Wrist circumference as a novel negative risk factor for cardiovascular disease among adult men: a median follow-up of 9 years.

PURPOSE: Wrist circumference is an easy to measure anthropometric index of body frame and bone size. The aim of this study was to examine the association of wrist circumference with incidence of cardiovascular disease (CVD) among adult men. METHODS: For this study 2531 male participants aged ≥30 years, without any history of CVD were selected and followed from 1999 to 2011. Cox proportional hazard models and logistic regression were used to examine the relation of wrist circumference with incident CVD. RESULTS: A total of 339 cases of CVD were reported throughout a median follow-up of 9.4 years. In the multi-variable Cox model, 1 unit increase of wrist circumference was inversely associated with incident CVD with a HR (95 % CI) of 0.84 (0.72-0.98, P value = 0.02). The receiver operating characteristics curve in a logistic regression model for wrist circumference in prediction of CVD showed a cutoff of 17.75 cm, beyond which was associated with a lower risk for CVD. CONCLUSION: In a population with a high prevalence of CVD risk factors, it was shown that a higher wrist circumference was associated with lower risk for incident CVD. Further studies are needed to explore the underlying mechanisms of this inverse relation.

Changes in body mass index, waist and hip circumferences, waist to hip ratio and risk of all-cause mortality in men.

BACKGROUND: There is a paucity of data about the impact of changes in anthropometric measurements on the risk of mortality events, especially in men. METHODS: The study sample consists of 1805 Iranian men, aged ⩾ 30 years, free from cardiovascular disease at baseline; they had undergone health examinations in both phases I (1999-2001) and II (2001-2003) and were followed up until March 2010. Participants were categorized by changes in anthropometric measurements into four groups: Group 1, change percentage<-5%; Group 2, -5% ⩽ change percentages<+5%; Group 3, 5% ⩽ change percentage<10%; and Group 4, change percentage ⩾ 10%. Cox proportional hazard regression was performed to assess the hazard ratios (HRs) of the anthropometric changes for all-cause mortality, given group 2 as the reference. RESULTS: During 6.6 years of follow-up, 88 cases of mortality events occurred. The confounder-adjusted multivariate HRs for the first, third and fourth groups of hip circumference (HC) changes were 3.13(1.28-7.64), 0.75(0.43-1.31) and 0.82(0.23-2.99); the corresponding values for waist to hip ratio (WHR) change were 1.80(0.75-4.33), 1.21(0.70-2.1) and 2.32(1.25-4.3). After further adjustment for mediator covariates, results did not change. The equivalent values for body mass index and waist circumference did not reach statistical significance. CONCLUSIONS: In Middle Eastern Caucasian men, increase in WHR was associated with incident mortality, which was more prominent in those with ⩾ 10% increase in the ratio. Moreover, decrease in HC was highly associated with excess risk of mortality.

Added value of different metabolic syndrome definitions for predicting cardiovascular disease and mortality events among elderly population: Tehran Lipid and Glucose Study.

BACKGROUND/OBJECTIVES: To examine the association between the different definitions of metabolic syndrome (MetS) and the prediction of incident cardiovascular disease (CVD) and mortality events and to determine whether the concept of MetS adds to traditional risk factors among elderly Iranians. SUBJECTS/METHODS: The association between MetS and outcomes was examined in 922 adults aged ⩾65 years, free of CVD at baseline, using multivariate Cox proportional hazards models. To examine whether MetS could enhance prediction of outcomes beyond that achieved by risk factors; the net reclassification improvement index was used. RESULTS: During a median follow-up of 9.9 years, 207 CVD events and 193 deaths (82 CVD deaths) occurred. World health organization (WHO) and the joint interim statement (JIS) definitions were shown to be the strongest predictors of CVD events. The WHO definition predicted CVD and all-cause mortality events (hazard ratio (HR)=1.55 (95% confidence interval (CI)=1.15-2.09) and 2.08 (95% CI=1.23-3.51), respectively) and the JIS definition showed a risk for CVD mortality (HR=1.65 (95% CI=1.03-2.65)). Different definitions of MetS did not add to traditional risk factors in the prediction of different outcomes. CONCLUSIONS: The WHO definition was the strongest predictor of CVD and mortality outcomes; however, none of the MetS definitions provided added value to traditional risk factors.

