Prospective validation in identical Turkish cohort of two metabolic syndrome definitions for predicting cardiometabolic risk and selection of most appropriate definition/Iki metabolik sendrom taniminin kardiyometabolik risk ongorusunun ayni kohortta prospektif yolla degerlendirilmesi ve halkimiz icin en uygun tanimin secilmesi.OZET OZET (Russian: ОЗЕТ, Общество землеустройства е Amac: Bu calismanin amaci, yeni gelisen tip 2 diyabet ile koroner kalp hastaligini (KKH KKH Karakoram Highway (between Pakistan and China) KKH Kaufmännische Krankenkasse Halle (German) KKH Kandang Kerbau Hospital ) ongormede metabolik sendrom (MS) ATPIII taniminin rolunu TEKHARF modifikasyonlu tanimla karsilastirmak ve en uygun tanimi arastirmaktir. Yontemler: TEKHARF calismasi 1997/98 ve 2002/03 taramalarina katilip 2004/05 taramasina kadar Ká·dar , János 1912-1989. Hungarian politician and first secretary-general of the Hungarian Communist Party (1956-1988). A member of the invading Soviet forces in the 1956 revolution, he twice served as prime minister (1956-1958 and 1961-1965). izlenen [greater than or equal to] 28 yasindaki 1683 erkek ve 1718 kadin ortalama 5.9 yil suresince prospektif bicimde incelendi. TEKHARF modifikasyonu ozellikle abdominal abdominal /ab·dom·i·nal/ (ab-dom´i-n'l) pertaining to the abdomen. ab·dom·i·nal adj. Of or relating to the abdomen. n. An abdominal muscle. obeziteyi ([greater than or equal to] 95/[greater than or equal to] 91 cm) ilgilendirdi. Bulgular: Diyabetli kisiler dislandiktan sonra, yas ve cinsiyet ayarli MS tanimlarinin ikisi de diyabet gelismesini ayni ayni (īˑ·nē), n in the Kallawaya system of healing practiced in Bolivia, the communal act of bringing music, money, food, and other supportive items to sustain the nisbi riskle anlamli olarak ongordu (ATPIII 2.85 [%95GA 2.14; 3.80]; TEKHARF 2.84 [%95GA 2.13; 3.81]. Baslangictaki KKH'li katilimcilar dislandiktan sonra, yas ve cinsiyet ayarli MS tanimlarinin ikisi de KKH gelismesini benzer nisbi riskle anlamli olarak ongordu (ATPIII kohortun %36'sinda 2.10 [%95GA 1.64; 2.68]; TEKHARF tanimi kohortun %39.6'sinda 1.90 [%95GA 1.49; 2.43]. Her iki akibet icin erkeklerde TEKHARF tanimi, kadinlarda ATPIII tanimi, yuksek yogunluklu lipoprotein lipoprotein (lĭp'əprō`tēn), any organic compound that is composed of both protein and the various fatty substances classed as lipids, including fatty acids and steroids such as cholesterol. (HDL (Hardware Description Language) A language used to describe the functions of an electronic circuit for documentation, simulation or logic synthesis (or all three). Although many proprietary HDLs have been developed, Verilog and VHDL are the major standards. )-kolesterol sinir degeri nedeniyle, daha iyi ongoru sagladi. Metabolik sendromlu bireylerde ortalama yillik KKH riski %2'nin uzerindeyken, yasin The Yasin (Arabic: ياسين ) anti-tank rocket launcher is a weapon developed by Hamas' Izz ad-Din al-Qassam Brigades, named after the group's spiritual leader, Sheik Ahmed Yassin, who was assassinated by the Israeli Defense Forces (IDF) on March [greater than or equal to] 50 olmasi riskin daha yuksek oldugunu her iki cinsiyette isaret eden en uygun kriterdi. ATPIII tanimina bozuk aclik glukozu [greater than or equal to] 100 mg/dl ve erkekte bel cevresinin [greater than or equal to] 95 cm modifikasyonu halkimiz icin en uygun tanimi olusturdu ve hem daha buyuk bir kitleyi kapsam altina Altina (Serbian Cyrillic: Алтина) is an urban neighborhood of Belgrade, the capital of Serbia. Located in the Belgrade's municipality of Zemun, it is one of the newest and fastest growing parts of the city. aldi, hem de daha yuksek nisbi risk sergiledi. Yetiskinlerimizi tutan KKH'nin bu son tanimli MS'ten kaynaklanan orani Orani may refer to:
Sonuc: Diyabet ve KKH riskini ongordurmede erkeklerde TEKHARF tanimli MS daha degerli iken Iken is a small village and civil parish in the marshlands of the English county of Suffolk. It is near the estuary of the River Alde on the North Sea coast and is located south east of Snape and due north of Orford. , kadinlarda ATPIII taniminin aclik glukozu [greater than or equal to] 100 mg/dl modifikasyonunun hekimlerimizce benimsenmesi uygundur. Halkimizda KKH her 3 kisinin ikisinde MS zemininde gelismektedir; MS'lu bireyde yasin [greater than or equal to] 50 olmasi, her iki cinsiyette daha da yuksek riskin gostergesidir. (Anadolu Kardiyol Derg DERG Data Extraction and Reduction Guide 2007; 7: 29-34) Anahtar kelimeler: Adult Treatment Panel III tanimi, aterojen dislipidemi, koroner kalp hastaligi riski, metabolik sendrom, risk degerlendirmesi, tip 2 diyabet ABSTRACT Objectives: To investigate the relative values in the prediction of type 2 diabetes type 2 diabetes n. See diabetes mellitus. and coronary heart disease coronary heart disease: see coronary artery disease. coronary heart disease or ischemic heart disease Progressive reduction of blood supply to the heart muscle due to narrowing or blocking of a coronary artery (see atherosclerosis). (CHD CHD coronary heart disease. ChD abbr. Latin Chirurgiae Doctor (Doctor of Surgery) CHD, n.pr See disease, coronary heart. CHD canine hip dysplasia. ) by the metabolic syndrome metabolic syndrome n. See syndrome X. Metabolic syndrome A group of risk factors for heart disease, diabetes, and stroke. (MS) as defined by the ATPIII and by its modification of the Turkish Adult Risk Factor Study (TEKHARF-def) and selection of most appropriate definition. Methods: Prospective evaluation of 1683 men and 1718 women, aged [greater than or equal to] 28 years participating in the TEKHARF study surveys 1997/98 and 2002/03 with a mean follow-up follow-up, n the process of monitoring the progress of a patient after a period of active treatment. follow-up subsequent. follow-up plan of 5.9 years. The modification involved especially abdominal obesity abdominal obesity Androgenous obesity, truncal obesity Public health A clinical form of obesity which is more typical of ♂; those with AO waists > 40 