Impact of cardiac rehabilitation on erectile dysfunction in cardiovascular patients: a systematic review and meta-analysis.

Background: Cardiovascular diseases (CVDs) and erectile dysfunction (ED) frequently co-occur, significantly affecting the quality of life of individuals. Aim: To assess the impact of cardiac rehabilitation (CR) on ED in patients with CVD through a systematic review and meta-analysis. Methods: This study analyzed randomized controlled trials and other studies comparing CR with usual care for adult males (≥18 years) with any cardiac disease. Literature searches were extensive, and the risk of bias was evaluated by the Cochrane Collaboration tool. Data from 6 studies involving 668 participants were included in the meta-analysis. Outcomes: The primary outcome was the improvement in ED, as measured with the International Index of Erectile Function. Results: A statistically significant improvement in erectile function was observed across 6 studies, with a Morris dppc2 effect size of 0.38 (95% CI, 0.17-0.59). Despite initial high heterogeneity (I 2 = 95.7%), identification and correction for selective outcome reporting bias mitigated this issue. Clinical Translation: CR has a modest but statistically significant impact on improving ED in patients with CVD, indicating its potential positive contribution to the quality of life of this group. Strengths and Limitations: The study's strengths include a comprehensive literature search and a rigorous methodological approach. Limitations involve high heterogeneity among studies and a low level of evidence due to small sample sizes and study quality; however, the source of heterogeneity was identified and mitigated following risk-of-bias assessment. Conclusion: The results suggest that CR has a statistically significant but modest impact on improving ED in patients with CVD. Clinicians should consider the integration of CR into the clinical management of these individuals. This study underscores the potential for CR to contribute positively to the quality of life for patients with CVD by addressing associated ED (PROSPERO: CRD42022374625).

Assessment of lytic therapy effect in patients with intermediate-high risk pulmonary embolism for prevention of chronic thromboembolic pulmonary hypertension: A randomized, double-blind trial.

Background and Aims: This study aims to compare the effectiveness of thrombolytic therapy and anticoagulation in preventing chronic thromboembolic pulmonary hypertension (CTEPH). Method: A total of 60 patients with intermediate-high risk pulmonary embolism (PE) were randomly assigned to receive either thrombolytic therapy (n = 30) or anticoagulation (n = 30). Results: Echocardiographic assessments demonstrated no significant differences between the two treatment approaches in terms of right ventricular size (RVS) (on discharge in thrombolytic group: 31.17 ± 3.43 vs. anticoagulant group: 32.73 ± 5.27, p = 0.912), tricuspid annular plane systolic excursion (TAPSE) (on discharge in thrombolytic group: 17.66 ± 2.39 vs. anticoagulant group: 16.73 ± 2.93, p = 0.290), and systolic pulmonary artery pressure (SPAP) (on discharge in thrombolytic group: 32.93 ± 9.73 vs. anticoagulant group: 34.46 ± 9.30, p = 0.840). However, significant changes were observed in all assessed parameters within each treatment group (p < 0.001). The 6-month follow-up showed no significant difference between the two groups in terms of CTEPH incidence (p = 0.781) or functional class of the patients (p = 0.135). Conclusion: Based on the findings of this study, neither thrombolytic therapy nor anticoagulation demonstrated superiority over the other in reducing adverse outcomes associated with intermediate-high risk PE, including right ventricular size, SPAP, TAPSE, or CTEPH.

Color change of tooth-colored restorative materials bonded to silver diamine fluoride-treated dentine: a systematic review.

