Casale Monferrato Research Articles

Malignant pleural mesothelioma (MPM): Outcome of 352 patients (pts) treated by a dedicated multidisciplinary team (MT) in the highly asbestos polluted area of Casale Monferrato, Piedmont (Italy).

e20078Background: MPM has dismal prognosis with median overall survival (OS) of 12 months. Pts treated in referral centres perform better. Since 2009 in the highly asbestos polluted area of Casale ...

Extreme trauma in a polluted area: Bonds and relational transformations in an Italian community

In the community of Casale Monferrato, exposure to asbestos has led to an extremely traumatic situation that has encompassed cancer and death and affected a variety of social and environmental aspects of both individuals and the community. When an entire community is severely traumatized, psychoanalytic group therapy seems to be the most suitable therapeutic setting: it allows for the historization of the event and the creation of multiple narratives of somatopsychic suffering, producing a transformative effect on nonmentalized emotional aggregates. Making reference to clinical material, I will show how the possibility of sharing, with other minds, the meaning of the trauma also brought into the field each participant's vital aspects, possibly not very intense in each individual but consistently present in the functioning of the mind of the group. I will also illustrate how this led to the development of a new and more mature psychic asset, with which painful and deadly experiences connected to the trauma could be faced.

SENTIERI - Epidemiological study of residents in national priority contaminated sites: incidence of mesothelioma

The purpose of SENTIERI-ReNaM Project is to describe mesothelioma incidence in the Italian National Priority Contaminated Sites (NPCSs). The present report deals with 39 NPCSs (20 in Northern Italy, 8 in Central Italy and 11 in Southern Italy). Asbestos is specifically mentioned in the regulatory acts of recognition for 10 NPCSs and it is the only agent that has determined environmental contamination in 3 of them (Casale Monferrato, Broni, and Bari). The timeframe of the study is 2000-2011 for 34 out of 39 sites. The corresponding reference periods for the sites of Latium, Campania, Umbria, and Bolzano Province are, respectively, 2001-2011, 2005-2011, and 2006-2011. Standardized Incidence Ratios (SIRs) for mesothelioma, with their corresponding 90% Confidence Intervals, have been estimated for all sites. The interpretation of the study findings has been based on anamnestic information made available by the Italian National Mesothelioma Registry (ReNaM), and completed thanks to knowledge derived from the international scientific literature. In men, mesothelioma incidence has shown excesses in 27/39 sites and defects in the remaining 12; in women, excesses have been reported in 20 sites, defects in 15, and no cases have been detected in the remaining 4 sites. The highest annual incidence rates have been observed in the sites characterized only by the presence of asbestos- cement factories (Broni and Casale Monferrato): respectively, 98.0 and 68.6 per 100,000 per year in men, 72.1 and 45.8 in women. Besides these two sites, the highest rates have been observed in the sites with naval shipyards: 13.2 in men and 2.5 in women. Excesses of mesothelioma incidence have been confirmed (with respect to previous observations) in the sites of Broni, Casale Monferrato, Balangero, and in the coastal areas of Trieste, La Spezia, Venice, and Leghorn. Balangero has been the major European chrysotile quarry, while the other sites are characterized by the presence of naval shipyards with demonstrated use of asbestos before it was banned in 1992. An excess of mesothelioma incidence has also been confirmed in the site of Biancavilla, characterized by the presence of the fluoro-edenite fibrous amphibole, classified as carcinogenic to humans by the International Agency for Research on Cancer (IARC). An increased incidence of mesothelioma was also observed in the areas where no direct use of asbestos had previously been documented, like Cengio and Saliceto (chemical industry), Falconara on Sea (oil refinery), and Litorale Domizio Flegreo and Agro Aversano (a large area including multiple hazardous waste dumping sites). These findings show that a relevant proportion of Italian mesothelioma cases is concentrated in NPCSs. About 1,500 extra cases of mesothelioma have been estimated in the overall series of 39 sites (2000-2011), corresponding to 125 extra cases per year. The excess has concerned the sites with manufacture of asbestos-cement products, but also the areas with asbestos quarries, naval shipyards, illegal hazardous waste dumping sites with asbestos-containing materials, petrochemical industries, refineries and steel plants. In some sites, particularly Casale Monferrato and Broni, analytical epidemiological studies have shown the causal role of not only occupational, but also environmental exposures, with special reference to paving of gardens and courtyards with asbestos-cement industry by-products. The main novelty generated by the collaborative SENTIERI-ReNaM Project concerns the detection of significant mesothelioma excesses not only in sites where asbestos is explicitly reported as a source of contamination, but also in a number of areas defined "of national interest" for environmental cleanup due to other sources of pollution. This confirms that the range of economic activities and working and living environments affected by asbestos exposure is very wide and it is not restricted to the industrial sectors characterized by the direct use of this material.