inches had a 3 fold > risk of high cholesterol, were 4 times more likely to be in poor physical ([greater than or equal to] 95 cm in men, [greater than or equal to] 91 cm in women). Results: After exclusion of participants with diabetes at baseline The horizontal line to which the bottoms of lowercase characters (without descenders) are aligned. See typeface. baseline - released version and adjustment for sex and age, both MS definitions predicted the development of diabetes with virtually identical relative risks (RR) (ATPIII 2.85 [95%CI 2.14; 3.80]; TEKHARF 2.84 [95%CI 2.13; 3.81]. After similar exclusion and adjustments, both MS definitions predicted significantly the development of CHD with similar RRs (ATPIII 2.10 [95%CI 1.64; 2.68] in 36% of the cohort cohort /co·hort/ (ko´hort) 1. in epidemiology, a group of individuals sharing a common characteristic and observed over time in the group. 2. ; TEKHARF-def 1.90 [95%CI 1.49; 2.43] in 39.6% of the cohort. For both outcomes, the TEKHARF-def provided higher predictive values pre·dic·tive value n. The likelihood that a positive test result indicates disease or that a negative test result excludes disease. predictive value a measure used by clinicians to interpret diagnostic test results. in men, and (because of the high density lipoprotein High density lipoprotein (HDL) A fraction of total serum lipids, the so called "good" cholesterol. Mentioned in: Hypercholesterolemia (HDL)-cholesterol cutoff) the ATPIII definition in women. Absolute annual CHD risk in individuals with MS exceeded on average 2%, while age [greater than or equal to] 50 years constituted the most appropriate indicator of further elevated risk in both genders. Most suitable modifications of the ATPIII definition are proved to be impaired fasting glucose fasting glucose Fasting blood sugar, fasting plasma glucose Endocrinology Glucose obtained from a Pt who has had nothing–except water by mouth for 8+ hrs; FG is used in evaluating Pts for possible DM Ref range 65-115 mg/dL non-diabetic; 110-140 mg/dL, (IFG IFG Impaired Fasting Glucose IFG International Forum on Globalization IFG Individual and Family Grant IFG Inferior Frontal Gyrus IFG Inter-Frame Gap IFG I Feel Good IFG International Facilities Group (Northbrook, Illinois) ) [greater than or equal to] 100 mg/dl and in men [greater than or equal to] 95 cm of waist circumference. Most CHD cases afflicting af·flict tr.v. af·flict·ed, af·flict·ing, af·flicts To inflict grievous physical or mental suffering on. [Middle English afflighten, from afflight, Turkish adults (namely 61% in men and 69% in women) originated from the latter definition of MS. Conclusions: In predicting diabetes and CHD risk, the TEKHARF-def MS is more valuable in men; the ATPIII definition modified for IFG ([greater than or equal to] 100 mg/dl) should be adopted in women. In 2 out of every 3 cases, CHD originates from MS among Turks Turks, term applied in its wider meaning to the Turkic-speaking peoples of Turkey, Russia, Central Asia, Xinjiang in China (Chinese Turkistan), Azerbaijan and the Caucasus, Iran, and Afghanistan. , and age [greater than or equal to] 50 years is a good indicator of higher risk in both genders. (Anadolu Kardiyol Derg 2007; 7: 29-34) Key words: Adult Treatment Panel III definition, atherogenic ath·er·o·gen·ic adj. Initiating, increasing, or accelerating atherogenesis. atherogenic adjective Referring to the ability to initiate or accelerate atherogenesis—the deposition of atheromas, lipids, and dyslipidemia dyslipidemia /dys·lip·id·e·mia/ (-lip?id-e´me-ah) abnormality in, or abnormal amounts of, lipids and lipoproteins in the blood. dys·lip·i·de·mi·a n. , coronary heart disease risk, metabolic syndrome, risk assessment, type 2 diabetes mellitus Type 2 diabetes mellitus One of the two major types of diabetes mellitus, characterized by late age of onset (30 years or older), insulin resistance, high levels of blood sugar, and little or no need for supple-mental insulin. Giris Metabolik sendrom (MS), tip 2 diyabet ve kardiyovaskuler hastaliga artmis risk sergileyen ve genelde abdominal obeziteye eslik eden bir risk faktorleri kumelenmesidir. Kumelenen risk faktorleri yuksek trigliserid ve dusuk HDL-kolesterolden olusan aterojen dislipidemi, yuksek kan basinci ile glukoz, protrombotik ve proinflamatuvar durumlardan ibarettir (1,2). Cok etkenli bir patogeneze sahip MS'un altinda yatan baslica iki etken abdominal obezite ile insulin insulin, hormone secreted by the β cells of the islets of Langerhans, specific groups of cells in the pancreas. Insufficiency of insulin in the body results in diabetes. Insulin was one of the first products to be manufactured using genetic engineering. direncidir; yaslanma, fiziksel inaktivite, genetik unsurlar gibi tetikleyici faktorlerin varligi da iyi bilinir. Metabolik sendrom uc sene se·ne n. pl. sene See Table at currency. [Samoan, from Englishcent.] Noun 1. arayla, once Dunya Saglik Orgutu (3) sonra ATPIII kurulunca (1) tanimlandi; bunu bazi diger tanimlar (4) izledi. Halkimizda MS prevalansi ve akibetiyle ilgili ilk arastirma TEKHARF calismasinin 1997/98 taramasi esas alinarak ve ATPIII kriterleri uygulanarak gerceklestirildi (5). Her iki alanda onemli bilgiler ureten bu yayina ragmen, ozellikle erkeklerde abdominal obeziteye iliskin 102 cm'lik kriterin Turk See Mechanical Turk. erkeklerinin onemli bir bolumunu kapsamayarak risk altinda degilmis gibi gostermesi sonucu, yeni kriter ([greater than or equal to] 95 cm'lik bel cevresi) gelistirildi ve arastirmalarda kullani ldi (6, 7). Daha sonra kadinlarda da ([greater than or equal to] 91 cm'lik bel cevresi ile <45 mg/dl'lik yuksek yogunluklu lipoprotein (HDL)-kolesterol dusuklugu) yeni kriterlerin halkimizda daha uygun (8) olabilecegi dusunuldu. Bu kriterlerin validasyonu uzun vadede izlenen ayni kohorta iki farkli tanimin--burada ATPIII ve TEKHARF tanimlari olarak gececektir--uygulanmasi suretiyle karsilastirilarak gerceklestirilebilir. Bu arada Arada is a municipality in the Honduran department of Santa Bárbara. References
