OBJECTIVE:The prevalence of obstructive sleep apnea syndrome (OSAS) and metabolic syndrome is increasing worldwide, in part linked to epidemic of obesity. The purposes of this study were to establish the rate of metabolic syndrome and to compare fibrinogen, homocysteine, high-sensitivity C-reactive protein (hsCRP), leptin levels, and homeostasis model assessment insulin resistance (HOMA-IR) in the obese patients with and without OSAS.METHODS:The study population included 36 consecutive obese patients with OSAS (23 males; mean age, 50.0 ±19.7 years), and 34 obese patients without OSAS (17 males; mean age, 49.7±11.1 years) were enrolled as control group. Metabolic syndrome was investigated; fibrinogen, homocysteine, CRP, and leptin levels were measured, and IR was assessed.RESULTS:Metabolic syndrome was found in 17 (47.2%) obese OSAS patients, whereas only 29.4% of obese subjects had metabolic syndrome (P > 0.05). Obese patients with OSAS had significantly higher mean levels of triglyceride (P < 0.001), total-cholesterol (P = 0.003), low-density lipoprotein-cholesterol (P = 0.001), fasting glucose (P = 0.01), HOMA-IR (P <0.001), thyroid-stimulating hormone (P = 0.03), fibrinogen (P < 0.003), hsCRP (P <0.001), and leptin (P = 0.03) than control group . Besides, leptin level was positively correlated with waist (r = 0.512, P = 0.03) and neck circumferences (r = 0.547, P = 0.03), and fasting glucose (r = 0.471, P = 0.04) in OSAS patients, but not in obese subjects.CONCLUSION:This study demonstrated that obese OSAS patients may have an increased rate of metabolic syndrome and higher levels of serum lipids, fasting glucose, IR, leptin, fibrinogen, and hsCRP than obese subjects without sleep apnea. Thus, clinicians should be encouraged to systematically evaluate the presence of metabolic abnormalities in OSAS and vice versa.

Cardiac valve evaluation and adipokine levels in obese women treated with sibutramine ABS TRACTObjective: The aims of present study were 1) to evaluate cardiac valve characteristics, 2) to determine the plasma concentrations of fibrinogen, high sensitivity C-reactive protein (hsCRP), adiponectin, and tumor necrosis factor-α (TNF-α) in the obese women before and after 19 months sibutramine treatment in the obese women. Methods: Sixty obese women were enrolled in this prospective, randomized study. Thirty women received 10 mg once daily dose of sibutramine for 19 months. The rest of the obese women received 15 mg once daily dose of sibutramine for 19 months. All patients were evaluated with echocardiography. Plasma levels of adiponectin and TNF-α were measured by enzyme-linked immunosorbent assay (ELISA) and hsCRP by immunoturbimetric assay. Student paired and unpaired t tests were used to compare the 10 mg or 15 mg dose sibutramine effects either in groups or between the groups. Results: There were no signs of significant regurgitation or thickening of the mitral and aortic valves on echocardiographic evaluation performed after 19 months of treatment. Parameters of systolic function after 10 or 15 mg treatment were not different from pretreatment characteristics. Minimal tricuspid regurgitation was found in one (1/27) patient treated with 10 mg sibutramine after 19 months. Among obese patients treated with 15 mg sibutramine one patient (1/28) had minimal mitral valve regurgitation and 2 patients (2/28) had minimal aortic insufficiency. Stage II diastolic dysfunction in the 15 obese treated with 15 mg regressed to stage I diastolic dysfunction (50%). Stage II diastolic dysfunction in the 10 obese treated with 10 mg regressed to stage I diastolic dysfunction (33.3%). Mean levels of TNF-α(p=0.04), fibrinogen (p=0.03) and hsCRP (p=0.04)i decreased and adiponectin (p=0.03) levels increased in the obese treated with 10 mg sibutramine. Likewise, in the patients treated with 15 mg sibutramine, mean levels of TNF-α(p=0.01), fibrinogen (p= 0.02), and hsCRP (p= 0.04) decreased and adiponectin (p= 0.02) levels increased. Conclusion: Nineteen months of sibutramine treatment does not affect heart valve and systolic functions, however, diastolic dysfunction severity reduced with sibutramine treatment. Also In addition, mean levels of adiponectin, TNF-α, fibrinogen and hs-CRP change with 19 months sibutramine treatment. (Anadolu Kardiyol Derg 2010; 10: 226-32)