Massive Trauma in A Community Exposed to Asbestos: Thinking and Dissociation among the Inhabitants of Casale Monferrato

In Casale Monferrato, asbestos exposure has been a traumatic occurrence that has caused cancer and death among the town's inhabitants, resulting in the loss of trust and hope with regard to the future and the loss of healthy aspects of the self. This traumatic history has been denied for many years – part of an ‘out of sight, out of mind’ attitude that is often justified by financial interests. When traumatization is due to the careless behaviour of the owners of the major economic resources in a community, group identity is deeply affected. In such a situation, psychoanalytic group therapy seems to be the best means to historicize the event and create multiple narratives of somatopsychic suffering. In this paper, we present the experience of the first multifamily group in Casale Monferrato, focusing on the possibility of ‘diluting’ transference‐ and countertransference‐related feelings of helplessness, thereby making them more bearable and thinkable. Sharing the meaning of the trauma also highlighted vital aspects in the functioning of the mind of the group, leading to a new and more mature way of facing illness and death.

Pleural mesothelioma and occupational and non-occupational asbestos exposure: a case-control study with quantitative risk assessment

ObjectivesCasale Monferrato (north west Italy) is an area with an exceptionally high incidence of mesothelioma caused by asbestos contamination at work and in the general environment from the asbestos-cement Eternit...

Asbestos fibers in the gallbladder of patients affected by benign biliary tract diseases

This exploratory study aimed to evaluate the presence of asbestos fibers in the biliary tract of patients living in an asbestos-polluted area using scanning electron microscopy. Thin gallbladder sections were obtained from five patients who were operated on for gallbladder stones and the bile fluid of one of the patients was analyzed using variable-pressure scanning electron microscopy coupled with energy-dispersive spectroscopy. All patients were from Casale Monferrato, Italy, a well-known asbestos-polluted city, where the Eternit factory had operated since the beginning of the century until 1985. All the inorganic phases found in the gallbladder were analyzed for morphology and chemistry. Fibers and particles consistent with minerals defined by law as 'asbestos' were detected in three out of five patients. These findings suggest that asbestos fibers can be found in the gallbladder of patients exposed to asbestos, although how they reach the biliary tract remains unknown. Further studies to confirm these results are under way.

Malignant mesothelioma due to non-occupational asbestos exposure from the Italian national surveillance system (ReNaM): epidemiology and public health issues

IntroductionItaly produced and imported a large amount of raw asbestos, up to the ban in 1992, with a peak in the period between 1976 and 1980 at about 160 000...

Community exposure to asbestos in Casale Monferrato: from research on psychological impact to a community needs-centered healthcare organization.

Asbestos exposure has a negative impact on both the physical health of the population, and on its psychological and community components. Usually such issues are addressed via top-down strategies, but this approach is unable to address the interpersonal processes connected to living in a specific context. The work carried on in Casale Monferrato since 2006 proceeds in the opposite direction: promoting a different interaction between health system policy-makers and administrators, field actions, and system thinking. Our goal was to create a reliable model that could fit into other contexts, while being flexible and adapting to specific backgrounds. Starting from the results obtained during a first assessment phase, a psychoanalytic group was arranged, aimed at promoting the symbolization and signification of the emotions related to the ill-fated prognosis. The clinical work offers a space for handling the illness and its psychological impact, in order to achieve: 1) a subjective perception of themselves as not impotent and alone; 2) improved abilities of caregivers to manage the disease; 3) enhanced quality of residual life. An integrated multidimensional intervention promotes resilience in the community, but it requires time, for patients, relatives, and the professionals involved. Only with the combined support of oncologists and the entire ward staff will an internal trust be free to grow within a somato-psychic space able to accommodate and sustain the participants during the final stages of their own life, or that of someone close to them.

NT-proBNP linking low-moderately impaired renal function and cardiovascular mortality in diabetic patients: the population-based Casale Monferrato Study.