Yontemler Katilimcilar TEKHARF calismasi 1997/98 taramasina katilan ve 2002/03 taramasinda yeni alinan kohort (toplamin 1/7'i), son olarak 2004/05 taramasina kadar izlendi. Calisma kapsamina 3401 kisi Ki·si See Jixi. (1683 erkek ile 1718 kadin) girdi. TEKHARF calismasi takip taramasinin katilimci lari la·ri n. pl. lari See Table at currency. [Georgian.] Noun 1. lari - the basic unit of money in Georgia Georgian monetary unit - monetary unit in Georgia ve yontemiyle ve de yeni kohortun nitelikleriyle ilgili ayrintilar daha once yayinlanmisti (9). Olcumler ve tanimlar Sigara iciciligi hic icmemisler, terketmis olanlar ve halen Halen is a municipality located in the Belgian province of Limburg. On January 1 2006 Halen had a total population of 8,624. The total area is 36.29 km² which gives a population density of 238 inhabitants per km². icenler tarzinda gruplandirildi. Bel cevresi kisi ayakta dururken, ic camasirinin uzerinden, hafif ekspirasyon sonunda alt kaburga kenari yla crista crista /cris·ta/ (kris´tah) pl. cris´tae [L.] crest. cris´tae cu´tis dermal ridges; ridges of the skin produced by the projecting papillae of the dermis on the palm of the hand or sole iliaca ortasindaki duzeyden bir mezure ile olculdu. Beden Bed´en n. 1. (Zool.) The Abyssinian or Arabian ibex (Capra Nubiana). It is probably the wild goat of the Bible. kitle indeksi (BKI BKI Babbar Khalsa International BKI Kota Kinabalu, Sabah, Malaysia - Kota Kinabalu (Airport Code) BKI Bible Knowledge Institute BKI Brasil Kaffe Import (Danish Coffee Importer) ) agirligin boyun karesine bolunmesiyle hesaplandi (kg/[m.sup.2]). Kan basinci birey oturur pozisyonda iken sag koldan bir ERKA sfigmomanometresi ile iki kez olculdu. Ilk olcume birkac dakika dinlenmekten sonra gecildigi gibi, iki olcum arasinda en az 3 dakika ara ile ve Alman Ulusal Kan Basinci Programinca istenen teknige (10) uygun bicimde yapildi. Degerler en yakin Ya´kin n. 1. (Zool.) A large Asiatic antelope (Budorcas taxicolor) native of the higher parts of the Himalayas and other lofty mountains. 2 mmHg olarak kaydedildi ve analizler icin iki okumanin ortalama degeri kullanildi. Kuru kuru /ku·ru/ (koo´roo) an infectious form of prion disease with a long incubation period found only in New Guinea and thought to be associated with ritual cannibalism. ku·ru n. kimya yontemi ve Reflotron cihaziyla yapilan HDL-kolesterol olcumleri EDTA'li alinan kandan ayrilan plazmada, diger tetkikler (total kolesterol, glukoz ve aclikta olculen trigliseridler) serumda tayin edildi. C-reaktif protein (CRP C-reactive protein (CRP) A protein present in blood serum in various abnormal states, like inflammation. Mentioned in: Pelvic Inflammatory Disease CRP, n.pr See C-reactive protein. ) ve apolipoprotein B Apolipoprotein B (APOB) is the primary apolipoprotein of low density lipoproteins (LDL or "bad cholesterol"), which is responsible for carrying cholesterol to tissues. While it is unclear exactly what functional role APOB plays in LDL, it is the primary apolipoprotein component konsantrasyonlari Behring Beh·ring , Emil Von 1854-1917. German physiologist. He won a 1901 Nobel Prize for work on serum immunization against diphtheria and tetanus. kitleri ve nefelometri (BN Prospec, Behring Diagnostics (1) Software routines that test hardware components (memory, keyboard, disks, etc.). Diagnostics are often stored in ROM chips and activated on startup. (2) Error messages in a programmer's source code that refer to statements or syntax that the compiler or assembler , Westwood Westwood. 1 Residential town (1990 pop. 12,557), Norfolk co., E Mass., in the greater Boston area; settled 1640, inc. 1897. It has several early 18th-century buildings. 2 Residential borough (1990 pop. 10,446), Bergen co., NE N.J. , MA) ile olculdu. Abdominal obezite icin halkimizda en iyi gostergenin bel cevresi oldugu TEKHARF calismasinda (11) anlasilmisti. Metabolik sendrom kriteri olarak, ilk sikta NCEP NCEP National Cholesterol Education Program ATPIII tarafindan onerilen kriterlere (1) uyuldu. Ikinci sikta (TEKHARF modifikasyonlu tanim), bu olcutlere uyulmakla birlikte, prediyabet icin aclik serum glukozu 100-125 mg/dl, bel cevresi olcutleri icin erkekte [greater than or equal to] 95 cm (7), kadinda [greater than or equal to] 91 cm ve HDL-kolesterol dusuklugu (erkekte <40 mg/dl, kadinda <45 mg/dl) alindi. Diyabet (DM) tanisi icin ilacla tedavi altinda bulunma, aclik serum glukozu [greater than or equal to] 126 mg/dl veya tokluk glukozu [greater than or equal to] 200 mg/dl duzeyleri alindi (12). Metabolik sendromlu bireylerde potansiyel yuksek risk belirleyicileri bakimindan bu yazida baslica risk faktorleri olarak, su degiskenlerin rolu arastirildi: CRP [greater than or equal to] 2.0 mg/l, apolipoprotein B >120 mg/dl, HOMA HOMA Homeostasis Model Assessment HOMA Heads of Marine Agencies (Australia) (homeostatic model assessment The homeostatic model assessment (HOMA) is a method used to quantify insulin resistance and beta-cell function. It was first described under the name HOMA by Matthews et al in 1985. ) indeksi >2.1, yas [greater than or equal to] 50, sigara icim durumu, total/HDL-kolesterol orani erkekte >5.0, kadinda >4.5. Insidan KKH'nin belirlenmesi Olenler hakkinda bilgi The term Bilgi could mean:
