Visceral Obesity Mediates the Association Between Metabolic Syndrome and Obstructive Sleep Apnea Syndrome.

BACKGROUND: Metabolic syndrome (MetS) and visceral obesity are more prevalent in obstructive sleep apnea syndrome (OSAS). We investigated the association of visceral fat (VF) measures with the components of MetS in OSAS patients with different severity levels, according to World Health Organization (WHO, 1999), National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III, 2001), and International Diabetes Federation (IDF, 2005) definitions. PATIENTS AND METHODS: Study population was grouped according to polysomnography results as non-OSAS [who had apnea-hypopnea index (AHI) <5, n = 51], mild OSAS (5 < AHI <15, n = 52), moderate OSAS (15 < AHI <30, n = 53), and severe OSAS (AHI >30, n = 53). VF ratio was measured by abdominal bioimpedance analysis. Waist-to-hip ratio (WHR), homeostasis model assessment of insulin resistance (HOMA-IR), and lipid profiles were assessed in all subjects. RESULTS: The prevelance of MetS in OSAS patients was 30.0%, 35.6%, and 44.4% according to WHO, NCEP-ATP III, and IDF definitions, respectively. MetS was found in 27.5% non-OSAS and 72.8% OSAS according to at least one definition (P = 0.012). Within OSAS group, 27.2% subjects had average, 38.0% had slightly excessive, and 34.8% had an excessive VF ratio. The prevelance of MetS was similar in various VF ratios (P > 0.05). However HOMA-IR increased progressively with VF ratio after adjusting for age, gender, and body mass index (BMI; P = 0.02). AHI increased progressively with BMI (P = 0.02), WHR (P = 0.03), VF ratio (P = 0.01), HOMA-IR (P = 0.02), and MetS (P = 0.016). CONCLUSION: Since severity of OSAS, in terms of AHI and insulin resistance, is both associated with VF rather than BMI, VF should be suggested to link OSAS and MetS. The IDF definition is more sensitive in OSAS patients to diagnose MetS, as central obesity and insulin resistance are obligatory components. This would allow clinicians to intervent earlier to adverse metabolic outcomes of OSAS.

Circulating E-selectin levels and insulin resistance are associated with early stages of atherosclerosis in nonfunctional adrenal incidentaloma.

OBJECTIVE: To evaluate circulating E-selectin levels in patients with nonfunctional adrenal incidentaloma (NFA) in relation to insulin resistance and early atherosclerosis. SUBJECTS AND METHODS: A total of 40 patients with NFA (mean [SD] age: 55.6 [10.7] years; 70% were females) and 35 controls (mean [SD] age: 51.5 [8.1] years; 71.4% were females) selected from age-, gender- and body mass index (BMI)- matched healthy subjects were enrolled. Serum hsCRP, lipid profile, insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) were evaluated. High-resolution B-mode ultrasonography was performed. Serum levels of E-selectin were evaluated by enzyme-linked immunosorbent assay. RESULTS: Patients with NFA had significantly higher values for E-selectin (14.9 (4.8) vs. 12.2 (4.1) ng/mL, p < 0.01) and CIMT (0.6 (0.1) vs. 0.5 (0.1) mm, p < 0.05) than controls. Serum E-selectin levels showed a statistically significant association with hsCRP (r = 0.751, p < 0.001), HOMA-IR (r = 0.575, p < 0.001) and CIMT (r = 0.762, p < 0.001). CIMT (Carotid intima media thickness) was increased in patients with NFA patients with NFA were more insulin resistant than controls and statistically significant relationship was found between size of tumor and HOMA-IR (r = 0.361, p < 0.001). CONCLUSION: In conclusion, based on significantly higher values for E-selectin, CIMT and HOMA-IR in patients with NFA than controls along with significant correlation of E-selectin levels to CIMT, HOMA-IR and hs-CRP, our findings seems to indicate an increased risk of early atherosclerosis and impaired endothelial function in NFA patients, particularly in case of insulin resistance.

