Association of dietary fatty acids and the incidence risk of cardiovascular disease in adults: the Tehran Lipid and Glucose Prospective Study.

BACKGROUND: Considering the inconsistent available findings regarding the cardioprotective effect of dietary fatty acid composition, we prospectively examined the feasible association between the dietary fatty acids and the cardiovascular disease (CVD) incidence in framework of the population-based Tehran Lipid and Glucose Study. METHODS: A total of 2369 participants (19-70 years, 43.5% men) without CVD at baseline (2006-2008) were included and followed-up for 6.7 years. Fatty acids' dietary intake was estimated using a 168-item semi-quantitative food frequency questionnaire. The CVD incidence risk across tertiles of dietary fatty acids was predicted via Cox proportional hazards regression models. RESULTS: The average age and body mass index of the included population were 38.5 ± 13.3 years and 26.6 ± 4.8 kg/m2 at baseline. Over 6.7 years of follow-up, 79 cases of CVD were detected. The risk of CVD was lower in upper tertile of monounsaturated fatty acids, oleic acid, and docosahexaenoic acid + eicosapentaenoic acid among the tertiles. No significant associations were found between total fat, saturated and polyunsaturated fatty acids' intake, and CVD. CONCLUSIONS: Our results suggest that the dietary fatty acid composition might affect the incidence risk of CVD within the Iranian population.

Risk factors for cardiovascular disease and mortality events in adults with type 2 diabetes - a 10-year follow-up: Tehran Lipid and Glucose Study.

BACKGROUND: To identify risk factors for cardiovascular disease (CVD) and mortality events in patients with type 2 diabetes and to calculate their population attributable fraction among a representative Iranian population. METHODS: A total of 1198 patients with type 2 diabetes (504 men and 694 women), aged ≥30 years, without prevalent CVD, with a median follow-up of 10 years were included in current study. To examine the association between risk factors and their outcomes, multivariate sex-adjusted Cox proportional hazard regression models were used. RESULTS: During the study, 281 and 172 participants experienced CVD and all-cause mortality events, respectively. Regarding CVD events, fasting plasma glucose (FPG) level of 7.22-<10 mmol/L [hazard ratio (HR): 1.46, 95% CI 1.12-1.96], FPG level ≥10 mmol/L (HR 2.04, 1.53-2.72), hypertension (HR 1.65, 1.28-2.13), hypercholesterolaemia (HR 1.96, 1.40-2.75) and high waist to hip ratio (HR 1.30, 0.99-1.70; p = 0.051) were significant predictors, and corresponding population attributable fractions were 9.76, 17.84, 23.26, 41.63 and 14.76%, respectively. Considering all-cause mortality events, hypertension (HR 1.70, 1.23-2.36), FPG level ≥10 mmol/L (HR 2.31, 1.55-3.20) and smoking (HR 1.45, 1.03-2.04) were significant predictors, and corresponding population attributable fractions were 25.81, 20.88 and 11.18%, respectively. Meanwhile, being overweight or obese was associated with lower all-cause and CVD mortality events. CONCLUSIONS: Among modifiable risk factors in patients with type 2 diabetes, hypercholesterolaemia and central adiposity for CVD, smoking for mortality events and hypertension and poor glycaemic control for both outcomes need to be paid most attention by healthcare professionals. Copyright © 2016 John Wiley & Sons, Ltd.

Do different metabolic syndrome definitions predict cerebrovascular events and coronary heart disease independent of their components?: 9 years follow-up of the tehran lipid and glucose study.

BACKGROUND AND PURPOSE: The purpose of this study was to examine whether metabolic syndrome (MetS), applying different definitions, predicts incident coronary heart disease (CHD) and cerebrovascular events (CVAs) independent of its components. METHODS: Among 2548, aged ≥ 50 years, World Health Organization, International Diabetes Federation, and Joint Interim Statement criteria were used to define MetS. Cox proportional hazards regression was implemented to estimate hazard ratios of incident CVA and CHD. RESULTS: During 9.3 years of follow-up, 72 and 343 cases of CVA and CHD events occurred. The multivariate hazard ratios (95% CI) of incident CVA and CHD were 2.71 (1.57-4.68) and 2.07 (1.63-2.64) for MetS as defined by the Joint Interim Statement, respectively. There was no difference among the 3 definitions of MetS regarding the prediction of the CVA incidence. However, MetS as defined by the Joint Interim Statement predicted CHD better than the International Diabetes Federation definition. After adjustment for components, MetS lost its association with CHD and CVA; in this model, the elevated blood pressure and high fasting plasma glucose (International Diabetes Federation definition) showed significant risk for CVA events; regarding CHD events, the elevated blood pressure, high fasting plasma glucose, and, for World Health Organization definition, obesity and dyslipidemia remained as predictors. CONCLUSIONS: All definitions of MetS were associated with CVA and CHD events. After adjusting its components, MetS lost its association with incident CVA and CHD; however, elevated blood pressure for both CVA and CHD events and high fasting plasma glucose for CHD events remained as independent predictors in all definitions.