Angina is pain, "discomfort," or pressure localized in the chest that is caused by an insufficient supply of blood (ischemia) to the heart muscle. , yeni miyokard iskemisi (onceki trasesinde bulunmadan son EKG'de 4.1-2, 5.1-2 veya 7.1 Minnesota Minnesota, state, United States Minnesota (mĭn'ĭsō`tə), upper midwestern state of the United States. It is bordered by Lake Superior and Wisconsin (E), Iowa (S), South Dakota and North Dakota (W), and the Canadian provinces kodlarinin [13]) varligi. Ilk taramada KKH kanitlari olmadigi halde, gecen sure icersinde koroner baypas ameliyatina ya da anjiyoplastiye/ stent stent (stent) 1. a device or mold of a suitable material, used to hold a skin graft in place. 2. a slender rodlike or threadlike device used to provide support for tubular structures that are being anastomosed, or yerlestirilmesine tabi ta·bi n. pl. tabi or ta·bis A socklike cotton, silk, or nylon foot covering with a separate section for the big toe and a thick padded sole, worn in Japan with thong sandals, clogs, or zoris. tutulmus kisiler (9). Veri analizi Ilgi ceken degiskenler ortalama [+ or -] standart sapma degerleri ya da yuzde olarak ifade edildi. TEKHARF calismasinin son 7-yillik takibi suresince ortaya cikan akibetler icin iki MS taniminin ongorusunu belirlemek amaciyla, DM veya KKH tanilari baslangicta bulunan katilimcilar dislanip lojistik regresyon analizi yapildi. Multivariye modellerin hepsi ayrica yas ayarlamasina tabi tutuldu. Istatistikler Windows icin SPSS-10 programi kullanilarak yapildi. Bulgular Kohort bireylerinin baslangictaki ortalama yasi 48.3 [+ or -] 12 yil, ortalama takip suresi 5.9 yildi (toplam 20.000 kisi-yili). Bu surede, 168'i erkekte olmak uzere, 324 yeni gelisen (insidan) KKH, 118'i erkekte olmak uzere, 223 yeni gelisen DM saptandi. Baslangicta kohortun tumunde ATPIII tanimli MS prevalansi %37.1 (erkekte %31.2, kadinda %42.8), TEKHARF tanimli MS prevalansi %40.5 (erkekte %41.4, kadinda %39.7) olarak bulundu. MS tanimi alanlarda komponentlerin prevalansi Metabolik sendromun iki taniminda 5 komponentin erkek ve kadinlardaki sikligi Tablo 1'de karsilastirmali olarak sunulmustur. Cinsiyet ayrimi yapilmadan degerlendirmede, HDL-kolesterol dusuklugu, yuksek kan basinci ve abdominal obezite her iki tanimda da kohortun buyuk cogunlugunda mevcuttur. TEKHARF taniminda abdominal obezite diger iki bileske ile ayni sikliga (%83'e) ulasmistir. Ayrica, hipertrigliseridemi prevalansi yalniz erkeklerde %65'e duserken, bozulmus aclik glukoz tani minin degismesi sonucu, bu komponent %39'luk prevalansa yukselmistir. Diyabeti ongormede MS tanimlari Baslangicta bulunan diyabetli kisiler dislandiktan sonra, yas ve cinsiyet ayarli MS tanimlarinin ikisi de diyabet gelismesini ayni nisbi riskle anlamli olarak ongordu (ATPIII 2.85 [%95GA 2.14; 3.80]; TEKHARF 2.84 [%95GA 2.13; 3.81]. Erkekte 118 diyabeti ongormede TEKHARF tanimli MS 2.33 [%95GA 1.58; 3.45] ile ATPIII'e 2.02 [%95GA 1.37; 2.96] kiyasla daha ustunken, kadinda 105 diyabeti ongormede tersi gecerliydi: 3.59'a [%95GA 1.32; 5.55] karsi ATPIII ile 4.54 [%95GA 2.85; 7.23]. Koroner hastaligi ongormede MS tanimlari Baslangicta bulunan KKH'li katilimcilar dislandiktan sonra, yas ve cinsiyet ayarli MS tanimlarinin ikisi de KKH gelismesini benzer nisbi riskle anlamli olarak ongordu (ATPIII kohortun %36'sinda 2.10 [%95GA 1.64; 2.68]; TEKHARF tanimi kohortun %39.6'sinda 1.90 [%95GA 1.49; 2.43] (Tablo 2). Erkekte 168 KKH'yi ongormede kohortun %40'ini kapsayan TEKHARF tanimli MS 2.07 [%95GA 1.47; 2.91] ile kohortun %30'unu kapsayan ATPIII'e 2.04 [%95GA 1.46; 2.86] kiyasla daha ustunken, kadinda 156 KKH'yi ongormede yine tersi gecerliydi: 1.74'e [%95GA 1.22; 2.47] karsi ATPIII ile 2.16 [%95GA 1.51; 3.10]. Insidan KKH'nin ongorulmesini ayrica 3 farkli modifikasyonlu tanim icin denetledik (Tablo 2). Erkeklerde TEKHARF tanimi (veya bunda bozuk aclik glukoz siniri icin 110 mg/dl alinmasi) ATPIII tani mina gore %37 oraninda daha fazla toplum bazinda mutlak ongoru degerine sahipti. Kadinlarda abdominal obezite sinir secenekleri nisbi riski ya da toplum bazinda mutlak ongoru degerini onemli olcude etkilemezken, HDL-kolesterol olcutunun 45 yerine 50 mg/dl, bozuk aclik glukoz siniri icin de 110 yerine 100 mg/dl olarak kullanilmasi daha iyi mutlak ongoru sagliyordu. Yetiskinlerimizde MS icin en iyi KKH ongorusu saglayan ATPIII tanimi modifikasyonuna (aclik kan glukozunun [greater than or equal to] 100 mg/dl, ve erkeklerde bel cevresi [greater than or equal to] 95 cm) iliskin ongoru sonuclari yine Tablo 2'de sunulmaktadir. Cinsiyette anlamli farklilik gorulmeyen nisbi risk, toplu olarak 2.19 [%95GA 1.70; 2.81] boyutundadir. KKH riski acisindan MS komponentlerinin nisbi riski TEKHARF tanimli MS'un bileskelerinin 5'inin birden yasla birlikte lojistik regresyon modeline katilmasinin erkekle kadin icin ayri ayri sonuclari Tablo 3'te ozetlenmistir. HDL-kolesterol ile bozuk glukoz regulasyonunun hicbir cinsiyette bagimsiz ongoruye yol acmamasina karsilik, yuksek KB ozellikle kadinda, trigliserid de ozellikle erkekte anlamli ongoru saglamaktadir. Abdominal obezite kadinda bagimsiz ongoruye sahipken, erkekte bel cevresinin bagimsiz bicimde anlamli cikmamasina karsilik aclik trigliseridlerinin anlamli bulunmasi, abdominal obezitenin bagimsizligini serum trigliseridlerinin ustlendigini gostermektedir. MS'un KKH riskini yukselten bazi etkenler TEKHARF tanimli MS'un veritabanimizda 10-yila projeksiyonlu mutlak riski %25.8 idi (MS bulunmayanlarda %11.4). Arastirmamiz icin dikotomize edilen risk faktorlerinden apo B [greater than or equal to] 120 mg/dl, CRP [greater than or equal to] 2.0 mg/l, HOMA indeksi [greater than or equal to] 2.1, yas [greater than or equal to] 50, sigara icim durumu, total/ HDL-kolesterol orani >5.0 denetlenmis ve ozellikle 10-yillik mutlak riskleri hesaplanmistir. Secilen sinir degerleri orneklemi yaklasik olarak iki esit dilime boluyordu, sadece apo B siniri 65 persentilden geciyordu ama yuksek olarak genel kabul goren bir sinirdi. C-reaktif protein ve HOMA, ayrica yas-ayarli lojistik regresyon analizine tabi tutulmustur. Tablo 4'te gorulmektedir ki, sadece yas [greater than or equal to] 50, HOMA >2.1 ve CRP [greater than or equal to] 2.0 mg/l (ve kadinda apo B >120 mg/dl) MS'lu bireylerin mutlak riskini anlamli bicimde yukseltmektedir. Yas-ayarli regresyon analizinde, gerek HOMA, gerekse CRP'nin gozlemlenen nisbi riski anlamliliga ulasmamistir. Halkimizin koroner hastalik insidansi icin MS'un etkisi Takip suresinde fatal ve fatal olmayan KKH'nin gelistigi 324 kisiden 211'i (%65.1), bu calismada yeni onerilen TEKHARF tanimli MS'ten kaynaklanmaktadir. Bu oran erkeklerimizde %61.3 (168 kisiden 103'u) iken, kadinlarda %69.2 (156 kisiden 