Circulating E-selectin levels and insulin resistance are associated with early stages of atherosclerosis in nonfunctional adrenal incidentaloma

Objective To evaluate circulating E-selectin levels in patients with nonfunctional adrenal incidentaloma (NFA) in relation to insulin resistance and early atherosclerosis.Subjects and methods A total of 40 patients with NFA (mean [SD] age: 55.6 [10.7] years; 70% were females) and 35 controls (mean [SD] age: 51.5 [8.1] years; 71.4% were females) selected from age-, gender- and body mass index (BMI)- matched healthy subjects were enrolled. Serum hsCRP, lipid profile, insulin levels and the homeostasis model assessment of insulin resistance (HOMA-IR) were evaluated. High-resolution B-mode ultrasonography was performed. Serum levels of E-selectin were evaluated by enzyme-linked immunosorbent assay.Results Patients with NFA had significantly higher values for E-selectin (14.9 (4.8) vs. 12.2 (4.1) ng/mL, p < 0.01) and CIMT (0.6 (0.1) vs. 0.5 (0.1) mm, p < 0.05) than controls. Serum E-selectin levels showed a statistically significant association with hsCRP (r = 0.751, p < 0.001), HOMA-IR (r = 0.575, p < 0.001) and CIMT (r = 0.762, p < 0.001). CIMT (Carotid intima media thickness) was increased in patients with NFA patients with NFA were more insulin resistant than controls and statistically significant relationship was found between size of tumor and HOMA-IR (r = 0.361, p < 0.001).Conclusion In conclusion, based on significantly higher values for E-selectin, CIMT and HOMA-IR in patients with NFA than controls along with significant correlation of E-selectin levels to CIMT, HOMA-IR and hs-CRP, our findings seems to indicate an increased risk of early atherosclerosis and impaired endothelial function in NFA patients, particularly in case of insulin resistance.

International warfarin genotype-guided dosing algorithms in the Turkish population and their preventive effects on major and life-threatening hemorrhagic events.

AIM: To determine the accuracy of international warfarin pharmacogenetic algorithms developed on large multiethnic cohorts (comprising more than 1000 subjects) to predict therapeutic warfarin doses in Turkish patients. MATERIALS & METHODS: We investigated two Turkish warfarin-treated cohorts: patients with no history of hemorrhagic or thromboembolic event and patients with major and life-threatening hemorrhagic events. RESULTS: International pharmacogenetic algorithms showed good performances in predicting the therapeutic dose of patients with no history of bleedings, but they did not significantly detect the incorrect warfarin dose of patients with major and life-threatening hemorrhagic events. CONCLUSION: Although genetic information can predict the therapeutic warfarin dose, the accuracy of the international pharmacogenetic algorithms is not sufficient to be used for warfarin screening in Turkish patients.

Elastography in the differential diagnosis of thyroid nodules.

Despite the publication of a recent meta-analysis of elastography in thyroid nodules, further work is necessary on this issue in different populations. In this study, we aimed to evaluate the clinical value of elastography on nodular goiters in mild iodine-deficient regions without excluding patients according to nodule characteristics. This prospective study was conducted between April 2010 and December 2011 in Yildirim Beyazit Diskapi Research Hospital Endocrinology outpatient clinic. Five hundred twenty-eight nodular goiter patients who underwent thyroid fine-needle aspiration biopsy were included in our study. Elastography scores and indexes were measured with real-time ultrasound elastography (Hitachi® EUB 7000 HV machine with 13 MHz linear transducer). There were 471 females and 57 males and their ages ranged from 45 years to 78 years. A total of 601 nodules were evaluated in these patients. The area under the curve (AUC) for the elasto score was 0.91 (p < 0.0001) and AUC for the strain index (SI) was 0.96 (p < 0.0001). We suggest that the SI reflects malignancy better than the elasto score. We conclude that elastography scores greater than 3 have 76% sensitivity and 96% specificity for diagnosing malignancy. For SI, we conclude that 3.75 (83% sensitivity and 95% specificity) is the cutoff point. Elasto score and SI measurements of thyroid nodules in our population are efficient and increase the diagnostic performance of the sonography.

Papillary thyroid cancer case masked by subacute thyroiditis.

