risks for coronary heart disease (CHD) and diabetes (T2DM) of the hypertriglyceridemic waist' phenotype (HtgW) warrant further investigation. We studied this issue and whether partial proinflammatory conversion of apolipoprotein (apo) A-I by lipoprotein(a) [Lp(a)] is a codeterminant. Materials and Methods In a population-based prospective study, 1328 Turkish adults were analysed in four groups by the presence of abdominal obesity and elevated triglycerides (Htg). Results LDL-cholesterol levels, significantly elevated in isolated Htg, were lower in HtgW, yet significantly higher apoB and complement C3 values existed in women with HtgW in whom also the lowest Lp(a) values prevailed. Lp(a) was linearly associated, more strongly in HtgW than in the remaining groups, with apoB and, in women inversely, with gamma-glutamyltransferase. Incident HtgW was predicted, not in men, but in women inversely by Lp(a) (OR 0 center dot 80 [95%CI 0 center dot 65; 0 center dot 97]), regardless of adjustment for relevant confounders. After adjustment for conventional risk factors, HtgW (OR 2 center dot 84) and high apoA-I/HDL-C ratio (OR 1 center dot 50) were significantly and additively associated with combined prevalent and incident CHD risk. High apoA-I and low HDL-cholesterol levels interacted therein in women. Type-2 diabetes was strongly predicted by HtgW, mediated in men by high apoA-I/HDL-C ratio. Conclusion HtgW is associated with excess inflammatory markers, is predicted in women paradoxically by lower circulating Lp(a) and is associated in both sexes with marked excess cardiometabolic risk to which high apoA-I/HDL-C ratio contributes additively. These findings are consistent in women with apoA-I being oxidized via aggregation to Lp(a).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 Association of serum albumin levels with traditional risk factors and insulin resistance among Turkish adults(2007) Yazıcı, Mehmet; Onat, Altan; Hergenç, Gülay; Esen, Ali Metin; Can, Günay; Uyarel, HüseyinObjectives: We investigated serum albumin levels and their association with insulin resistance (IR), metabolic syndrome (MS), coronary heart disease (CHD), and traditional risk factors among Turkish adults. Study design: Serum albumin levels were measured colorimetrically in 1052 subjects representing the population of Western Turkey (Marmara and Central Anatolian regions), and were studied cross-sectionally. Metabolic syndrome was identified by modified criteria of the Adult Treatment Panel III. Results: The median age was 53 years. Metabolic syndrome was identified in 44.7% of males and in 49.4% of females. The mean serum albumin level was 4.39±0.38 mg/dl in males and 4.34±0.33 mg/dl in females (p=0.01). In univariate analyses, serum albumin concentrations showed positive correlations with apolipoprotein B, HDL-cholesterol, and total bilirubin in both genders, a positive correlation with systolic blood pressure in females, and an inverse correlation with log CRP in males. In a linear regression analysis with 11 variables for serum albumin levels, age showed an inverse, and total cholesterol showed a positive independent effect in both genders. While smoking significantly affected serum albumin levels in females, this relationship was only of near significance in males. Other independent variables were serum creatinine in females (positive), and diastolic blood pressure (positive) and log HOMA (inverse) in males. In age- and sex-adjusted analyses, serum albumin showed no correlations with MS and CHD. Conclusion: Independent of renal dysfunction, insulin resistance may contribute to low serum albumin levels in Turkish men and, in this context, may be playing a mediating role for oxidative stress and subclinical chronic inflammation.