High normal blood pressure is an independent risk factor for cardiovascular disease among middle-aged but not in elderly populations: 9-year results of a population-based study.

Data are conflicting and sparse regarding the impact of high normal blood pressure (BP) (systolic BP (SBP) of 130-139 mm Hg or diastolic BP (DBP) of 85-89 mm Hg) on incident cardiovascular disease (CVD) among middle-aged vs elderly population. We examined the risk of BP categories among 6273 participants ≥ 30 years, free of CVD at baseline, during more than 9.3 years follow-up. Cox regression analysis was used to estimate the hazard ratio (HR) of CVD for normal BP group (SBP between 120-129 mmHg or DBP between 80-85 mmHg), high normal BP group and hypertension group (SBP ≥ 140 mm Hg or DBP ≥ 90 mmHg or taking antihypertensive drugs), considering those with optimal BP (SBP<120 mmHg and DBP<80 mmHg) as reference. During follow-up, 512 CVD events occurred. There was significant interaction between age and BP categories (P=0.028) in prediction of CVD. In multivariate analysis, HRs (95% CIs) of CVD were 1.62 (1.11-2.37) and 2.20 (1.57-3.09) for middle aged with high normal and hypertensive BP groups, respectively. Among elderly (≥ 60 years), HR was 2.09 (1.36-3.21) only for hypertensive ones. High normal BP is a risk factor for incident of CVD only among middle-aged population. Furthermore, the effect of hypertension on incident CVD was stronger among younger population.

Evaluation of association between intima-media thickness of the carotid artery and risk factors for cardiovascular disease in patients on maintenance hemodialysis.

Cardiovascular disease is the most common cause of mortality and morbidity in patients with end-stage renal disease (ESRD). Atherosclerosis is a systemic disease, and carotid and coronary vessels are at comparable risk for developing pathologic changes. For this reason, increase in the thickness of the intima-media layers of carotid arteries can be a harbinger of coronary atherosclerosis and also a prognostic factor for cardiovascular accidents. In this study, we evaluated the status of carotid intima-media thickness (CIMT) in patients with ESRD on dialysis and analyzed its association with other risk factors for cardiovascular diseases. This cross-sectional study was conducted on patients referred for hemodialysis (HD) to the Taleghani Hospital (Shahid Beheshti University of Medical Sciences, Tehran, Iran) during 2007-2008. At the beginning, biochemical parameters and common cardiovascular risk factors were extracted from the patients' files, and then CIMT was measured by using B-Mode high-resolution ultrasonography, 1 cm proximal to the carotid bulb in the posterior wall. Finally, correlation between other risk factors and CIMT was made. One hundred patients with chronic and advanced renal disease were evaluated, including 46% females and 54% males. The mean age of these patients was 59.2 ± 13.1 years, with a range of 26-81 years. Correlations between CIMT and age (P = 0.023, r = 0.478), dialysis duration (P = 0.017, r = 0.435), number of cigarettes smoked (P = 0.026, r = 0.429), diastolic blood pressure (P = 0.013, r = 0.455) and fasting blood sugar (P = 0.045, r = 0.346) were significant. Risk factors for cardiovascular disease in patients on HD are of significant interest because of the high prevalence and frequency of the disease in this group of patients. However, in the present study, we were not able to find a very consistent and definite role for some risk factors in our patients. More studies are required to make clear the role of these factors in patients on HD.

Cardiovascular risk and all-cause mortality attributable to diabetes: Tehran lipid and glucose study.