Shadow of diabetes over cardiovascular disease: comparative quantification of population-attributable all-cause and cardiovascular mortality.

BACKGROUND: We contrasted impacts on all-cause and cardiovascular disease (CVD) mortality of diabetes vs. CVD. METHODS: Among participants the Tehran lipid and glucose study aged ≥ 30 years (n = 9752), we selected those who participated in the follow-up study until 20 March 2009 (n = 8795). Complete data on covariate were available for 8, 469 participants, contributing to a 67935 person-year follow up. In the analysis of outcomes (all-cause and CVD mortality), diabetes and CVD were assessed using Cox proportional hazard regression model adjusting for established CVD risk factors. We used population attributable hazard fraction (PAHF) and rate advancement period (RAP) that expresses how much sooner a given mortality rate is reached among exposed than among unexposed individuals. RESULTS: Ten percent of the participants self-reported to have pervious CVD, and diabetes was ascertained in 17% of participants at baseline examination. During a median follow-up of 9 years 386 participants died of which 184 were due to CVD. All-cause and CVD mortality rate (95% CIs) were 5.5 (5.0-6.1) and 2.6 (2.3-3.0) per 1000 person-year, respectively. The PAHF of all-cause mortality for diabetes 9.2 (7.3-11.1) was greater than the one for CVD 3.5 (1.1-5.5). RAP estimates for all-cause mortality associated with diabetes ranged from 7.4 to 8.6 years whereas the RAP estimates for all-cause mortality associated with CVD ranged from 3.1 to 4.3 years. The PAHF of CVD mortality for diabetes 9.4 (6.8-12.0) was greater than the one for CVD 4.5 (1.8-7.0). RAP estimates for CVD mortality associated with diabetes ranged from 8.2 to 9.8 years whereas the RAP estimates for CVD mortality associated with CVD ranged from 4.7 to 6.7 years. CONCLUSIONS: We demonstrated that diabetes, which was shown to be keeping pace with prevalent CVD in terms of conferring excess risk of incident CVD, is currently causing more deaths in the population than does CVD.

Association between moderate renal insufficiency and cardiovascular events in a general population: Tehran lipid and glucose study.

BACKGROUND: Chronic kidney disease(CKD) has been proposed as a risk factor for cardiovascular disease (CVD). There is conflicting evidence among community based studies regarding the association between CKD and CVD. Furthermore, in order to assess the possible interaction between CKD and BMI, we also examined the association between CKD and CVD, across different BMI categories. METHODS: The risk of CVD events was evaluated in a large cohort of participants selected from the Tehran Lipid and Glucose Study. Participants(mean age, 47.4 years) free of previous CVD were followed up for 9.1 years. GFR ml/min per 1.73 m(2) was estimated using the MDRD formula. RESULTS: Of the 6,209 participants, 22.2%(1381) had CKD with eGFR ml/min per 1.73 m(2) <60 at baseline. Almost all of them (99%) were in stage 3a. Moderate renal insufficiency only predicted CVD outcomes independently when we adjusted for age and sex. After further adjustment, the presence of moderate CKD lost its statistical significance to confer an independent increased risk of CVD events with a hazard ratio of: HR: 1.14, CI 95% 0.91-1.42. Furthermore, when participants were categorized according to CKD status and BMI groups, after further adjustment, no interaction was found(P = 0.2). CONCLUSION: CKD was not an independent risk factor for CVD events in a community-based study in a Tehranian population and the higher prevalence of CVD in subjects with mild to moderate renal insufficiency might be due to the co-occurrence of traditional CVD risk factors in this group.

New and known type 2 diabetes as coronary heart disease equivalent: results from 7.6 year follow up in a Middle East population.