Subacute thyroiditis (SAT) association with thyroid carcinoma has been rarely reported in the literature. We present a patient with SAT and papillary thyroid cancer that was suspected by ultrasonographic evaluation (US) following SAT treatment. A fifty-four-year old female patient referred to our department due to tachycardia, jitteriness and pain in cervical region for the past one month. SAT diagnosis was established by physical examination, laboratory and ultrasonographic findings. After treatment, control thyroid US revealed regression of the hypoechogenic regions seen in both lobes, and a previously unreported hypoechogenic lesion with microcalcification focus that had irregular borders and was not clearly separated from the surrounding parenchyma located in the posterior aspect of the lobe (Elasto score: 4, Strain index: 7.08). Fine needle aspiration biopsy was taken from this nodule; cytology was assessed to be compatible with papillary thyroid carcinoma. Postsurgical pathology evaluation showed a papillary microcarcinoma. SAT may produce ultrasound changes that obscure the coexistence of papillary carcinoma. We recommend that patients with SAT have ultrasonography after they recover. Hypoechogenic regions bigger than 1 cm that are present in the follow-up post-therapy US should be assessed by biopsy.

Papillary thyroid cancer case masked by subacute thyroiditis / Caso de carcinoma papilar de tiroide mascarado por tireoidite subaguda

Subacute thyroiditis (SAT) association with thyroid carcinoma has been rarely reported in the literature. We present a patient with SAT and papillary thyroid cancer that was suspected by ultrasonographic evaluation (US) following SAT treatment. A fifty-four-year old female patient referred to our department due to tachycardia, jitteriness and pain in cervical region for the past one month. SAT diagnosis was established by physical examination, laboratory and ultrasonographic findings. After treatment, control thyroid US revealed regression of the hypoechogenic regions seen in both lobes, and a previously unreported hypoechogenic lesion with microcalcification focus that had irregular borders and was not clearly separated from the surrounding parenchyma located in the posterior aspect of the lobe (Elasto score: 4, Strain index: 7.08). Fine needle aspiration biopsy was taken from this nodule; cytology was assessed to be compatible with papillary thyroid carcinoma. Postsurgical pathology evaluation showed a papillary microcarcinoma. SAT may produce ultrasound changes that obscure the coexistence of papillary carcinoma. We recommend that patients with SAT have ultrasonography after they recover. Hypoechogenic regions bigger than 1 cm that are present in the follow-up post-therapy US should be assessed by biopsy.

A associação da tireoidite subaguda (TSA) com o carcinoma de tiroide foi raramente relatada na literatura. Apresentamos uma paciente com TSA e tumor papilar de tiroide suspeito na ultrassonografia (US) após o tratamento para a TSA. Uma mulher de 54 anos de idade foi encaminhada ao nosso departamento com taquicardia, agitação e dor na região cervical, com duração de 1 mês. O diagnóstico de TSA foi estabelecido pelo exame físico, e pelos achados laboratoriais e ultrassonográficos. Depois do tratamento, o US para controle da tiroide mostrou regressão das regiões hipoecoicas vistas em ambos os lobos e uma lesão hipoecoica anteriormente não observada com focos de microcalcificação, bordas irregulares, não claramente separada do parênquima circundante e localizada na região posterior do lobo. (Escore elástico: 4, índice de deformação: 7,08). Foi feita uma biópsia do nódulo por meio de aspiração por agulha fina. A citologia mostrou-se compatível com um carcinoma papilar de tiroide. A avaliação pós-cirúrgica mostrou um microcarcinoma papilar. A TSA pode produzir alterações ultrassonográficas que obscurecem a coexistência de carcinoma papilar. Recomendamos que pacientes com TSA passem por exame ultrassonográfico após a recuperação. Regiões hipoecoicas maiores que 1 cm encontradas no US para acompanhamento pós-tratamento devem ser avaliadas por biópsia.

Elastography in the differential diagnosis of thyroid nodules in Hashimoto thyroiditis.

Elastography is a method which assesses the risk of the malignancy and provides information about the degree of hardness in tissue. Hashimoto's thyroiditis, autoimmune lymphocytic infiltration and fibrosis, is considered to be a very common disease that is able to change the hardness of the tissue. The diagnostic value of elastography of this group of patients has not previously been reported. In our study, we aimed to determine the diagnostic value of elastography in 283 patients (255 female, 28 male) with Hashimoto's thyroiditis. Elastography score and index were measured with real-time ultrasound elastography (Hitachi(®) EUB 7000 HV machine with using 13 MHz linear transducer). The outcome of this measure shows that malignant nodules were with higher elastography scores (ES) and strain indexes (SI) values. ES ≥3 were observed in 16/20 malignant and 130/263 benign nodules, respectively. The area under the curve (AUC) for the elasto score (AUC) was 0.72 (p = 0.001), and AUC for the strain index was 0.77 (p < 0.0001). Accordingly, our study suggests that strain index reflects malignancy better than the elasto score. We conclude that elastography score is ≥3 providing 80 % sensitivity and 50 %, six specificity for diagnosing malignancy. For strain index, we found that 2.45 (72.2 % sensitivity and 70 % specificity) is a cut-off point. We have detected a lower cut-off point for SI in Hashimoto patients although sensitivity and specificity decreases in Hashimoto in this population.

