Heart surgery over two decades: what we have learned about results and changing risks.

OBJECTIVES: Using the cardiac surgery database is of high importance in referral centers and can lead to a better quality of care for patients. Tehran Heart Center (THC) is a cardiovascular referral center that was inaugurated in 2001. In this report, we aimed to present the third report of trends in patients' cardiovascular risk factors and surgical procedures from 2002 to 2021 that have been gathered for all THC patients. METHODS: This serial cross-sectional study was conducted at Tehran Heart Center from 2002 to 2021. All patients undergoing cardiac surgeries were eligible to enter the study (N = 63,974). Those with miscellaneous types of surgeries were excluded (N = 9556). The distribution of cardiac surgeries (including isolated coronary artery bypass graft (CABG), isolated valve, and CABG + valve surgeries) and their respective in-hospital mortality were recorded. Furthermore, 20-year trends in the prevalence of various cardiovascular risk factors (CVRFs) among the following groups were evaluated: a) isolated CABG, b) aortic valve replacement/repair for aortic stenosis (AS/AVR/r), and c) isolated other valve surgeries (IVS). RESULTS: A total of 54,418 patients (male: 70.7%, age: 62.7 ± 10.8 years) comprised the final study population, with 84.5% prevalence of isolated CABG. Overall, the AS/AVR/r group was in between the CABG and IVS groups concerning CVRFs distribution. Excluding some exceptions for the AS/AVR/r group (in which the small sample size (N = 909) precluded observing a clear trend), all studied CVRFs demonstrated an overall rising trend from 2002 to 2021 in all three groups. Regarding in-hospital mortality, the highest rate was recorded as 4.0% in 2020, while the lowest rate was 2.0% in 2001. CONCLUSIONS: Isolated CABG remained the most frequent procedure in THC. Notable, increasing trends in CVRFs were observed during this 20-year period and across various types of cardiac surgeries, which highlights the clinical and policy-making implications of our findings.

Epidemiology of substance and opium use among adult residents of Tehran; a comprehensive report from Tehran cohort study (TeCS).

BACKGROUND: The prevalence and burden of substance and opium use have increased worldwide over the past decades. In light of rapid population changes in Tehran, we aimed to evaluate the prevalence of opium and other substance use among adult residents in Tehran, Iran. METHOD: From March 2016 to March 2019, we utilized data from 8 296 participants in the Tehran Cohort Study recruitment phase (TeCS). We calculated the age-sex-weighted prevalence of substance use and the geographic distribution of substance use in Tehran. We also used logistic regression analysis to determine possible determinants of opium use. RESULT: We analyzed data from 8 259 eligible participants with complete substance use data and the average age of participants was 53.7 ± 12.75 years. The prevalence of substance use was 5.6% (95% confidence interval [CI]: 4.6- 7.1%). Substance use was more common in males than females (Prevalence: 10.5% [95% CI: 8.6- 12.6%] vs. 0.5% [95% CI: 0.2- 1.2%], respectively). The age-sex weighted prevalence of substance use was 5.4% (95% CI: 4.6-7.1%). Moreover, opium was the most frequently used substance by 95.8% of substance users. Additionally, we found that male gender (Odds ratio [OR]: 12.1, P < 0.001), alcohol intake (OR: 1.3, P = 0.016), and smoking (OR: 8.5, P < 0.001) were independently associated with opium use. CONCLUSIONS: We found that the prevalence of substance use in Tehran was 5.6%, and opium was the most frequently used substance. In addition, male gender, lower levels of education, alcohol, and tobacco consumption are the main risk factors for substance use in Tehran. Healthcare providers and policymakers can utilize our results to implement preventive strategies to minimize substance use in Tehran.

Prevalence of insufficient physical activity among adult residents of Tehran: a cross-sectional report from Tehran Cohort Study (TeCS).