108'u) mertebesindeydi. Tartisma TEKHARF kohortunun 1998'den sonraki takibinde ATPIII tani mli ve TEKHARF tanimli MS'un yeni gelisen DM ve KKH'yi ongordurmedeki degerinin karsilastirildigi bu prospektif populasyona dayali calismada, erkeklerde TEKHARF tanimli MS'un, kadinlarda--HDL-kolesterol sinir degeri nedeniyle--ATPIII tanimli MS'un daha degerli oldugu anlasildi. TEKHARF tanimli MS prevalansi calisma baslangicinda erkeklerde %41.4, kadinlarda %39.7 olarak bulundu. TEKHARF tanimli MS'lu bireylerde daha yuksek risk tasiyan altgrup icin her iki cinsiyette de yasin [greater than or equal to] 50 olmasi saptandi. Halkimizda MS icin ATPIII taniminda aclik glukozu [greater than or equal to] 100 mg/dl modifikasyonu ile erkeklerde bel cevresi [greater than or equal to] 95 cm kriteri benimsenmelidir. Metabolik sendromun akibetini inceleyen onceki calismamiza (5) gore, eldeki inceleme 1.4 kat daha genis bir orneklemin 2 kat uzun bir ortalama izleme suresine ve 2.5 kat yuksek KKH sayisina dayandigindan, daha guvenilir ve anlamli bulgulara ulasmak beklenir. Ustelik, onceki calismada incelenmeyen MS-DM iliskisinin bu kez ele alinmasi, inceleme ufkunu genisletmektedir. DM ve KKH ongorusunde iki MS tanimi Karsilastirmaya girismeden once, toplumumuzda diyabeti bulunmayan MS'lularda yas-ayarli diyabeti ongorme riskinin, MS'u bulunmayanlara kiyasla 3-4 kat oldugu, bu calismadan cikmaktadir. Batili toplumlarda bu riskin yaklasik 5 kat oldugu (2,14-16) bildirilmistir. Bizde bir ozellik de, bu kesimde diyabet riskinin kadinlarda erkeklere gore iki kat yuksek bulunmasidir ki, asagida irdelenecektir. Erkek ve kadinlar birlikte ele alininca her iki MS tanimi da KKH ongorusunde 2.2'lik guclu bir yas-ayarli nisbi risk saglamistir. Bir onceki analizimizde (5), ilgili nisbi riskin 1.71 oldugu hatirlanirsa, bu defa nisbi risk %30 oraninda daha yuksek cikmistir. MS'un KKH nisbi riski ilerleme safhasina bagli olarak 1.5 ila 3.0 olarak ozetlenmistir (2). Iki kat uzun takip suremizin bunda onemli bir rolu oldu-gu one surulebilir, cunku progresif nitelikli MS'un kisa donemden cok, uzun vadede KKH ve DM riski yaratacagi vurgulanmistir (2). Tum KKH'ni degil de, yalniz kardiyovaskuler mortaliteyi inceleyen San Antonio San Antonio (săn ăntō`nēō, əntōn`), city (1990 pop. 935,933), seat of Bexar co., S central Tex., at the source of the San Antonio River; inc. 1837. Kalp calismasinda (17) NCEP-MS icin yas-ayarli riskin 2.01 saptanmasi ile de bulgularimiz uyum halindedir. Turk erkeklerinde TEKHARF tanimli MS'un daha yuksek prediktif deger tasidigi kuskusuzdur. Bu, tanimin 1/3 oraninda daha fazla erkegi kapsamasindan, buna bu·na n. A synthetic rubber made from the polymerization of butadiene and sodium. [Originally a trademark.] Noun 1. ragmen de yas-ayarli nisbi riskin DM icin %15 daha yuksek olusundan anlasilmaktadir. Boylece, valide edilmis olan TEKHARF tanimi disinda, MS kriterleri (spesifik olarak bel cevresi 95 degil de, 102 cm) kullanmanin yani ltici olacagi hekimlerimizce bilinmelidir. Metabolik sendromun en onemli unsuru olan abdominal obezite prevalansinin MS'lu erkekte ATPIII taniminda %56 gibi hayli dusuk bir orandan, %85 gibi makul bir orana gelmesi de, kriterin gecerliligi icin bir gostergedir. Kadinlarimizda TEKHARF tanimli MS'in yas-ayarli nisbi riski DM icin 3.59, KKH icin de 1.74 ile anlamli olmakla birlikte, ATPIII tanimli MS'e kiyasla her iki bakimdan 1/5 oraninda daha az guclu cikti. KKH ongorusuyle ilgili sonucta--abdominal obezite veya prediyabet kriterinin degil de--HDL-kolesterol kriterinin <45 mg/dl'ye cekilerek daha daraltilmasinin baskin rol oynadigi anla-silmistir. Metabolik sendrom Genetik Epidemiyoloji Projesi'nde (18) Turk kadini ile erkegi arasinda HDL-kolesterol 25'inci persentil degerleri arasinda sadece 5 mg/dl'lik fark bulunmasi, kadinda HDL-kolesterol kriterini 45 mg/dl'a cekmemize baslica gerekce teskil etmisti. Fakat eldeki prospektif calismamizda bu varsayim valide edilememesi, 50 mg/dl sinirinin ayni nisbi riski sergilemesine karsilik daha kapsamli olmasi, bu sinirin uygunlugunu gostermektedir. Dolayisiyla, Turk kadinlari icin MS taniminda ATPIII kriterlerinin (1) prediyabet icin modifikasyonlu kriterinin kullanilmasi uygundur; abdominal obezite kriterinin yukari cekilmesi onemli fark yaratmayacak bir secenektir. Diyabet ongorusunde yalniz iki tanimli inceleme yaptigimiz, ek secenekleri ele almadigimiz icin, ATPIII kriterlerinin daha iyi cikmasinda glukoz, bel cevresi ve HDL-kolesterol sinir deger farkliliklarindan hangisinin baskin oldugunu soylemek guctur. Ancak, bunun HDL-kolesterol olmadigini yine bu dergiye yakinda sundugumuz diyabetle ilgili bir prospektif calismadan soyleyebiliriz; cunku glukozun dahil olmadigi bir regresyon modelinde abdominal obezite diyabetin baslica ongordurucusuydu. Hangi hangi Noun NZ 1. an open-air cooking pit 2. the food cooked in it 3. the social gathering at the resultant meal [Maori] MS'lu bireylerde KKH riski yuksektir? Total/HDL kolesterol oraninin >5.0 olmasi MS mutlak riskine anlamli bir katkida bulunmamis, apo B duzeyinin >120 mg/dl olmasi da yalniz kadinlarda anlamli bir katki getirmistir. Her ne kadar HOMA indeksinin >2.1, CRP duzeyinin de [greater than or equal to] 2.0 mg/dl olmasi, MS'lu bireyin daha yuksek risk tasidigini ifade etse de, bunlarin kismen yas uzerinden olustugu soylenebilir ve sonucta yasin [greater than or equal to] 50 olmasi yuksek risk icin en uygun ve en pratik kriter olarak tanimlanabilir. Mutlak KKH riskinin [greater than or equal to] 50 yasindaki erkekte yilda %4, kadinda yilda %3.5-4 olduguna dikkat cekmekte isabet var. Genel tedavi prensiplerine gore, bu kisilere zayiflama ve egzersiz onlemlerinin yani sira, ilacla (statin stat·in n. Any of a class of drugs that inhibit a key enzyme involved in the synthesis of cholesterol and promote receptor binding of LDL cholesterol, resulting in decreased levels of serum cholesterol. ve/veya fibrat, antihipertansif veya yeni gelistirilecek ilaclar) mudahalenin de gerektigi aciktir. Yuksek KKH riskine iliskin bu [greater