Gender-modulated risk of coronary heart disease, diabetes and coronary mortality among Turks for three major risk factors, and residual adiposity risk.
BACKGROUND
We determined the proportion of the effects of body mass index (BMI) or its categories on cardiometabolic outcomes mediated through systolic blood pressure (SBP), total cholesterol and fasting glucose.


METHODS
Cox regression analyses were performed for incident outcomes among Turkish Adult Risk Factor study participants in whom the three mediators had been determined (n = 2158, age 48.5 ± 11 years). Over a mean 10.2-years' follow-up, new coronary heart disease (CHD) developed in 406, diabetes in 284 individuals, and 149 CHD deaths occurred.


RESULTS
Hazard ratios (HR) of BMI for incident diabetes were no more than marginally attenuated by the 3 mediators including glucose, irrespective of gender. Compared to "normal-weight", sex- and age-adjusted RRs for incident CHD of overweight and obesity were 1.40 and 2.24 (95 % CI 1.68; 2.99), respectively, in gender combined. Only three-tenths of the excess risk was retained by BMI in men, six-tenths in women. No mediation of glycemia was discerned in males, in contrast to greatest mediation in females. HR of age-adjusted continuous BMI was a significant but modest contributor to CHD mortality in each gender. While the BMI risk of CHD death was abolished by mediation of SBP in men, HR strengthened to over two-fold in women through mediation of fasting glucose.


CONCLUSIONS
Mediation of adiposity by 3 traditional factors exhibited among Turkish adults strong gender dependence regarding its magnitude for CHD risk and the mediation by individual risk factors. Retention of the large part of risk for diabetes in each sex and for CHD in women likely reflects underlying autoimmune activation.
Departments of Public Health, Istanbul University, Yazıcı sok. 18/5, Kocamustafapaşa, 34098, Istanbul, Turkey. gunaycan09@yahoo.fr.
Günay
G
Can
Departments of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
Altan
A
Onat
Departments of Public Health, Istanbul University, Yazıcı sok. 18/5, Kocamustafapaşa, 34098, Istanbul, Turkey.
Eray
E
Yurtseven
Department of Endocrinology and Metabolism, Ataturk University Faculty of Medicine, Erzurum, Turkey.
Yusuf
Y
Karadeniz
Bağcılar Educational Hospital, Istanbul, Turkey.
Tuğba
T
Akbaş-Şimşek
Departments of Biochemistry Laboratory, Institute of Cardiology, Istanbul University, Istanbul, Turkey.
Ayşem
A
Kaya
Departments of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
Hüsniye
H
Yüksel
Autoimmune activation; Body mass index; Coronary heart disease; Coronary mortality; Gender difference; Type-2 diabetes
Science. 1993 Jan 1;259(5091):87-91
7678183
JAMA. 2013 Jan 2;309(1):71-82
23280227
Int J Epidemiol. 2004 Aug;33(4):751-8
15105409
Mediators Inflamm. 2013;2013:136584
23843680
Lancet. 2011 Jul 2;378(9785):31-40
21705069
PLoS One. 2013 Jul 30;8(7):e65174
23935815
Am Heart J. 2010 Dec;160(6):1163-9
21146673
Circulation. 2004 Jan 27;109(3):433-8
14744958
Arch Intern Med. 2007 Sep 10;167(16):1720-8
17846390
Circulation. 2006 Feb 14;113(6):898-918
16380542
JAMA. 2007 Nov 7;298(17):2028-37
17986696
Nutr Metab Cardiovasc Dis. 2015 Mar;25(3):295-304
25315666
Lancet. 2011 Mar 26;377(9771):1085-95
21397319
JAMA. 2001 May 16;285(19):2486-97
11368702
Stat Med. 1997 Jul 15;16(13):1515-27
9249922
Circulation. 1996 Apr 1;93(7):1372-9
8641026
Nature. 2006 Dec 14;444(7121):875-80
17167476
Diabetes Care. 2003 Nov;26(11):3160-7
14578255
Arch Med Res. 2015 Oct;46(7):564-71
26415088
Metabolism. 2011 Apr;60(4):499-512
20580781
Lancet. 2014 Mar 15;383(9921):970-83
24269108
J Epidemiol Community Health. 1992 Oct;46(5):470-6
1479313
Lancet. 2009 Mar 28;373(9669):1083-96
19299006
Curr Pharm Des. 2014;20(4):575-84
23565630
Atherosclerosis. 2007 Mar;191(1):182-90
16678831
World J Diabetes. 2013 Oct 15;4(5):210-8
24147205
Heart. 2006 Jul;92(7):886-92
16269437