BACKGROUND: The desirable properties of silver diamine fluoride (SDF) make it an effective agent for managing dental caries and tooth hypersensitivity. There are several clinical instances that SDF application might precede the placement of direct tooth-colored restorations. On the other hand, SDF stains demineralized/carious dental tissues black, which might affect the esthetic outcomes of such restorations. Color is a key parameter of esthetics in dentistry. Therefore, this study aims to systematically review dental literature on color/color change of tooth-colored restorations placed following the application of SDF on dentine. METHODS: Comprehensive search of PubMed, Embase, Scopus and ISI Web of Science databases (until August 2023) as well as reference lists of retrieved studies was performed. In vitro studies reported color or color change of tooth-colored restorative materials applied on SDF-treated dentine were included. Methodological quality assessment was performed using RoBDEMAT tool. Pooled weighted mean difference (WMD) and 95% confidence interval (95% CI) was calculated. RESULTS: Eleven studies/reports with a total of 394 tooth-colored restorations placed following a) no SDF (control) or b) SDF with/without potassium iodide (KI)/glutathione dentine pre-treatments were included. Color change was quantified using ∆E formulas in most reports. The pooled findings for the comparison of resin-based composite (RBC) restorations with and without prior 38% SDF + KI application revealed no statistically significant differences in ∆E values at short- and long-term evaluations (~ 14 days: WMD: -0.56, 95% CI: -2.09 to 0.96; I2: 89.6%, and ~ 60 days: WMD: 0.11; 95% CI: -1.51 to 1.72; I2: 76.9%). No studies provided sufficient information for all the items in the risk of bias tool (moderate to low quality). CONCLUSIONS: The limited evidence suggested comparable color changes of RBC restorations with and without 38% SDF + KI pre-treatment up to 60 days. The included studies lacked uniformity in methodology and reported outcomes. Further studies are imperative to draw more definite conclusions. PROTOCOL REGISTRATION: The protocol of this systematic review was registered in PROSPERO database under number CRD42023485083.

Prevalence, characteristics, and risk factors of non-alcoholic fatty liver disease in North East of Iran: a population-based study.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a common dietary disorder caused by fatty changes in the liver parenchyma and hepatocytes without alcohol consumption. The present study aimed to investigate the prevalence, characteristics, and risk factors of NAFLD in the Mashhad Persian Cohort Study population. METHOD: The present population-based cross-sectional study included all PERSIAN Organizational Cohort study in Mashhad University of Medical Sciences (POCM), Mashhad, Iran by census sampling method. Eligible participants were divided into two groups due to their NAFLD condition (NAFLD positive or NAFLD negative). All enrolled participants were evaluated based on their clinical aspects, anthropometric measures, laboratory tests, and ultrasound features. Statistical analysis was conducted using SPSS software version 16 (SPSS Inc., Chicago, USA -version 16). A P-value less than 0.05 was considered as the significance level. RESULTS: A total of 1198 individuals were included in the study, of which 638 (53.3%) were male and the rest were female. The mean age of the participants was 46.89 ± 8.98 years. A total of 246 patients (20.53%) were NAFLD positive, of which 122 (49.59%) were in grade 1, 112 (45.52%) were in grade 2, and 12 (4.87%) were in grade 3. The prevalence of fatty liver was significantly higher in males than in females (p < 0.001). There were significant differences between NAFLD positive and NAFLD negative participants in terms of having a history of hypertension (P = 0.044), body mass index (P < 0.001), body fat percentage (P = 0.001), waist circumference (P < 0.001), liver craniocaudal length (P = 0.012), fasting blood sugar (FBS) (P = 0.047), aspartate aminotransferase (AST) (P = 0.007), and alanine aminotransferase (ALT) (P = 0.001). Further analysis revealed a strong significant association between BMI, previous history of hypertension, higher levels of serum ALT, and NAFLD (P < 0.05). CONCLUSION: It can be concluded that ultrasound findings accompanied by laboratory AST and ALT level enzymes could be a cost-benefit approach for NAFLD early diagnosis. The craniocaudal size of the liver could be a beneficent marker for estimating the severity of the disease; however, more studies are recommended to evaluate this variable for future practice against the issue.

Worldwide Prevalence of Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis.

