Based on 20 years experiences of follow-up of the Turkish Adult Risk Factor (TARF) study, this review summarizes the distribution of risk factors among Turks which is dominated by components of the metabolic syndrome (MetS), especially abdominal obesity and atherogenic dyslipidemia. The adoption of a 95 cm cutoff for male abdominal circumference was crucial in the understanding of cardiometabolic risk factors. The prevalence of MetS, type-2 diabetes and coronary heart disease (CHD) are high, alike in Iranians. The TARF study demonstrated that low-grade systemic inflammation and oxidative stress are major determinants of cardiometabolic risk in the population at large, and involves the female sex to a greater extent than the male. As a result, impaired anti-inflammatory and atheroprotective function developed in middle-aged and elderly obese individuals emerging as dysfunction of apolipoprotein A-I and HDL particles. This dysfunction is currently a major driver cardiometabolic risk in Turkish adults leading to substantial excess diabetes and CHD. Separate algorithms for diabetes and CHD were derived that improved the risk prediction of these diseases
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