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    Elevated serum uric acid in nondiabetic people mark pro-inflammatory state and HDL dysfunction and independently predicts coronary disease
    (Springer London Ltd, 2013) Onat, Altan; Can, Gunay; Ornek, Ender; Altay, Servet; Yuksel, Murat; Ademoglu, Evin
    We explored the association of serum uric acid (UA) concentrations with pro-inflammatory state and high-density lipoprotein (HDL) dysfunction. UA tertiles in tracked 1,508 nondiabetic participants were analyzed cross-sectionally for associations with inflammation biomarkers and protective proteins over a mean follow-up of 4.9 years for incident coronary heart disease (CHD) using Cox proportional hazards regression. In the absence of metabolic syndrome (MetS), UA tertiles significantly distinguished, in each sex, increasing categories of three MetS components (inflammation/oxidation markers, apolipoprotein (apo)B) and (inversely) current smoking (but not protective proteins such as HDL, apoA-I, and adiponectin). Distinctions attenuated in the presence of MetS. Linear regression model revealed fasting triglycerides (1.86 mg/dl variance), male sex, and gamma-glutamyl transferase and age as covariates of UA levels in women. In Cox analysis, incident CHD (n = 137) was predicted by mid and upper UA tertile in men alone at significant hazard ratios of 2.7, additively to conventional risk factors. Elevated serum UA levels, linked to triglycerides, mark in nondiabetic people pro-inflammatory state, and, notably, HDL dysfunction. CHD risk is independently predicted by elevated UA levels in nondiabetic men and is modulated by MetS and gender.
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    High adiponectin levels fail to protect against the risk of hypertension and, in women, against coronary disease: involvement in autoimmunity?
    (Baishideng Publishing Group Inc, 2013) Onat, Altan; Aydin, Mesut; Can, Gunay; Koroglu, Bayram; Karagoz, Ahmet; Altay, Servet
    AIM: To investigate whether serum adiponectin protects against cardiometabolic risk in a population sample with prevailing metabolic syndrome. METHODS: Middle-aged adults representative of a general population with baseline circulating adiponectin measurements (n = 1224) were analyzed prospectively at a mean of 3.8 years' follow-up, using continuous values or sex-specific tertiles. Total adiponectin was assayed by an ELISA kit. Type-2 diabetes was identified by criteria of the American Diabetes Association. Hypertension was defined as a blood pressure >= 140 mmHg and/or >= 90 mmHg and/or use of antihypertensive medication. Outcomes were predicted using Cox proportional hazards regression analysis in models that were controlled for potential confounders. RESULTS: In models of multiple linear regression, sex hormone-binding globulin, fasting insulin (inverse) and, in men, age were significant independent covariates of serum adiponectin which further tended in women to be positively associated with serum creatinine. Cox regression analyses for incident coronary heart disease (CHD), adjusted for sex, age, non-HDL cholesterol, waist circumference and C-reactive protein, revealed significant inverse association with adiponectin tertiles in men but not women (HR = 0.66; 95% CI: 0.32-1.38 for highest tertile). Cox regression for type-2 diabetes in a similar model (wherein glucose replaced non-HDL cholesterol), adiponectin tertiles appeared to protect in each gender. HR for incident hypertension roughly displayed unity in each of the adiponectin tertiles (P -trend = 0.67). CONCLUSION: High adiponectin levels failed to protect against the development of hypertension and, in women, against CHD, presumably paralleling impairment in renal function as well. Involvement of adiponectin in autoimmune complex with loss of antioxidative- antiatherogenic properties may be underlying. (C) 2013 Baishideng. All rights reserved.
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    Low acylation stimulating protein levels are associated with cardiometabolic disorders-secondary to autoimmune activation?
    (Turkish Soc Cardiology, 2017) Onat, Altan; Altay, Servet; Yuksel, Murat; Karadeniz, Yusuf; Can, Gunay; Yuksel, Husniye; Ademoglu, Evin
    Objective: We investigated the possible association of serum acylation stimulating protein (ASP) with cardiometabolic disorders and the evidence of autoimmune activation. Methods: Population-based randomly selected 1024 participants were cross-sectionally and prospectively analyzed. ASP concentrations were measured with a validated ELISA kit. Correlations were sought separately in subjects with no cardiometabolic disorders (n=427) designated as healthy. Results: ASP was positively correlated with total testosterone and inversely correlated with platelet activating factor (PAF), PAF-acetylhydrolase (AH), in each gender, and positively correlated in healthy men with lipoprotein [Lp](a) and apolipoprotein B. Correlations of ASP with PAF values =22 nmol/L were abolished, contrasted to a strongly inverse one in subjects with PAF Conclusion: Findings can be explained by the notion of operation of immune responses against both ASP and oxidized PAF-like lipids of Lp(a) to yield for reduced values and increased likelihood of cardiometabolic disorders.
