Metabolic syndrome and cardiovascular risk assessment tools' estimations of 10-year cardiovascular risk: a population-based study.

Background: This cross-sectional study determines the association between 10-year cardiovascular disease (CVD) risk, estimated using four CVD risk assessment tools, and metabolic syndrome (MetS) in northern Iranian general population. Methods: We used the data of 2371 participants aged 40-74 without any history of diabetes mellitus from a cohort study conducted among 6140 subjects aged 10-90 years in northern Iran. Three definitions of MetS were used. The four CVD risk assessment tools used to estimate the 10-year CVD risk included pooled cohort equations of ACC/AHA, Systematic Coronary Risk Evaluation (SCORE) equations (for low-risk and high-risk European countries), and Framingham general cardiovascular risk profile for use in primary care. Logistic regression was used to determine the association between various definitions of MetS and 10-year CVD risk of ≥5%, ≥ 7.5%, and ≥10%, based on the related risk assessment tools. Results: In men, univariate logistic regression analysis showed the strongest association between 10-year risk of ≥0.1 estimated by Framingham risk profile and the three definitions of MetS. In women, the 10-year risks by Framingham risk profile and SCORE equations for high-risk European countries had stronger associations with various definitions of MetS than others. No significant associations were detected between estimated risks of four risk assessment tools and various definitions of MetS in multivariate logistic regression analyses. Conclusion: No independent associations were observed between estimations of 10-year CVD risk using four risk assessment tools and various definitions of MetS.

The Prevalence of Non-alcoholic Fatty Liver Disease and Diabetes Mellitus in an Iranian Population.

BACKGROUND Type II diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) are important causes of morbidity and mortality worldwide. We aimed to estimate the prevalence of DM in the context of NAFLD. METHODS In this cross-sectional study, we studied 5052 participants, aged 18 years and older, of a baseline population-based cohort in northern Iran (N=6143). The prevalence of DM was estimated in individuals with and without NAFLD. The association between NAFLD and T2DM was evaluated using logistic regression with the adjustment of confounding effects of age, sex, body mass index, lipid profiles, and fasting insulin. RESULTS In men, the prevalence (95% confidence interval) of T2DM was 5.34% (4.35%-6.34%) and 15.06% (13.12%-17.00%) in individuals without and with NAFLD, respectively (p <0.001). In women without NAFLD, the prevalence was 8.27% (6.83%-9.71%) while in the presence of NAFLD, the prevalence was 27.21% (24.59%-29.83%), (p <0.001). In univariate analysis, the chance of having T2DM was 3.700 (3.130-4.380) times more in patients with NAFLD compared with subjects without NAFLD (p<0.001). This chance was reduced (Odds Ratio=1.976, 95% CI: 1.593-2.451, p <0.001) after removing the effects of other variables. CONCLUSION The prevalence of T2DM is increased in the context of NAFLD. This condition may be considered as an independent predictor of T2DM.

Non-alcoholic fatty liver disease (NAFLD) and 10-year risk of cardiovascular diseases.

BACKGROUND AND AIMS: The association between cardiovascular diseases (CVD) and non-alcoholic fatty liver disease (NAFLD) was confirmed by a large body of evidence. This study was conducted to determine the association between NAFLD and 10-year CVD risk. METHODS: This study utilized the data of 2804 subjects aged 40-74 years from a cohort study of northern Iran. Two CVD risk assessment tools, American College of Cardiology/American Heart Association and Framingham general cardiovascular risk profile for use in primary care, were utilized to determine the 10-year CVD risk in patients with NAFLD and the individuals without this condition. The mean risks were compared between these two groups. RESULTS: Using ACC/AHA approach, the mean risk in male participants suffering NAFLD was 14.2%, while in men without NAFLD was 11.7% (P-value < 0.0001). Using Framingham approach, the mean risks were 16.0 and 12.7% in men with and without NAFLD, respectively (P-value < 0.0001). Using ACC/AHA approach, the mean risks in female participants with and without NAFLD were 6.7 and 4.6%, respectively (P-value < 0.0001). Applying Framingham approach, the mean risk was 8.2% in women with NAFLD and 5.4% in women without NAFLD (P-value < 0.0001). CONCLUSION: The individuals with NAFLD had a higher risk of 10-year CVD events than individuals without NAFLD, according to both ACC/AHA tool and primary care version of Framingham tool. A large proportion of NAFLD patients fulfill the criteria of statin therapy recommendation, suggesting that statin therapy could reduce 10-year CVD risk in NAFLD patients.

Comparison of cardiovascular risk assessment tools and their guidelines in evaluation of 10-year CVD risk and preventive recommendations: A population based study.

BACKGROUND: Identification of individuals at risk of cardiovascular diseases (CVDs) results in better clinical outcomes and may help policy makers in conscious decision making for community based and national intervention strategies. The main aim of this study was to compare various CVD risk assessment tools and their related guidelines in estimation of 10-year CVD risk and subsequent therapeutic recommendations, respectively. METHODS: Data of 3086 subjects aged 40-74years from a cohort study of northern Iran were utilized in this cross-sectional study. The risks were calculated based on American College of Cardiology/American Heart Association (ACC/AHA) tool, two versions of Systematic Coronary Risk Evaluation (SCORE) equations (for low and high risk European countries) and Framingham approach. We also detected participants who ought to be recommended for treatment based on the specific guidelines related to each of the risk assessment tools. RESULTS: Mean cardiovascular risks were 12.96%, 8.84%, 1.90% and 3.45% in men and 5.87%, 2.13%, 0.8% and 1.13% in women based on ACC/AHA, Framingham, SCORE equation for low-risk European countries and high-risk European countries, respectively. Based on ACC/AHA, Adult Treatment Panel III (ATPIII) and European Society of Cardiology (ESC) guidelines related to SCORE equations for low and high risk European countries 58.2%, 27.1%, 21.1% and 28.6% of men and 39.7%, 33.0%, 29.5% and 30.7% of women were recommended to statin therapy, respectively. CONCLUSIONS: In conclusion, more individuals were recommended for treatment by ACC/AHA guideline than the other guidelines.