Background: The prevalence of pelvic organ prolapse is varied in different countries. For validating the results of numerous studies on the prevalence of Pelvic organ prolapse in the world, a meta-analysis study seems necessary to provide an accurate and valid prevalence for planners and researchers in this field. Therefore, we aimed to investigate the worldwide prevalence of pelvic organ prolapse using the meta-analysis method. Methods: By using valid keywords, searching was done in ISI Web of Science, PubMed, Scopus, and Medline databases, and 22 articles were selected based on inclusion criteria between 2009 and 2021. The quality of articles was checked using The Joanna Briggs Institute (JBI) checklist. Meta-analysis was performed on collected data using Comprehensive Meta-Analysis Software (CMA, Version 2). Meta-analysis of data was done with a random-effects model. The heterogeneity of the study was checked using the I2 index. Publication bias was assessed by the Egger test and funnel graph. Results: The overall prevalence of included studies was 30.9% (95% confidence interval: 24.4-38.2%), (P<0.001, heterogeneity I2=99.8%). Meta-analysis of subgroups in studies that used a questionnaire to estimate the prevalence rate showed the prevalence was 25.0% and, in the studies, used the physical examination was 41.8%. Conclusion: Studies carried out in different parts of the world have examined the prevalence of pelvic organ prolapse using different tools. Since some cases are asymptomatic, especially in the low stage of prolapse, physical examination of pelvic organ prolapse should be considered an essential tool in evaluating pelvic organ prolapse.

Exposure to occupational air pollution and vascular endothelial dysfunction in workers of the steel industry in Iran.

Air pollution is recognized as a risk factor for cardiovascular diseases; however, the precise underlying mechanisms remain unclear. This study investigated the impact of occupational air pollution exposure on endothelial function in workers within the steel industry. Specifically, we examined male employees in the coke-making division of the Isfahan Steel Company in Iran, as well as those in administrative roles with no known history of cardiovascular risk. Data on age, body mass index, duration of employment, blood pressure, fasting blood sugar, and lipid profile were collected. To assess endothelial function, flow-mediated dilation (FMD) was measured. The baseline brachial artery diameter was greater (mean difference [95% CI] = 0.068 mm [0.008 to 0.128]), while the FMD was lower (mean difference [95% CI] = -0.908 % [-1.740 to -0.075]) in the coke-making group than in the control group. After controlling for potential confounding variables, it was observed that working in the coke-making sector of the industry was associated with lower FMD (F = 3.954, p = .049). These findings indicated that occupational air pollution exposure among workers in the steel industry is linked to impaired endothelium-dependent vasodilation.

First Iranian guidelines for the diagnosis, management, and treatment of hyperlipidemia in adults.

This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low-density lipoprotein cholesterol (LDL-C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL-C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL-C without comorbidities and risk factors was considered an LDL-C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women.

Efficacy and safety of basal insulins in people with type 2 diabetes mellitus: a systematic review and network meta-analysis of randomized clinical trials.

Aim: The comparative effectiveness of basal insulins has been examined in several studies. However, current treatment algorithms provide a list of options with no clear differentiation between different basal insulins as the optimal choice for initiation. Methods: A comprehensive search of MEDLINE, Embase, Cochrane Library, ISI, and Scopus, and a reference list of retrieved studies and reviews were performed up to November 2023. We identified phase III randomized controlled trials (RCTs) comparing the efficacy and safety of basal insulin regimens. The primary outcomes evaluated were HbA1c reduction, weight change, and hypoglycemic events. The revised Cochrane ROB-2 tool was used to assess the methodological quality of the included studies. A random-effects frequentist network meta-analysis was used to estimate the pooled weighted mean difference (WMD) and odds ratio (OR) with 95% confidence intervals considering the critical assumptions in the networks. The certainty of the evidence and confidence in the rankings was assessed using the GRADE minimally contextualized approach. Results: Of 20,817 retrieved studies, 44 RCTs (23,699 participants) were eligible for inclusion in our network meta-analysis. We found no significant difference among various basal insulins (including Neutral Protamine Hagedorn (NPH), ILPS, insulin glargine, detemir, and degludec) in reducing HbA1c. Insulin glargine, 300 U/mL (IGlar-300) was significantly associated with less weight gain (mean difference ranged from 2.9 kg to 4.1 kg) compared to other basal insulins, namely thrice-weekly insulin degludec (IDeg-3TW), insulin degludec, 100 U/mL (IDeg-100), insulin degludec, 200 U/mL (IDeg-200), NPH, and insulin detemir (IDet), but with low to very low certainty regarding most comparisons. IDeg-100, IDeg-200, IDet, and IGlar-300 were associated with significantly lower odds of overall, nocturnal, and severe hypoglycemic events than NPH and insulin lispro protamine (ILPS) (moderate to high certainty evidence). NPH was associated with the highest odds of overall and nocturnal hypoglycemia compared to others. Network meta-analysis models were robust, and findings were consistent in sensitivity analyses. Conclusion: The efficacy of various basal insulin regimens is comparable. However, they have different safety profiles. IGlar-300 may be the best choice when weight gain is a concern. In contrast, IDeg-100, IDeg-200, IDet, and IGlar-300 may be preferred when hypoglycemia is the primary concern.

