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.

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.

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.

The Best Obesity Indices to Use in a Single Factor Model Indicating Metabolic Syndrome: a Population Based Study.

OBJECTIVE: Although metabolic syndrome (MetS) is a major health problem worldwide, there is no universal agreement on its definition. One of the major disagreements is dealing with the issue of obesity in this definition. This study was conducted to determine a preferably better index of obesity which can be interrelated with other components of MetS in a single factor model of MetS. DESIGN: Out of 6140 participants of a cohort study of subjects aged 10-90 years in northern Iran, the baseline data of 5616 participants aged 18-75 was considered.  Confirmatory factor analysis was conducted using AMOS software to evaluate a single factor model of MetS in which blood pressure, triglyceride (TG), high density lipoprotein (HDL), fasting blood sugar (FBS) and obesity measures including waist circumference (WC), body mass index (BMI),  waist to hip ratio (WHR) and waist to height ratio (WHtR) were used as indicators of metabolic syndrome. Four single factor models differing from each other by obesity indices were evaluated. The models were evaluated in all 5616 subjects and 4931 subjects without diabetes mellitus according to sex separately. RESULTS: All single factor models had appropriate fit indices with CFI > 0.95, GFI > 0.95 and RMSEA < 0.08 in non-diabetic population, wherein all models obtained the best values of fit indices in men and good fit indices in women. In the general population of men, the single factor models built based on WHR (Chi-square=6.9, df=2, P-value=0.031, RMSEA = 0.028, CI = 0.007-0.052, CFI = 0.994, GFI = 0.999 and AIC = 22.9)  and WHtR (Chi-square = 9.97, df = 2, P-value = 0.007, RMSEA = 0.036, CI = 0.016-0.059, CFI = 0.992, GFI = 0.998 and AIC = 25.97) were fitted properly with data while in th general population of women, the model based on WHR obtained better fit indices (Chi-square = 7.5, df = 2, P-value = 0.023, RMSEA = 0.033, CI = 0.011-0.060, CFI = 0.994, GFI = 0.998 and AIC = 23.5). Models based on WHtR obtained better regression weights than WHR. CONCLUSION: While single factor validity of MetS was confirmed in almost all models, the best models were different according to sex and population of study.

Nonalcoholic Fatty Liver: The Association with Metabolic Abnormalities, Body Mass Index and Central Obesity--A Population-Based Study.

BACKGROUND: To assess the prevalence of nonalcoholic fatty liver (NAFL) in Iran and to evaluate correlates of NAFL in categories of body mass index (BMI). METHODS: Using a cluster random sampling approach, 7723 subjects over 18 years of age underwent abdominal ultrasonography, laboratory evaluations, blood pressure, and anthropometric measurements and were interviewed to obtain baseline characteristics. Prevalence of NAFL according to BMI and waist to hip ratio and its association with metabolic abnormalities in categories of BMI were assessed in multivariate analysis. RESULTS: The overall prevalence of NAFL was 35.2% [95% confidence interval (CI) 34.1-36.3]. A significant number of subjects with BMI < 30 had NAFL [22.1% (CI 21.0-23.2)]. Waist to hip ratio for 38.2% (CI 35.6-40.8) of the subjects with NAFL, and BMI < 30 was higher than normal values. The odds ratio for association of NAFL and dyslipidemias were higher in subjects with BMI < 30 versus those with BMI ≥ 30: (1) hypertriglyceridemia: 2.21 vs. 1.57, P = 0.006; (2) lower high-density lipoprotein: 1.29 versus 0.98, P = 0.046. Higher low-density lipoprotein also revealed greater association with NAFL in subjects with BMI < 25 than those with BMI ≥ 25 (odds ratio 1.84 vs. 1.1, P = 0.015). CONCLUSIONS: NAFL shows stronger association with central obesity compared to high BMI. NAFL has stronger association with dyslipidemias in subjects with low compared with high BMI.

Prevalence of metabolic syndrome in Amol and Zahedan, Iran: a population based study.

PURPOSE: So far, a variety of prevalence rates have been reported for the metabolic syndrome (MetS) according to several definitions. The aim of this study was to assess the prevalence of MetS in Iran according to two definitions and compare the characteristics of the subjects who met the MetS criteria according to the different definitions. METHODS: Participants were recruited from family registries of public health centers. After obtaining demographic and clinical data, the subjects underwent anthropometric measurements and laboratory evaluations. MetS was defined according to the NCEP-ATPIII and IDF criteria. The subjects were then categorized into 3 groups: 1) Healthy non-MetS subjects based on either definition, 2) Individuals with MetS according to only one of the definitions, and 3) Individuals who met both NCEP-ATPIII and IDF criteria for MetS. RESULTS: Totally, 5826 subjects in Amol and 2243 subjects in Zahedan were enrolled in the study. The weighted prevalence of MetS according to the NCEP-ATPIII and IDF criteria was 27.8% and 26.9% in Amol and 12% and 11.8% in Zahedan, respectively. Overall, 18.9% of the subjects fulfilled both criteria for MetS. However, a considerable proportion (8.5%) met the MetS criteria according to only one definition but not both. CONCLUSIONS: MetS is increasingly prevalent in Iran as well as other parts of the world. Due to non-uniform definitions of MetS, some of the subjects who meet MetS according to one set of criteria might be considered healthy according to another definition and consequently would not receive the preventive health services.