BACKGROUND: Insufficient physical activity (PA) is a major risk factor for non-communicable diseases (NCDs) and one of the leading causes of premature mortality worldwide. This study examined the prevalence and independent determinants of insufficient PA among adults resident of Tehran utilizing Tehran Cohort Study Data (TeCS). METHOD: We used the recruitment phase data from the TeCS with complete data on PA. PA was assessed through a Likert-scaled question and categorized into three groups. Utilizing data from the 2016 national census, the age- and sex-weighted prevalence of insufficient PA in Tehran was determined. The adjusted logistic regression model is used to neutralize influencing factors and determine the factors associated with insufficient PA. RESULT: The weighted prevalence of insufficient PA was 16.9% among the 8213 adult citizens of Tehran, with a greater prevalence among females (19.0% vs. 14.8% among males). Additionally, older age groups, unemployed, housewives, and illiterate educated participants displayed a much higher prevalence of insufficient PA (p < 0.001). Moreover, Tehran's central and southern districts had higher rates of insufficient PA. Concerning the adjusted regression model, older age (Odds ratio [OR]: 4.26, 95% confidence interval [95% CI]: 3.24-5.60, p < 0.001), a lower education level (p < 0.001), unemployment (OR: 1.80, 95% CI: 1.28-2.55, p = 0.001), being a housewife (OR: 1.44, 95% CI: 1.15-1.80, p = 0.002), higher body mass index (BMI) (OR for BMI > 30: 1.85, 95% CI: 1.56-2.18, p < 0.001), opium consumption (OR: 1.92, 95% CI: 1.46-2.52, p < 0.001), diabetes mellitus (OR: 1.25, 95% CI: 1.06-1.48, p = 0.008), hypertension (OR: 1.29, 95% CI: 1.11-1.50, p = 0.001), and coronary artery diseases (OR: 1.30, 95% CI: 1.05-1.61, p = 0.018), were significantly associated with insufficient PA. CONCLUSIONS: The identified associated factors serve as a valuable guide for policymakers in developing tailored intervention strategies to address the needs of high-risk populations, particularly among older adults and females.

7-year outcomes in diabetic patients after coronary artery bypass graft in a developing country.

BACKGROUND: Revascularization in diabetic patients with coronary artery disease remains a challenge in cardiology practice. Although clinical trials have reported the mid-term superiority of coronary artery bypass grafting (CABG) surgery over percutaneous coronary intervention in these patients, little is known about the long-term outcomes of CABG in diabetic patients compared to non-diabetics, particularly in developing countries. METHODS: Between 2007 and 2016, we recruited all patients who underwent isolated CABG in a tertiary care cardiovascular center in a developing country. The patients were followed at 3-6 months and 12 months after surgery, and then annually. The study endpoints were 7-year all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). RESULTS: Of 23,873 patients (17,529 males, mean age 65.67 years) who underwent CABG, 9227 (38.65%) patients were diagnosed with diabetes. After adjustment for potential confounders, patients with diabetes experienced a 31% increase in MACCE seven years after surgery compared to the non-diabetic patients (HR = 1.31, 95% CI: 1.25-1.38, P-value < 0.0001). Meanwhile, diabetes contributes to a 52% increase in the risk of all-cause mortality after CABG (HR = 1.52, 95% CI: 1.42-1.61, P-value < 0.0001). CONCLUSIONS: Our study showed a higher risk of all-cause mortality and MACCE at seven years in diabetic patients undergoing isolated CABG. The outcomes in the studied center in a developing country were comparable to western centers. The high incidence of adverse outcomes in the long term in diabetic patients implies that not only short-term but long-term measures should be taken to improve the CABG outcomes in this challenging patient population.

Epidemiology and prevalence of tobacco use in Tehran; a report from the recruitment phase of Tehran cohort study.