Long-term outcome and prognostic value of angiographic slow/no-reflow phenomenon after emergency percutaneous coronary intervention for ST-elevation myocardial infarction.

BACKGROUND: The coronary slow flow/no-reflow phenomenon (CSF/NRP) is a common complication of emergency percutaneous coronary intervention (PCI) for ST-elevated myocardial infarction (STEMI). Its long-term prognostic value, however, remains unclear. This study investigated the long-term outcome and prognostic value of CSF/NRP after emergency PCI for STEMI. METHODS: This retrospective, multicenter registry-based cohort study was conducted in STEMI patients who underwent emergency PCI between 2015 and 2016. Incidence of in-hospital mortality, major adverse cardiac and cerebrovascular events (MACCEs), and all-cause mortality during long-term follow-up were compared between CSF/NRP patients and the normal flow group. Cox proportional-hazards regression model was performed to identify the predictive impact of CSF/NRP in short- and long-term outcomes. RESULTS: A total of 649 STEMI patients were included in the study, of whom 193 (29.7%) developed CSF/NRP following emergency PCI. The CSF/NRP group had a higher incidence of in-hospital mortality than the non-CSF/NRP group (8.2 vs. 4.3%, P  = 0.04). All-cause mortality incidence was also higher in the CSF/NRP group during 5-year follow-up (22.2 vs. 16.2%, P  = 0.04). The Cox proportional hazards model adjusting for demographic and clinical variables identified the NRP as an independent predictor of 5-year cardiac mortality [hazard ratio: 1.89; 95% confidence interval (CI): 1.07-3.31; P  = 0.02]. In a landmark analysis, no difference was seen in overall mortality among the two study groups between 1 month and 5-year follow-up (hazard ratio: 1.33; 95% CI: 0.80-2.21, P -value: 0.23). Kaplan-Meier analysis showed lower 3-year cumulative MACCE-free survival in the CSF/NRP group compared with the normal flow group ( P  = 0.02). CONCLUSION: CSF/NRP in STEMI patients is associated with a worse short- and long-term prognosis. These results, however, are mostly related to the acute phase, and CSF/NRP had limited influence on clinical outcomes in early survivors of STEMI.

The association between C-reactive protein and coronary artery calcification: a systematic review and meta-analysis.

BACKGROUND: While coronary artery calcification (CAC) is recognized as a reliable marker for coronary atherosclerosis, the relationship between the concentration of C-reactive protein (CRP) and the incidence and progression of CAC remains controversial. METHOD: PubMed, Embase, Web of Science, and Scopus were systematically searched to identify relevant observational studies until October 2023. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis was employed to calculate pooled odd ratios (OR) and corresponding 95% confidence intervals, considering heterogeneity among the studies. RESULTS: Out of the 2545 records, 42 cross-sectional and 9 cohort studies were included in the systematic review. The meta-analysis on 12 eligible cross-sectional studies revealed no significant association between CAC and CRP [pooled OR: 1.03 (1.00, 1.06)]. Additionally, an insignificant association was found between CAC and CRP through meta-analysis on three eligible cohort studies [pooled OR: 1.05 (0.95, 1.15)] with no considerable heterogeneity across studies. Sensitivity analyses indicated that the meta-analysis models were robust. There was no evidence of publication bias. CONCLUSION: Based on the meta-analysis findings, elevated levels of CRP did not emerge as a valuable prognostic maker for CAC incidence and progression prediction.

