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ABSTRACT: OBJECTIVE: We aimed to assess whether apolipoprotein (apo) A-I levels that generated type-2 diabetes and coronary disease among Turks contribute to prehypertension and hypertension. METHODS: A population-based sample of 2207 adults (mean age 53±11 years) was studied prospectively over a 6.5 years' follow-up. Individuals with hypertension and/or prehypertension were excluded at baseline. RESULTS: At baseline, levels of apoA-I increased in each sex, from the normotensive to prehypertensive and hypertensive group (by mean 7.6 mg/dL, p<0.001) concomitantly with age, waist circumference, fasting triglycerides, apoB, C-reactive protein (CRP) and homeostasis model assessment. In logistic regression models, adjusted for confounders comprising waist circumference or triglycerides, prehypertension was predicted independently by apoA-I at RRs of 1.23 (95%CI 0.97; 1.52) or 1.32 (95%CI 1.04; 1.74), respectively. Despite showing a positive association, apoA-I did not independently predict in similar models the development of hypertension; the determinants were rather waist circumference, or fasting triglycerides or CRP [RR 1.16 (95%CI 1.05; 1.28)] and, in women, diabetes. In a linear regression analysis for circulating apoA-I including 10 variables, apoB and in men systolic blood pressure were positively associated. CONCLUSION: In contributing to prehypertension, the pro-inflammatory apoA-I, mediated by apoB, is independent of triglyceridemia. Other inflammatory processes conjointly are likely mechanistically involved in the development of hypertension in a population with prevalent metabolic syndrome.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 04/2013; · 0.44 Impact Factor
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ABSTRACT: OBJECTIVE: Impaired function of high-density lipoprotein (HDL) particles generates cardiometabolic disorders in people prone to impaired glucose tolerance for which clinical biomarkers need delineation. STUDY DESIGN: Prospective population-based study. METHODS: Totally, data of 2725 adults followed-up over 7.3±3.0 years were analyzed by Cox regression analysis. C-reactive protein (CRP), complement C3 (C3), triglycerides (Trg) and HDL-cholesterol were tested to predict risk for incident diabetes or coronary heart disease (CHD). RESULTS: Beyond atherogenic dyslipidemia, high-Trg/normal HDL-cholesterol category was associated with elevated CRP and diabetes risk in women. Normotriglyceridemic men with normal HDL-cholesterol showed higher apolipoprotein A-I levels and higher diabetes risk than men having low HDL-cholesterol. Diabetes risk doubled in hypertriglyceridemic women regardless of HDL-cholesterol. Trg/HDL-C>2 in men and Trg>1.7 mmol/L in women were best predictors of diabetes. C3>1.3 g/L served additively in women alone. Regarding CHD risk, not CRP, but C3 contributed independently to Trg/HDL>2 in men [RR 2.46 (95% CI 1.33; 4.53)]; a high ratio was merely additive to elevated CRP in women. Among five cut-off values, predictive values for diabetes were highest for CRP >2.5 mg/L in men, Trg>1.7 mmol/L and C3>1.3 g/dL in women. CONCLUSION: Trg/HDL-C ratio >2 and/or CRP >2.5 mg/L in men and Trg>1.7 mmol/L+C3>1.3 g/dL in women are most appropriate markers regarding impaired antiinflammatory or atheroprotective HDL function. In normotriglyceridemic men with normal HDL-cholesterol levels, diabetes risk may be elevated due to presumably dysfunctional apolipoprotein A-I.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 09/2012; · 0.44 Impact Factor
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ABSTRACT: We evaluated the associations of short stature with coronary heart disease (CHD) risk or overall mortality, which vary with sex and ethnicity/race.
Such associations were studied prospectively at a mean 13.5-years' follow-up in a population-based sample of 3394 Turkish adults (mean age 44±11 years) using Cox proportional hazards models. Covariates of height were sought in sex-specific tertiles.
Height averaged 162.7±6.5 cm. Age-adjusted estimated marginal means for serum triglycerides, C-reactive protein and complement C3 in women (but not men) were significantly higher with decreasing height tertiles. In sex- and age-adjusted models, height was associated in men with neither incident CHD, nor death. In women, 1-SD increment (6.5 cm) in height only tended to marginal inverse association with CHD, but predicted significantly all-cause death (HR 0.83, 95% CI 0.59-0.98); HR attenuated only marginally after further adjustment for family income bracket, smoking status, alcohol usage, systolic blood pressure, serum high-density lipoprotein (HDL)- and non HDL-cholesterol. A threshold below 160 cm of female height doubled the adjusted risk of death compared to taller women.