INTRODUCTION: Tobacco use is a major health concern worldwide, especially in low/middle-income countries. We aimed to assess the prevalence of cigarette smoking, waterpipe, and pipe use in Tehran, Iran. METHODS: We used data from 8272 participants of the Tehran Cohort Study recruitment phase. Tobacco use was defined as a positive answer to using cigarettes, waterpipes, or pipes. Participants who did not report tobacco use during the interview but had a previous smoking history were categorized as former users. Age- and sex-weighted prevalence rates were calculated based on the national census data, and characteristics of current and former tobacco users were analyzed. RESULTS: Age- and sex-weighted prevalence of current tobacco users, cigarette smokers, waterpipe, and pipe users in Tehran was 19.8%, 14.9%, 6.1%, and 0.5%, respectively. Current tobacco use was higher in younger individuals (35-45 years: 23.4% vs. ≥ 75 years: 10.4%, P < 0.001) and men compared to women (32.9% vs. 7.7% P < 0.001). The prevalence of tobacco use increased with more years of education (> 12 years: 19.3% vs. illiterate: 9.7%, P < 0.001), lower body mass index (< 20 kg/m2: 31.3% vs. ≥ 35 kg/m2: 13.8%, P < 0.001), higher physical activity (high: 23.0% vs. low: 16.4%, P < 0.001), opium (user: 66.6% vs. non-user: 16.5%, P < 0.001), and alcohol use (drinker: 57.5% vs. non-drinker: 15.4%, P < 0.001). Waterpipe users were younger (46.1 vs. 53.2 years) and had a narrower gender gap in prevalence than cigarette smokers (male/female ratio in waterpipe users: 2.39 vs. cigarette smokers: 5.47). Opium (OR = 5.557, P < 0.001) and alcohol consumption (OR = 4.737, P < 0.001) were strongly associated with tobacco use. Hypertension was negatively associated with tobacco use (OR = 0.774, P = 0.005). CONCLUSION: The concerning prevalence of tobacco use in Tehran and its large gender gap for cigarette and waterpipe use warrant tailored preventive policies.

Prevalence, awareness, treatment, and control of type 2 diabetes mellitus among the adult residents of tehran: Tehran Cohort Study.

BACKGROUND: The prevalence of type 2 diabetes mellitus has increased in the past decades. We investigated the prevalence of diabetes and its awareness, treatment, and control among adult residents of Tehran. METHODS: We used the recruitment phase data of the Tehran Cohort study, enrolling a random sample of adult residents of Tehran aged ≥35 years. Diabetes was defined as self-report, current use of glucose-lowering medications, and/or fasting plasma glucose (FPG) ≥126mg/dl. Impaired fasting glucose (IFG) was defined as an FPG of 100-125mg/dl. Awareness was defined as diabetes self-report, treatment as receiving glucose-lowering medications, and glycemic control as FPG <126mg/dl. The age- and sex-weighted estimates were calculated using the 2016 national census. Logistic regression models were used to determine the factors associated with diabetes awareness, treatment, and control. RESULTS: A total of 8151 participants were included. Age- and sex-weighted prevalence of diabetes mellitus and IFG were 16.7% (95% CI: 15.1-18.4) and 25.1% (95% CI: 23.1-27.1), respectively. Diabetes was more prevalent in the eastern and central districts of Tehran. Advanced age (OR per 1-year increase: 1.026, 95% CI: 1.021-1.030), male sex (OR: 1.716, 95% CI: 1.543-1.909), higher BMI levels (OR for BMI ≥35 vs. <20 kg/m2: 4.852, 95% CI: 3.365-6.998), pre-existing hypertension (OR: 1.552, 95% CI: 1.378-1.747), dyslipidemia (OR: 1.692, 95% CI: 1.521-1.883), and chronic kidney disease (OR: 1.650, 95% CI: 1.019-2.673) were associated with an increased odds of diabetes mellitus. On the contrary, diabetes mellitus was less likely in current tobacco (OR: 0.872, 95% CI: 0.765-0.994) and alcohol users (OR: 0.836, 95% CI: 0.703-0.994) compared to non-users. Among diabetic individuals, 82.8% were aware of their condition, 71.9% received treatment, and 31.7% of treated patients had adequate glycemic control. Advanced age and pre-existing comorbidities, including hypertension and dyslipidemia, were associated with higher diabetes awareness and treatment. Furthermore, advanced age, higher levels of education, and female sex were determinants of better glycemic control among treated diabetic participants. CONCLUSION: There is a high prevalence of diabetes and IFG among adult residents of Tehran. Additionally, more than two-thirds of treated diabetics living in Tehran remain uncontrolled.

Effect of Different Blood Groups on Long-Term Outcomes of Surgical Revascularisation.

