Overweight and obesity prevalence and its predictors in a general population: A community-based study in Kerman, Iran (Kerman coronary artery diseases risk factors studies).

BACKGROUND: The aim of this study was to present age-sex standardized prevalence of overweight and obesity as well as central obesity and its associated variables in an adult population of Iran. METHODS: Around 5900 adult individuals aged 15-75 years enrolled to the study from 2009 to 2011 applying randomized cluster household survey in Kerman, southeastern of Iran. Overweight was defined as body mass index (BMI) 25-29.9 kg/m2, obesity was considered as BMI ≥ 30 kg/m2, and central obesity was regarded as waist circumference (WC) > 88 cm for women and 102 cm for men. RESULTS: The overall age-sex standardized prevalence of overweight, obesity and central obesity was 29.6% (29.5% men, 29.7% women), 13.0% (9.3% men, 16.9% women) and 14.4% (7.5% men, 21.5% women), respectively. "Overweight/obesity" increased by age, [adjusted odds ratio (AOR): 7.9 95% confidence interval (CI): 5.8, 10.7)] for 65-75 years old, 11.7 (95% CI: 9, 15.3) for 55-65 years old, 10.1 (95% CI: 7.8, 13) for 45-54 years old compared with the first age group), female gender [AOR: 1.5 (1.3, 1.8); P < 0.001], higher education (AOR > 1.5 compared with illiterate individuals; P < 0.001), and low physical activity [AOR: 1.4 (95% CI: 1.1, 1.8); P = 0.006] and decreased by smoking [AOR: 0.4 (95% CI: 0.3, 0.6); P < 0.001] and opium using [AOR: 0.5 (95% CI: 0.4, 0.7); P < 0.001]. Female gender [AOR: 4.1 (95% CI: 3.3, 5); P < 0.001], advanced (AOR > 7 for age groups ≥ 35 years old; P < 0.001) positively, while smoking [AOR: 0.6 (0.4, 0.8); P = 0.004] negatively were the most significant predictors for abnormal WC. CONCLUSION: Our data reveal that overweight and obesity affected almost half of the adult population (43.0%), and central obesity was around 15.0%, which reflect the high prevalence of this abnormality. In addition, several demographic, social and lifestyle factors were associated with obesity. Appropriate interventions and strategies with a concentration of the general population are needed to deal with its potential subsequent consequences.

The prevalence of low physical activity in an urban population and its relationship with other cardiovascular risk factors: Findings of a community-based study (KERCADRS) in southeast of Iran.

BACKGROUND: The low physical activity (LPA) more or less affects every community. Because of high prevalence of cardiovascular diseases in Iran and their relationship with LPA, this study aimed to measure precisely the epidemic size of LPA and determine its relationship with six other coronary artery disease (CAD) risk factors among an urban population aged 15 to 75 years in Kerman, Iran. METHODS: Using household survey, 5895 adults were randomly recruited through single-stage cluster sampling from 250 postal codes. Demographic characteristics, blood pressure, blood glucose, cholesterol, triglyceride, smoking, opium use, mental status and physical activities at work, rest and recreation were assessed and ranked as low, moderate and intense. Adjusted odds ratio (AOR) was reported as a measure of the relationship between LPA and other CAD risk factors. RESULTS: The prevalence of low, moderate, and intense physical activity were 42.1% (40.3-43.9), 45.0% (43.6-47.4) and 12.4% (11.1-13.9), respectively. LPA showed a sudden rise from 36.8% to 45.4% after the age of 25 years. On average, women had less physical activity than men (45.1% vs. 39.2%, P= 0.01). Participants with low physical activity compared to those without physical activity had significantly higher chance of anxiety [odds ratio 1.39; confidence interval (95% CI) 1.08-1.79; P = 0.01], hypertension (1.59; 1.08-2.35; P = 0.02), hyper-cholesterolemia (1.37; 1.06-1.76; P = 0.02), cigarette smoking (1.52; 1.07-2.11; P = 0.01), opium addiction (1.47; 1.07-2.02; P = 0.02) and overweight/obesity (1.34; 1.05-1.71; P = 0.02). CONCLUSION: LPA was very common in the studied population and almost half of the adults were at risk for CAD because of insufficient level of physical activity. Such risky life-style pattern makes the emerging of CAD epidemic unavoidable, if effective interventions not being in place timely to this community.

Effect of opium addiction on aspirin resistance in stable angina pectoris.

BACKGROUND: The rate of cardiovascular diseases in developing countries is approximately 60% and it is still has an increasing trend. The clinical effectiveness of aspirin in preventing cardiovascular events has been well proven. Although aspirin is an effective and inexpensive drug, its consumption is not equally beneficial for all patients. Many factors can be affective on the efficacy of antiplatelet drugs such as aspirin. METHODS: This study was carried out on 260 patients who had stable angina pectoris and coronary artery disease was approved by coronary angiography. Based on opium addiction, the patients were divided into two groups. Opium addiction was diagnosed base on Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. The mid-stream morning urinary sample were collected for measuring the urinary 11-dehydroxy thromboxane B2 level (UTXB2). Urinary level of UTXB2 was considered as an aspirin resistance index. FINDINGS: The mean age of patients was 57.3 ± 8.9; and 44.6% of them were females. The aspirin resistance rate was 41.5%. Significant difference in aspirin resistance was observed between the opium addicts and non-addicts. (51.5% vs. 31.5%) (P = 0.001). The effects of confounding variables such as diabetes, hypertension, and hyperlipidemia were eliminated by regression logistic multivariable analysis. CONCLUSION: The prevalence of aspirin resistance in patients with stable angina pectoris was 41.5%. The prevalence of aspirin resistance in patients with stable angina pectoris who had opium addiction was significantly higher them non-addicts.