Prevalence and risk factors of hepatitis C virus infection in amol city, north of iran: a population-based study (2008-2011).

BACKGROUND: Hepatitis C Virus (HCV) infection is one of the most important causes of chronic liver disease and related problems in the world .There are few population-based studies on the prevalence and risk factors of hepatitis C infection in Iran, which could not provide enough information. Moreover, the prevalence and risk factors of hepatitis C infection are not similar in all parts of Iran. OBJECTIVES: The aim of this survey was to determine the prevalence and risk factors of HCV infection in the general population of the city of Amol, north of Iran. PATIENTS AND METHODS: This was a population-based study. Using a cluster sampling approach, 6145 individuals of both genders and different ages were involved from general population of urban and rural areas of Amol, The inclusion criteria were Iranian nationality, willing to participate in the study, and lifelong residence in Amol city and surrounding areas. Anti-hepatitis C antibody was measured by a third generation of ELISA. The positive results were confirmed by Recombinant Immuno Blot Assay (RIBA) and quantitative HCV-RNA polymerase chain reaction (PCR) tests. Potential risk factors of HCV transmission were recorded. RESULTS: The mean age of participants was 42.70 ± 17.10 years. Of these participants, 57.2% (n = 3483) were male. Anti-HCV antibody was positive in 12 individuals from which five were RIBA positive. Three of these subjects were PCR positive. The prevalence of HCV was more predominant among males than females. The common risk factors among the study subjects included history of minor or major surgery (34.7%), unsterile punctures (21.2%), history of traditional phlebotomy (5.8%), and history of hepatitis among close relatives (5.7%). In univariate regression analysis, unsterile punctures and history of infection in family members were associated with HCV infection. CONCLUSIONS: We confirm that in Amol city and surrounding areas, the prevalence of true HCV infection is 0.05%, which is lower than that previously reported from Iran.

Transient elastography in hepatitis C virus-infected patients with beta-thalassemia for assessment of fibrosis.

AIM: We sought to evaluate the performance of transient elastography (TE) for the assessment of liver fibrosis in chronic hepatitis C (CHC) patients with beta-thalassemia. METHODS: Seventy-six CHC patients with beta-thalassemia underwent TE, liver biopsy, T2 -weighted magnetic resonance imaging (MRI) for the assessment of liver iron content (LIC) and laboratory evaluation. The accuracy of TE and its correlation with the other variables was assessed. RESULTS: TE values increased proportional to fibrosis stage (r = 0.404, P < 0.001), but was independent of T2 -weighted MRI-LIC (r = 0.064, P = 0.581). In multivariate analysis, fibrosis stage was still associated with the log-transformed TE score(standardized ß = 0.42 for F4 stage of METAVIR, P = 0.001). No correlation was noted between LIC and TE score (standardized ß = 0.064, P = 0.512). The area under the receiver operating characteristic curve for prediction of cirrhosis was 80% (95% confidence interval, 59-100%). A cut-off TE score of 11 had a sensitivity of 78% and specificity of 88.1% for diagnosing cirrhosis. The best cut-off values for "TE-FIB-4 cirrhosis score" comprising TE and FIB-4 and "TE-APRI cirrhosis score" combining TE with aspartate aminotransferase-to-platelet ratio index (APRI) both had 87.5% sensitivity and 91.04% specificity for the diagnosis of cirrhosis. CONCLUSION: Regardless of LIC, TE alone or when combined with FIB-4 or APRI, is a diagnostic tool with moderate to high accuracy to evaluate liver fibrosis in CHC patients with beta-thalassemia. However, because splenectomy in a proportion of our subjects might have affected the platelet count, the scores utilizing APRI and FIB-4 should be interpreted cautiously.

Vitamin D deficiency prevalence in summer compared to winter in a city with high humidity and a sultry climate.

BACKGROUND: Vitamin D deficiency is high in winter because of reduced exposure to sunlight. It seems that in places with high humidity and a sultry climate, exposure to sunlight in summer can be low too. This study was designed to determine the vitamin D deficiency prevalence in Sari, a city with a high humidity climate at the end of summer, and compare it to winter. MATERIAL AND METHODS: This cross-sectional study was carried out on men and women aged 10 to 70. Clustered blood samples were received from 351 subjects who participated in this study toward the end of summer, and in winter. The levels of serum vitamin D, calcium, phosphorus, alkaline phosphatase and PTH were measured. T test and X2 were used for data analysis. RESULTS: 351 subjects (66.4% women, 33.6% men) aged 11 to 69 (mean age ± SD 37.11 ± 12.6) participated in the study. The mean 25-(OH) D concentration in summer was 13.41 ± 13, and in winter it was 11.7 ± 11, and the difference was statistically significant (p < 0.02). The prevalence of 25-OHvitamin D deficiency was 87.5% (307) in winter and 78.6% (276) in summer (p < 0.05). CONCLUSION: This study shows that although in this area with a high humidity climate, seasonal variation of vitamin D is statistically significant, the prevalence of Vitamin D insufficiency is as high in summer as in winter.