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Objective The goal of this study was to determine variables preceding and predicting incident obstructive sleep apnea syndrome (OSAS) in the population at large. Methods Anthropometric, lipid, and non-lipid variables in participants with newly developing OSAS (n = 131) were compared with those of a cohort sample (n = 2615) of the Turkish Adult Risk Factor study. Available values preceding (by a median of 32 mo) the development of OSAS were used in multivariable Cox regression models. Results Significant determinants of OSAS assessed by group differences were waist/neck circumference and fibrinogen. Fasting triacylglycerols, systolic blood pressure, and C-reactive protein in men and low sex hormone–binding globulin and elevated homeostatic model assessment in women were further significant covariates. Cox regression analysis for the risk of incident OSAS confirmed the independent predictive value of central obesity measures, especially neck circumference (having a twofold hazard ratio) and younger age. Age-adjusted former smoking status and—compared with the lowest tertile—the upper two tertiles of fibrinogen (relative risk = 1.66, 95% confidence interval: 1.05–2.63) were significant predictors. Elevated triacylglycerols in males and high apolipoprotein B and lowest high-density lipoprotein cholesterol tertile in females also predicted subsequent OSAS. Systolic blood pressure and total cholesterol did not prove to be independent predictors in multivariable adjusted Cox models in which partial sex-dependent independence of obesity measures of the previously stated five variables was essentially retained. Conclusions An enhanced pro-inflammatory state appeared to be the underlying pathophysiologic mechanism for OSAS, whereas in men, the added factor of high-density lipoprotein dysfunction was suggested. Because it contributes to the pro-inflammatory state, discontinuance of smoking was another further significant predictor of OSAS.

The population-based CANHEART (Cardiovascular Health in Ambulatory Care Research Team) “big data” cohort examining the relationship between high-density lipoprotein cholesterol (HDL-C) and cause-specific mortality rates was of interest in several aspects [(1)][1]. These investigators found that

The recent paper by Wilkins et al. [(1)][1] was highly interesting. They examined nearly 2,800 young participants (mean age, 25 years) of a multicenter cohort, aiming to quantify the association of concordance and discordance between apolipoprotein (apo) B and low-density lipoprotein-cholesterol (