BACKGROUND: To investigate whether the known diabetes mellitus (KDM) or newly diagnosed diabetes mellitus (NDM) could be regarded as a coronary heart disease (CHD) risk equivalent among a relatively young Middle East population with high prevalence of diabetes mellitus (DM). METHODS: A population based cohort study of 2267 men and 2931 women, aged ≥ 30 years. Prior CHD was defined as self-reported or ECG positive CHD at baseline, KDM as subjects using any kind of glucose-lowering medications and NDM according to fasting plasma glucose and 2-h postchallenge glycemia.Participants were categorized to six groups according to the presence of known or newly diagnosed DM and CHD at baseline (DM-/CHD-, DM-/CHD+, NDM+/CHD-, NDM+/CHD+, KDM+/CHD-, KDM+/CHD+) and Cox regression analysis were used to estimate the hazard ratio (HR) of CHD events for these DM/CHD groups, given DM-/CHD-as the reference. RESULTS: During 7.6-year follow up, 358 CHD events occurred. After controlling traditional risk factors, HRs of CHD events for DM-/CHD+ group were 2.1 (95% CI: 1.4-3.1) and 5.2 (3.2-8.3) in men and women respectively. Corresponding HRs for NDM+/CHD-were 1.7 (1.1-2.7) and 3.1 (1.8-5.6) and for KDM+/CHD-were 1.7 (0.9-3.3) and 6.2 (3.6-10.6) in men and women respectively. The HRs for NDM+/CHD+ and KDM+/CHD+ groups (i.e. participants with history of both diabetes and CHD) were 6.4 (3.2-12.9) and 8.0 (4.3-14.8) in women and 3.2 (1.9-5.6) and 4.2 (2.2-7.8) in men, respectively.The hazard of CHD events did not differ between KDM+/CHD-and DM-/CHD+ in both genders using paired homogeneity test, however the HR for NDM+/CHD-was marginally lower than the HR for DM-/CHD+ in women (p = 0.085). CONCLUSIONS: KDM patients in both genders and NDM especially in men exhibited a CHD risk comparable to nondiabetics with a prior CHD, furthermore diabetic subjects with prior CHD had the worst prognosis, by far more harmful in women than men; reinforcing the urgent need for intensive care and prophylactic treatment for cardiovascular diseases.

Familial aggregation of the metabolic syndrome: Tehran Lipid and Glucose Study.

AIMS: Familial aggregation of the metabolic syndrome has been reported in some nations. The aim of this study was to evaluate familial aggregation of the metabolic syndrome in Tehranian families. METHODS: In a cross-sectional study, anthropometry, blood pressure and biochemical data were collected for 4,558 individuals in the Tehran Lipid and Glucose Study. Variables of the metabolic syndrome in offspring were correlated with those of their parents. RESULTS: There were 1,274 fathers, 1,576 mothers, 802 sons and 906 daughters. Prevalence of metabolic syndrome was 24.4% for fathers, 39.7% for mothers, 9.0% for sons and 7.6% for daughters. Triglycerides and HDL-C of children whose fathers had metabolic syndrome, and BMI, triglycerides and HDL-C of those whose mothers had it were significantly different from those adolescents whose parents were free of metabolic syndrome. Compared with children whose parents did not have metabolic syndrome, the odds ratio (confidence interval) for children with both parents having metabolic syndrome was 4.53 (2.42-8.8) for metabolic syndrome, 2.22 (1.17-4.19) for abdominal obesity, 1.90 (1.15-3.13) for high blood pressure, 2.66 (1.77-4.00) for low HDL-C and 3.16 (2.10-4.75) for high triglyceride levels. CONCLUSION: This survey provides evidence suggesting that there is a familial aggregation of the metabolic syndrome among Iranian families.

Outcomes of a Longitudinal Population-based Cohort Study and Pragmatic Community Trial: Findings from 20 Years of the Tehran Lipid and Glucose Study.