BackgroundFew data are available to assess whether a low-moderate reduction in estimated glomerular filtration rates (eGFR) has a role per se on cardiovascular (CV) mortality or other biomarkers such as NT-proBNP allow to explain such association.Methods and FindingsIn a prospective study including 1,645 type 2 diabetic subjects of the population-based Casale Monferrato Study, who had no clinical evidence of heart failure and eGFR >45 ml/min/1.73 m2, we examined 6 years CV mortality. Multivariate Cox proportional hazards modeling were used to estimate the effect of NT-proBNP on the association between eGFR and mortality, independently of baseline CV risk factors, albumin excretion rate (AER) and C-reactive protein (CRP). During follow-up, 327 people died (149 of CV diseases) out of 8334.5 person-years. Compared to eGFR≥90 ml/min/1.73 m2, values of 60–89 and 45–59 ml/min/1.73 m2 conferred a fully adjusted hazard ratios (HRs) of CV mortality of 1.74 (1.08–2.82) and 1.95 (1.03–3.68), respectively. After further adjustment for NT-proBNP, however, HRs were no longer significant (HRs 1.42, 0.83–2.42 and 1.22, 0.59–2.51). In this model, HR for logNT-proBNP was 1.84 (1.52–2.22). Adding NT-proBNP to the model improved the C-statistic of CV mortality from 0.79 (0.76–0.83) to 0.84 (0.81–0.87), yielded an IDI of 0.03 (p = 0.02), and a NRI of 0.44 (p = 0.016).ConclusionsIn diabetic people a modest reduction in renal function increased 6-year CV mortality independently of albuminuria. This association, however, was mainly explained by the effect of NT-proBNP, that remained the strongest prognostic marker for a worse CV outcome, even after adjustment for other CV risk factors and pre-existing CVD.

Levels of N-terminal pro brain natriuretic peptide are enhanced in people with the uncomplicated metabolic syndrome: a case-cohort analysis of the population-based Casale Monferrato study.

Both metabolic syndrome (MetS) and N-amino terminal fragment of the prohormone B-type natriuretic peptide (NT-proBNP) confer increased risk of cardiovascular diseases (CVD). We assessed if NT-proBNP levels were greater in people with uncomplicated MetS, who had neither CVD/chronic kidney disease (CKD) nor diabetes, as compared with subjects who met none of the defining criteria of the MetS. A case-cohort study from the non-diabetic population-based Casale Monferrato study was performed, after exclusion of all subjects with established CVD, CKD [estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2)], and CRP values ≥3 mg/L. Cases (n = 161) with MetS were compared with all subjects within the cohort (n = 124) who were completely free of any component of the MetS. Serum NT-proBNP was centrally measured by immunoenzymatic assay. NT-proBNP levels were significantly higher in cases than in control subjects [35.4 (15.5-98.2) vs 24.4 (11.7-49.6) pg/mL, p = 0.014]. In logistic regression analysis, compared with NT-proBNP values in the lower quartiles (≤49.64 pg/mL), higher values conferred odds ratio 4.17 (1.30-13.44) of having the MetS, independently of age, sex, microalbuminuria, CRP, eGFR, and central obesity. This association was evident even after the exclusion of hypertensive subjects. Further adjustment for log-HOMA and diastolic blood pressure did not modify the strength of the association, while central obesity was a negative confounder. Compared with people without any component of the MetS, those with uncomplicated MetS, who had neither CVD/CKD nor diabetes, had increased NT-proBNP values, even if they were normotensive and although absolute values were still in the low range. The insulin resistance state did not mediate this association, while central obesity was a negative confounder.

