The Impact of Obesity on Cardiovascular Diseases in Turkey [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2003; 31(5): 279-289

The Impact of Obesity on Cardiovascular Diseases in Turkey

Altan Onat1

Focusing on coronary heart disease (CHD), this article reviews the impact of obesity on cardiovascular disease among Turks, based primarily on the data obtained in the Turkish Adult Risk Factor Study, a prospective study ongoing since 1990 on a representative sample of Turkish adults. After summarizing basic knowledge on obesity and abdominal obesity and adipocyte metabolism, the prevalences in this population were estimated (2.8 milllion men and 7.7 milllion women with abdominal obesity). Waist circumference revealed significant correlations with dyslipidemia, fasting glucose and physical activity and, above all, with blood pressure and C-reactive protein. The two good surrogates of visceral adiposity among Turkish adults, examined by computed tomography, were waist girth and body mass index (BMI), while waist-to-hip ratio was clearly inferior. In men, waist girth is the parameter of choice due to a closer relationship with visceral adipose tissue area, whereas in women BMI approached it. Best cutoff values for waist circumference were 96 cm in men and >88 cm in women, thus pointing to a lower action level of waist circumference in men than hitherto recommended. A 4-year prospective analysis disclosed that the age-adjusted relative CHD risk in men with a waist 96 cm was 1.65-fold the risk in men having a waist less than 96 cm. Waist girth significantly predicted nonfatal and/or fatal CHD risk, independent of salient risk factors, imparting a 34% excess risk for each increment of 12 cm (=1 SD). In contrast to the prevalence of abdominal obesity in men being similar to Western populations, it is a standard in peri- and postmenopausal Turkish women. Though abdominal obesity in Turkish adults is a main determinant of dyslipidemia as well, compared to Western adults (in particular among women), it affects to a greater extent (systolic) blood pressure, which appears the main determinant of coronary risk among Turks. It is concluded that the attributable risk for the population - estimated as 25,000 of the new cases of CHD that develop each year - highlights abdominal obesity in 3rd rank among the risk factors in Turkish adults, after hypertension and smoking, jointly with low HDL-cholesterol, namely, before elevated LDL-cholesterol and diabetes.

Keywords: Abdominal obesity, cardiovascular risk, obesity, visceral adiposity, waist circumference

How to cite this article
Altan Onat. The Impact of Obesity on Cardiovascular Diseases in Turkey. Turk Kardiyol Dern Ars. 2003; 31(5): 279-289
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