than or equal to] 50 yas gozlemi, daha onceki arastirmamizda da (19) saptanmis ve Turk Kardiyoloji Dernegi Koroner Kalp Hastaligindan Korunma ve Tedavi Kilavuzunda (20) yer almisti. Daha genis arastirmanin ilk bulguyu desteklemesi gecerliligini vurgulayan bir husustur. Riski daha yuksek cikan MS'a, ulkemizde yilda 200 bin yeni koroner olay bagli Kriterleri ve tanimlari belirlerken verilerden birey icin cikan nisbi risk ile bu tanimin toplumda yakaladigi toplam birey sayisini (toplumdaki payi) ayri ayri goz onunde tutmak gerekir. Bu iki unsur birbirine ters gidebilir, kriterin yukseltilmesi ongoruyu artirirken ozgullugu ya da kapsadigi birey sayisi azalabilir. Bu durumda agir basan kriteri tercih etmek dogru olabilir. Metabolik sendromun prevalansi onceki prospektif calismamizda %33, nisbi riski de 1.71 bulunmustu (5); bu incelemede, prediyabet icin aclik glukozu [greater than or equal to] 100 mg/dl iceren kriterlerle, erkekte bel cevresi icin [greater than or equal to] 95 cm modifikasyonlu ATPIII tanimi uygulaninca, prevalans %42, nisbi risk de 2.2 olarak saptandi. Bu demektir ki, yeni kriterler bir yandan %27 oraninda daha fazla yetiskini kapsamakta, ote yandan %28 oraninda daha yuksek KKH riski ongormektedir, yani %62 oraninda daha fazla toplum bazinda mutlak ongorucu degere sahiptir. Bu bilgi halkin kalp sagligi acisindan saglik politikasini etkilemesi beklenen onemli bir katkiyi temsil etmektedir. Turk yetiskinlerinde her yil gelisen 310 bin yeni koroner olay tahminine (9) dayanarak, bunlardan yilda 200 bininin MS zemininde gelistigi tahmin edilebilir. Boylece, MS'e bagli yilda 120 bin KKH gelistigine yonelik 4-5 yil onceki tahminimizden (5) hayli daha fazla oldugu yargisina varilmaktadir. MS komponentlerinin nisbi KKH riski Komponentlerden ucunun toplumumuzda bagimsiz riske sahip oldugu bu calismada ortaya konmustur; bunlar yuksek KB, abdominal obezite ve yuksek trigliserid duzeyleridir. Sonuncusu, 1990 taramasinin esas alindigi ve yeni yayinlanan calismada (21) oldugu gibi, yalniz erkeklerde anlamli bagimsizlik sergilemistir. Abdominal obezite ise, KKH riski icin kadinlarda diger risk faktorlerinden bagimsiz anlamli katki yaparken, erkekte bu katkiyi serum trigliseridleri ustlenmektedir. HDL-kolesterol iki cinsiyette de KKH riskine--bel ve trigliseridden--bagimsiz katkida bulunmamaktadir, aynen bozulmus glukoz regulasyonu gibi. Metabolik sendrom tanisinda gerekli bir olcut olan plazma trigliseridlerinin olculmedigi katilimcilarin kucuk bir bolumunde MS'in bir sonraki tanimina bakarak belirlenmesi bir kisitlama ise de, bu hem her iki tanim icin de gecerli olup, hem de ancak dilusyon yanilgisina surukleyerek kardiyometabolik risk boyutunun bastirilmasina yol acabilirdi. Buna karsilik, halkimizi temsil eden populasyona dayali bir taramanin one donuk bicimde incelenmesi, orneklemin genisligi ve takip suresinin yeterliligi elde edilen sonuclar yonunden calismanin guclu yanlarini olusturmaktadir. Sonuc olarak, bu prospektif calismada, kardiyometabolik riski ongordurmede erkeklerde TEKHARF tanimli MS'un, kadinlarda ATPIII tanimli MS'un daha degerli oldugu anlasildi. Halkimizda MS icin ATPIII tanimina aclik glukozu [greater than or equal to] 100 mg/dl ile erkeklerde bel cevresi [greater than or equal to] 95 cm modifikasyonu getiren tanim benimsenmelidir. Bu tanimin ulkemizde yaygin olarak benimsenmesi, risk degerlendirmede daha saglikli olmaya imkan taniyacaktir. Yeni tanimli MS daha cok kiside daha fazla ongorucu degere sahiptir. Yasin [greater than or equal to] 50 olmasi, her iki cinsiyette daha yuksek KKH riski tasindiginin guvenilir ve en pratik bir gostergesidir. Tesekkurler: TEKHARF Calismasini yillar boyunca destekleyen basta Turk Kardiyoloji Dernegi olmak uzere, cesitli ilac sirketlerine sukran borcluyuz. Kismi lojistik destekleri icin Saglik Bakanli gina tesekkur ederiz. Yine tarama ekiplerinde yillarca yer alan elemanlarimizin calismalarini takdir ediyoruz. Kaynaklar (1.) Executive Summary of the Third Report of the National Cholesterol Education Program The National Cholesterol Education Program is a program managed by the National Heart, Lung and Blood Institute, a division of the National Institutes of Health. Its goal is to reduce increased cardiovascular disease rates due to hypercholesterolemia (elevated cholesterol (NCEP) Expert Panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA JAMA abbr. Journal of the American Medical Association 2001; 285: 2486-97. (2.) Grundy SM. Metabolic syndrome: connecting and reconciling cardiovascular cardiovascular /car·dio·vas·cu·lar/ (-vas´ku-ler) pertaining to the heart and blood vessels. car·di·o·vas·cu·lar adj. Abbr. and diabetes worlds. J Am Coll Cardiol 2006; 47: 1093-100. (3.) Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus diabetes mellitus Disorder of insufficient production of or reduced sensitivity to insulin. Insulin, synthesized in the islets of Langerhans (see Langerhans, islets of), is necessary to metabolize glucose. In diabetes, blood sugar levels increase (hyperglycemia). and its complications. Part 1: diagnosis and classification of diabetes mellitus; provisional Temporary; not permanent. Tentative, contingent, preliminary. A provisional civil service appointment is a temporary position that fills a vacancy until a test can be properly administered and statutory requirements can be fulfilled to make a permanent appointment. report of a WHO consultation. Diabet Med 1998; 15: 539-53. (4.) Alberti KG, Zimmet P, Shaw J. IDF (Intermediate Distribution Frame) A wiring rack located between the MDF (main distribution frame) and the intended end user devices (telephones, routers, PCs, etc.). Cables run from the outside world to the MDF and then to the IDFs. See MDF and wiring rack. Epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause Task Force Consensus Group. The metabolic met·a·bol·ic adj. Of, relating to, or resulting from metabolism. Metabolic Refers to the chemical processes of an organ or organism. syndrome--a new world-wide