Öğe Associations of alcohol consumption with blood pressure, lipoproteins, and subclinical inflammation among Turks(Elsevier Science Inc, 2008) Onat, Altan; Hergenç, Gülay; Dursunoğlu, Dursun; Ordu, Serkan; Can, Günay; Bulur, Serkan; Yüksel, HüsniyeGender-related impact of alcohol consumption on blood pressure (BP), serum lipoprotein profile, and C-reactive protein (CRP) concentrations was evaluated prospectively. Alcohol drinking status was assessed as abstainers and categories of light, moderate, and heavy (daily >40 ml ethanol) intake. Mean age of the 3,443 men and women who were followed up for a mean of 7.4 years was 47.6 +/- 12 years. In each multivariable linear or logistic regression analysis, alcohol drinking status was adjusted for age, sex, smoking status, and physical activity. Among men. drinking was significantly associated positively with low-density lipo protein (LDL) cholesterol, apolipoprotein (apo) B, systolic and diastolic BR and with CRP in a log-linear manner exhibiting features of a threshold at heavy drinking. With respect to response of serum triglycerides to light-to-moderate drinking, whereas men exhibited a significant increase, women exhibited a decline (P < .05). Lower BPs (P < .03) and CRP levels (P = .032) were observed in female drinkers than abstainers and, as distinct from men, no increases in LDL cholesterol and apoB were noted. Heavy drinking tended to protect the sexes against the risk of developing low high-density lipoprotein cholesterol levels in prospective multi adjusted analyses. Sex modulates response of cardiometabolic risk variables to moderate alcohol consumption among Turks. Only women respond with lower triglycerides and CRP, whereas men show a log-linear positive association of drinking categories with BP, LDL cholesterol, apoB, and CRP. (C) 2008 Elsevier Inc. All rights reserved.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 Complement C3 and other acute phase proteins: comparative associations with risk factors and relation to coronary risk(W B Saunders Co Ltd, 2004) Onat, Altan; Hergenç, Gülay; Sansoy, Vedat; Uzunlar, Bülent; Yazıcı, Mehmet; Sarı, İbrahim; Can, Günay…Öğe Discordance between insulin resistance and metabolic syndrome: features and associated cardiovascular risk in adults with normal glucose regulation(W B Saunders Co-Elsevier Inc, 2006) Onat, Altan; Hergenç, Gülay; Türkmen, Serdar; Yazıcı, Mehmet; Sarı, İbrahim; Can, GünayThe aims of this study were to investigate the extent of concordance between metabolic syndrome (MS) and insulin resistance (IR), the features of discordance, and the magnitude of their independent association with cardiovascular disease (CVD) risk. After exclusion of individuals with diabetes and impaired fasting glucose, the population sample of 1534 men and women, representative of Turkish adults (mean age, 52.2 years), were evaluated cross-sectionally and at a mean 2 years' follow-Lip. Metabolic syndrome was identified by criteria of the Adult Treatment Panel III, except for male waist circumference (> 94 cm). Insulin resistance was defined by the upper quartile in the sample (> 2.245) of the homeostatic model assessment (HOMA) index. Clinical fatal and nonfatal CVD existed or developed in 165 subjects. Waist circumference proved to be by far the strongest significant determinant of HOMA in both sexes, followed by triglycerides. The cohort was categorized into 4 by the presence or absence of MS and IR. Each of the latter represented 34% and 25%, but together constituted 45% of the sample, thus disclosing concordance in a third of the conditions combined. The nonconcordant IR/NoMS group was less common than the MS/NoIR group and was distinct front the latter in having significantly lower waist girth, blood pressure, apolipoprotein B and triglyceride levels, and higher high-density lipoprotein cholesterol, glucose, and insulin levels and physical activity in both sexes. When adjusted for 5 important risk factors, although the excess risk in men with MS failed to attain significance, men with IR were associated with a significant 1.9-fold CVD risk. The IR/NoMS group had a 2.2-fold (95% confidence interval, 0.97-5.11) CVD likelihood compared with the large iusulin-sensitive group, after adjustment for age, sex, log C-reactive protein, low-density lipoprotein cholesterol, smoking status, physical activity, and the 2 groups of MS with or without IR. Overlapping between MS and IR is limited in either sex, and MS/NoIR is more common than IR/NoMS. Overall, IR is more significantly associated with CVD risk than MS in men and in both sexes after adjustment for important confounders. Insulin resistance without MS tends to implicate in middle-aged and elderly Turkish men roughly a 2-fold CVD risk, corresponding to 50% excess risk per 1 SD in HOMA index, independent of MS and important covariates. (c) 2006 Elsevier Inc. All rights reserved.