Ultra-processed food consumption and cardiovascular events rate: An analysis from Isfahan Cohort Study (ICS).

BACKGROUND AND AIMS: The contribution of ultra-processed foods (UPFs) to daily energy intake and, therefore, their health effects may vary between countries. We aimed to investigate the association between UPFs and the incidence risk of cardiovascular events (CVEs) and cardiovascular mortality in the Isfahan cohort study. METHODS AND RESULTS: In 2001, 6504 participants aged ≥35 years were enrolled and followed until 2017. Dietary intake was assessed using a validated food frequency questionnaire, and the NOVA system was applied for UPF classification. Any new case of CVE, including fatal and non-fatal myocardial infarction (MI) or stroke, unstable angina (UA), and CVD death, was recorded. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated through Cox proportional hazards regression models. A total number of 819 CVE, 164 MI, 348 UA, 172 strokes, and 181 cardiovascular deaths were recorded during 61352.5 person-years of follow-up. The median (IQR) of UPF consumption was 2.47 (1.00-5.23) times/week. In the fully adjusted model, individuals in the fourth quartile of UPFs had no higher risk for incident MI and UA (HR = 1.12, 95% CI: 0.87, 1.46; P for trend = 0.364), stroke (HR = 0.93, 95% CI: 0.58, 1.46; P for trend = 0.601), cardiovascular mortality (HR = 0.95, 95% CI: 0.61, 1.47; P for trend = 0.596), and CVE (HR = 1.08, 95% CI: 0.88,1.34; P for trend = 0.515) in comparison with those in the first quartile. CONCLUSION: This mid-term prospective cohort study provides no evidence for a significant association between UPF and CVE risk. Longer studies are required to confirm this association.

Approaches for boosting self-confidence of clinical nursing students: A systematic review and meta-analysis.

Background: Self-confidence is a key element in successfully promoting achievement strivings among the healthcare workforce. Targeted interventions can strengthen this characteristic in nursing students, thus improving the quality of hospital services. Objectives: We evaluated the effect of educational interventions on boosting self-confidence in nursing students using systematic review and meta-analysis. Methods: A comprehensive search was used to screen the related studies in Scopus, PubMed, Embase, Web of Science, and PsycINFO. Peer-reviewed literature in English until June 2023 was reviewed. Inclusion criteria were controlled trials, either non-randomized studies of intervention (NRSI) or randomized (RCTs). Studies were assessed for methodological quality by the Cochrane Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) and the Cochrane "Risk of Bias" tool for RCTs (RoB 2.0) and quality assessment tool for before-after (pre-post) studies with no control group. The main outcome was the self-confidence score of nursing students because of educational methods or intervention/s. Using the inverse variance weights method, a pooled standardized mean difference (SMD) estimate with a corresponding 95% confidence interval (CI) was determined. Random-effects meta-analysis was used to assess conceptual heterogeneity using Stata. Results: Twenty-two studies were selected involving 1758 participants and 940 cases of nursing students in the intervention group on boosting self-confidence (Fourteen Randomized controlled trials, Five Quasi-experimental, and three Before-After studies). The post-intervention self-confidence results in the nursing student's intervention group were significantly greater (SMD) (SMD for Controlled experimental design = 0.51; 95% CI = 0.14-0.89), (SMD for Quasi-experimental = 0.04; 95% CI = -0.33-0.41), (SMD for Before-After (Pre-Post) = 2.74; 95% CI = 1.85-3.63). The random-effect meta-analysis of 22 interventional studies determined that educational interventions are significantly associated with the improving self-confidence of nursing students. The intervention showed a moderate impact on the research units, according to Cohen's d results. Also, the results of simulation learning intervention (SMD = 0.42; 95% CI = 0.03-0.81) showed a significant relationship between intervention and outcome in studies. Conclusions: Analysis of our findings revealed the successful impact of most interventional approaches in boosting self-confidence, especially in the long term. It can be concluded that self-confidence is a multifactorial concept that can be improved by using targeted combination intervention strategies.

Association of triglyceride glucose index with cardiovascular events: insights from the Isfahan Cohort Study (ICS).