BACKGROUND: ABO blood groups are considered to be associated with cardiovascular disease. Nonetheless, the definite effect of ABO blood groups on the clinical outcome of coronary artery bypass graft surgery (CABG) is still undetermined. We evaluated whether ABO blood groups can predict long-term major adverse cardiocerebrovascular events (MACCE) in CABG patients. METHOD: In this retrospective cohort study, we retrieved the clinical files of eligible patients treated with isolated CABG in our hospital between March 2007 and March 2016. We divided the patients into four ABO subgroups. The primary study endpoints were the occurrence of all-cause mortality and MACCE during long-term follow-ups. We used Cox regression survival analysis to define the association of ABO blood groups with the occurrence of MACCE. RESULTS: Of 17,892 patients who underwent isolated CABG, 17,713 (mean age, 61.19±9.47 years, 74.6% male) were successfully followed, and their data used in the final analysis. Our multivariable analysis demonstrated that patients with different blood groups had similar 5-year mortality and 5-year MACCE. CONCLUSIONS: Our findings suggest that in patients who underwent CABG, ABO blood groups were not associated with long-term MACCE.

Sex and age difference in risk factor distribution, trend, and long-term outcome of patients undergoing isolated coronary artery bypass graft surgery.

BACKGROUND: Preoperative coronary artery disease risk factors (CADRFs) distribution and pattern may also have an important role in determining major adverse cardiovascular events (MACEs). In this study, we aimed to evaluate the CADRFs distribution and trend over 10 years and also the long-term outcome of CABG in different age-sex categories. METHOD: In this registry-based serial cross-sectional study, we enrolled 24,328 patients who underwent isolated CABG and evaluated the prevalence of CADRFs according to sex and age. We used inverse probability weighting (IPW) to compare survival and MACE between the sexes. We also used Cox regression to determine each CADRFs effect on survival and MACEs. RESULTS: In general, DLP (56.00%), HTN (53.10%), DM (38.40%), and positive family history (38.30%) were the most frequent risk factors in all patients. Prevalence of HTN, DLP, DM, obesity, and positive family history were all higher in women, all statistically significant. The median follow-up duration was 78.1 months (76.31-79.87 months). After inverse probability weighting (to balance risk factors and comorbidities), men had lower MACEs during follow-up (HR 0.72; 95% CI 0.57-0.91; P value 0.006) and there was no significant difference in survival between sexes. DM and HTN were associated with higher mortality and MACEs in both sexes. CONCLUSION: Although DLP is still the most frequent CADRF among the CABG population, the level of LDL and TG is decreasing. Women experience higher MACE post CABG. Therefore, health care providers and legislators must pay greater attention to female population CADRFs and ways to prevent them at different levels.

Left Atrial Size; a Missing Component in Scoring Systems for Predicting Atrial Fibrillation Following Coronary Artery Bypass Surgery.

BACKGROUND: Several risk factors have been associated with the development of postoperative atrial fibrillation (AF). However, some important factors that may play substantial roles have been neglected in the final suggested risk models. In this study, we aimed to derive a new clinical risk index to predict AF in coronary artery bypass graft (CABG) patients. METHODS: In this retrospective cohort study we enrolled 3047 isolated CABG patients. A random sample of 2032 patients was used to derive a risk index for the prediction of post-CABG AF. A multivariate logistic regression model identified the independent preoperative predictors of post-CABG AF, and a simple risk index to predict AF was constructed. This risk index was cross-validated in a validation set of 1015 patients with isolated CABG. RESULTS: Post-CABG AF occurred in 15.9% and 15.7% of the patients in the prediction and validation sets, respectively. Using multivariate stepwise analysis, four preoperative variables including advanced age, left atrial (LA) enlargement, hypertension and cerebrovascular accident contributed to the prediction model (area under the receiver operating characteristic curve curve = 0.66). The effect of advanced age appeared to be dominant [age ≥ 75 years; odds ratio: 4.134, 95% confidence interval (CI): 2.791-6.121, p < 0.001]. Moderate to severe LA enlargement had an odds ratio of 2.176 (95% CI: 1.240-3.820, p = 0.013) for developing AF in our risk index. CONCLUSIONS: LA size was an important factor in risk stratification of post-CABG AF, which remained significant in the final model. Future scoring system studies might benefit from the use of this variable to obtain a more robust predictive value.