Environmental Asbestos Exposure and Pleural Malignant Mesothelioma in Italy

Up to the asbestos ban in 1992 an amount of 3,748,550 tons of raw asbestos has been produced in Italy, with a peak in the period between 1976 and 1980 with a consistent delay in trend with respect to many other industrialized countries. As a consequence, in Italy a surveillance system of mesothelioma incidence is active since 2002 by the National Register of Mesotheliomas (ReNaM) searching cases and defining asbestos exposure modalities. ReNaM collected a caselist of 15,845 MM cases, the standardised incidence rates for pleural mesothelioma in 2008 is 3.84 (per 100,000) for men and 1.45 for women; 0.26 and 0.12 for peritoneal site respectively and less than 1 case for million inhabitants for pericardial and tunica vaginalis testis forms. Among 15,845 MM collected cases, the modalities of exposure to asbestos fibres have been investigated for 12,065 subjects (76.1%) and we found 514 cases (4.3%) with an environmental exposure to asbestos (they lived near sources of asbestos pollution and they have been not occupationally exposed), 530 (4.4%) with a familial exposure (they have lived with a cohabitant occupationally exposed) and 188 (1.6%) have suffered an exposure due to hobby-related or leisure activities. A statistically significant difference in median age at diagnosis, at first exposure and of the latency period has been found (p&lt;0.01). Clusters of MM cases due to environmental exposure are prevalently related to the presence of asbestos-cement industry plants (Casale Monferrato, Broni, Bari), to shipbuilding and repair activities (Monfalcone, Trieste, La Spezia, Genova, Castellamare di Stabia, Livorno, Taranto) and to soil contamination (Biancavilla in Sicily). Asbestos pollution outside the workplaces contributes in a significant magnitude to the burden of asbestos-related diseases; there is a need to discuss how to deal compensation rights for malignant mesothelioma cases induced by a not occupational exposure to asbestos.

Ambiente, salute, comunità locali. Partecipazione sociale e politiche pubbliche in una regione italiana

The aim of this article is to discuss the possibility of political institutions taking steps to participatory model of governance of environmental issues. Starting with three exemplary cases of serious risks for the environment and health in Piedmont (asbestos pollution caused by the Ethernet plant at Casale Monferrato, the rehabilitation of the Bormida Valley, urban mobility and traffic pollution) the paper analyzes the social and political vitality of local communities and the impact of the process of social mobilization on public policies. Particular focus is given to the demand for health and environmental quality from local communities involved and to the possibility that citizens’ participation can help activate a process of social and institutional innovation

The effect of age and NT-proBNP on the association of central obesity with 6-years cardiovascular mortality of middle-aged and elderly diabetic people: the population-based Casale Monferrato study.

BackgroundAmong people with type 2 diabetes the relationship between central obesity and cardiovascular mortality has not been definitely assessed. Moreover, NT-proBNP is negatively associated with central obesity, but no study has examined their combined effect on survival. We have examined these issues in a well-characterized population-based cohort.Methods and FindingsSurvival data of 2272 diabetic people recruited in 2000 who had no other chronic disease have been updated to 31 December 2006. NT-proBNP was measured in a subgroup of 1690 patients. Cox proportional hazards modeling was employed to estimate the independent associations between cardiovascular and all-cause mortality and waist circumference. Mean age was 67.9 years, 49.3% were men. Both age and NT-proBNP were negatively correlated with waist circumference (r = −0.11, p<0.001 and r = −0.07, p = 0.002). Out of 2272 subjects, 520 deaths (221 for CV mortality) occurred during a median follow-up of 5.4 years. Central obesity was not associated with CV mortality (hazard ratio, HR, adjusted for age, sex, diabetes duration, 1.14, 95% CI 0.86–1.52). NTproBNP was a negative confounder and age a strong modifier of this relationship (p for interaction<0.001): age<70 years, fully adjusted model HR = 3.52 (1.17–10.57) and age ≥70 years, HR = 0.80 (0.46–1.40). Respective HRs for all-cause mortality were 1.86 (1.03–3.32) and 0.73 (0.51–1.04).ConclusionsIn diabetic people aged 70 years and lower, central obesity was independently associated with increased cardiovascular mortality, independently of the negative effect of NT-proBNP. In contrast, no effect on 6-years survival was evident in diabetic people who have yet survived up to 70 years.

Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: A systematic review and meta-analysis

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The wild rat as sentinel animal in the environmental risk assessment of asbestos pollution: A pilot study

Asbestos has been banned in many countries, including Italy. However, sources of exposure may still exist, due to asbestos in-situ or past disposal of asbestos-containing waste. In an urban area with past high environmental exposure, like Casale Monferrato, the lung fiber burden in sentinel animals may be useful to identify such sources. A pilot study was conducted to assess the feasibility of its determination in wild rats, a suitable sentinel species never used before for environmental lung asbestos fiber burden studies.Within the framework of pest control campaigns, 11 adult animals from 3 sites in the urban area of Casale Monferrato and 3 control rats from a different, unexposed town were captured. Further, 3 positive and 3 negative control lung samples were obtained from laboratories involved in breeding programs and conducting experimental studies on rats. Tissue fiber concentration was measured by scanning electron microscopy with energy dispersive spectrometry.Asbestos (chrysotile and crocidolite) was identified in the lungs from rats from Casale Monferrato, but not in control rats and in negative control lung samples. Asbestos grunerite at high concentration was found in positive control lung samples.Measurement of the lung fiber burden in wild rats has proved feasible: it was possible not only to detect, but also to characterize asbestos fibers both qualitatively and quantitatively. The pilot study provides the rationale for using wild rats as sentinels of the soil contamination level in Casale Monferrato, to identify areas with the possible presence of previously unrecognized asbestos sources.