Öğe Evidence for a complex risk profile in obese postmenopausal Turkish women with hypertriglyceridaemia and elevated apolipoprotein B(Portland Press Ltd, 2004) Onat, Altan; Yazıcı, Mehmet; Can, Günay; Sniderman, AllanThe aim of the present study was to examine possible pathophysiological relationships among a wide array of proatherogenic risk factors in postmenopausal women. Fasting lipids, apoB (apolipoprotein B), BMI (body mass index) and waist circumference were measured in 178 women (59.4 +/- 7.2 years) from the Turkish Adult Risk Factor Study. Fasting levels of complement C3, insulin, SHBG (sex hormone-binding globulin), cortisol, oestradiol, testosterone and DHEA-S (dehydroepiandrosterone sulphate) were also determined. This is the first study to examine the relationships of all these variables with apoB. In the first of two different approaches, three groups of obese women were compared. Group 1 comprised women who were normolipidaemic with normal apoB; group 2, women who were hypertriglyceridaemic, but with normal apoB; and group 3, women who were hypertriglyceridaemic with elevated apoB. Complement C3, fasting insulin and glucose were significantly higher and HDL-C (high-density lipoprotein-cholesterol) and SHBG levels were significantly lower in group 3 than in group 1. In the former group, the testosterone/SHBG ratio tended to be higher, indicating more free testosterone, than in group 1. The mean risk score in group 3 and the odds ratio for coronary disease by logistic regression analysis were significantly higher, 2.56 (confidence intervals, 1.12-5.85; P = 0.026), compared with the two other groups combined. In examining the whole group, apoB levels correlated significantly with a wider array of pro-atherogenic risk factors than did LDL-C (low-density lipoprotein-cholesterol), particularly being linked to complement C3 and glucose, as well as the risk score. Complement C3 demonstrated the widest associations and was significantly linked with BMI, waist circumference, insulin, glucose, fibrinogen, triacylglycerols (triglycerides) and apoB and was inversely correlated with HDL-C and SHBG. SHBG was also correlated inversely with a wide spectrum of risk variables. In summary, in Turkish women, apoB was linked with a complex array of proatherogenic risk factors, and hypertriglyceridaemia with elevated apoB was associated with a higher risk of coronary disease.Öğe Female and urban participants demonstrate an adverse trend in overall mortality in Turkey - and a report on the TARF survey 2016(Turkish Soc Cardiology, 2017) Onat, Altan; Özbek, Mehmet; Karakoyun, Süleyman; Uzun, Okan; Keskin, Muhammed; Karadeniz, Yusuf; Can, GünayObjective: This study is an examination of 1) overall mortality trend in the Turkish Adult Risk Factor (TARF) study stratified by sex and place of residence, and 2) brief report on main aspects of the 2016 survey. Methods: The period of last 18 years was divided into 2 for trend analysis of data. Required information on deaths was obtained. Baseline age >= 40 years at the beginning of each period was the inclusion criterion. Cox regression analyses were performed. Results: Among over 2500 participants in each, deaths were recorded in 281 and 334 individuals in Periods 1 and 2, respectively, and baseline mean age was 54.6 years and 56.4 years, respectively, in each period. Age-adjusted hazard ratio for mortality in Period 2 remained virtually the same for rural males, rose to borderline significance for urban males and rural females (p=0.06, p=0.09), and increased 1.72-fold for urban females (p=0.006), as compared to Period 1. Whereas males gained an average of 3.8 years of survival in the later period compared with the earlier period, females gained only 1.8 years. This narrowed the difference in mean age at death in favor of women from 2.5 years to 0.5 year. Of 1144 participants to be surveyed in the TARF 2016, 48 were lost to follow-up, 695 were examined, and 39 participants were ascertained to be deceased. In 362 cases, verbal information was obtained regarding health status. Conclusion: Gain in survival in Turkish women has distinctly stagnated compared with men, and hazard of death has risen significantly for women and urban residents in the past decade, suggesting interaction between female sex and urban residence. Both phenomena require recognition and adoption of appropriate measures.