Illness Perceptions in Patients with Premature Coronary Artery Disease: A Sex-Based Analysis 8 Years After the Diagnosis.

To assess illness perceptions in patients with premature atherosclerotic coronary artery disease (CAD), 717 adults with premature CAD (diagnosis of CAD in men age < 45 years and women age < 55 years) completed sociodemographic indices, the Beck's Depression Inventory-II, Beck Anxiety Inventory and the Brief Illness Perceptions 8 years after the diagnosis. Mean age was 49.59 ± 3.57 years for men and 57.72 ± 4.90 years for women at the time of study. Both sexes were treated through coronary artery bypass graft surgery, percutaneous coronary intervention, or medical treatment. Depressive and anxiety symptoms were significantly more prevalent among women. Generally, the patients believed that their disease was chronic and well controlled and that it had no considerable negative impact on their routine life. Overall, patients had a low concern about their illness. Women had a more negative perception of their disease than did men which may indicate their need for higher psychological support.

Prevalence of obesity and overweight in an adult population of Tehran metropolis.

Purpose: Obesity is a chronic low-grade inflammatory condition with increasing global prevalence and is associated with cardiovascular diseases. In this study, we aimed to investigate the prevalence of obesity in the Tehran cohort study (TeCS) population. Methods: We used the data collected by systematic random sampling during the recruitment phase of TeCS. The data comprised 4215 households from all districts of the Tehran metropolis, from which 8296 adults aged ≥ 35 years participated between May 2016 and February 2019. Sociodemographic data, medical history, laboratory tests, and anthropometric measurements were gathered from the participants. Participants with missing data were excluded from the final analysis. Finally, the data was analyzed using SPSS version 23, and distribution maps were created by Stata 14.2. Results: A total of 8211 participants (53.9% women) with an average age of 53.7 ± 12.6 years were studied. The age-weighted prevalence of overweight and obese among women was (37.5% [95% confidence interval (CI): 34.5, 40.6] and 35.5% [95% CI: 32.6 -38.6]) compared to men (47% [95% CI: 43.6, 50.3] and 22.9% [95% CI: 20.1 -25.8]). The prevalence of substantially increased risk of metabolic complications (SIRMC) based on waist circumference (WC) and waist-to-hip ratio (WHR) was 49.2% (95% CI: 46.3 -52.2) and 75.5% (95% CI: 72.7 -78.1) respectively. Conclusions: The prevalence of obesity in Tehran (29.3%) was much higher than in previous reports, particularly among older people, women, and socioeconomically underdeveloped districts. After age 55, more than 80% of women had SIRMC compared to 30% of men. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01365-4.

Epidemiology and Prevalence of Dyslipidemia Among Adult Population of Tehran: The Tehran Cohort Study.

BACKGROUND: Dyslipidemia is among the leading risk factors for cardiovascular diseases (CVDs), with an increasing global burden, especially in developing countries. We investigated the prevalence of dyslipidemia and abnormal lipid profiles in Tehran. METHODS: We used data from 8072 individuals aged≥35 from the Tehran Cohort Study (TeCS) recruitment phase. Fasting serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and triglyceride were measured. Dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria, and high LDL/HDL was defined as a ratio>2.5. The age-sex standardized prevalence rates were calculated based on the 2016 national census. Furthermore, the geographical distribution of dyslipidemia and lipid abnormalities was investigated across Tehran's zip code districts. RESULTS: The age-sex standardized prevalence was 82.7% (95% CI: 80.1%, 85.0%) for dyslipidemia, 36.9% (95% CI: 33.8%, 40.1%) for hypertriglyceridemia, 22.5% (95% CI: 19.9%, 25.4%) for hypercholesterolemia, 29.0% (95% CI: 26.1%, 32.1%) for high LDL-C, 55.9% (95% CI: 52.6%, 59.2%) for low HDL-C, and 54.1% (95% CI: 50.9%, 57.3%) for high LDL/HDL ratio in the Tehran adult population. The prevalence of dyslipidemia, low HDL-C, and high LDL/HDL ratio was higher in the northern regions, hypercholesterolemia was higher in the southern half, and high LDL-C was more prevalent in the middle-northern and southern areas of Tehran. CONCLUSION: We found a high prevalence of dyslipidemia, mainly high LDL/HDL in the Tehran adult population. This dyslipidemia profiling provides important information for public health policy to improve preventive interventions and reduce dyslipidemiarelated morbidity and mortality in the future.