Copeptin, a surrogate marker for arginine vasopressin, is associated with cardiovascular risk in patients with polycystic ovary syndrome.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) have higher risk for cardiovascular disease (CVD). Copeptin has been found to be predictive for myocardial ischemia. We tested whether copeptin is the predictor for CVD in PCOS patients, who have an increased risk of cardiovascular disease. METHODS: This was a cross sectional controlled study conducted in a training and research hospital. The study population consisted of 40 reproductive-age PCOS women and 43 control subjects. We evaluated anthropometric and metabolic parameters, carotid intima media thickness and copeptin levels in both PCOS patients and control group. RESULTS: Mean fasting insulin, homeostasis model assessment insulin resistance index (HOMA-IR), triglyceride, total cholesterol, low density lipoprotein cholesterol (LDL-C), free testosterone, 17-OH progesterone, Dehydroepiandrosterone sulfate (DHEAS), carotid intima media thickness (CIMT) levels were significantly higher in PCOS patients. Mean copeptin level was in 12.61 ± 3.05 pmol/L in PCOS patients while mean copeptin level was 9.60 ± 2.80 pmol/L in healthy control women (p < 0.001). After adjustment for age and BMI, copeptin level was positive correlated with fasting insulin, free testosterone levels, CIMT, and HOM A-IR. CONCLUSIONS: Copeptin appeared to have an important role in metabolic response and subsequent development of atherosclerosis in insulin resistant, hyperandrogenemic PCOS patients.

The use of 1.5-anhydroglucitol for monitoring glycemic control in islet transplant recipients.

We evaluated whether 1,5-anhydroglucitol (1,5-AG) (GlycoMark(®)), a test for measuring postprandial glucose and glucose variability, could be a tool for assessing short-term glycemic control in islet cell transplant (ICT) subjects. Data of 21 subjects, with type 1 DM and allogenic islet transplantation, who had concomitant fructosamine, HbA1c, 1,5-AG (n = 85 samples), and capillary glucose self-monitoring measurements (n = 2,979) were analyzed retrospectively at different time points after ICT. A significant negative association was observed between 1,5-AG and HbA1c (p = 0.02), but not with fructosamine. When HbA1c was divided in quartiles as <5.6, 5.6-5.9, 5.9-6.2, and >6.2, a decrease of an estimated 0.70 ± 0.30 µg/ml in 1,5-AG was associated with each quartile of increase in HbA1c (p < 0.0001). There was a significant decline of 1.64 ± 0.3mg/dl in postprandial glucose values for each 1 unit increase in 1,5-AG (p < 0.0001). For those with HbA1c ≥ 6.0% when 1,5-AG was ≥8.15 µg/ml, the mean estimated glucose level was 103.71 ± 3.66 mg/dl, whereas it was 132.12 ± 3.71 mg/dl when 1,5-AG was <8.15 µg/ml. The glucose variability (Glumax - Glumin) in subjects with 1,5-AG <8.15 µg/ml was 46.23 mg/dl greater than the subjects with 1,5-AG ≥8.15 µg/ml (HbA1c ≥ 6.0%). There was no significant association between GlycoMark and glucose variability where HbA1c < 6%. 1,5-AG significantly associated with postprandial glucose levels and glucose variability in ICT recipients with near-normal HbA1c (6.0-6.5%) levels. These findings suggest that 1,5-AG can be used to differentiate those ICT subjects with higher glucose variability despite having near-normal HbA1c. However, prospective studies are needed to evaluate the association between GlycoMark levels and the parameters of graft dysfunction/failure.

Vitamin D3 levels and insulin resistance in papillary thyroid cancer patients.