Body Roundness Index and Waist-to-Height Ratio are Strongly Associated With Non-Alcoholic Fatty Liver Disease: A Population-Based Study.

BACKGROUND: A strong association between obesity and non-alcoholic fatty liver disease (NAFLD) has been reported. OBJECTIVES: This study was conducted to evaluate if new obesity indices, including a body shape index (ABSI) and body roundness index (BRI), have stronger associations with NAFLD than waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). METHODS: In this cross-sectional study, we utilized the data of 4,872 participants aged 18 - 74 years from a cohort study conducted among 6,143 subjects in northern Iran. Logistic regression analysis was performed on NAFLD as the outcome and obesity measures (based on Z-score values) as potential predictors. Receiver operating characteristic (ROC) analyses were conducted, in which NAFLD was considered as a reference variable and obesity measures as classification variables. The discriminatory ability of the obesity measures was reported based on area-under-the-curves, and the related cut-off points of BRI and WHtR were determined using the Youden index (YI). RESULTS: Based on our results, BRI (OR = 5.484 for men and OR = 3.482 for women) and WHtR (OR = 5.309 for men and OR = 3.854 for women) showed a higher association with NAFLD than ABSI (OR = 1.363 for men and OR = 1.003 for women) and WHR (OR = 3.123 for men and OR = 1.628 for women). The optimal cut-off points for BRI were 4.00 (sensitivity = 82.7%, specificity = 70.8%) for men and 5.00 (sensitivity = 83.3%, specificity = 71.7%) for women. The optimal cut-off points for WHtR were 0.533 (sensitivity = 82.7%, specificity = 70.8%) for men and 0.580 (sensitivity = 83.3%, specificity = 71.7%) for women. CONCLUSIONS: While BRI and WHtR have equally strong associations with NAFLD, ABSI and WHR have weaker associations with NAFLD than BRI and WHtR.

The Best Obesity Indices to Discriminate Type 2 Diabetes Mellitus.

BACKGROUND: It is expected that the number of people with diabetes will reach 435 million by 2030. Obesity is considered the most important predictor of type 2 diabetes mellitus (T2DM). We conducted the present study to determine the best usual discriminator indices of obesity to diagnose diabetes mellitus (DM). METHODS: Of 6143 subjects aged 10-90 years from a baseline cohort study, the data of 5772 participants aged >18 years and without history of type 1 diabetes were utilized to analyze in this study. The cohort study was carried out in northern Iran and sampling frame was provided from related local health centers. The capability of obesity indices, including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and body adiposity index (BAI), in the discrimination of DM was evaluated. Discriminatory capabilities were evaluated using the receiver operating characteristic (ROC) curve. Logistic regression analysis was performed to determine the strength of association between obesity indices and DM. RESULTS: The areas under ROC curve of BAI, BMI, WC, and WHR were 0.6244 (0.5918-0.6570), 0.6214 (0.5908-0.6520), 0.6636 (0.6341-0.6930), and 0.7303 (0.7032-0.7575) in men and 0.5961 (0.5674-0.6249), 0.5963 (0.5690-0.6235), 0.6850 (0.6593-0.7108), and 0.7529 (0.7297-0.7761) in women, respectively. In the multivariate model, one unit increase in Z-score of BMI, WC, and WHR increased the chance of DM by 49%, 65%, and 51% in men and by 17%, 51%, and 67% in women, respectively. No association was found between DM and BAI in this model. CONCLUSIONS: While WHR had an appropriate discriminatory capability for T2DM in the population of northern Iran, BAI and BMI did not.

Thyroid dysfunction and choleduocholithiasis.

BACKGROUND: Disturbances in lipid metabolism which occur during hypothyroidism leadto the formation of gallstones. This study aims to evaluate the thyroid functionpattern in patients with common bile duct (CBD) stones. METHODS: This case-control study recruited 151 patients with preliminary diagnosesof CBD stone who underwent ERCP (cases). The control group comprisedhealthy people who met the study criteria in the same hospital. The controlgroup underwent ultrasonography to exclude any asymptomatic bile duct lithiasis.A questionnaire that included demographic and anthropometrics datawere completed by an assigned physician. Morning blood samples that followed12 hours of fasting were taken from all participants for measurements ofserum total thyroxin (T4), serum thyroid stimulating hormone (TSH), fastingblood sugar (FBS), triglycerides (TG), total cholesterol, low density lipoprotein(LDL) and high density lipoprotein (HDL). RESULTS: The mean TSH in patients (2.59 ± 4.86mg/dl) was higher than the controlgroup (2.53± 4.13 9mg/dl). In subclinical hypothyroidism, serum TSH levelshigher than 5 MU/L were found in 30.6% of cases compared with 22.5% ofcontrols [OR: 1.53; 95 % confidence interval (95% CI): 0.968-2.438). Hypothyroidismwas detected in 10.8% of the control group and in 11.3% of cases(OR: 1.87; 95% CI: 0.578-2.043). The mean total cholesterol levels in caseswas higher than the control group (p=0.61).The levels of TG (p=0.05), HDL(73.35 vs. 46.41; p<0.01) and LDL (64.81.88 vs. 111.04; p<0.01) was statisticallysignificant between both groups. CONCLUSION: There is an association between thyroid disorders and the presence of bileduct stones. Thyroid testing in patients with gallstone and bile duct stones isrecommended because hypothyroidism may be a predisposing factor for stonepassage from the gallbladder.