Prevalence, Awareness, Treatment, and Control of Hypertension among Adult Residents of Tehran: The Tehran Cohort Study.

Background: High levels of blood pressure (BP) remain undetected and poorly controlled in large segments of the population leading to an enormous burden in terms of disease and mortality. Objective: We aimed to assess the prevalence, awareness, treatment, and control of hypertension in Tehran. Methods: We used the data of 8,296 adults aged ≥35 years from the Tehran Cohort Study who were enrolled between May 2016 and February 2019. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, self-report, and/or current antihypertensive medication use. The age- and sex-weighted prevalence of hypertension and high normal BP was calculated using the 2016 national census. Furthermore, awareness, treatment, and control of hypertension were analyzed. Results: The mean age of the participants was 53.8 ±12.75 years, and 54.0% were women. The weighted prevalence of hypertension and high normal BP were 36.5% and 12.2%, respectively. Among hypertensive individuals, 68.2% were aware of hypertension, 53.3% were receiving medication, and 40.4% had adequate BP control. The awareness, treatment, and control of hypertension were significantly higher in women (72.2% vs. 63.4% [P < 0.001], 55.1% vs 51.1% [P = 0.020], and 42.7% vs. 37.7% [P = 0.004], respectively) and this gap considerably increased with advancing age. Hypertension was more prevalent in northern Tehran but with a better treatment rate and control in the same regions. Conclusion: Despite the high prevalence of hypertension in the adult population of Tehran, the rates of awareness, treatment, and control of hypertension are unsatisfactory and demand comprehensive strategies to improve this situation, especially in younger men.

Prognostic significance of positive family history in outcomes after coronary artery bypass grafting: Do we need to update our assumptions?

BACKGROUND: Recent research suggests a protective role for positive family history of premature cardiovascular disease (FHpCVD) in patients undergoing coronary artery bypass grafting. We aimed to further investigate this unlikely association. METHODS: In this registry-based cohort study, patients who underwent first-time non-emergent coronary bypass surgery at Tehran Heart Center between 2007 and 2016 were included. Patients with and without FHpCVD were compared in terms of all-cause mortality and first non-fatal cardiovascular events (CVEs) comprising non-fatal acute coronary syndrome, non-fatal stroke or transient ischemic attack, and repeat coronary revascularization. RESULTS: A total of 13,156 patients were included (mean age 60.83 ± 9.57, 74.5% male), among which 2684 (20.4%) patients had FHpCVD. Median follow-up was 77.7 months. FHpCVD was weakly associated with reduced all-cause mortality using inverse probability weight (IPW) method (hazard ratio [HR] = 0.853; 95% confidence interval [CI] 0.730-0.997; P = 0.046), and not associated with non-fatal CVEs considering death as the competing event (sub-distribution HR [SHR] = 1.124; 95% CI 0.999-1.265; P = 0.053). Within a subgroup of patients without previous myocardial infarction or revascularization (7403 cases; 56.3%), FHpCVD was associated with lower mortality (HR = 0.700; 95% CI 0.548-0.894; P = 0.004) and higher non-fatal CVEs (SHR = 1.197; 95% CI 1.019-1.405; P = 0.028), whereas among patients with previous coronary events, there was no association between FHpCVD and outcomes. CONCLUSIONS: FHpCVD was associated with lower all-cause mortality but higher non-fatal CVEs, especially in those without prior coronary events. Such discordance calls for caution in assuming a protective role for FHpCVD. The prognostic significance of FHpCVD needs further evaluation among surgical patients.

Effect of postoperative atrial fibrillation on early and mid-term outcomes of coronary artery bypass graft surgery.