BACKGROUND: There is limited evidence regarding the evaluation of the association between the triglyceride glucose (TyG) index, an indicator of insulin resistance, and the incident risk of cardiovascular disease (CVD). Therefore, we aimed to examine the relationship between the TyG index and CVD incidence in a cohort of Iranian adults. METHODS: This study was performed in the framework of the Isfahan Cohort Study (ICS). The study population included 5,432 individuals aged ≥ 35 years. CVD events, including acute myocardial infarction (MI), stroke, and unstable angina (UA), were diagnosed by physicians. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. The relationship between the TyG index and CVD events was investigated using Cox regression models. Receiver operating characteristics (ROC) curve analysis was used to determine the best cut-off for the TyG index for predicting CVD outcomes. RESULTS: During a median follow-up period of 11.2 years, a total number of 819 CVD, 164 MI, 172 stroke, and 384 UA were recorded. Following adjustment for multiple confounders, elevated TyG levels were associated with a higher risk of CVD (HR = 1.48; 95% CI 1.22-1.79; p < 0.001), MI (HR = 2.24; 95% CI 1.42-3.52; p < 0.001), stroke (HR = 1.45; 95% CI 0.96-2.19; p = 0.042), but not UA (HR = 1.28; 95% CI 0.96-1.69). The optimal TyG index cut-off was 8.91 for predicting CVD (sensitivity 58%; specificity 58%), 9.04 for predicting MI (sensitivity 57%; specificity 65%), 8.92 for predicting stroke (sensitivity 57%; specificity 57%), and 8.98 for predicting UA (sensitivity 53%; specificity 61%). CONCLUSION: We found a robust, direct association between the TyG index and the incidence of CVD events. This emphasizes the significance of observing the TyG index as an indicator of the occurrence of CVD events.

Association of the triglyceride glucose index with all-cause and cardiovascular mortality in a general population of Iranian adults.

BACKGROUND: The triglyceride glucose (TyG) index is a new and low-cost marker to determine insulin resistant which may be a predictor of cardiovascular disease (CVD). Although available evidence showed that its association with CVD mortality (CVM) and all-cause mortality (ACM) may differ in different populations, scarce data are available in this regard specially in low and middle-income countries. PURPOSE: To examine the association between TyG index and risk of CVM and ACM in Iranians. METHODS: This prospective cohort study included 5432 adults (age ≥ 35 years) with no history of CVD events. Fasting glucose and triglyceride were measured at baseline in all participants and TyG index was calculated. Cox frailty model was used to calculate hazard ratios (HRs) for CVM and ACM across the tertiles of TyG index. RESULTS: After a median follow-up of 11.25 years, a total number of 191 cardiovascular deaths, and 487 all-cause mortality was recorded. The risk of both CVM and ACM increased across the tertiles of TyG index. In the adjusted model for lifestyle and metabolic variables, the risks of ACM and CVM increased by 41% (95% CI 1.11, 1.81; P for trend = 0.005) and 64% (95% CI 1.07, 2.50; P for trend = 0.024), respectively. However, adjustment for diabetes mellitus disappeared the significance for both ACM and CVM. These associations may vary by sex. TyG was not related to the risk of non-CVD mortality. CONCLUSION: The predicting value of TyG index for ACM and CVM might be mediated by diabetes status. Further studies are required to confirm these findings.

Lipid accumulation product and visceral adiposity index for incidence of cardiovascular diseases and mortality; results from 13 years follow-up in Isfahan cohort study.