AIM: To quantify the burden of cardiovascular diseases (CVD), and all-cause mortality attributable to diabetes. SUBJECTS AND METHODS: Data on an 8.6-yr follow-up of 6331 participants (2741 men), free of CVD at baseline, were analyzed to determine the burden of CVD and all-cause mortality attributable to self-reported and screen-detected diabetes mellitus (SRDM and SDDM, respectively). Risks of events of interest were separately assessed for women and men using Cox-proportional-hazard model. RESULTS: The mean age at baseline was 47 yr with 997 (15.7%) of participants having diabetes (men 14.8%, women 16.5%). SRDM and SDDM prevailed in 9.7% (men 9.2, women 10.2%) and 6.0% of participants (men 5.7, women 6.3%), respectively. During follow up (52,404 person-yr), we observed 447 incident cases of CVD [387 had coronary heart disease (CHD)] and 209 deaths. Among men, participants with SDDM had increased relative hazard for all-cause mortality translated to a population attributable risk fraction (PAF) of 10.1%. Among women, SDDM was associated with CVD and CHD but not with all-cause mortality; so that 9.3% and 8.8% of CVD and CHD events were respectively attributable to the SDDM. If SRDM had been eliminated from the population, the incidences of CVD, CHD, and death would have decreased by 10.5, 9.5, and 17.3% in men; and 22.0, 24.2, and 17.8% in women, respectively. CONCLUSION: SDDM and SRDM have high PAF for all-cause mortality and CVD. Besides diabetes treatment and prevention, screening to detect undiagnosed diabetes should warrant high priority among the public health strategies to lower the incidence of CVD and mortality.

Family history of diabetes modifies the effect of blood pressure for incident diabetes in Middle Eastern women: Tehran Lipid and Glucose Study.

Elevated blood pressure (BP) may lead to incident diabetes. However, data about the effect of different BP components on incident diabetes in Middle Eastern women is lacking. We evaluated systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) and mean arterial pressure (MAP) as independent predictors of diabetes in Iranian women. We performed a population-based prospective study among 3028 non-diabetic women, aged ≥20 years. Odds ratios (ORs) of diabetes were calculated for every 1 s.d. increase in SBP, DBP, PP and MAP. During ≈6 years of follow-up, 220 women developed diabetes. There were significant interactions between family history of diabetes and SBP, PP and MAP (P≤0.01) in predicting incident diabetes. In women without a family history of diabetes, all BP components were significantly associated with diabetes in the age-adjusted model; the risk factor-adjusted ORs were significant (P<0.05) for SBP, PP and MAP (1.30, 1.34 and 1.27, respectively) with similar predictive ability (area under the receiver operating characteristic curve ≈83%). In women with family history of diabetes, in the age-adjusted model, SBP, DBP and MAP were associated with diabetes; in multivariable model, they were not independent predictors of diabetes. In conclusion, in women without family history of diabetes, SBP, PP and MAP, were independent predictors of diabetes with almost similar predictive ability; hence, in the evaluation of the risk of BP components for prediction of diabetes, the presence of family history of diabetes should be considered.

Pulse pressure and systolic blood pressure are powerful independent predictors of cardiovascular disease in diabetic adults: results of an 8.4 years follow-up of Tehran Lipid and Glucose Study (TLGS).

AIM: To determine the role of different blood pressure (BP) components as predictors of cardiovascular disease (CVD) in diabetic patients. METHODS: We followed 828 diabetic patients, aged ≥30 years, without baseline CVD and not taking antihypertensive drugs. The hazard ratios (HRs) for CVD were calculated for a 1 standard deviation (SD) change in each BP measure using Cox proportional regression analysis. RESULTS: During median 8.4 year- follow up, 134 CVD events occurred. Systolic BP (SBP), pulse pressure (PP) and mean arterial pressure (MAP) were independent predictors of CVD with multivariate adjusted hazard ratios (HRs) of 1.35, 1.36 and 1.23 respectively (all p<0.05) and similar discriminatory power (C statistics ≈75%). The multivariate models containing MAP plus one other BP component highlighted the significant improvement in the goodness of fit to predict incident CVD (likelihood ratio test =0.01); however this was not so for SBP and PP. In the elderly subjects, only PP and SBP were significantly associated with CVD. CONCLUSION: The SBP and PP are significant independent predictors of CVD in all diabetic populations (including younger and elder groups) and other BP components did not add to these measures in risk prediction.

