Prospective epidemiologic evidence of a "protective" effect of smoking on metabolic syndrome and diabetes among Turkish women--without associated overall health benefit.

UNLABELLED: Sex-specific effects of cigarette smoking on the development of metabolic syndrome (MS) and diabetes (DM), concomitant with its clinical impact on CHD, were prospectively evaluated in a cohort of 3385 participants (mean age 48 years), representative of Turks. Heavy smoking denoted smoking 11 or more cigarettes daily. During a mean 5.9-year follow-up, 485 incident cases of MS and 216 of DM were diagnosed. Among women, baseline characteristics as a whole were similar. Smoking status was inversely associated with waist circumference (p=0.004) and predicted in women hyperinsulinemia (p=0.045) after adjustment for age and body mass index. In the prediction of MS, heavy smoking was significantly "protective" (RR 0.50 [95% CI 0.26; 0.94]) in women and in both genders combined, after adjustment for age, baseline family income bracket and physical activity grade. As predictor of new DM, heavy smoking was significantly "protective" (RR 0.54 [95% CI 0.35; 0.83]) in all adults and in women (RR 0.13 [95% CI 0.02; 0.97]), after similar adjustment. Additional adjustment for insulin and CRP levels hardly modified in women the RRs, though attenuated to borderline significance risk for MS and DM due to smaller sample size. Risks of incident CHD and overall mortality were significantly elevated in smoking men, but not in women, when adjusted for age, serum total cholesterol, elevated BP, DM and physical activity grade. CONCLUSIONS: Heavy cigarette smoking is "protective" of future MS and DM in Turkish women, mainly via protection from obesity. A separate modest effect on central obesity appeared independent of plasma insulin concentrations. Evidence of a translated beneficial effect on subsequent CHD or all-cause mortality did not emerge.

Serum carbohydrate antigen 125 levels in nonischemic dilated cardiomyopathy: a useful biomarker for prognosis and functional mitral regurgitation.

The authors investigated the prognostic relevance of serum carbohydrate antigen 125 (CA125) levels in nonischemic dilated cardiomyopathy (NICMP) and assessed whether increased levels relate to the degree of functional mitral regurgitation (FMR). Seventy-seven patients with NICMP were enrolled and followed-up for 10 ± 2 months in this prospective study. Receiver-operating characteristic analysis established a cutoff CA125 value of 25 U/mL for predicting mortality. Patients were divided into two groups according to their CA125 levels (CA125 <25 U/mL [n=58] and CA125 ≥ 25 U/mL [n=19]). Patients with high CA125 values had statistically worse functional status, higher B-type natriuretic peptide (BNP) levels, higher left ventricular volumes, lower ejection fraction, higher E/Em ratio, higher pulmonary artery systolic pressure, and more severe FMR. On the multivariate analysis, serum CA125 (P=.002) and severe FMR (P=.04) were identified as the independent predictors of mortality. Serum CA125 levels also correlated with BNP levels and FMR severity (P<.001). Serum CA125 is a powerful prognostic biomarker that is associated with the severity of heart failure, serum BNP levels and several echocardiographic parameters including left ventricular volumes, systolic and diastolic functions, pulmonary artery pressure, and the degree of FMR. Serum CA125 was also shown as an independent predictor of mortality during 10 ± 2 months of follow-up.

Association between mild renal dysfunction and insulin resistance or metabolic syndrome in a random nondiabetic population sample.

AIMS: The association of mild renal dysfunction (estimated glomerular filtration rate [eGFR] 60-89.9 ml/min/1.73 m(2)) with insulin resistance (IR) or metabolic syndrome (MS) needs be investigated in a population in which MS prevails. METHODS: After excluding subjects with diabetes mellitus, 1,678 subjects from a representative cohort (median age 52 years) were studied cross-sectionally. eGFR was based on serum creatinine concentrations using the quadratic GFR equation and categorized by 90 and 60 ml/min/1.73 m(2) as limits. MS was identified using the modified criteria of the Adult Treatment Panel-III. RESULTS: In men, whereas MS was not significantly associated with a reduced eGFR category when controlled for homeostatic model assessment (HOMA), HOMA adjusted for MS or for its components was significantly associated with the likelihood of a reduced eGFR. This likelihood was increased by 14% with a doubling of HOMA in men. Age was the dominant correlate of reduced eGFR in women, whereby an association with HOMA was not significant. CONCLUSION: Mildly impaired kidney function is common in nondiabetic adults among whom MS prevails, and in men it is mainly associated with IR but not with central obesity and MS-related dyslipidemia. The quadratic GFR equation enables an acceptable estimation of GFR in a general population.