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    Normal thyroid-stimulating hormone levels, autoimmune activation, and coronary heart disease risk
    (Springer, 2015) Onat, Altan; Aydin, Mesut; Can, Gunay; Celik, Etem; Altay, Servet; Karagoz, Ahmet; Ademoglu, Evin
    Whether euthyroid status affects cardiovascular disease risk is unclear. We aimed to investigate whether serum thyroid-stimulating hormone (TSH) levels within the normal range are related to the risk of coronary heart disease (CHD). In participants of the Turkish Adult Risk Factor Study (mean age 52.7 +/- A 11.5), in whom TSH was measured in the 2004/05 survey, cross-sectional and longitudinal analyses were performed. Subjects with TSH concentrations < 0.3 and > 4.2 mIU/L were excluded to ensure euthyroid status leaving 956 individuals as the study sample. Mean follow-up was 4.81 +/- A 1.3 years. Men had 18 % lower (p < 0.001) geometric mean TSH levels (1.10 mIU/L) than women (1.35 mIU/L). Correlations of TSH with risk variables were notably virtually absent except weakly positive ones in men with age and systolic blood pressure (SBP). The age-adjusted TSH mid-tertile in men was associated with lowest lipoprotein [Lp](a), apoB, and total cholesterol values. Incident CHD was predicted in Cox regression analyses in men [HR of 2.45 (95 %CI 1.05; 5.74] and in combined sexes by the lowest compared with the highest TSH tertile, after adjustment for age, smoking status, SBP, and LDL-cholesterol. Analysis for combined prevalent and incident CHD stratified by metabolic syndrome (MetS) confirmed the independent association with the lowest TSH tertile in men, specifically in men without MetS. TSH levels within normal range, low due to partial assay failure, may manifest as independent predictors of incident CHD, particularly in middle-aged men. Autoimmune responses involving serum Lp(a) under oxidative stress might be implicated mechanistically.
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    TARF Survey 2011: mortality and performance in the long-term follow-up
    (Turkish Soc Cardiology, 2012) Onat, Altan; Aydin, Mesut; Koroglu, Bayram; Ornek, Ender; Altay, Servet; Celik, Ethem; Karagoz, Ahmet
    Objectives: We analyzed all-cause and coronary mortality data of the Turkish Adult Risk Factor Study cohort in Marmara and Central Anatolia regions, surveyed in 2011, and overall performance of long-term (21 years) follow-up of participants. Study design: A total of 1,588 participants with an age range of 45 to 74 years were surveyed. Information on the mode of death was obtained from first-degree relatives and/or personnel of local health offices. Information on survivors was obtained from history, physical examination, and 12-lead electrocardiograms. Loss to follow-up was defined as the lack of physical examination for at least eight years. Results: Of the surveyed participants, 854 were examined, information on health status was obtained in 606 subjects, 46 individuals (28 men, 18 women) were ascertained to have died, and 82 subjects were lost to follow-up. A total of 2,800 person-years were added to follow-up. Nineteen deaths were attributed to coronary heart disease (CHD) and five deaths to cerebrovascular events. Overall mortality was estimated as 10.9 per 1000 person-years. In the age bracket of 45-74 years, overall annual all-cause mortality and CHD mortality were 12.8 and 5.5 per mille, respectively. Based on the total loss to follow-up (31.2%) during the past two decades, an annual loss to follow-up may be derived as 19.3 for every 1000 participants. This loss was nearly twice as high in participants living in big cities compared to those in smaller towns and rural areas. Conclusion: A trend to slight reduction in coronary mortality, though not in overall mortality, before the age 75 years is noted in Turks. Annual loss to follow-up amounts to 2% of the participants.
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    TEKHARF 2011 taraması: Ölümler ve uzun vadeli takipte performans
    (2012) Köroğlu, Bayram; Çelik, Ethem; Onat, Altan; Aydın, Mesut; Karagöz, Ahmet; Örnek, Ender; Altay, Servet
    Amaç: Türk Erişkinlerinde Kalp Hastalıkları ve Risk Faktörleri (TEKHARF) Çalışmasının Marmara ve İç Anadolu bölgelerine ilişkin 2011 taramasında kaydedilen tümnedenli ve koroner kökenli ölüm verileri ile 21 yıllık uzun vadeli takip performansı değerlendirildi. Çalışma planı: Taramada izlenen örneklem sayısı 1588 kişi, taranan kişilerde yaş aralığı 45-74 idi. Ölüm konusunda birinci derece akraba ve/veya aile sağlık merkezi personelinden bilgi alındı; yaşayanlarda bilgi edinmekten başka, fizik muayene ve 12-derivasyonlu EKG kaydı yapıldı. Katılımcının takipten kaybı, en az sekiz yıl süreyle muayene edilmemiş olma durumu olarak tanımlandı. Bulgular: T aranan ö rneklemden 8 54 k işi m uayene edildi, 606 kişinin sağlık durumu hakkında bilgi edinildi ve 46 kişinin (28 erkek, 18 kadın) öldüğü belirlendi. Seksen iki kişi takipten kayıp kabul edildi. İzlemeye 2800 kişi-yılı eklenmiş oldu. Ölümlerin 19u koroner hastalığa, beşi serebrovasküler olaya bağlandı. Şimdiye dek tüm nedenli ölümler geneli 1000 kişi-yılında 10.9 bulundu. Anılan yaş kesiminde toplam yıllık mortalite binde 12.8, koroner kalp hastalığı ölüm prevalansı binde 5.5 düzeyindeydi. Tarama başlangıcından itibaren toplam takip kaybının %31.2 olması sonucu, izlenen her 1000 kişiden yılda 19.3ünün kayıp hanesine geçtiği ifade edilebilir. Bu kayıp, küçük şehir ve köylerde oturan katılımcılara kıyasla, büyük şehirlerde neredeyse iki kat yüksekti. Sonuç: Yetmiş beş yaşından önce tüm nedenli ölümlerin değilse de, koroner kökenli ölümlerin sıklığı hafifçe gerileme eğilimindedir. Tarama katılımcılarının her yıl %2si takipten uzaklaşmaktadır.