N-Terminal Probrain Natriuretic Peptide Is a Stronger Predictor of Cardiovascular Mortality Than C-Reactive Protein and Albumin Excretion Rate in Elderly Patients With Type 2 Diabetes

OBJECTIVETo study whether N-terminal probrain natriuretic peptide (NT-proBNP) is a short-term independent predictor of both all-cause and cardiovascular (CV) mortality in type 2 diabetic patients and to establish whether albuminuria and C-reactive protein (CRP) affect this relationship.RESEARCH DESIGN AND METHODSThe prospective study included 1,825 type 2 diabetic patients from the population-based cohort of the Casale Monferrato study. CV risk factors, preexisting CVD, and NT-proBNP levels were evaluated at baseline. All-cause and CV mortality were assessed 5.5 years after baseline examination. Multivariate Cox proportional hazards modeling was used to estimate mortality hazard ratios (HRs).RESULTSDuring the follow-up period, 390 people died (175 for CVD) out of 9,101 person-years of observations. A significantly increased mortality risk by quartiles of NT-proBNP was observed (test for trend, P < 0.001). NT-proBN P values >91 pg/mL conferred HRs of 2.05 (95% CI 1.47–2.86) for all-cause and 4.47 (2.38–8.39) for CV mortality, independently of CV risk factors, including CRP and albumin excretion rate (AER). The association was also significant for modest rises in NT-proBNP levels and in patients without microalbuminuria and CVD at baseline (upper quartiles HRs 3.82 [95% CI 1.24–13.75]) and 3.14 [1.00–9.94]). Albuminuria and NT-proBNP had an additive effect on mortality, though the association was stronger for NT-proBNP.CONCLUSIONSNT-proBNP is a strong independent predictor of short-term CV mortality risk in elderly people with type 2 diabetes, including those without preexisting CVD. This association is evident even in people with slightly increased values, is not modified by CRP, and is additive to that provided by AER.

Prediction of mortality and macrovascular complications in type 2 diabetes: validation of the UKPDS Outcomes Model in the Casale Monferrato Survey, Italy

The United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model can be used to estimate the lifetime occurrence of major diabetes-related complications in order to calculate health economic outcomes. The aim of the study was to assess the performance of the model by comparing the predicted and observed mortality and the incidence of macrovascular complications in an Italian population-based cohort with type 2 diabetes. We used data from the Casale Monferrato Survey, a cohort enrolled in 1988 and surveyed in 1991 (n = 1,967) to assess the prevalence of cardiovascular risk factors. In 2000, a new survey included all the members of the original cohort who were still alive (n = 860), and in addition all individuals identified with a new diagnosis of type 2 diabetes since 1993 (n = 2,389). We compared the mortality predicted by the model for the 1991 survey over the subsequent 17-year period with the observed risk. The following outcomes were analysed in the 2000 survey: myocardial infarction (MI), other ischaemic heart disease, stroke, congestive heart failure (CHF) and amputation. For all-cause mortality, the predictions from the model at 5 and 10 years (23% and 47%, respectively) were identical to the observed risks. At 15 years, the risk of death was slightly overestimated (an estimate of 67% vs 64% observed, 95% CI 61%, 66%). The performance of the model was best for patients with a recent history of disease (duration <6 years). Among the complications, the predicted cumulative incidences of MI and CHF were very close to those observed. External validation is essential to assess the accuracy of simulation models. The UKPDS Outcomes Model satisfactorily predicted a set of actual incidences of mortality and complications in an Italian diabetes cohort up to a duration of approximately 12 years. The longer term performance of such models should be carefully evaluated.

