The definition of glomerular hyperfiltration has not been agreed upon and the pathophysiological mechanisms have not been well explored. Low serum creatinine concentrations may be associated with increased risk of coronary heart disease (CHD) or cardiopulmonary events the impact of which needs further study. Consecutive applicants to a cardiovascular hospital free of moderate/severe chronic kidney disease (age 55.6 ± 8.2 years) were grouped into those without (“healthy”, n = 469) and with CHD (320 stable and acute coronary syndrome cases) at baseline and into sex-specific quartiles of CKD-EPI equation-estimated glomerular filtration rate (eGFR). New or recurrent cardiovascular (myocardial infarction, stroke, heart failure [HF]) events, obstructive pulmonary disease (COPD) and death were determined during 3-years’ follow-up. Among 25 deaths and 75 cardiopulmonary events, HF was the leading nonfatal event. Age, serum uric acid and left ventricular ejection fraction proved the best independent inverse covariates of eGFR in the “healthy” sample. The highest eGFR quartile (“hyperfiltrators”), exhibiting significantly lower serum LDL-cholesterol levels, significantly predicted the combined outcome (at a RR of 6) in “healthy” subjects, after adjustment for sex, age, body mass index, smoking status and presence of hypertension. This finding was paralleled by the highest eGFR quartile calculated also by the MDRD equation, replicating this also in the CHD group. Renal “hyperfiltrators” represent individuals with autoimmune activation (involving serum creatinine, partly escaping assay), are misclassified into optimal renal function and actually are at significantly higher risk of death, HF or cardiopulmonary events. Low serum creatinine levels may represent a clue to the existence of autoimmune activation.

Background and objectives: Hypertension is a global health problem and a major risk factor for cardiovascular diseases. Vitamin D deficiency is closely related to high blood pressure and the development of hypertension. This study investigated the relationship between the vitamin D and blood pressure status in healthy adults, and their 8-year follow-up was added. Materials and Methods: A total of 491 healthy middle-aged participants without any chronic illness, ages 21 to 67 at baseline, were divided into two groups as non-optimal blood pressure (NOBP) and optimal blood pressure (OBP). NOBP group was divided into two subgroups: normal (NBP) and high normal blood pressure (HNBP). Serum 25-hydroxy vitamin D levels were measured with the immunoassay method. 8-year follow-up of the participants was added. Results: The average vitamin D level was detected 32.53 ± 31.50 nmol/L in the OBP group and 24.41 ± 14.40 nmol/L in the NOBP group, and a statistically significant difference was found (p < 0.001). In the subgroup analysis, the mean vitamin D level was detected as 24.69 ± 13.74 and 24.28 ± 14.74 nmol/L in NBP and HNBP, respectively. Together with parathyroid hormone, other metabolic parameters were found to be significantly higher in the NOBP. During a median follow-up of 8 years, higher hypertension development rates were seen in NOBP group (p < 0.001). Conclusions: The low levels of vitamin D were significantly associated with NBP and HNBP. The low levels of vitamin D were also associated with the development of hypertension in an 8-year follow-up.

This study aimed to examine the overall and coronary mortality in the 2014 Turkish Adult Risk Factor Study survey, and the distribution of cumulative mortality and incident coronary heart disease (CHD) across 7 geographic regions. Information on mode of death was appropriately obtained. Information collected from survivors was based on history, examination of the cardiovascular system and the Minnesota coding of electrocardiograms. Cox regression analyses were performed. Of the 1.323 participants to be surveyed, 87 were lost to follow-up, 753 examined, and 35 ascertained as deceased. In 448 subjects, verbal information alone was obtained regarding health status. Nineteen deaths were of coronary and cerebrovascular origin. Cumulative 24-year assessment of the entire cohort in the age bracket 45-74 years disclosed high coronary mortality, at 7.3 per 1000 person-years in men and 3.8 in women, and recorded a limited decline of 18% since the year 2000. Age-adjusted Cox regression analysis, comprising 614 deaths and 482 incident CHD over a follow-up of 9.6 years, revealed higher mortality rates in the Mediterranean region and in men in the Black Sea and Marmara regions. The age-adjusted CHD incidence was significantly higher in males of the Mediterranean and females of the Southeast regions. An estimated 400-420.000 incident CHD cases develop currently each year in Turkey. The generally high age-adjusted overall mortality in Turkey displays significant differences across geographic regions. Age-adjusted CHD incidence is not regressing sufficiently, and is especially high among men of the Mediterranean and women of the Southeast regions.