Triglyceride/HDL-cholesterol ratio is an independent predictor for coronary heart disease in a population of Iranian men.

BACKGROUND AND AIMS: To determine whether triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C), which has been shown to be an indicator of the metabolic syndrome (MetS) and insulin resistance, can predict coronary heart disease (CHD) independently of total cholesterol (TC) and other risk factors in an Iranian population with a high prevalence of MetS and low HDL-C. METHODS AND RESULTS: Between February 1999 and August 2001, 1824 men > or =40 years old, free of clinical cardiovascular diseases at baseline, were followed. Baseline measurements included serum level of TC, HDL-C, TG and risk factors for CHD including age, systolic and diastolic blood pressure, body mass index, waist circumference, diabetes, smoking and a family history of premature cardiovascular diseases. During a median follow up of 6.5 years until March 2007 (11,316 person-years at risk), a total of 163 new CHD events (27 fatal and 136 nonfatal) occurred. The prevalence of MetS in subjects with TG/HDL-C > or =6.9 (top quartile) reached 63.6% versus 3.0% in those with TG/HDL-C <2.8 (low quartile). According to a stepwise Cox proportional hazard model, including TG and TG/HDL-C quartiles, with TC and other risk factors, men in the top quartile of TG/HDL-C relative to the first quartile had a significant hazard ratio (HR) of 1.75 (95% CI, 1.02-3.00), while TG did not remain in the model. CONCLUSION: The evaluation of TG/HDL-C ratio should be considered for CHD risk prediction in our male population with a high prevalence of MetS.

Effect of long-term continuous methimazole treatment of hyperthyroidism: comparison with radioiodine.

OBJECTIVE: To investigate the long-term effects of continuous methimazole (MMI) therapy. DESIGN AND METHODS: Five hundred and four patients over 40 years of age with diffuse toxic goiter were treated with MMI for 18 months. Within one year after discontinuation of MMI, hyperthyroidism recurred in 104 patients. They were randomized into 2 groups for continuous antithyroid and radioiodine treatment. Numbers of occurrences of thyroid dysfunction and total costs of management were assessed during 10 years of follow-up. At the end of the study, 26 patients were still on continuous MMI (group 1), and of 41 radioiodine-treated patients (group 2), 16 were euthyroid and 25 became hypothyroid. Serum thyroid and lipid profiles, bone mineral density, and echocardiography data were obtained. RESULTS: There was no significant difference in age, sex, duration of symptoms and thyroid function between the two groups. No serious complications occurred in any of the patients. The cost of treatment was lower in group 1 than in group 2. At the end of 10 years, goiter rate was greater and antithyroperoxidase antibody concentration was higher in group 1 than in group 2. Serum cholesterol and low density lipoprotein-cholesterol concentrations were increased in group 2 as compared with group 1; relative risks were 1.8 (1.12-2.95, P<0.02) and 1.6 (1.09-2.34, P<0.02) respectively. Bone mineral density and echocardiographic measurements were not different between the two groups. CONCLUSION: Long-term continuous treatment of hyperthyroidism with MMI is safe. The complications and the expense of the treatment do not exceed those of radioactive iodine therapy.

Late results of balloon pulmonary valvuloplasty in adults.

This study shows late results of adult patients with pulmonary stenosis after successful balloon pulmonary valvuloplasty. Late results of this procedure are as good as early results.