definition. Lancet lancet /lan·cet/ (lan´set) a small, pointed, two-edged surgical knife. lan·cet n. 2005; 366:1059-62. (5.) Onat A, Ceyhan K, Basar O, Erer B, Toprak S, Sansoy V. Metabolic syndrome: major impact on coronary coronary /cor·o·nary/ (kor´o-nar?e) encircling like a crown; applied to vessels, ligaments, etc., especially to the arteries of the heart, and to pathologic involvement of them. cor·o·nar·y adj. risk in a population with low cholesterol levels--a prospective and cross-sectional evaluation. Atherosclerosis atherosclerosis (ăth'ərōsklərō`sĭs): see arteriosclerosis. atherosclerosis or hardening of the arteries 165: 285-92, 2002. (6.) Onat A, Hergenc G, Turkmen S Turkmen Member of a Central Asian people belonging to the southwestern branch of the Turkic linguistic group. At the beginning of the 21st century, they numbered more than six million, and most lived in Turkmenistan and adjacent parts of Central Asia. , Yazici M, Sari I, Can G. Discordance discordance /dis·cor·dance/ (dis-kord´ans) the occurrence of a given trait in only one member of a twin pair.discor´dant dis·cor·dance n. between Insulin resistance Insulin Resistance Definition Insulin resistance is not a disease as such but rather a state or condition in which a person's body tissues have a lowered level of response to insulin, a hormone secreted by the pancreas that helps to regulate the level and metabolic syndrome: features and associated cardiovascular risk in adults with normal glucose regulation. Metabolism metabolism, sum of all biochemical processes involved in life. Two subcategories of metabolism are anabolism, the building up of complex organic molecules from simpler precursors, and catabolism, the breakdown of complex substances into simpler molecules, often 2006; 55: 445-52. (7.) Onat A, Uyarel H, Hergenc G, Karabulut A, Albayrak S, Can G. Determinants and definition of abdominal obesity as related to risk of diabetes, metabolic syndrome and coronary disease in Turkish men: a prospective cohort study A cohort study is a form of longitudinal study used in medicine and social science. It is one type of study design. In medicine, it is usually undertaken to obtain evidence to try to refute the existence of a suspected association between cause and disease; failure to refute . Atherosclerosis 2006; May 7; [Epub ahead of print]. (8.) Onat A, Sari I, Hergenc G, Yazici M, Can G, Uyarel H, et al. Predictors of and consequences in relation to the degree of abdominal obesity among Turkish women: a prospective population-based study. (In press 2007) (9.) Onat A, Sansoy V, Hergenc G, Soydan I, Adalet K. Halkimiza iliskin temel veri uretiminden evrensel tibba katkiya. In: Onat A, editor. Turk Eriskinlerinde Kalp Sagligi: Istanbul; Argos Iletisim: 2005. s. 166. (10.) Hense HW, Stieber J. Blutdruck-Messkurs. Heidelberg; GSF-MEDIS Institut: 1988. (11.) Onat A, Avci GS, Barlan MM, Uyarel H, Uzunlar B, Sansoy V. Measures of abdominal obesity assessed for visceral visceral /vis·cer·al/ (vis´er-al) pertaining to a viscus. vis·cer·al adj. Relating to, situated in, or affecting the viscera. visceral pertaining to a viscus. adiposity adiposity /ad·i·pos·i·ty/ (ad?i-pos´i-te) obesity. cerebral adiposity fatness due to cerebral disease, especially of the hypothalamus. adiposity obesity. and relation to coronary risk. Int J Obes 2004; 28: 1018-25. (12.) Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, et al. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2003; 26: 3160-7. (13.) Rose GA, Blackburn H, Gillum RF, Prineas RJ. Cardiovascular Survey Methods, 2nd edition. Geneva Geneva, canton and city, Switzerland Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. , WHO, 1982. p 124-27. (14.) Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA. Metabolic syndrome and development of diabetes mellitus: application and validation See validate. validation - The stage in the software life-cycle at the end of the development process where software is evaluated to ensure that it complies with the requirements. of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol 2002; 156: 1070-7. (15.) Lorenzo C, Okoloise M, Williams K, Stern MP, Haffner SM. The metabolic syndrome as a predictor of type 2 diabetes: the San Antonio Heart study. Diabetes Care 2003; 26: 3153-9. (16.) Schmidt MI, Duncan BB, Bang H, Pankow JS, Ballantyne CH, Golden SH, et al. The Atherosclerosis Risk in Communities investigators. Identifying individuals at high risk for diabetes: The Atherosclerosis Risk in Communities study. Diabetes Care 2005; 28: 2013-8. (17.) Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP. National Cholesterol Education Program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart study. Circulation 2004; 110: 1251-7. (18.) Wyszynski DF, Waterworth DM, Barter barter: see exchange. barter Direct exchange of goods or services without the use of money or any other intervening medium of exchange. Barter is conducted either according to established rates of exchange or by bargaining. PJ, Cohen cohen or kohen (Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male. J, Kesaniemi YA, Mahley RA, et al. Relation between atherogenic dyslipidemia and the Adult Treatment Program-III definition of metabolic syndrome (Genetic Epidemiology of Metabolic Syndrome Project). Am J Cardiol 2005; 95: 194-8. (19.) Onat A, Sansoy V. Halkimizda koroner hastaligin bassuclusu metabolik sendrom: koroner risk ile iliskisi ve yuksek risk kriterleri. Turk Kardiyol Dern Ars 2002; 30; 8-15. (20.) Turk Kardiyoloji Dernegi Koroner Kalp Hastaligi Korunma ve Tedavi Kilavuzu. TKD TKD Tae Kwon Do (martial art) TKD Türk Kütüphaneciler Dernegi (Turkish Librarians' Association) TKD Türk Kardiyoloji Dernegi (Turkish Cardiology Association) Yayinlari, Istanbul; Yenilik Basimevi: 2003. s 13. (21.) Onat A, Sari I, Yazici M, Can G, Hergenc G, Avci GS: Plasma triglycerides Triglycerides Fatty compounds synthesized from carbohydrates during the process of digestion and stored in the body's adipose (fat) tissues. High levels of triglycerides in the blood are associated with insulin resistance. , an independent predictor of cardiovascular disease Cardiovascular disease Disease that affects the heart and blood vessels. Mentioned in: Lipoproteins Test cardiovascular disease in men: a prospective study based on a population with prevalent metabolic syndrome. Int J Cardiol 2006; 108: 89-95. Yazisma Adresi: Prof. Dr. Altan Onat, Nisbetiye cad. 37/24, Etiler 34335, Istanbul, Turkey Tel.: 0212 351 62 17 Fax: 0212 351 42 35 E-mail: alt_onat@yahoo.com.tr Altan Onat (1,2), Gulay Hergenc (3), Gunay Can (4) Turk Kardiyoloji Dernegi (1), Istanbul Universitesi Cerrahpasa Tip Fakultesi, Kardiyoloji (2) ve Halk Sagligi (4) Anabilim Dali, Yildiz Teknik Universitesi, Biyoloji Bolumu (3,) Istanbul, Turkiye