CONTEXT: The Tehran lipid and glucose study (TLGS) is one of the oldest population-based longitudinal cohort studies, providing knowledge about the incidence and risk factors of some non-communicable diseases (NCDs) in West Asia which hitherto was relatively scarce. We reviewed the methods and results related to the outcome measurements of this study. EVIDENCE ACQUISITION: We reviewed all the TLGS papers which reported the incidence of NCDs. RESULTS: The TLGS was initiated in 1999 - 2001 on a population in district no. 13 of Tehran with the same age distribution of the overall Tehran population and with a middle socioeconomic status. Totally, 15005 individuals, aged ≥ 3 years, participated in the first examination; reexaminations were conducted in a triennial manner and 3550 individuals were added in the second examination. All participants were also followed up annually and asked about any medical event leading to hospitalization or death. A part of participants was assigned to an educational program for lifestyle modification. High incidence of cardiovascular disease (CVD), premature CVD, diabetes and hypertension (around 19, 6, 10 and 31 in men and 11, 5, 11 and 29 in women per 1000 person-year, respectively) besides the high incidence of pre-diabetes and pre-hypertension (around 46 and 76 in men and 37 and 49 in women per 1000 person-year, respectively) showed a worrying situation. Fortunately, the results of the community interventions were promising with around 20% reduction in the risk of metabolic syndrome up to six years. CONCLUSIONS: These precise detections of different outcomes in the TLGS provided valuable evidences for prediction and prevention of NCDs in Iran with some novelties in the middle-income countries in the world. The Tehran thyroid study (TTS) and the Tehran cardiometabolic genetic study (TCGS), conducted in the framework of the TLGS, are among few studies aiming to determine the natural course of thyroid function and to identify patterns of genetic polymorphisms related to cardiometabolic outcomes, respectively.

Diagnostic Accuracy of Dual-Source Computerized Tomography Coronary Angiography in Symptomatic Patients Presenting to a Referral Cardiovascular Center During Daily Clinical Practice.

BACKGROUND: There are numerous studies that address the diagnostic value of dual-source computed tomography (DSCT) as an alternative to conventional coronary angiography (CCA). However, the benefit of application of DSCT in a real world clinical setting should be evaluated. OBJECTIVES: To determine the diagnostic accuracy of DSCT technique compared with CCA as the gold standard method in detection of coronary artery stenosis among symptomatic patients who are presented to a referral cardiovascular center during daily clinical practice. PATIENTS AND METHODS: Evaluating the medical records of a tertiary care referral cardiovascular center, 47 patients who had undergone DSCT and CCA, and also met the inclusion and exclusion criteria of the study were selected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) of the DSCT imaging technique were calculated. RESULTS: In total, 97.8% of the segments (628/642) could be visualized with diagnostic image quality via DSCT coronary angiography. The mean heart rate during DSCT was 69.2 ± 12.2 bpm (range: 39 - 83 bpm), and the mean Agatston score was 507.7 ± 590.5 (range: 0 - 2328). Per segment analysis of the findings revealed that the sensitivity, specificity, PPV, NPV, positive LR (PLR) and negative LR (NLR) of DSCT technique for evaluation of patients with coronary artery disease were 93.7%, 96.8%, 92.7%, 97.2%, 29.4, and 0.066, respectively. Also per vessel, analysis of the findings showed a sensitivity of 97.1%, a specificity of 94.0%, PPV of 95.3%, NPV of 96.3%, PLR of 16.1, and NLR of 0.030. CONCLUSION: Our results indicate that DSCT coronary angiography provides high diagnostic accuracy for the evaluation of CAD patients during daily routine practice of a referral cardiovascular setting.

Risk Factors for Incidence of Cardiovascular Diseases and All-Cause Mortality in a Middle Eastern Population over a Decade Follow-up: Tehran Lipid and Glucose Study.