OBJECTIVES: The long-term prognostic role of postoperative atrial fibrillation (POAF) in cardiovascular outcomes in patients undergoing cardiac surgery is uncertain. Our goal was to investigate the impact of new-onset POAF on midterm adverse cardiovascular events after coronary artery bypass graft (CABG) surgery. METHODS: We performed a retrospective cohort study of patients who underwent isolated CABG without a preoperative history of atrial fibrillation/flutter. POAF was defined as episodes of AF lasting ≥30 s during the hospitalization period. The effect of POAF on midterm all-cause mortality and cerebrovascular accidents/transient ischaemic attacks (CVA/TIA) was assessed using a Cox proportional hazard regression model in a competing risk setting. Additional analyses were performed on patients surviving an event-free early postoperative period (i.e. within 30 postoperative days after the index operation). RESULTS: A total of 9,310 patients were followed for a median duration of 48.7 months. New-onset POAF was associated with an increased risk of midterm all-cause mortality (HR = 1.648, 95% confidence interval: 1.402-1.937; P < 0.001) and CVA/TIA (subdistribution-HR = 1.635, 1.233-2.167; P = 0.001). After excluding patients who died during the early postoperative period, POAF remained significantly associated with higher late all-cause mortality (HR = 1.518, 1.273-1.811; P < 0.001). However, the risk of late CVA/TIA in patients who survived the early postoperative period without having a stroke was similar between those with and without POAF (subdistribution-HR = 1.174, 0.797-1.729; P = 0.418). CONCLUSIONS: New-onset POAF after CABG is associated with an increased risk of midterm overall mortality and stroke. However, late stroke risk is likely similar between patients with and without POAF who survive an event-free early postoperative period.

The association between different body mass index levels and midterm surgical revascularization outcomes.

BACKGROUND: There are conflicting results regarding the relationship between overweight/obesity and the outcomes of coronary artery bypass graft surgery (CABG), termed "the obesity paradox". This study aimed to evaluate the effects of body mass index (BMI) on the midterm outcomes of CABG. METHODS: This historical cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016. The patients were divided into five categories based on their preoperative BMIs (kg/m2): 18.5≤BMI<25, 25≤BMI<30, 30≤BMI<35, 35≤BMI<40, and BMI≥40. Patients with BMIs below 18.5 kg/m2 were excluded. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. For the assessment of the linearity of the relationship between continuous BMI and the outcomes, plots for time varying hazard ratio of BMI with outcomes were provided. RESULTS: Of 17 751 patients (BMI = 27.30 ±4.17 kg/m2) who underwent isolated CABG at our center, 17 602 patients (mean age = 61.16±9.47 y, 75.4% male) were included in this study. Multivariable analysis demonstrated that patients with pre-obesity and normal weight had similar outcomes, whereas patients with preoperative BMIs exceeding 30 kg/m2 kg/m2 had a significantly higher risk of 5-year all-cause mortality and 5-year MACCEs than those with pre-obesity. Additionally, a positive association existed between obesity degree and all-cause mortality and MACCEs. Further, BMIs of 40 kg/m2 or higher showed a trend toward higher MACCE risks (adjusted hazard ratio, 1.32; 95% confidence interval, 0.89 to 1.95), possibly due to the small sample size. A nonlinear, albeit negligible, association was also found between continuous BMI and the study endpoints. CONCLUSIONS: Our findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs. These findings indicate that physicians and cardiac surgeons should encourage patients with high BMIs to reduce weight for risk modification.

Perivascular nitric oxide delivery to saphenous vein grafts prevents graft stenosis after coronary artery bypass grafting: a novel sheep model.

OBJECTIVES: Graft stenosis is a major complication of coronary artery bypass grafting with autologous saphenous vein grafts. Nitric oxide (NO) is believed to prevent this phenomenon. We studied the effect of perivascular application of an NO donor on the degree of stenosis of such grafts in an ovine model. METHODS: Twenty white Iranian ewes were randomized to coronary artery bypass grafting using autologous saphenous vein grafts with application of an elastomer gel containing diethylenetriamine NO adduct in 0.9% sodium chloride solution around the grafted vessel (intervention group) or with the gel containing the saline solution alone (controls). Graft vessels were studied after 1 year using spot angiography and histological examination. RESULTS: The mean degree of stenosis was significantly lower in the intervention group than in the controls as found by histology (92.3 ± 5.5 vs. 80.9 ± 8.3%; p = 0.004). Although the difference in the angiographic score was not significant, the mean score was still lower in the intervention group (9.5 ± 11.3 vs. 12.0 ± 11.8). CONCLUSIONS: Perivascular application of an NO donor was, at least histologically, effective in reducing graft stenosis in our ovine model. This can be a step toward the development of drug-eluting coronary artery bypass grafts.