To analyze (1) the sex-specific and age-bracket defined all-cause and coronary mortality in the 23-years' follow-up of the Turkish Adult Risk Factor Study, and (2) to determine the nation-wide prevalence of Type-2 diabetes and its recent trend. Information on the mode of death was obtained from first-degree relatives and/or health personnel of local heath office. Information collected in survivors was based on history, physical examination of the cardiovascular system and Minnesota coding of resting electrocardiograms. Diabetes was defined by criteria of the American Diabetes Association without the use of glycated hemoglobin. Of the 1370 participants to be surveyed, 768 were examined, in 452 subjects information was gathered, and 29 men, 18 women were ascertained to have died. Cumulative assessment of the entire cohort in the age bracket 45-74 years disclosed coronary mortality to be 7.5/1000 person-years in men and 3.74 in women, persisting to be high among the European countries. The recent decline observed in overall mortality seemed to halt as well. Of greatest concern was the finding in the past 12 years that the rate of rise in the age-controlled prevalence of Type-2 diabetes was as high as 5% annually. Overall and coronary mortality in Turkish adults continue to be high, while an elicited annual increase of 5% in the age-controlled prevalence of diabetes is virtually alarming and requires new public health policies.

Background/Objectives: Acromegaly is associated with multiple metabolic comorbidities, but the relationship between disease activity and metabolic dysfunction-associated steatotic liver disease (MASLD) or cardiovascular risk remains unclear. This study aimed to assess the prevalence and severity of MASLD and liver fibrosis in patients with acromegaly relative to healthy controls and explore whether disease activity influences these parameters. We also evaluated cardiovascular risk indicators in acromegaly patients. Methods: A retrospective case-control study was conducted between 2000 and 2022, involving 58 acromegaly patients and 58 healthy controls. Patients were classified as active or in biochemical remission. MASLD was assessed using the fibrosis-4 (FIB-4) index, MASLD fibrosis score, body mass index, diabetes (BARD) score, the aspartate aminotransferase-to-platelet index (APRI), and the aspartate aminotransferase-to-alanine aminotransferase ratio. Cardiovascular evaluation included pulse wave velocity (PWV) and carotid intima–media thickness (CIMT). Results: The median age of the acromegaly group was 47.5 (39–57) years, compared to 42 (40–48) years in the control group (p = 0.041). APRI (p < 0.001), FIB-4 (p < 0.001), MASLD fibrosis score (p < 0.001), and BARD score (p < 0.001) were significantly higher in the acromegaly group. The prevalence of hepatic steatosis was also higher in the acromegaly group (p < 0.001). Diastolic blood pressure (p = 0.015) and PWV (p = 0.012) were significantly higher in the acromegaly group. Conclusions: Acromegaly patients have an increased risk of MASLD and fibrosis, but this risk is unassociated with disease activity. Similarly, cardiovascular risk parameters remain elevated regardless of disease activity. These findings suggest that the systemic effects of acromegaly may persist despite biochemical control.

Introduction: The objective was to assess the triglyceride-glucose (TyG) index and the homeostatic model assessment for insulin resistance (HOMA-IR) in the evaluation of insulin resistance in patients with acromegaly and to compare results with healthy controls. Material and methods: A retrospective case-control study was conducted at the Department of Endocrinology, Necmettin Erbakan University, Meram Faculty of Medicine. The study included 50 acromegalic patients and 50 age- and sex-matched healthy controls. Results: The median age and sex distribution were similar between the acromegaly and control groups (p > 0.05). Compared to the control group, acromegalic patients had significantly higher fasting glucose, HbA_1c, total cholesterol, triglyceride, TyG index, and AST levels (p < 0.05 for all), while hemoglobin and platelet counts were significantly lower (p < 0.05). Diabetes mellitus (DM) was present in 24.0% of acromegalic patients. Compared to those without DM, acromegalic patients with DM were significantly older, had greater frequency of cardiovascular disease, and higher glucose, HbA_1c, and neutrophil levels (p < 0.05). The TyG index showed a significant correlation with fasting glucose in both groups, but it correlated with insulin and HOMA-IR only in controls. Conclusion: Acromegalic patients exhibit significant metabolic alterations, including higher TyG index levels and increased DM prevalence, despite having similar HOMA-IR values to healthy controls. Keywords: acromegaly insulin resistance TyG index HOMA-IR