BACKGROUND: To examine the association between potentially modifiable risk factors with cardiovascular disease (CVD) and all-cause mortality and to quantify their population attributable fractions (PAFs) among a sample of Tehran residents. METHODS: Overall, 8108 participants (3686 men) aged≥30 years, were investigated. To examine the association between risk factors and outcomes, multivariate sex-adjusted Cox proportional hazard regression analysis were conducted, using age as time-scale in two models including general/central adiposity: 1)adjusted for different independent variables including smoking, education, family history of CVD and sex for both outcomes and additionally adjusted for prevalent CVD for all-cause mortality 2)further adjusted for obesity mediators (hypertension, diabetes, lipid profile and chronic kidney disease). Separate models were used including either general or central adiposity. RESULTS: During median follow-up of >10 years, 827 first CVD events and 551 deaths occurred. Both being overweight (hazard ratio (HR), 95%CI: 1.41, 1.18-1.66, PAF 13.66) and obese (1.51, 1.24-1.84, PAF 9.79) played significant roles for incident CVD in the absence of obesity mediators. Predicting CVD, in the presence of general adiposity and its mediators, significant positive associations were found for hypercholesterolemia (1.59, 1.36-1.85, PAF 16.69), low HDL-C (1.21, 1.03-1.41, PAF 12.32), diabetes (1.86, 1.57-2.27, PAF 13.87), hypertension (1.79, 1.46-2.19, PAF 21.62) and current smoking (1.61, 1.34-1.94, PAF 7.57). Central adiposity remained a significant positive predictor, even after controlling for mediators (1.17, 1.01-1.35, PAF 7.55). For all-cause mortality, general/central obesity did not have any risk even in the absence of obesity mediators. Predictors including diabetes (2.56, 2.08-3.16, PAF 24.37), hypertension (1.43, 1.11-1.84, PAF 17.13), current smoking (1.75, 1.38-2.22, PAF 7.71), and low education level (1.59, 1.01-2.51, PAF 27.08) were associated with higher risk, however, hypertriglyceridemia (0.83, 0.68-1.01) and being overweight (0.71, 0.58-0.87) were associated with lower risk. CONCLUSIONS: Modifiable risk factors account for more than 70% risk for both CVD and mortality events.

Different obesity phenotypes, and incident cardiovascular disease and mortality events in elderly Iranians: Tehran lipid and glucose study.

AIM: To determine the impact of body mass index and the presence of metabolic syndrome (MetS) on cardiovascular disease (CVD) and mortality events in an elderly Tehranian population. METHODS: A population-based cohort of 1199 participants aged ≥65 years were followed for a mean of 9.74 years. Participants were stratified according to body mass index categories and MetS status. Cox regression analyses were used to estimate the hazard ratio of CVD and mortality events, given overweight participants without MetS as reference. RESULT: During follow up, 271 CVD events and 239 deaths (106 CVD deaths) occurred. Regarding CVD, multivariate-adjusted hazard ratios for CVD events in normal weight and obese participants without MetS were 1.21 (95% CI 0.77-1.91) and 1.46 (95% CI 0.64-3.34), respectively, and for normal weight, overweight and obese participants with MetS were 2.07 (95% CI 1.23-3.28), 1.72 (95% CI 1.13-2.62), and 1.53 (95% CI 0.95-2.45), respectively. Corresponding hazard ratios for CVD mortality were 2.08 (95% CI 0.93-4.82), 1.07 (95% CI 0.13-8.78), 3.71 (95% CI 1.55-8.85), 2.42 (95% CI 1.06-5.51) and 3.31 (95% CI 1.39-7.88), and for all-cause mortality were 1.41 (95% CI 0.9-2.23), 1.33 (95% CI 0.51-3.47), 1.84 (95% CI 1.1-3.09), 1.46 (95% CI 0.93-2.34) and 1.5 (95% CI 0.91-2.56), respectively. In the presence of diabetes in place of MetS, all of the diabetic participants regardless of body mass index category highlighted a significant risk for CVD and mortality events. CONCLUSION: Among the elderly population, the presence of MetS was necessary for exploring the risk of CVD events and its mortality; however, only the normal weight population with MetS had a significant risk for all-cause mortality

No Obesity Paradox-BMI Incapable of Adequately Capturing the Relation of Obesity with All-Cause Mortality: An Inception Diabetes Cohort Study.

Background. To reconcile "the obesity paradox," we tested if (1) the contribution of anthropometric measures to mortality was nonlinear and (2) the confounding of hip circumference contributed to the obesity paradox recently observed among diabetic patients. Methods. We analyzed data of diabetic patients attending a community-based prospective, "Tehran lipid and glucose study." In the mortality analysis, anthropometric measures-body mass index (BMI), waist, and hip circumference-were assessed using Cox models incorporating cubic spline functions. Results. During 12 990 person-years follow-up, BMI levels below 27 and those above 40 kg·m(-2) were associated with increased mortality. When we added waist circumference to the BMI in the multivariate-adjusted model, the steepness of BMI-mortality association curve slope for values below 27 kg·m(-2) increased, whereas the steepness of BMI-mortality association curve slope for values above this threshold decreased. Further adjusting the model for hip circumference, the steepness of the slopes of the association curve moved towards null on both extremes and no associations between BMI and all-cause mortality remained. Conclusion. BMI harbors intermixed positive and negative confounding effects on mortality of waist and hip circumference. Failing to control for the confounding effect of hip circumference may stymie unbiased hazard estimation and render conclusions paradoxical.