In contrast to men, short stature in Turkish women tends to be an independent risk marker for CHD, and height below 160 cm is a strong marker of death. Gender-specific early-life influences enhancing pro-inflammatory state may affect death and future CHD.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 03/2012; 12(4):289-97. · 0.44 Impact Factor
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ABSTRACT: We determined in non-diabetic persons the associations of current smoking with future glucose and insulin concentrations.
Middle-aged non-diabetic adults (n=1071) were studied in whom these values were measured at baseline and 5.2-years later.
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.
Smoking among Turks induces at long-term lower fasting insulin levels which represent improved insulin sensitivity in women, yet a reduced one in men.
Clinical biochemistry 01/2012; 45(1-2):37-42. · 2.02 Impact Factor
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ABSTRACT: We determined in non-diabetic persons the risk of fasting and non-fasting glucose levels for pre-diabetes, diabetes, and coronary heart disease (CHD), including the roles of serum C-reactive protein (CRP) and HDL cholesterol, and delineated risk profiles of the pre-diabetic states. Over 7¼ years, 2,619 middle-aged Turkish adults free of diabetes and CHD were studied prospectively. Using different serum glucose categories including impaired fasting glucose (IFG, 6.1-6.97 mmol/L) and impaired glucose tolerance (IGT), outcomes were analyzed by Cox regression. IFG was identified at baseline in 112 and IGT in 33 participants. Metabolic syndrome components distinguished individuals with IFG from those with normoglycemia. Participants with IGT tended to differ from adults in normal postprandial glucose categories in regard to high levels of triglycerides, apoA-I, and CRP. Diabetes risk, adjusted for sex, age, waist circumference, CRP, and HDL cholesterol, commenced at a fasting 5.6-6.1 mmol/L threshold, was fourfold at levels 6.1-6.97 mmol/L. Optimal glucose values regarding CHD risk were 5.0-6.1 mmol/L. Fasting and postprandial glucose values were not related to CHD risk in men; IGT alone predicted risk in women (HR 3.74 [1.16;12.0]), independent of age, systolic blood pressure, non-HDL cholesterol, waist circumference, smoking status, and CRP. HDL cholesterol was unrelated to the development of IFG, IGT, and diabetes, while CRP elevation independently predicted the development of diabetes. IGT independently predicts CHD risk, especially in women. HDL dysfunction associated with low-grade inflammation is a co-determinant of pre-diabetic states and their progression to diabetes.
Acta Diabetologica 07/2011; · 2.78 Impact Factor
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ABSTRACT: Serum γ-glutamyltransferase (GGT) is associated with oxidative stress and hepatic steatosis. The extent to which its value in determining incident cardiometabolic risk (coronary heart disease (CHD), metabolic syndrome (MetS), hypertension and type 2 diabetes) is independent of obesity needs to be further explored in ethnicities. After appropriate exclusions, a cohort of 1,667 adults of a general population (age 52 ±11 years) was evaluated prospectively at 4 year's follow-up using partly Cox proportional hazard regressions. GGT activity was measured kinetically, and values were log-transformed for analyses. MetS was identified by Adult Treatment Panel-III criteria modified for male abdominal obesity. Median (interquartile range) GGT activity was 24.9 (17.0; 35.05) U/l in men, 17.0 (12.3; 24.0) U/l in women. In linear regression analysis, while smoking status was not associated, (male) sex, sex-dependent age, alcohol usage, BMI, fasting triglycerides and C-reactive protein (CRP) were significant independent determinants of circulating GGT. Each 1-s.d. increment in (= 0.53 ln GGT) GGT activity significantly predicted in each sex incident hypertension (hazard ratio (HR) 1.20 (95% confidence interval (CI) 1.10; 1.31)), and similarly MetS, after adjustment for age, alcohol usage, smoking status, BMI and menopause. Strongest independent association existed with diabetes (HR 1.3 (95% CI 1.1; 1.5)) whereas GGT activity tended to marginally predict CHD independent of total bilirubin but not of BMI. Higher serum total bilirubin levels were protective against CHD risk in women. We conclude that elevated serum GGT confers, additively to BMI, risk of hypertension, MetS, and type 2 diabetes but only mediates adiposity against CHD risk.