Both insulin resistance (IR) and vitamin D deficiency (VDD) are found to be associated with many cancer types. In this study, we evaluated the presence of IR and VDD in thyroid cancer patients based on controls. Total 344 papillary thyroid cancer and 116 controls were part of the study. Glucose, insulin, homeostasis model analysis-insulin resistance (HOMA-IR) (control group 2.12 ± 0.9 and patient group 3.6 ± 1.1; p < 0.0001), LDL were significantly high; HOMA-S and vitamin D3 levels (control group 19.11 ± 8 and patient group 17 ± 16; p = 0.004) were significantly low in the patient group. Vitamin D deficiency (64/108 in controls vs 166/235; p = 0.026) and insulin resistance (24/108; 115/235; p < 0.0001) were more frequent in papillary thyroid cancer patients. After regression analysis, tumor diameter showed significant association with log-HOMA-IR (B = 0.315; p = 0.017) and log-vitamin D3 (B = 0.207; p = 0.04). Vitamin D deficiency and insulin resistance frequencies show no difference between micro- and macropapillary thyroid cancers. Receiver operating characteristic curve shows the best cutoff point for tumor diameter showing that the presence of lymph node metastasis was 0.65 cm with 81.2 % sensitivity and 52 % specificity. Best cutoff point for the capsular invasion tumor diameter was 0.75 cm with 83.3 % sensitivity and 60.4 % specificity. No difference between follicular and classical type papillary thyroid carcinomas has been yet discovered. As a result, thyroid cancer patients are more insulin resistant and vitamin D3 deficient. Vitamin D3 levels and HOMA-IR index may affect tumor diameter. Tumor size that is lower than 1 cm (0.65-0.75 cm) may be related with capsular invasion and lymph node involvement.

The association between severity of vitamin D deficiency and Hashimoto's thyroiditis.

OBJECTIVE: The relation between vitamin D and autoimmune disorders has long been investigated regarding the important roles of this hormone in immune regulation. We evaluated 25-hydroxyvitamin D (25OHD) status in subjects with Hashimoto's thyroiditis (HT) and healthy controls. METHODS: Group-1 included 180 euthyroid patients (123 females/57 males) with HT who were on a stable dose of L-thyroxine (LT). A total of 180 sex-, age-, and body mass index (BMI)-matched euthyroid subjects with newly diagnosed HT were considered as Group-2, and 180 healthy volunteers were enrolled as controls (Group-3). All 540 subjects underwent thyroid ultrasound and were evaluated for serum 25OHD, anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin (anti-TG) levels. RESULTS: Group-1 had the lowest 25OHD levels (11.4 ± 5.2 ng/mL) compared to newly diagnosed HT subjects (Group-2) (13.1 ± 5.9 ng/mL, P = .002) and to control subjects (15.4 ± 6.8 ng/mL, P<.001). Serum 25OHD levels directly correlated with thyroid volume (r = 0.145, P<.001) and inversely correlated with anti-TPO (r = -0.361, P<.001) and anti-TG levels (r = -0.335, P<.001). We determined that 48.3% of Group-1, 35% of Group-2, and 20.5% of controls had severe 25OHD deficiency (<10 ng/mL). Female chronic HT patients had the lowest serum 25OHD levels (10.3 ± 4.58 ng/mL), and male control subjects had the highest (19.3 ± 5.9 ng/mL, P<.001). CONCLUSIONS: We demonstrated that serum 25OHD levels of HT patients were significantly lower than controls, and 25OHD deficiency severity correlated with duration of HT, thyroid volume, and antibody levels. These findings may suggest a potential role of 25OHD in development of HT and/or its progression to hypothyroidism.

The association between severity of obstructive sleep apnea and prevalence of Hashimoto's thyroiditis.