Wrist circumference as a novel predictor of hypertension and cardiovascular disease: results of a decade follow up in a West Asian cohort.

No study has yet evaluated the effect of wrist circumference on risk of incident hypertension and cardiovascular disease (CVD) in an adult population. The present study included 3642 women, aged ≥30 years, free of CVD at baseline, who had undergone health examinations between January 1999 and 2001 and were followed up until March 2010. Cox proportional hazard regression was performed to assess the hazard ratios (HRs) of wrist circumference for CVD and hypertension events. During 10 years of follow-up, 284 cases of first CVD and 615 cases of incident hypertension occurred. In a model adjusted for conventional CVD risk factors, the HR of 1 cm increase in wrist circumference was 1.15 (1.06-1.25) for hypertension and was marginally significant for CVD (HR, 1.12 [1.00-1.25]; P-value 0.052). After considering body mass index and waist circumference in the model, we found significant interaction between waist circumference and wrist circumference in risk prediction of hypertension and CVD (P < .001). In non-centrally obese women (waist circumference <95 cm), in multivariable model plus body mass index and waist circumference, increase in wrist circumference was independently associated with both hypertension (HR, 1.17 [1.02-1.35]) and CVD (HR, 1.29 [1.03-1.61]). However, among centrally obese women (waist circumference ≥95 cm), wrist circumference increase could not predict either hypertension (HR, 0.97 [0.84-1.18]) or CVD events (HR, 0.90 [0.75-1.07]). Wrist circumference as a novel anthropometric measure was an independent predictor for incident hypertension and CVD events among non-centrally obese women.

The incidence of coronary heart disease and the population attributable fraction of its risk factors in Tehran: a 10-year population-based cohort study.

BACKGROUND: Data on incidence of coronary heart disease (CHD) is scarce in the Middle East and little is known about the contribution of known risk factors in this area. METHODS: The incidence of CHD and the effect of modifiable risk factors were explored in 2889 men and 3803 women aged 30-74 years in the population based cohort of the Tehran Lipid and Glucose Study, during 1999-2010. Average population attributable fraction (aPAF) was calculated for any risk factor using direct method based on regression model. RESULTS: The crude incidence rate in men was about twice that in women (11.9 vs. 6.5 per 1000 person-years). The aPAF of hypertension, diabetes, high total cholesterol and low-HDL cholesterol was 9.4%, 6.7%, 7.3% and 6.1% in men and 17%, 16.6%, 12% and 4.6% in women respectively. This index was 7.0% for smoking in men. High risk age contributed to 42% and 22% of risk in men and women respectively. CONCLUSIONS: The incidence in this population of Iran was comparable to those in the US in the seventies. Well known modifiable risk factors explained about 40% and 50% of CHD burden in men and women respectively. Aging, as a reflection of unmeasured or unknown risk factors, bears the most burden of CHD, especially in men; indicating more age-related health care is required.

Contribution of glomerular filtration rate to 10-year cardiovascular and mortality risk among hypertensive adults: Tehran lipid and glucose study.

The authors tested the hypotheses that (1) estimated glomerular filtration rate (eGFR) predicts cardiovascular disease (CVD) or mortality risk among hypertensive patients, (2) associations are curvilinear, and (3) diabetes modifies these associations. Data from a 10-year follow-up of 3179 hypertensive patients 18 years and older were analyzed. Measurements included eGFR and CVD risk factors, and outcomes were CVD and mortality. Cox models were developed to estimate the hazard ratios (HRs) for different endpoints for a 1-standard deviation (SD) increment in eGFR. The nonlinearity in associations was examined by cubic spline method. Mean (SD) age of the participants (59.0% women) was 56.3 (12.3) years. During follow-up (10-year), 629 incident cases of CVD (296 women) and 320 deaths (130 women) were documented. The incidence rate of different outcomes decreased across increasing eGFR quintiles. Among men, irrespective of their diabetes status, eGFR was inversely associated with risk of mortality. Among women, irrespective of their diabetes status, eGFR did not predict mortality. Neither among men nor among women did eGFR predict CVD or coronary heart disease. No evidence was found for nonlinearity in these associations. eGFR was independently associated with mortality among hypertensive men with or without diabetes. When information on traditional CVD risk factors was available, eGFR provided no additional predictive value for CVD.