Background: /Aims: Visceral adiposity index (VAI) and lipid accumulation product (LAP) are novel anthropometric indices that have shown an association with metabolic syndrome; however, limited data are available regarding the predictive performance of these indices for the incidence of cardiovascular diseases (CVD) and mortality. Methods: This study was performed on the data retrieved from Isfahan Cohort Study (ICS). ICS is an ongoing population-based cohort study conducted in 3 counties in central Iran. Pearson correlation analysis was performed between LAP, VAI, and metabolic parameters. Cox regression analysis and receiver operative characteristics (ROC) curve analysis were performed in order to evaluate the ability of VAI and LAP for the incidence of CVD, CVD-associated mortality, and all-cause mortality. We further compared the predictive performance of VAI and LAP with body mass index (BMI). Results: LAP and VAI were significantly correlated with all metabolic variables, including blood pressure, fasting blood glucose, and lipid profile components. Univariate regression analysis indicated a significant association between LAP and VAI and CVD incidence. In multivariate analysis, only VAI was significantly associated with CVD incidence. Regarding CVD mortality, only VAI in the multivariate analysis revealed a significant association. Interestingly, Both VAI and LAP were negatively associated with all-cause mortality. ROC curve analysis indicated the superior performance of LAP and VAI for predicting CVD incidence compared to BMI; however, BMI was better in predicting all-cause mortality. Conclusion: Compared to BMI, LAP and VAI have better predictive performance for the incidence of CVD. In contrast, BMI was superior to VAI and LAP in the prediction of all-cause mortality.

Antianginal effects of empagliflozin in patients with type 2 diabetes and refractory angina; a randomized, double-blind placebo-controlled trial (EMPT-ANGINA Trial).

INTRODUCTION: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are emerging antidiabetic agents with various potential cardiovascular benefits. The EMPT-ANGINA trial examined the effect of empagliflozin on the angina burden in those with concurrent type 2 diabetes mellitus (T2DM) and refractory angina (RA). METHOD: In this 8-week, double-blind, randomized, placebo-controlled trial, 75 patients with T2DM and RA were randomly assigned to one of two groups: empagliflozin (n = 37) and placebo (n = 38). The primary outcome was an improvement in angina, which was assessed by the Seattle Angina Questionnaire (SAQ). The secondary outcomes of this study included alterations in the SAQ domains and exercise test components. RESULTS: The mean age of individuals in the empagliflozin and placebo groups was 67.46 ± 9.4 and 65.47 ± 7.0 years, respectively (p = .304). Patients who received empagliflozin showed a significant improvement in both the primary endpoint, which was the SAQ Summary Score (192.73 ± 20.70 vs. 224 ± 25.36, p < .001) and the secondary endpoints. Exercise test components, including treadmill exercise duration, time till angina, 1 mm ST-segment depression onset, and heart rate (HR) recovery, were all significantly improved in the empagliflozin group. This positive impact was reached with no clinically significant changes in resting and exertion HR or blood pressure. There were no significant side effects in the empagliflozin group (p = .125). CONCLUSION: Empagliflozin can be safely added as a metabolic modulator agent to existing antianginal medications in individuals with concurrent T2DM and RA to reduce angina symptoms and enhance exercise capacity with minimal side effects.

Medication Adherence With Polypill in Cardiovascular Disease and High-Risk Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Involving 7364 Participants.

Considering the worldwide mortality and morbidity of cardiovascular diseases (CVDs), the necessity of using multiple pills due to the chronicity of this condition, and the importance of medication adherence in these patients, we conducted this systematic review and meta-analysis to assess the polypill effect on adherence in patients with established CVD and at high risk. To accomplish this review, we searched various databases to access grey literature and several electronic databases to find randomized controlled trials (RCTs) assessing polypills compared to individual pills from January 2000 to October 2022. The outcomes were primarily medication adherence, secondarily systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C) serum level, and serious adverse events (SAEs). Ultimately, 2820 studies were detected and narrowed to 8 RCTs based on the eligibility criteria. In this study, involving 7364 patients, there was a significant improvement in medication adherence in the polypill group compared to the individual pills group (Risk Ratio [RR] = 1.29; [95%CI: 1.10; 1.50]). Out of secondary outcomes, SBP was significantly decreased (Mean Difference [MD] = -1.72 mmHg; [95%CI: -2.40; 1.03]), but LDL-C serum level (MD = -0.65 mg/dl; [95%CI: -4.47; 3.16]) and SAE (RR = 1.08; [95%CI: f0.98; 1.20]) did not have a notable difference in polypill compared to individual pills.

Body weight changes and diabetes mellitus incident: A cohort study from the Middle East.