Risk and causalty in environmental disasters

A Dossier dedicated to environmental issues is a rare but important event in the history of AI&R. Environmental issues (and even more specific health related risks and severe events with morbidity-mortality outcomes) are hardly, or at best marginally part of the basic training of the medical and nursing professionals. A clear indicator of the otherness of these problems, with respect to the culture and competences which guide routine practice, is the very difficult, and therefore rare, possibility of the use of medical records for the production of timely and/or periodical scientific-epidemiological reports. The Dossier (to be closely linked and integrated with the Editorial, is principally based on two major disasters which have even occupied the national and international chronicles over at least the last few years: the thousands of workers and community victims of asbestos in Casale Monferrato; the area-wide and decades-long exposure to chemical industrial pollution of the workers and population of Taranto. The cases are presented with a combination of narrative testimonies of professionals and lay witness of the two scenarios, and essential epidemiological data, which refer to the original, abundant documents and publications. Because of its critical and specific importance and controversial character, the issue of juridical criminal responsibility is discussed, technically but didactically by an expert who has been directly involved with the cases. Two apparently atypical but, in fact, strictly complementary contributions conclude the Dossier, recalling the need of extending the meaning of environmental variables, on one side to the broader socioeconomic context, on the other to the highly personal (professional and human) experiences met in crossing one of the most described but substantially ignored faces of the diseased cultural and physical environment in the South.

Quality of life and personality traits in patients with malignant pleural mesothelioma and their first-degree caregivers

Asbestos exposure causes significant pleural diseases, including malignant pleural mesothelioma (MPM). Taking into account the impact of MPM on emotional functioning and wellbeing, this study aimed to evaluate the quality of life and personality traits in patients with MPM and their first-degree caregivers through the World Health Organization Quality of Life–BREF (WHOQOL-BREF) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). The sample was composed of 27 MPM patients, 55 first-degree relatives enrolled in Casale Monferrato and Monfalcone (Italy), and 40 healthy controls (HC). Patients and relatives reported poorer physical health than the HC. Patients had a higher overall sense of physical debilitation and poorer health than relatives and the HC, more numerous complaints of memory problems and difficulties in concentrating, and a greater belief that goals cannot be reached or problems solved, while often claiming that they were more indecisive and inefficacious than the HC. First-degree relatives reported lower opinions of others, a greater belief that goals cannot be reached or problems solved, support for the notion that they are indecisive and inefficacious, and were more likely to suffer from fear that significantly inhibited normal activities than were HC. In multinomial regression analyses, partial models indicated that sex, physical comorbidities, and the True Response Inconsistency (TRIN-r), Malaise (MLS), and Behavior-Restricting Fears (BRF) dimensions of the MMPI-2-RF had significant effects on group differences. In conclusion, health care providers should assess the ongoing adjustment and emotional wellbeing of people with MPM and their relatives, and provide support to reduce emotional distress.

Circulating anti-Hsp70 levels in nascent metabolic syndrome: the Casale Monferrato Study

The metabolic syndrome (MetS) confers an increased risk of both type 2 diabetes and cardiovascular diseases (CVD). Heat shock protein 70 (Hsp70), an intracellular polypeptide, can be exposed on the plasma membrane and/or released into the circulation, eliciting both native and immune responses that may contribute to vascular damage. Our aim was to assess if serum anti-Hsp70 antibody levels were cross-sectionally associated with uncomplicated MetS. A cross-sectional case-control study from the nondiabetic cohort of the Casale Monferrato Study was performed. Subjects with established CVD and/or abnormal renal function were excluded. Case subjects (n = 180) were defined as those fulfilling the criteria for the diagnosis of MetS. Control subjects (n = 136) were completely free of any component of the MetS. Serum anti-Hsp70 levels were measured by immunoenzymatic assay. We found that anti-Hsp70 antibody levels were significantly higher in cases than in control subjects [122.6 (89.5-155.6) vs 107.1 (77.3-152.4) μg/ml, p = 0.04], even after age and sex adjustment. In logistic regression analysis, higher levels of log-anti-Hsp70 conferred greater odds ratio (OR) for MetS, independently of age and sex. There was a statistically significant trend of ORs across quartiles of anti-Hsp70 and values greater than 108.0 μg/ml conferred a 77% increased OR of MetS as compared with values in the lower quartiles. The strength of the association slightly decreased after further adjustment for apolipoprotein B, smoking, and albumin excretion rate. In conclusion, our results show that serum anti-Hsp70 antibody levels are independently associated with nascent MetS.