Hypertriglyceridemic waist: the point of divergence for prediction of CVD vs. mortality: Tehran Lipid and Glucose Study.

AIMS: We examined hypertriglyceridemic waist (HTGW) predictability for CVD and mortality. METHODS: Among Tehran Lipid and Glucose Study's participants aged ≥30 (n=8071), we selected those who participated in the follow-up study until 20-March-2009 (n=7154). After exclusions (320 missing data on waist circumference or triglycerides), 6834 (3830 women) participants remained eligible with a total of 59,873 person-year follow-up. When CVD was outcome, we further excluded 426 participants with history of previous CVD. RESULTS: All-cause mortality, CVD mortality, and incident CVD rate among men (per 1000-person-year) were 7.9 (95% CIs: 6.9-9.1), 4.1 (95% CIs: 3.4-5.0), and 13.0 (95% CIs: 11.7-14.6), respectively. Among women, corresponding figures were 3.7 (95% CIs: 3.1-4.4), 1.7 (95% CIs: 1.3-2.1), and 7.3 (95% CIs: 6.4-8.3), respectively. After adjustment for potential confounders, HTGW came to be inversely associated with all-cause mortality among both men (HR 0.384, 95% CIs 0.281-0.526) and women (HR 0.642, 95% CIs 0.430-0.958). Multivariate adjusted HR (95% CIs) of HTGW for CVD mortality was 0.453 (95% CIs 0.298-0.688) among men and 0.760 (95% CIs 0.431-1.338) among women. HTGW increased the age-adjusted risk of incident CVD, among both men (40%) and women (97%). The multivariate hazard ratio of HTGW for incident CVD was 0.945 (95% CIs 0.746-0.1.198, P value=0.640) among men and 1.470 among women (HR 95% CIs 1.111-1.944, P value=0.007). CONCLUSION: HTGW was the point of divergence for prediction of CVD vs. mortality. HTGW, despite its predictive value for CVD, might not help in capturing risk of all-cause or CVD mortality. Individuals without HTGW constitute a heterogeneous subgroup with a jumble of risk factors that put them at risk for all-cause or CVD mortality.

Prediction of cardiovascular events with consideration of general and central obesity measures in diabetic adults: results of the 8.4-year follow-up.

BACKGROUND: Obesity is one of the most important cardiovascular disease (CVD) risk factors among diabetic populations. We evaluated the ability of different anthropometric measures for predicting CVD among type 2 diabetic patients. METHODS: The study consisted of 411 men and 599 women, aged ≥30 years, free of CVD at baseline with a median follow-up of 8.4 years. The adjusted hazard ratios (HRs) for CVD were calculated for a 1 standard deviation change in body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) using Cox proportional regression analysis. RESULTS: A total of 188 CVD events occurred (men, 90; women, 98). In women, in confounder-adjusted analysis [age, fasting plasma glucose (instead of glycosylated hemoglobin), and positive family history of CVD], WHR was associated with incident CVD [1.32 (1.06-1.65)], followed by WC and WHtR, which were marginally significant (P=0.06 and 0.08, respectively); after adjustment for hypertension and hypercholesterolemia, only WHR predicted CVD significantly. In men, the confounder-adjusted (age, fasting plasma glucose, and aspirin use) HR to predict CVD was significant only for WHR [HR 1.21(1.00-1.48)]. CONCLUSION: This study showed WHR was the most powerful predictor of CVD among anthropometric measures, followed by WHtR, in diabetic population.

Electrocardiography-defined silent CHD and risk of cardiovascular events among diabetic patients in a Middle Eastern population.

BACKGROUND: We assessed the clinical outcomes of symptomatic and asymptomatic coronary heart disease (CHD) with type 2 diabetic patients. DESIGN: Population-based cohort study. METHODS: The study sample consisted of 380 men and 546 women, aged ≥30 years. Silent CHD was defined using Minnesota coding criteria on baseline electrocardiogram (ECG), in the absence of a history of CHD and symptoms of angina. Participants were categorized into four groups: group 1, participants with no CHD symptoms and with normal ECG; group 2, silent CHD; group 3, participants with symptomatic CHD but with normal ECG; group 4, participants with symptomatic CHD and ECG-determined CHD. Cox regression analysis was used to estimate the hazard ratios (HRs) of cardiovascular disease (CVD) and CHD events for these groups, with group 1 as the reference. RESULTS: During median follow up of 9.2 years, we ascertained 226 CVD events (202 CHD). In the multivariable-adjusted model, among men, HRs (95% CI) of CVD events were 2.32 (1.29-4.16), 2.56 (1.47-4.46), and 3.97 (2.24-7.02) for groups 2, 3, and 4, respectively; the corresponding figures among women were 1.19 (0.65-2.18), 1.90 (1.24-2.92), and 1.92 (1.02-3.62) respectively. Similar results were achieved for CHD events. CONCLUSION: In both sexes, symptomatic CHD was an independent predictor of recurrent CVD/CHD, regardless of ECG results. In diabetic men with asymptomatic CHD, ECG could be of prognostic value for incident CVD/CHD. The present study provides evidence-based support only in men for the ADA recommendation of 'further cardiac testing for diabetic patients with an abnormal resting ECG'.