Introduction: Elevated serum ferritin levels are associated with insulin resistance, type 2 diabetes and metabolic syndrome (MetS) as well as systemic inflammation and cardiovascular disease. The associations between ferritin and hemoglobin levels with individual components of MetS are unclear. The aims of the study were 1) to compare the ferritin levels, and 2) to investigate the relationships between ferritin, high-sensitivity CRP (hs-CRP), fasting glucose, fasting insulin and homeostasis model assessment (HOMA-IR) levels in elderly patients. Subjects and Methods: Study population included 121 (mean age 64.3 ± 14.1 yrs) (80 female, 41 male) elderly patients. The study population was evaluated for MetS by Adult Treatment Panel III (ATPIII). Demographic and biochemical data such as fasting insulin, hs-CRP, fasting glucose and ferritin levels were evaluated. Biochemical data were evaluated retrospectively. Insulin resistance (IR) was estimated using the HOMA. Results: Metabolic syndrome was diagnosed in 39 elderly patients (32.2%). In elderly patients with MetS, mean levels of ferritin, hs-CRP, fasting glucose, fasting insulin and HOMA were found to be 72.9 ± 33.1 ng/ml, 0.90 ± 0.01, 99.1 ± 20.1 mg/dl, 13.4 ± 1.1 µU/l, 3.0 ± 0.1, respectively. However, mean levels of ferritin, hs-CRP, fasting glucose, fasting insulin and HOMA were found to be 54.1 ± 33.1 ng/ml, 0.67 ± 0.1, 91.9 ± 17.0 mg/dl, 8.4 ± 2.7 µU/l, 2.71 ± 0.9, in the other elderly patients, (p = 0.0012), (p = 0.70), (p = 0.70), (p = 0.003), (p = 0.80) respectively. Mean levels of ferritin were positively correlated with diastolic (r = 0.850, p = 0.03), systolic blood pressures (r = 0.700, p = 0.02), and fasting insulin (r = 0.444, p = 0.003) in elderly with MetS. Conclusions: Mean levels of ferritin were increased in elderly patients with metabolic syndrome. And also, ferritin levels were positively correlated with systolic and diastolic blood pressures as well as fasting insulin but not with hs-CRP levels in elderly patients with metabolic syndrome.

Aim: Metabolic syndrome (MetS) is a major risk factor for both diabetes mellitus and cardiovascular disease (CVD). The aims of the study were 1) to investigate the insulin receptor substrate-1 (IRS-1) and insulin receptor substrate-2 (IRS-2) gene polymorphisms in patients with MetS and 2) to examine the relationships between gene polymorphisms and components of MetS. Patients & Methods: The study population included 100 patients with MetS and 30 patients without MetS as control group. Metabolic syndrome (MS) was defined as in ATP III. Entire coding exons of IRS-1 and IRS-2 genes were amplified by polymerase chain reaction (PCR). Insulin resistance (IR) was estimated using the homeostasis model assessment (HOMA). Results: In patients with MetS, 34 (34%), had G972R (rs1801278) gene polymorphism and 66 (66%) had no nucleotide substitutions at the IRS-1 gene (p < 0.0001). As for the IRS-2 gene, 18.0% of the patients were heterozygous and 11.0% were homozygous for the G1057D mutation, 2.0% were heterozygous for the P1031P and P1033PG1057 mutations, 17.0% were heterozygous for P1033P, 3.0% were homozygous for P1033P and 5% were heterozygous for the G 1067D and P1033P mutations in patients with MetS (p = 0.0001). However, none of the control subjects had nucleotide substitutions in the IRS-1 and IRS-2 genes. There were no correlations between IRS-1/IRS-2 gene polymorphisms and metabolic syndrome components such as waist circumference, blood pressure, triglyceride, HDL-Cholesterol, LDL-Cholesterol and HOMA-IR levels. Conclusion: Insulin receptor substrate-1 and 2 gene polymorphisms were associated with metabolic syndrome but not its components.

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