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 Incidence, prevalence, and mortality estimates for chronic atrial fibrillation in Turkish adults(2008) Uyarel, Hüseyin; Onat, Altan; Yüksel, Hüsniye; Can, Günay; Ordu, Serkan; Dursunoğlu, DursunObjectives: We investigated the incidence, prevalence, and mortality of chronic atrial fibrillation (AF) in Turkish adults. Study design: In a prospective and cross-sectional design, we analyzed 3,450 eligible participants (1707 men, 1743 women; mean age 52±13 years) of the Turkish Adult Risk Factor Study, who had been surveyed until 2006/07. Those who were dead and were found to have AF at base-line were excluded in the estimation of AF prevalence and incidence, respectively. Results: Atrial fibrillation was determined in 67 participants. The total follow-up was 34,100 person-years (mean 9.9 years). There were 43 prevalent and 46 incident cases, which corresponded to 1.25% and 1.35 per 1000 person-years, respectively. For age brackets of 32-59, 60-69, and ?70 years, the prevalence rates were 0.46%, 2.09%, and 2.49%, and the incidence rates were 0.31, 1.98, and 3.50 per 1000 person-years, respectively. Both were higher in women of all age groups, with female-to-male ratios for overall prevalence and incidence being 1.69 and 1.19, respectively. Survival after onset of AF was 5 to 9 years and overall mortality was 6.8 per 100 person-years. Hypertension was the most common cause of AF, followed by advanced age. Contrary to expectations, waist circumference of men with AF was smaller by 1.9 cm than that of women. Serum C-reactive protein levels in men with AF (mean 1.21 mg/I) were significantly lower than women with AF (mean 2.62 mg/l) and than males without AF (mean 1.78 mg/l). Conclusion: In Turkish adults, the current incidence and prevalence of chronic AF can be extrapolated to be 35,000 per year (22,000 in women) and 310,000 (200,000 in women), respectively. Considering the low incidence in males, it seems that inflammatory processes may play a minor role in the development of AF in Turkish men.Öğe Independent prediction of metabolic syndrome by plasma fibrinogen in men, and predictors of elevated levels(Elsevier Ireland Ltd, 2009) Onat, Altan; Özhan, Hakan; Erbilen, Enver; Albayrak, Sinan; Küçükdurmaz, Zekeriya; Can, Günay; Hergenç, GülayThe role of plasma fibrinogen levels in predicting metabolic syndrome (MetS) and assessment of determinants of these levels were investigated. A total of 2234 men and women, aged 49 +/- 12 years, representative of Turkish adults who had plasma fibrinogen determinations, were prospectively evaluated and followed for a mean of 6.6 years. The modified Clauss method was used for assays. MetS was defined by ATPIII criteria modified for male abdominal obesity. MetS cases at baseline were excluded in prospective analyses. Median (interquartile range) fibrinogen values were 2.87 (2.29; 3.56) g/L. Fibrinogen levels predicted significantly newly developing MetS in men (RR 1.40 [95%CI 1.07; 1.83] for a 2-fold increment), after adjustment for age and smoking status, and (RR 1.32 [95%CI 0.95; 1.83] again for doubling), after additional adjustment for all 5 components of MetS. MetS was not significantly predicted by fibrinogen levels in women in either multivariable model. By regression analysis of eight covariates, not waist circumference, but systolic blood pressure, current smoking and C-reactive protein (CRP) in men, and age in women were predictors of elevated (>3.0 g/L) fibrinogen at follow-up (p<0.05 in all). Conclusions: Plasma fibrinogen predicts MetS independently of its components in men, in contradistinction to women, and, hence, is likely one of its components. Hyperfibrinogenemia representing an inflammatory state is postulated as the underlying mechanism. Central obesity is linked to elevation in fibrinogen mainly through the mediation of blood pressure, CRP, and via being affected by cigarette smoking. Crown Copyright (C) 2008 Published by Elsevier Ireland Ltd. All rights reserved.