Tablo 1. Iki tanimli MS'li katilimcilarda komponentlerin cinsiyete
gore prevalansi
Genel
MS ATPIII sayi %
HDL-K <40/50 mg/dl 1088 89.0
Bel >102/88 cm 944 75.3
Bozuk Gluk Reg 110 mg/dl 307 24.3
Trigliserid >150 mg/dl 499 65.4
Yuksek KB [greater than or equal to]130/85 mmHg 1121 88.9
MS TEKHARF
HDL-K <40/50 mg/dl 996 83.6
Bel [greater than or equal to]95/91 cm 1119 83.4
Bozuk Gluk Reg 100 mg/dl 521 38.8
Trigliserid >150 mg/dl 546 61.8
Yuksek KB [greater than or equal to]130/85 mmHg 1141 82.4
Erkek
MS ATPIII sayi %
HDL-K <40/50 mg/dl 455 89.7
Bel >102/88 cm 290 55.8
Bozuk Gluk Reg 110 mg/dl 118 22.5
Trigliserid >150 mg/dl 209 76.3
Yuksek KB [greater than or equal to]130/85 mmHg 470 89.5
MS TEKHARF
HDL-K <40/50 mg/dl 532 87.1
Bel [greater than or equal to]95/91 cm 569 84.8
Bozuk Gluk Reg 100 mg/dl 224 33.4
Trigliserid >150 mg/dl 271 64.7
Yuksek KB [greater than or equal to]130/85 mmHg 548 78.2
Kadin
MS ATPIII sayi %
HDL-K <40/50 mg/dl 633 88.5
Bel >102/88 cm 654 89.2
Bozuk Gluk Reg 110 mg/dl 189 25.7
Trigliserid >150 mg/dl 290 59.3
Yuksek KB [greater than or equal to]130/85 mmHg 651 88.5
MS TEKHARF
HDL-K <40/50 mg/dl 464 80.0
Bel [greater than or equal to]95/91 cm 550 82.0
Bozuk Gluk Reg 100 mg/dl 297 44.2
Trigliserid >150 mg/dl 275 59.3
Yuksek KB [greater than or equal to]130/85 mmHg 593 86.7
MS'i olan ve olmayanlarda risk faktor prevalansi daima p<0.001
Gluk Reg- glukoz regulasyonu, HDL- yuksek yogunluklu lipoprotein,
KB- kan basinci, MS- metabolik sendrom
Tablo 2. KKH'si dislanmis orneklemde 324 insidan KKH'nin cesitli
MS Tanim modifikasyonlariyla ongorulmesi
Genel n = 3230 ([paragraph])
Yas ayarli MS n * RR GA
ATPIII tanimi 1162 2.10 1.64; 2.68
ATPIII tanimi + AKS 100 mg/dl 1222 2.19 1.71; 2.81
TEKHARF AKS 100 mg/dl + bel 1278 1.90 1.49; 2.43
[greater than or equal to]
91cm + HDL <45 mg/dl
ATPIII tanimi + bel [greater 1181 2.04 1.60; 2.60
than or equal to] 91 cm +
HDL < 45 mg/dl
ATPIII tanimi + bel [greater 1241 2.20 1.71; 2.81
than or equal to] 91 cm +
HDL < 50 mg/dl
Onerilen tanim ([dagger]) 1358 2.19 1.70; 2.81
Erkek n = 1588
Yas ayarli MS n * RR GA
ATPIII tanimi 474 2.04 1.46; 2.85
ATPIII tanimi + AKS 100 mg/dl 503 2.08 1.49; 2.92
TEKHARF AKS 100 mg/dl + bel 639 2.07 1.47; 2.91
[greater than or equal to]
91cm + HDL <45 mg/dl
ATPIII tanimi + bel [greater 593 2.23 1.59; 3.13
than or equal to] 91 cm +
HDL < 45 mg/dl
ATPIII tanimi + bel [greater 593 2.23 1.59; 3.13
than or equal to] 91 cm +
HDL < 50 mg/dl
Onerilen tanim ([dagger]) 639 2.07 1.47; 2.91
Kadin n = 1642
Yas ayarli MS n * RR GA
ATPIII tanimi 688 2.16 1.51; 3.10
ATPIII tanimi + AKS 100 mg/dl 719 2.33 1.61; 3.37
TEKHARF AKS 100 mg/dl + bel 639 1.74 1.22; 2.47
[greater than or equal to]
91cm + HDL <45 mg/dl
ATPIII tanimi + bel [greater 588 1.85 1.31; 2.63
than or equal to] 91 cm +
HDL < 45 mg/dl
ATPIII tanimi + bel [greater 648 2.17 1.52; 3.10
than or equal to] 91 cm +
HDL < 50 mg/dl
Onerilen tanim ([dagger]) 719 2.33 1.61; 3.37
([dagger]) ATPIII tanimi, AKS >100 mg/dl, erkekte bel >95 cm
([paragraph]) Baslangoctaki KKH' si disllanmis
Bel modifikasyonlu ATPIII tanimi seceneklerinde erkekte daima
[greater than or equal to]95 cm kullanildi
AKS- aclik kan sekeri, GA- guven araligi, HDL- yuksek yogunluklu
lipoprotein, KKH- koroner kalp hastaligi, MS- metabolik sendrom,
RR- nisbi risk
Tablo 3. Insidan KKH'nin yas ayarli MS ogelerince ongorulmesi
(n = 2007)
Erkek
RR GA
Yuksek KB [greater than or equal to] 130/85 mmHG 1.61 0.952; 2.71
Aclik trigliseridi >150 mg/dl 1.89 1.15; 3.12
Bel cevresi [greater than or equal to] 95/91 cm 1.10 AD
HDL-K <40/45 mg/dl 1.25 AD
Bozuk glukoz regul. >100 mg/dl 1.22 AD
Kadin
RR GA
Yuksek KB [greater than or equal to] 130/85 mmHG 2.77 1.47; 5.19
Aclik trigliseridi >150 mg/dl 1.71 1.09; 2.67
Bel cevresi [greater than or equal to] 95/91 cm 2.02 1.25; 3.27
HDL-K <40/45 mg/dl 1.20 AD
Bozuk glukoz regul. >100 mg/dl 1.25 AD
Analize 926 erkek ile 1081 kadin girdi, 87 ve 105 bireyde KKH gelisti
AD- anlamli degil, GA- guven araligi, HDL- yuksek yogunluklu
lipoprotein, K- kolesterol, KB- kan basinci, KKH- koroner kalp
hastaligi, MS- metabolik sendrom, regul.-regulasyon, RR- nisbi risk
Tablo 4. MS'li bireylerde sinir ustu degerli parametrelere gore
10-yillik mutlak insidan KKH riski (AR) *
Genel
n p
([paragraph]) AR % ([dagger])
Yas [greater than or equal 152/670 38.5 0.001
to] 50 yil
HOMA >2.1 55/247 37.8 0.024
CRP >2.0 mg/l 112/606 31.4 0.013
Apolipoprotein B >120 mg/dl 76/448 28.8 0.051
TC/HDL-K orani >5/4.5 129/841 25.9 0.81
Erkek
n p
([paragraph]) AR % ([dagger])
Yas [greater than or equal 77/321 40.7 0.001
to] 50 yil
HOMA >2.1 25/110 38.5 0.10
CRP >2.0 mg/l 49/251 33.1 0.082
Apolipoprotein B >120 mg/dl 31/215 24.4 0.94
TC/HDL-K orani >5/4.5 70/427 27.8 0.85
Kadin
n p
([paragraph]) AR % ([dagger])
Yas [greater than or equal 75/349 36.4 0.001
to] 50 yil
HOMA >2.1 30/137 37.1 0.118
CRP >2.0 mg/l 63/355 30.0 0.047
Apolipoprotein B >120 mg/dl 45/233 32.7 0.005
TC/HDL-K orani >5/4.5 59/414 24.2 0.91
* basit capraz-tabulasyon usuluyle
([dagger]) sinir alti degerli MS'liye gore p degeri
([paragraph]) Ilk rakam KKH sayisini, son rakam riske acik
MS'li birey sayisini gostermektedir
AR = 10-yillik mutlak KKH riski
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