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    Autoimmune activation as a determinant of atrial fibrillation among Turks A prospective evaluation
    (Lippincott Williams & Wilkins, 2018) Simsek, Baris; Altay, Servet; Ozbilgin, Nazmiye; Onat, Altan
    Although low-grade inflammation has been linked to the prediction of atrial fibrillation (AF), evidence from some reports suggest that autoimmune activation might potentially be a relevant mechanism. We assessed the predictive value of inflammation and other markers for the risk of incident AF. A score of age-controlled anthropometric, lipid, and nonlipid variables was compared in participants with recorded nonvalvular persistent/permanent AF (n=110) to those of a nested cohort sample (n=1126) of the Turkish Adult Risk Factor study. Available values preceding by 2 (1) years the development of AF were used regarding incident AF (n=87) in multivariable regression. Comparing age-controlled inflammation and other markers across the 2 groups, low apolipoprotein (apo) B and total cholesterol levels differed highly significantly in each sex. Moreover, low-density lipoprotein (LDL)-cholesterol and fasting insulin concentrations were significantly lower, sex hormone binding globulin (SHBG), glucose and systolic blood pressure higher in women alone, while C-reactive protein levels were similar. A model of multivariable logistic regression analyses for overall AF and 2 models for incident AF demonstrated a consistent inverse predictive value for apoB in each gender [relative risk (RR) 0.44 (95% confidence interval (CI), 95% CI 0.30-0.66], along with age, as main determinants. SHBG in females and waist circumference in males were further significantly associated with initial AF. Never smoking (compared with ever smoking) tended to predict AF. These findings, collectively, are highly consistent with an autoimmune process in which damaged epitope of apoB due to proinflammatory state emerge as a basic mechanism in the development of AF. ApoB level is likely only apparently reduced due to partial escape from assay.
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    High-Normal Thyroid-Stimulating Hormone in Euthyroid Subjects is Associated with Risk of Mortality and Composite Disease Endpoint only in Women
    (TERMEDIA PUBLISHING HOUSE LTD, 2018) Altay, Servet; Onat, Altan; Can, Gunay; Tusun, Eyyup; Simsek, Baris; Kaya, Adnan
    Introduction: The aim of the study was to evaluate whether serum thyroid-stimulating hormone (TSH) within the normal range in euthyroid subjects (having normal free triiodothyronine (fT3) and thyroxine (fT4)) is related to the risk of overall mortality or a composite endpoint of death and nonfatal events. Material and methods: In 614 middle-aged adult hospital screenees, free of uncontrolled diabetes at baseline, the association of sex-specific TSH tertiles with death was prospectively assessed using Cox regression, with the composite endpoint assessed using logistic regression in adjusted analyses, stratified by gender. Results: In total, 64 deaths and additional incident nonfatal events in 141 cases were recorded at a mean 7.55 years' follow-up. Multivariable linear regression revealed TSH to be significantly associated among men with age (p = 0.006), but in women inversely with fT3 and fT4 (p < 0.001, and p = 0.024 respectively). In logistic regression analysis, adjusted for age, fT3, fT4, systolic blood pressure and serum total cholesterol, sex-specific baseline TSH tertiles were associated in men neither with the risk of death nor with composite endpoint. In contrast, in women, the highest compared with the bottom TSH tertile predicted the risk of composite endpoint (relative risk: 2.02, 95% CI: 1.07-3.82) and, much more strongly, the mortality risk, independently of fT4 increments. Conclusions: The significant association of higher range of normal serum TSH in euthyroid middle-aged adults with the risk of death and nonfatal adverse outcomes in women alone cannot be accounted for by the action of thyroid hormone and is consistent with involvement of TSH in the pro-inflammatory state.