Öğe Indices of abdominal obesity and obesity in Turkish adults: Influence on levels of insulin, glucose intolerance, inflammation and on coronary prediction(2003) Onat, Altan; Ceyhan, Köksal; Sansoy Vedat; Uyarel, Hüseyin; Yazıcı, Mehmet; Uzunlar, Bülent; Hergenç, GülayIn the old and newly recruited cohorts of the Turkish Adult Risk Factor Study consisting of 2350 men and women (mean age 52±12 years), body mass index (BMI), waist circumference and waist-to-hip ratio (WHR) were assessed cross-sectionally and prospectively. Coronary heart disease (CHD) was diagnosed based on clinical findings and Minnesota coding of resting electrocardiograms. At standardized age, mean waist circumference and BMI in men were 90.7 cm and 27.3 kg/m2, respectively, and in women 90.8 ile 29.1 kg/m2, respectively. It is estimated that 10.5 million adults (22.6% of men and 61% of women) in Turkey may be designated to have abdominal obesity. Following difference in magnitude or ratio of variables existed across the highest and lowest quintiles of waist circumference: 22 mg/dl in apolipoprotein (apo) B, 3.5-fold to 2-fold in C-reactive protein (CRP), 2 to 2.4-fold in fasting serum insulin concentrations. Furthermore, diabetes was more frequent by 2.2-fold in men and by 4.8-fold in women across these quintiles. In a logistic regression analysis over a 4-year follow-up, waist circumference significantly predicted nonfatal and/or fatal CHD risk in men, and among men and women combined, independent of 9 other salient risk factors, imparting 35% excess risk for each increment of 12 cm (= I SD) of waist circumference. In the presence of the latter, BMI failed to contribute to CHD prediction. It was concluded that abdominal obesity in Turkish adults not only substantially elevated the concentrations of important cardiovascular risk factors such as serum apo B, insulin, CRP, and the prevalence of type II diabetes, but also contributed independently to cardiovascular morbidity and mortality, particularly among men. The "curve" between CHD risk and the stated atherogenic risk factors suggested that Turkish men with a waist circumference of 96 cm should be considered at the "action level". These findings should guide fitture public heart health policies.Öğe Lifestyle and Metabolic Determinants of Incident Hypertension, With Special Reference to Cigarette Smoking: A Longitudinal Population-Based Study(Oxford Univ Press, 2009) Onat, Altan; Uğur, Murat; Hergenç, Gülay; Can, Günay; Ordu, Serkan; Dursunoğlu, DursunBACKGROUND Lifestyle and metabolic determinants of incident hypertension in a population with a high prevalence of metabolic syndrome (MetS) need to be further assessed. METHODS A representative sample of middle-aged and elderly Turkish adults was prospectively evaluated over a mean 7.4 years, after exclusion of prevalent hypertension and major renal dysfunction. RESULTS In 2,427 men and women, aged 45.8 +/- 11.7 years, Kaplan-Meier analysis showed in combined genders mean time to incident hypertension to be 7.23 years in never, 7.78 years in current smokers (P < 0.001). Age and female sex were major determinants of subsequent hypertension after adjustment for physical activity grade, family income bracket, smoking status, usage of alcohol and of hormone replacement or birth control pill. Relative risk (RR) for incident hypertension of current vs. never smoking was reduced in women (P = 0.058) and both genders combined (P = 0.054). Former smokers uniformly exhibited significantly higher risk for the development of hypertension than both never (P = 0.054) and current (P < 0.001) smokers, whereby abdominally obese individuals were at increased risk. In further multivariable models, circulating C-reactive protein (CRP) and fasting insulin emerged as modest independent determinants and waist girth, modulated by current smoking, as a major determinant of subsequent hypertension. CONCLUSIONS Age, female sex, and waist circumference are major and serum insulin and CRP modest determinants of incident hypertension in middle-aged Turkish adults in whom current cigarette smoking plays a protective role at borderline significance, largely by modulating waist girth. Former smokers with abdominal obesity are under higher risk of subsequent hypertension than current smokers.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 Mortality and coronary events in the Turkish Adult Risk Factor Survey 2006: Mortality is declining in women whereas overall prevalence of coronary heart disease is on the incline [TEKHARF 2006 taramasinda ölüm ve koroner olaylar: Kadinlarda mortalitede azalma, koroner kalp hastali?i genel prevalansinda artma](2007) Onat, Altan; Albayrak, S.; Karabulut, A.; Ayhan, E.; Kaya, Z.; Küçükdurmaz, Z.; Tuncer, M.Objectives: We analyzed all-cause and coronary mortality, incidence and prevalence of coronary heart disease (CHD) in a cohort of the Turkish Adult Risk Factor Study which was surveyed in the summer of 2006 essentially in geographic regions other than