Obesity 06/2011; 20(4):842-8. · 4.28 Impact Factor
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ABSTRACT: We addressed whether or not the risk of coronary heart disease (CHD) in non-diabetic persons is linear at the lower end of fasting glucose levels. Middle-aged Turkish adults (n=2893) free from diabetes and CHD at baseline were studied prospectively over a 7.6-year follow-up. Participants with fasting glucose measurements were analyzed in 3 groups separated by 90 mg/dl and 110 mg/dl limits. Outcomes were analyzed by Cox regression. Cox regression for CHD incidence (n=374) showed an increased age-adjusted risk in the <90 mg/dl fasting glucose group (n=788) [HR 1.32 (1.03; 1.68)], compared with the 90-110 mg/dl group after adjustment for sex, age and the glucose groups. Further adjustment for waist circumference, C-reactive protein and conventional risk factors attenuated the HR to 1.27 (p=0.077). The risk profile in the low-glucose group could not be accounted for by age, smoking status, systolic blood pressure or fasting insulin levels but tended to show higher levels of circulating C-reactive protein. The increased CHD risk observed in individuals with lower compared with higher normal glucose concentrations is likely to be related to an associated pro-inflammatory state.
Diabetes research and clinical practice 01/2011; 91(2):220-5. · 2.16 Impact Factor
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ABSTRACT: We analyzed the distribution of cumulative all-cause and cardiovascular mortality and incident coronary heart disease (CHD) across the seven geographic regions of Turkey and presented overall and coronary mortality findings of the 2010 survey of the Turkish Adult Risk Factor Study.
A total of 1406 participants were surveyed. Information on the mode of death was obtained from first-degree relatives and/or health personnel of local heath offices. Information on survivors was obtained from history, physical examination, and 12-lead electrocardiography.
Of the surveyed participants, 686 were examined; information on health status was obtained in 577 subjects, and 32 participants (14 women, 18 men; mean age 72.3±15.6 years) were ascertained to have died. The total duration of follow-up was 2,520 person-years. Nineteen deaths were of coronary (n=16) or cerebrovascular (n=3) origin. Cumulative 20-year assessment of the entire cohort for the age bracket of 45-74 years disclosed a high coronary mortality rate, being 7.4 and 4.1 per 1000 person-years in men and women, respectively, and representing a limited decline after year 2000. Age-adjusted Cox regression analysis comprising 433 deaths and 506 incident CHD cases over a 7.3-year follow-up showed similar mortality rates across the regions, and a significantly high CHD incidence in males of the Black Sea and Marmara regions and in females of the Southeast Anatolia. Currently, 480,000 incident CHD cases are estimated yearly in Turkey.
The high age-adjusted overall mortality in Turkey shows nonsignificant differences across geographic regions, whereas the age-adjusted CHD incidence is high in the Black Sea and Marmara regions.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2011; 39(4):263-8.
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Emre Akkaya,
Erkan Ayhan,
Hüseyin Uyarel,
Mehmet Ergelen,
Ayça Türer,
Deniz Demirci,
Duygu Demirci, Gökhan Ciçek,
Mehmet Gül,
Zeki Günaydın,
Ahmet Narin
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ABSTRACT: We investigated the effect of chronic kidney disease (CKD) on in-hospital results in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction (STEMI).
The study included 2,486 patients (2,070 men, 416 women) who were treated with primary angioplasty for STEMI. Of these, 273 patients (11%) were found to have CKD (glomerular filtration rate <60 ml/min/1.73 m2) before the procedure. Patients with and without CKD were evaluated with respect to demographic and clinical features, primary angioplasty findings, and in-hospital clinical results.