Objective: Obesity is a known risk factor for diabetes, but the effect of weight changes on the incidence of diabetes is not yet determined. This study aims to evaluate the long-term effects of weight change [based on body mass index (BMI)] on the incidence of diabetes mellitus (DM) in a middle eastern population. Method: In the Isfahan Cohort Study (ICS) 6504 adults equal or greater than 35 years of age were recruited at 2001 and were followed until 2013. Absolute BMI changes (ΔBMI) were calculated by subtracting the baseline BMI from the BMI measured at follow-ups. To compare participants with different baseline BMI easier, relative changes in BMI were quantified as the percentage of changes from baseline. DM was assessed based on standard definitions. Multivariable Cox regression was used to determine the association between ΔBMI and the incidence of diabetes. Results: During follow-ups, 261 new cases of diabetes were recorded, with an IR of 3401.29 per 100,000 P-Y. The highest number of new cases of type 2 DM belongs to participants with overweight and obesity who had minimal BMI changes (less than 5% of their baseline BMI limits; 42 and 38 new cases, respectively). Participants who were obese at baseline and had lost more than 10% or gained 5-10% of baseline BMI were in the groups with the highest IR [360.05-95% CI (239.3-541.8) and 322.39-95% CI (178.5-582.1) respectively]. There was no significant association between BMI changes and the incidence of DM in the participants with normal BMI, overweight, and obesity at baseline in cure and adjusted models. Conclusions: This study showed there was no significant association between diabetes mellitus incidence and BMI changes.

The Effect of Telenursing on Disease Outcomes in People with Type 2 Diabetes Mellitus: A Narrative Review.

Method: A comprehensive search of online databases, including PubMed, Scopus, Cochrane Library, and Google Scholar, was performed using the following MeSH keywords: telenursing, telephone follow-up, diabetes mellitus, disease management, glycemic, self-care, treatment adherence, and quality of life, up to September 2023. Two reviewers independently screened pertinent studies based on the prespecified outcomes (treatment adherence, self-care, glycemic control, and quality of life) and extracted data from all eligible studies. Results: Of all retrieved records, 23 studies including 5 quasiexperimental (21%) and 18 randomized controlled trials (RCTs) (79%) from five continents met the inclusion criteria. Both male and female patients were considered in the included studies, with mean age of 56.2 years old and a follow-up range of 12 weeks to 18 months. Findings showed that telenursing or nurse telephone follow-up significantly increased mean self-care efficacy score, improved adherence to the treatment regimen, decreased glycosylated hemoglobin and plasma glucose levels (but not lipid profile and body mass index), and improved quality of life compared to the routine care in people with T2DM. Conclusion: Telenursing can effectively supplement healthcare professionals to manage PWT2D. Increasing patients' knowledge about their drugs, insulin administration, and diabetes complications improves self-care behaviors and medical adherence. Consistently, improved self-care and regular use of treatment result in improved metabolic indicators and decreased rate of complications, which is associated with a better quality of life.

Are different perceived stressors associated with metabolic syndrome: a longitudinal cohort study of adults in central Iran.

Purpose: The link between metabolic syndrome (MetS) and various stressors has not been thoroughly investigated. We aimed to examine the relationship between MetS and different perceived stressors. Methods: In this study, we included participants of the Isfahan Cohort study from three counties in central Iran, with data in the 2007 (n = 3178) and 2013 (n = 1693) follow-up stages. We examined the association between distress and perceived stress domains (including job security, job conflicts, personal conflicts, loss and separation, social relations, and health concerns) and MetS. Results: MetS was identified in 35.8% of participants in the 2007 cohort and 46.2% in the 2013 cohort. In the fully adjusted analysis, the odds ratio (OR) (95%CI) for MetS according to psychological status was 1.65 (1.64-1.65) for psychological distress level, 1.09 (1.01-1.20) for psychological distress score, and 1.21 (1.09-1.42) for total perceived stress score. There was also evidence of association for social relations, personal conflicts, job conflicts, job security, health concern, loss and separation, educational concerns, and sexual life subscales. Conclusion: Perceived stressors and some of their subscales were associated with MetS.