Obstructive sleep apnea (OSA) has long been suggested to increase the risk of development of autoimmune diseases. We investigated the prevalence of Hashimoto's thyroiditis (HT) in 245 euthyroid individuals, who were suspected of having OSA. After polysomnography, subjects were grouped according to apnea-hypopnea index (AHI) consecutively as controls (n=27F/32M, AHI<5), mild-OSA (n=22F/37M, 5≤AHI<15), moderate-OSA (n=23F/38M, 15≤AHI<30) and severe-OSA (n=30F/36M, AHI≥30). Diagnosis of HT based on thyroid ultrasound and positivity of serum anti-thyroglobulin (anti-TG) and anti-thyroid peroxidase (anti-TPO) antibodies. Hashimoto's thyroiditis was diagnosed in 32.2% of controls and in 46.8% of all OSA patients (p=0.03). Severe-OSA patients had the highest HT frequency (51.5%) compared to controls (p=0.02), mild-OSA (42.3%, p=0.03) and moderate-OSA (45.9%, p=0.05) groups. Forty-two of control subjects (71.2%) were negative for both of the anti-TPO and anti-TG, whereas 99 (53.2%) of OSA subjects were positive at least for one of them (p=0.01). HT was detected in 62% of females, 29% of males (p<0.001). Severe female OSA patients had the highest HT prevalence (73.3%), while male control subjects had the lowest (18.7%) among all groups (p<0.001). There was no significant correlation between thyroid volume and severity of OSA but isthmus thickness was significantly correlated to AHI (p<0.01, r=0.22). In conclusion, OSA patients presented higher HT prevalence parallel to severity of OSA, especially among women. These results may lead to further investigations about relation between OSA and auto-immune thyroiditis and to development of screening schemas for severe-OSA patients for early diagnosis of HT before development of hypothyroidism.

Struma ovarii presenting with Hashimoto's thyroiditis: a case report.

INTRODUCTION: We report the case of a patient diagnosed with a struma ovarii with lymphocytic thyroiditis of her ectopic thyroid tissue. We believe that this case presents an unusual variation of a struma ovarii and a rare presentation of subclinical hyperthyroidism. CASE PRESENTATION: A 17-year-old Caucasian female patient who had undergone an ovariectomy and been diagnosed with a struma ovarii was subsequently found to have persistent subclinical hyperthyroidism with a low radioiodine uptake. Abdominal magnetic resonance imaging and iodine-131 whole body scanning showed no residue or recurrence and a thyroid ultrasonography was normal. Laboratory and histopathological findings suggested Hashimoto's thyroiditis as the cause of the subclinical thyrotoxicosis, which had presumably started at the ectopic tissue. CONCLUSION: Struma ovarii is a rare cause of thyrotoxicosis, and can be difficult to diagnose in the presence of co-existing thyroid disorders. In patients with a struma ovarii who have not undergone thyroidectomy, there is no common consensus on management in terms of residue, recurrence or metastasis. Autoimmune thyroiditis must be kept in mind for a differential diagnosis.

Heart-type fatty acid binding protein (H-FABP): relationship with arterial intima-media thickness and role as diagnostic marker for atherosclerosis in patients with impaired glucose metabolism.

BACKGROUND: Heart type fatty acid binding protein (H-FABP) has been closely associated with acute coronary syndrome, cardiac abnormalities, stroke, and obstructive sleep disorder in previous studies. The aim of this study was to evaluate and compare the serum H-FABP levels and carotid artery intima-media thickness (CIMT) between patients with prediabetes and control subjects. RESEARCH DESIGN AND METHODS: We measured serum H-FABP levels in 58 prediabetic patients, 29 with impaired fasting glucose (IFG) and 29 with impaired glucose tolerance (IGT) and 28 age-, sex- and body mass index-matched control subjects using a sandwich enzyme-linked immunosorbent assay (ELISA), and in order to measure CIMT, all participants underwent high-resolution B-mode ultrasonography. RESULTS: Serum H-FABP levels were significantly elevated in pre-diabetic patients when compared with that of control subjects (IFG: 32.5 ± 34.2 ng/dL, IGT: 45.4 ± 45.8 ng/dL, control: 16.8 ± 14.9 ng/dL; p = 0.011). The difference in means of H-FABP levels between patients with IGT or IFG and control subjects was significant (p = 0.010 and p = 0.009, respectively). CIMT was higher in the pre-diabetic groups compared with the control group (IFG: 0.6 ± 0.1, IGT: 0.6 ± 0.1, control: 0.5 ± 0.1; p < 0.001), and H-FABP level was positively correlated with CIMT (p < 0.001, rho = 0.626). CONCLUSION: Our results indicate that patients with pre-diabetes are at increased risk for cardiovascular disease. In addition, serum H-FABP levels could represent a useful marker for myocardial performance in patients with IFG and IGT.