Patients with CKD exhibited a higher mean age, Killip class, and higher frequencies of female gender, diabetes, hypertension, anemia, and previous myocardial infarction (p<0.05). Angioplasty showed higher rates of right coronary artery lesion, multivessel disease, contrast nephropathy, unsuccessful procedure, and increased stenosis rate and stent length in CKD patients (p<0.05). Cardiovascular mortality occurred in 11.7% and 1.4% of patients with and without CKD, respectively (p<0.001). Patients with CKD had significantly higher incidences of target vessel revascularization, major cardiac events, stroke, cardiopulmonary resuscitation, hemodialysis, ventricular tachycardia/fibrillation, severe heart failure, cardiogenic shock, and significant hemorrhage (p<0.05). Multivariate analysis showed that CKD was an independent predictor of mortality (OR=4.1, 95% CI 1.83-9.17; p=0.001).
Our findings show that CKD patients undergoing primary angioplasty for STEMI have an increased risk profile and poorer in-hospital results, and that CKD represents an independent risk factor for mortality.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2011; 39(4):276-82.
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Erkan Ayhan,
Hüseyin Uyarel,
Mehmet Ergelen, Gökhan Ciçek,
Emre Akkaya,
Zeki Günaydın,
Turgay Işık,
Damirbek Osmonov,
Ayça Türer,
Ceyhan Türkkan,
Mehmet Bozbay,
Ahmet Narin
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ABSTRACT: We evaluated in-hospital and long-term clinical results of female patients following primary angioplasty for ST-elevation myocardial infarction (STEMI), in comparison with male patients.
We reviewed 2,644 patients (2,188 males, 456 females) who underwent primary angioplasty for STEMI between October 2003 and March 2008. Data on female patients concerning demographic and clinical characteristics, primary angioplasty results, in-hospital and 25-month follow-up results were compared with those of male patients.
Hypertension, diabetes mellitus, anemia, shock, and renal failure were more common in female patients, while smoking was more frequent in males (p<0.05). The mean age was higher in female patients (63.9±11.7 vs. 55.2±11.3 years, p<0.001). Females also presented with higher values of glucose, mean platelet volume, and platelet count, and lower hemoglobin and hematocrit values (p<0.05). The frequencies of multivessel disease and procedure failure were significantly higher, and pain-to-balloon time was significantly longer in females (p<0.05). Mortality associated with cardiovascular causes occurred in 148 patients (5.6%), being significantly higher in females (9.4% vs. 4.8%, p<0.001). In-hospital mortality, major cardiac events, stroke, cardiogenic shock, and major bleeding were more frequent in women (p<0.05). Long-term mortality rate was also significantly higher in females (10% vs. 4.5%, p<0.001). Multivariate analysis showed female gender as one of the independent predictors of mortality (odds ratio=1.75, 95% CI 1.02-2.99; p<0.04).
Female patients with STEMI undergoing primary angioplasty have a higher risk profile and poorer in-hospital and follow-up clinical results. Therefore, female patients should be treated more aggressively.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2011; 39(2):114-21.
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ABSTRACT: We determined the relationship of smoking status on APOC3 -482C>T polymorphism and apolipoprotein C-III (apoC-III) concentrations and the latter two parameters' influence on risk of diabetes and coronary heart disease (CHD).
Prediction of incident cases was assessed at 5.5years' follow-up in unselected 519 individuals of a general population genotyped for -482C>T polymorphism.
Female sex and current smoking were significantly associated with low circulating apoC-III in subjects without (p≤0.033) than with abdominal obesity (p=0.053) or than insulin resistant -482TT homozygotes (p=0.034) who had 20-30% higher serum apoC-III. Multi-adjusted serum apoC-III was log-linearly associated with fasting triglycerides. ApoC-III levels determined the development of diabetes [RR 1.56 (95%CI 1.21; 2.01)] and CHD [RR 1.38 (1.10; 1.72) for an increment of 14%], after adjustment for confounders.
APOC3 -482TT genotype is associated with high apoC-III concentrations only in the presence of abdominal obesity or insulin resistance, but not in current smokers who remain lean or insulin-sensitive. Rather than APOC3 -482C>T polymorphism, circulating apoC-III determines cardiometabolic risk.
Clinical biochemistry 12/2010; 44(5-6):391-6. · 2.02 Impact Factor
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ABSTRACT: We determined the independent predictive value of serum apolipoprotein (apo) B/LDL-cholesterol ratio for the risk of diabetes, metabolic syndrome (MetS) and coronary heart disease (CHD).