Electrocardiographic abnormalities improve classification of coronary heart disease risk in women: Tehran Lipid and Glucose Study.

OBJECTIVES: To examine the added value of electrocardiogram (ECG) abnormalities beyond the Framingham risk score (FRS) in risk stratification for coronary heart disease (CHD) in a population of Middle Eastern women. METHODS: The study population consisted of 2568 women aged ≥30 years, free from CHD symptoms and with no major Q or QS wave or complete left-bundle branch block in their baseline ECG. ECG abnormalities included ST depression (Minnesota codes 4.1-4.2), or T-wave items (Minnesota codes 5.1-5.2). Participants were categorized into 3 groups, according to their FRS. Cox regression analysis was used to estimate the hazard ratios (HR) of CHD events for ECG abnormalities among each FRS group. Net Reclassification Index (NRI) was used as the measure of predictive ability added to the FRS by ECG abnormalities. RESULTS: During 9.3 years, 127 CHD events occurred. In the FRS adjusted analysis, the HRs (95%CI) of CHD events were 3.69 (0.87-15.68), 3.82 (2.01-7.23) and 1.39 (0.47-4.16) for ECG abnormalities in each FRS category (i.e. 0-4.9%, 5-19.9 and ≥20%, respectively). Addition of ECG abnormalities to FRS did not significantly increase the C-statistics (0.838), but improved the predictive ability of the FRS by 20.8 (95% CIs 5.0-38.9) using the cut point free NRI. CONCLUSION: Among women, only in the intermediate risk group, ECG abnormalities were independently associated with increased risk of developing CHD. Addition of the ECG abnormalities to the FRS improved the classification of coronary heart disease risk, especially in this group.

Long-term continuous methimazole or radioiodine treatment for hyperthyroidism.

BACKGROUND: There is no general agreement as to which treatment is best for hyperthyroidism. The objective of this study is to investigate the effectiveness of continuous methimazole (MMI) treatment and to compare the results of neuropsychological testing in patients receiving long-term continuous MMI to those on replacement thyroxine following radioiodine-induced (RAI) hypothyroidism. METHODS: We enrolled 239 patients with diffuse toxic goiter who had recurrences of hyperthyroidism. Of these, 104 patients were randomized into two groups, MMI and treatment with thyroxine following RAI hypothyroidism. The remaining 135 patients voluntarily enrolled into either of the two groups. From all patients, 59 MMI-treated patients and 73 patients in the RAI group completed follow up. Thyroid function tests, serum lipids and lipoproteins, echocardiography, bone mineral density (BMD) and seven neuropsychology tests were performed at the final visit. RESULTS: In the RAI group compared to the MMI-treated group during a mean of 14 years follow up, there were more incidences of elevated TSH [> 5 mU/L; adjusted relative risk (RR) 1.23; 95% confidence interval (CI) 1.04-1.47), increased triglycerides (> 150 mg/dL; RR 2.20; 95% CI 1.34-3.62), HDL-C (< 40 mg/dL; RR 3.46; 95% CI 1.40 - 8.53), and early diastolic annular velocity (< 12.2 cm; RR 3.91; 95% CI 1.42-10.74), in addition to a decreased early diastolic to annular velocity ratio (< 6.7; RR 7.14; 95% CI 1.38-34.48). The MMI group scored better in neuropsychology tests that included mood, direction, logical memory, repeated numbers, and intelligence quotient (IQ). CONCLUSION: Long-term MMI treatment was superior to RAI therapy in patients with diffuse toxic goiter when mood, cognition, cardiac function and occurrence of thyroid dysfunction were compared. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT 201009224794N1.