Association between angiographically assessed coronary artery disease and serum levels of prostate specific antigen.

BACKGROUND: The increased incidence of coronary artery disease (CAD) in patients with conventional cardiovascular risk factors cannot be fully explained by the known risk factors. The aim of the study was to test whether there is an association between the levels of serum total PSA with the presence of CAD and its severity. METHODS: The study population consisted of 151 male patients aged < 55 years admitted at our center for elective coronary angiography. Patients having angiographic evidence of atherosclerosis (Gensini score > 6) in their epicardial coronary tree were categorized as having coronary artery disease (CAD(+) case group). Patients with Gensini score < or = 6 classified as having normal coronary arteries (CAD(-) control group). The presence and severity of CAD was determined by vessel score and Gensini score. The PSA levels were measured by the electrochemoluminescence (ECLIA) method. RESULTS: The mean level of serum PSA was found to be significantly higher in CAD patients than in those without CAD. In a multivariable logistic regression model, after adjusting for covariates, PSA level remained as an independent predictor for CAD occurrence (OR = 2.79; 95% CI: 1.04 - 7.49; p = 0.042). No significant correlation was found between the serum PSA level and the severity of CAD (r = 0.127, p = 0.122) or between PSA level and hsCRP level (r = 0.088, p = 0.282). CONCLUSIONS: It appears that PSA level is significantly associated with the presence of CAD. Further studies with larger sample size are required to confirm this result.

Prevalence of Depression in Iranian School Students: A Systematic Review and Meta-Analysis.

BACKGROUND: Depression is one of the major psychiatric disorders in the world. The present study was conducted to determine the prevalence of depression among Iranian school students through a meta-analysis. METHODS: All national and international information databases including PubMed, Scopus, Web of Science, SID, Magiran, Medlib were searched. The search phase was performed without language and time restrictions, but the searched studies were all in Persian and English, and the sources were updated by 03.08.2020. As the selected studies had high heterogeneity, the random effects model was used. RESULTS: In 51 studies with a sample of 537144 people, the prevalence of depression in Iranian school students was 37% (95%CI: 32, 42). In addition, the prevalence of depression in girl school students was 45% (95%CI: 25-65) and in boys was 28% (95%CI: 20-35). The prevalence of mild, moderate and severe depression in school students is 31%, 18% and 11%, respectively. Also, the prevalence of depression in primary school students was 12%, middle school students 32%, high school students 47% and pre-university students 46%. CONCLUSIONS: About a third of Iranian school students suffer from some degree of depression, and the prevalence of depression in girls is about twice that of boys. The prevalence of mild depression among school students is higher than moderate and severe depression. On the other hand, the prevalence of depression in school students from primary to pre-university level is increasing, which is very worrying.

Tehran cohort study (TeCS) on cardiovascular diseases, injury, and mental health: Design, methods, and recruitment data.

Cardiovascular disease, mental health, and injury are among the top health issues globally. In Tehran Cohort Study, we aimed to determine the prevalence, incidence, and trend of cardiovascular diseases, psychiatric symptoms, injury, and risk factors in Tehran households. We enrolled 4215 households in the recruitment phase from March 2016 to March 2019. Demographic characteristics, past medical history, medications, and familial history of the participants were collected. Rose angina pectoris, general health Questionnaire-28 (GHQ-28), and injury questionnaires were completed. Fasting blood samples were collected to measure routine biochemistry and store samples in the biobank. Anthropometric and physiological measurements and electrocardiograms were performed. The participants are followed every three years for up to 12 years. In total, 8296 individuals participated in the cardiovascular section, 10247 completed the GHQ-28, and 4167 households completed the injury questionnaire. The mean age of the participants was 48.2 (16.41), and 46.5% were male. 64.3% of recruited individuals had no symptoms of psychiatric disorders, and 3729 (89.5%) households did not have any severe injury requiring treatment. The participants' diversity and their invaluable data will help us provide a general picture of the current prevalence and incidence of the main study objectives.