Prediction of incident cases was assessed in 2466 adults at 7 years' follow-up.
ApoB/LDL ratio was independently associated log-linearly with waist circumference, and, only in men, with HDL-cholesterol in a multivariable regression model. Positive partial correlations existed with fasting insulin, fibrinogen and apo A-I and, only in women, with CRP. Cox regression analyses revealed the two highest apoB/LDL quartiles to be significant determinants of diabetes, at 2-fold RRs, independently of waist circumference, fasting glucose and other confounders. However, apoB/LDL quartiles were not independently associated with CHD in either gender. Only the highest apoB/LDL quartile was associated (RR 1.46) with the development of MetS. Serum apoB/LDL-cholesterol ratio, determined by insulin resistance and in women additionally by pro-inflammatory state, is of independent predictive value for incident diabetes and weakly for MetS, but not for CHD.
Clinical biochemistry 12/2010; 43(18):1381-6. · 2.02 Impact Factor
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ABSTRACT: We analyzed 2009 survey of the Turkish Adult Risk Factor (TARF) Study to assess the distribution of all-cause and cardiovascular mortality in urban and rural areas and sex-specific coronary mortality in the age-bracket of 45 to 74 years.
The Marmara and Middle East regions have been surveyed every odd year in the TARF Study. In 2009, 1,655 participants were surveyed. Information on the mode of death was obtained from first-degree relatives and/or health personnel of local heath office; 960 participants underwent physical examination and ECG recording, and 572 subjects were evaluated on the basis of information obtained regarding health status.
In the survey, 23 men and 20 women were ascertained to have died. Twenty-one deaths were attributed to coronary disease and four deaths to cerebrovascular events. Assessment of the entire cohort in the age bracket of 45-74 years after a 19-year follow-up disclosed a high coronary mortality with 7.5 per 1000 person-years in men and 3.9 in women. In a Cox regression analysis comprising 405 deaths (235 cardiovascular) and over 24,000 person-year follow-up, age-adjusted cardiovascular mortality was similar in rural and urban participants. All-cause mortality was higher in females living in urban areas than those living in rural areas (HR 1.41; 95% CI 1.02-1.96).
Cardiovascular mortality both in absolute terms and as a share of overall mortality persists to be high among Turkish adults, with similar rates in urban and rural areas. Age-adjusted all-cause mortality rate is higher among urban versus rural women.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 04/2010; 38(3):159-63.
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ABSTRACT: We investigated the incidence, predictors, and prognosis of gastrointestinal bleeding (GIB) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
We reviewed 2,541 consecutive patients (2,111 males, 430 females; mean age 56.5+/-11.8 years) who underwent primary PCI for STEMI. Data on clinical, angiographic findings, and in-hospital outcomes were collected. Gastrointestinal bleeding was defined as apparent upper or lower GIB or melena requiring cessation of antiplatelet or anticoagulant therapy and administration of erythrocyte infusion.
Gastrointestinal bleeding was observed in 27 patients (1.1%). Compared to 2,514 patients without GIB, patients with GIB were older (65.9+/-13.5 years vs. 56.4+/-11.8 years; p<0.001), exhibited higher frequencies of female gender (p=0.016), renal failure (p<0.001), and admission anemia (p<0.001), and had a lower procedural success rate (77.9% vs. 91.5%; p=0.02). The development of GIB was associated with significantly higher in-hospital mortality (18.5% vs. 2.9%; p<0.001), longer hospital stay (13.1+/-6.8 days vs. 7.0+/-3.7 days, p=0.02), and increased inotropic requirement (37% vs. 6.7%; p<0.001). In multivariate analysis, inotropic requirement (OR 4.17, 95% CI 1.7-10.4; p=0.002), age above 70 years (OR 3.33, 95% CI 1.4-8.0; p=0.007), and glomerular filtration rate lower than 60 ml/min/1.73 m(2) (OR 2.96, 95% CI 1.2-7.4; p=0.02) were independent predictors of in-hospital GIB.
The development of GIB is not an uncommon complication after primary PCI for STEMI. These patients have a prolonged hospital stay and increased in-hospital mortality. Increased inotropic requirement, age above 70 years, and impaired renal function are independent predictors of this complication.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 03/2010; 38(2):101-6.
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Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2010; 38(8):593.
