title: Little contribution of conventional factors in an algorithm to predicting death risk in Turkish adults.
abstract: OBJECTIVE
  Determinants of risk of death are highly relevant for the management strategy of individuals. We aimed to determine an algorithm for predicting risk of death in Turkish adults who have a high prevalence of metabolic syndrome (MetS).
  
  
  METHODS
  Nine-year risk of death was estimated in 3348 middle-aged adults, followed over 8.81±4.2years. Cox proportional hazard regression was used to predict risk of death. Discrimination was assessed using C-statistics.
  
  
  RESULTS
  Death occurred in 565 subjects. In multivariable analysis, high-density lipoprotein (HDL) and non-HDL cholesterol levels were not predictive in either sex; in women, current smoking was also not predictive. Age, presence of diabetes, systolic blood pressure ≥160mmHg and low physical activity were predictors in both sexes, beyond smoking status in men. Exclusion of coronary disease at baseline did not change risk estimates materially. Using an algorithm of the stated 7 variables showed an 11- to 18-fold spread in the absolute risk of dying among individuals in the highest than in the lowest of 4 risk score categories. C-statistics of the model using age alone was 0.790 in men, 0.808 in women (p<0.001 each), while the incorporation of 6 conventional risk factors contributed to C-index was >0.020 in males and 0.009 in females.
  
  
  CONCLUSIONS
  In a middle-aged population with prevalent MetS, serum lipoproteins and, in women, smoking status, were not relevant for the risk of death. The contribution of conventional risk factors beyond age to estimating risk of death was modest among Turkish men, and little in women in whom autoimmune activation is operative.
authors.affiliation: Department of Cardiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey. Electronic address: alt_onat@yahoo.com.tr.
authors.forename: Altan
authors.initials: A
authors.lastname: Onat
authors.affiliation: Department of Public Health, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Günay
authors.initials: G
authors.lastname: Can
authors.affiliation: Biochemistry Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Evin
authors.initials: E
authors.lastname: Ademoğlu
authors.affiliation: Biochemistry Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Kaya
authors.affiliation: Suruç State Hospital, Şanlıurfa, Turkey.
authors.forename: Eyyup
authors.initials: E
authors.lastname: Tusun
authors.affiliation: Department of Cardiology, Şanlıurfa Educational Hospital, Şanlıurfa, Turkey; Koç University Medical Faculty, Istanbul, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Ural
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008074:Lipoproteins / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000401:mortality*; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D008074:Lipoproteins
keywords: C-reactive protein; Diabetes type 2; Lipoproteins; Metabolic syndrome; Risk of death; Sex difference