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Cholesterol Education Program Adult Treatment panel III. (NCEP-ATPIII) criteria and the involvement of hemostasis and fibrinolysis in the metabolic syndrome.
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Serial measurements of ADAMTS-13 activity and inhibitors suggest that cyclosporine achieves its therapeutic effect either by reducing the inhibitor level or by diminishing its functional activity. Further studies are under way to explore the detailed mechanism of action of cyclosporine in the treatment of TTP.

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Acknowledgements This study is supported in part by grants from National Institutes of Health K08HL03279 and by the grant support from Ohio Biomedical Research and Technology Transfer Commission. References 1 Balogun RA, Sahadevan M, Sevigny J, Kaplan AA. Impact of therapeutic plasma exchange on cyclosporine kinetics during membrane-based lipid apheresis. Am J Kidney Dis 2001; 37: 1286–9. 2 Jin M, Cataland S, Bissell M, Wu HM. A rapid test for the diagnosis of thrombotic thrombocytopenic purpura using surface enhanced laser

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desorption/ionization time-of-flight (SELDI-TOF)-mass spectrometry. J Thromb Haemost 2006; 4: 333–8. Kessler CM. An introduction to factor VIII inhibitors: the detection and quantitation. Am J Med 1991; 91: 1S–5S. Bachman WR, Brennan JK. Refractory thrombotic thrombocytopenic purpura treated with cyclosporine. Am J Hematol 1996; 51: 93–4. Hand JP, Lawlor ER, Yong CK, Davis JH. Successful use of cyclosporine A in the treatment of refractory thrombotic thrombocytopenic purpura. Br J Haematol 1998; 100: 597–9. Itala M, Remes K. Excellent response of refractory life-threatening thrombotic thrombocytopenic purpura to cyclosporine treatment. Clin Lab Haematol 2004; 26: 65–7. Kierdorf H, Maurin N, Heintz B. Cyclosporine for thrombotic thrombocytopenic purpura. Ann Intern Med 1993; 118: 987–8. Nosari A, Bernuzzi P, Corneo R, Pungolino E, Muti G, Rossi V, Morra E. Late response to cyclosporine in refractory thrombotic thrombocytopenic purpura. Int J Hematol 2002; 76: 284–6. Pasquale D, Vidhya R, DaSilva K, Tsan MF, Lansing L, Chikkappa G. Chronic relapsing thrombotic thrombocytopenic purpura: role of therapy with cyclosporine. Am J Hematol 1998; 57: 57–61. Yamaguchi M, Nagata K, Hamaguchi H. Successful treatment of refractory thrombotic thrombocytopenic purpura with cyclosporine A and splenectomy. Rinsho Ketsueki 2000; 41: 676–80.

New International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment panel III (NCEP-ATPIII) criteria and the involvement of hemostasis and fibrinolysis in the metabolic syndrome I . M E R T E N S and L . F . V A N G A A L Department of Diabetology, Metabolism and Clinical Nutrition, Faculty of Medicine, Antwerp University Hospital, Antwerp, Belgium

To cite this article: Mertens I, Van Gaal LF. New International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment panel III (NCEP-ATPIII) criteria and the involvement of hemostasis and fibrinolysis in the metabolic syndrome. J Thromb Haemost 2006; 4: 1164–6.

The metabolic syndrome is recognized as a cluster of cardiovascular risk factors that frequently coincide with insulin resistance and intra-abdominal adiposity. Despite abundant research on the subject, definitions of the metabolic syndrome vary widely with respect to components and a number of criteria, using changing cut points, have been proposed. Recently, the International Diabetes Federation (IDF) launched a new definition, feeling there was a strong need for

Correspondence: L. F. Van Gaal, Department of Diabetology, Metabolism and Clinical Nutrition, Faculty of Medicine, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium. Tel.: +32 3 821 32 66; fax: +32 3 825 49 80; e-mail: luc.van.gaal@ uza.be Received 5 January 2006, accepted 13 February 2006

a diagnostic tool that could be used worldwide for epidemiological and clinical purposes [1]. In addition, the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria [2] were updated by the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) [3]. In a previous study [4], in overweight and obese women and men, we already demonstrated increased levels of plasminogen activator inhibitor-1 (PAI-1) activity in subjects with the metabolic syndrome according to the World Health Organization (WHO) [5] and NCEP-ATPIII [2] criteria, while von Willebrand factor antigen (VWF:Ag) was only increased in women using the WHO criteria and no influence was found on levels of fibrinogen. However, some studies, mostly population based, did find increased levels of fibrinogen or VWF:Ag using the same criteria [6–8]. In the present study, in a group of 559 patients (417 women and 142 men), we investigated the influence of the newly  2006 International Society on Thrombosis and Haemostasis

 2006 International Society on Thrombosis and Haemostasis

0.134 0.074 0.047 357 ± 87 166 ± 60 21.6 ± 9.6 334 ± 52 149 ± 49 18.8 ± 11.3 0.062 0.186