Serum level of plasminogen activator inhibitor type-1 in addicted patients with coronary artery disease.

BACKGROUND: Plasminogen activator inhibitor-1 (PAI-1) is a glycoprotein with inhibitory effects on the formation of plasmin from plasminogen by plasminogen activator. Thus, it prevents clot lysis in vessel walls. Several evidences prove the relationship between coronary artery disease and response to fibrinolytic therapy in patients with myocardial infarction (MI) with PAI-1 level. Opium addiction is one of the most important factors in causing MI and cardiovascular events. This is due to it causing imbalance between coagulation and anticoagulation factors in the blood. This study was designed and implemented to determine the levels of PAI-I in opium-addicted patients with coronary artery disease in comparison with non addicts. METHODS: In this case-control study, 160 patients with coronary heart disease (CHD), which was confirmed by angiography results, were enrolled. All of the patients had a medical history, their creatinine levels and lipid profile were evaluated, morphine urine test was performed, and after that a blood sample was taken to determine the levels of PAI-1. Thus, the 80 patients who had a positive morphine urine test result formed the case group, and the control group was constituted of the 80 patients with negative morphine test results. The two groups were matched. FINDINGS: Average level of PAI-1 in the control group was 2.4 ± 2.6 and in the case group was 8.8 ± 9.1 and it was statistically significant (P < 0.001). The frequency of two vessel disease was higher in opium addicted patients than non-addicted patients and this was statistically significant (P = 0.030). However, the frequency of single vessel and three vessel disease was the same in the two groups. The two groups had no differences in age, lipid profile, and creatinine level. Moreover, females are at a higher risk of high PAI-1 levels. CONCLUSION: PAI-1 levels in opium addicted patients with CHD are higher than other patients. In these patients, the risk of atherosclerosis and MI is higher than normal.

The effect of opium addiction on arrhythmia following acute myocardial infarction.

The effect of opium addiction on the appearance of different types of arrhythmias after acute myocardial infarction (AMI) has been assessed in few studies. This study is aimed to determine the effect of opium on post-MI arrhythmia and also to address the differences in the appearance of different types of arrhythmias after AMI between opium addicted and non-addicted patients. In this comparative study, participants were classified into two groups with opium addiction (n=94) and without opium addiction (n=106). Post-MI arrhythmias were determined among each group. Study populations were included all patients with first AMI admitted within 6 hours of the onset of chest pain to coronary care units (CCU) of two teaching hospitals affiliated to Kerman University of Medical Sciences (KUMS) in the city of Kerman, Iran. Opium addicted subjects had significantly more frequency of arrhythmia than non-opium addicted subjects (80.9% vs. 22.6%, respectively; P<0.001). Opium addiction was a strong predictor for the occurrence of post-MI arrhythmias in two models of crude analysis (crude OR=14.4, P<0.001) and after adjusting for potential confounder factors (adjusted OR = 21.9, P<0.001). The prevalence of sinus tachycardia, sinus bradycardia and atrial fibrillation in opium addicts were significantly higher than non opium addicts (P<0.05). The results of our study showed that opium addiction is a potential and strong risk for occurring post-MI arrhythmias.

Premature menopause and severity of coronary artery disease.

BACKGROUND: Relationship between premature menopause and presence, severity and life-threatening events of coronary artery disease (CAD) has been suggested in recent observations. The present study tried to assess relationship between age of menopause and severity of CAD in a sample of women with suspected CAD. METHODS: In a cross-sectional study, we included 189 consecutive women with suspected CAD that were candidate for coronary angiography and admitted to the Shafa hospital in Kerman city. Our final population for analysis included women who underwent natural menopause (n = 148) or premature menopause (n = 41). CAD severity was classified according to the number of coronary artery stenosis ≥ 50% in coronary angiography. RESULTS: Among 189 study patients with suspected CAD, 22.0% of those with early menopause and 23.6% of those with normal menopause suffered three coronary vessels involvement, while normal angiography features was shown in 39.0%o and 40.5%>, respectively. Regarding severity of CAD and left main lesions, no significant differences were found between the patients with and without premature menopause. According to the multivariable logistic regression model and with the presence of other patients' variables as cofounders, age of menopause could not predict the presence and severity of CAD in patients with suspected CAD. However, patients' age (OR: 1.11, p < 0.001) and family history of CAD (OR: 2.05, p = 0.04) were main predictors of the severity of CAD in these patients. CONCLUSIONS: Premature menopause does not predict occurrence or severity of CAD in women with suspected CAD, but women age and their family history of CAD are main predictors of the severity of CAD.