Marmara and Middle Anatolia. Study design: The survey consisted of 1585 participants (776 men, 809 women; mean age 55.3±11.8 years), accounting for 49% of all living participants of the overall cohort. Information on death was obtained from first-degree relatives and/or health personnel of local health offices. Survivors were evaluated by history, physical examination, and 12-lead electrocardiography. New coronary event was defined as fatal or nonfatal myocardial infarction, new stable angina, and/or myocardial ischemia that had occurred after the former survey. Results: Of the participants, 946 were examined, 599 subjects were evaluated on the basis of information gathered, and 40 deaths (27 men, 13 women) were documented. Cumulative follow-up of the survey starting from 1990 increased to 45,490 person-years with the addition of 2,842 person-years. Fifteen deaths were attributed to CHD. Annual overall mortality and coronary mortality rates were 14.1 and 5.1 per 1000 adults, respectively. In the 45 to 74 years age bracket, overall mortality declined to 10.9 (p=0.09) and coronary mortality to 5.6 per thousand. A decreasing trend in mortality was pronounced in women. The mean age at death increased to 67.1 years in men, and to 75.9 years in women. The prevalences of CHD were found to be 3%, 11%, and 27% in age groups of 39-49, 50-59, and ?60 years, respectively, which corresponded to an estimated population of 2.75 million. Conclusion: In the 45 to 74 years age bracket, overall and coronary deaths show a decreasing trend, particularly in women, which extends the mean age at death. However, the prevalence of CHD specific to age groups continues to rise, as well.Öğe The paradox of high apolipoprotein A-I levels independently predicting incident type-2 diabetes among Turks(Elsevier Ireland Ltd, 2010) Onat, Altan; Hergenç, Gülay; Bulur, Serkan; Uğur, Murat; Küçükdurmaz, Zekeriya; Can, GünayBackground: 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. (C) 2008 Elsevier Ireland Ltd. All rights reserved.Öğe Plasma triglycerides, an independent predictor of cardiovascular disease in men: A prospective study based on a population with prevalent metabolic syndrome(Elsevier Ireland Ltd, 2006) Onat, Altan; Sarı, İbrahim; Yazıcı, Mehmet; Can, Günay; Hergenç, Gülay; Avcı, Günsel Ş.Background and methods: We aimed to assess whether fasting plasma triglycerides independently predicted future fatal and nonfatal cardiovascular disease (CVD) in a population having a high prevalence of the metabolic syndrome. In the Turkish Adult Risk Factor Study, a population-based survey, 2682 men and women 20 years of age or over with fasting triglyceride values available and free of CVD at baseline examination in 1990, were prospectively followed up till 2003/04. Triglyceride concentrations were measured by the enzymatic dry chemistry method and stratified into sex-specific quintiles. Information on the mode of death was obtained from first-degree relatives and/or health personnel of local health office. Diagnosis of coronary heart disease and stroke among survivors was based on history, physical examination of the cardiovascular system and Minnesota coding of resting electrocardiograms. A total of 120 fatal and 221 new nonfatal CVD occurred among adults (mean age 43 +/- 14) during a mean 9.3 years of follow-up. Results: CVD was significantly and independently predicted by the top versus the bottom fasting triglyceride quintile in logistic regression analyses when adjusted for age, sex, BMI, systolic blood pressure, total cholesterol, lipid-lowering medication, status of smoking and of glucose regulation (relative risk [RR] in men and all adults 2.38 and 1.79, respectively, p both < 0.02). This corresponded to hazard ratios (HR) of 1.43 in men and 1.28 in men and women combined. Adjustment for HDL-cholesterol instead of total cholesterol in the same model gave also significant HRs corresponding to 1.42 in men and 1.32 in sexes combined. Conclusions: Fasting triglycerides are predictive of future CVD among men with an HR of 1.4, independent of age, diabetes, lipid-lowering medication, traditional risk factors including total cholesterol or HDL-C, in a population in which metabolic syndrome prevails. A modest independent risk increment in women did not reach significance. (c) 2005 Elsevier Ireland Ltd. All rights reserved.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.
