Incidence of cardiovascular diseases in an Iranian population: the isfahan cohort study

Introduction: accurate estimates of the incidence of cardiovascular diseases [CVD] comprising of acute myocardial infarction [AMI], unstable angina pectoris [UAP], sudden cardiac death [SCD], and stroke are very important for public health. However, such information is scarce, especially for middle- and low-income countries

Methods: the Isfahan Cohort Study [ICS] prospectively followed up 6504 individuals, 51.8% women, aged 35 years and over, 6323 initially free of CVD, from urban and rural areas in three districts in central Iran including Isfahan, Najafabad, and Arak. A panel of specialists in cardiology and neurology decided on the diagnosis of the occurred events based on patients’ hospital records, verbal autopsy, and death certificates

Results: after 32893 person-years of follow-up, 427 new cases of CVD events [229 in men] were registered. Confirmed cases of AMI, stroke, UAP, and SCD were 57, 43, 93, and 36 in men and 32, 48, 100, and 18 in women, respectively. The corresponding crude incidence rates were 352, 265, 352, and 220 per 100000 person-years in men and 186, 279, 584, and 104 in women, respectively. No significant differences were found in age at the time of events occurrence between men and women and between different event types except for SCD and stroke in women that in average the former occurred nine years later. CVD mortality rate was 331 per 100000 person-years in men and 203 in women

Conclusion: we found substantially high incidence rates for almost all CVDs and mortality. These findings need urgent consideration by health policy makers specifically for women

Opium decreases the age at myocardial infarction and sudden cardiac death: a long-and short-term outcome evaluation

Background: opium dependence is a recognized individual and public health threat, but little is known about its association with acute myocardial infarction [AMI] or sudden cardiac death [SCD]

Methods: in a cross-sectional study followed by a one-year matched longitudinal cohort, all 569 men hospitalized with AMI in all Cardiac Care Units [CCU] of Isfahan, Iran, were recruited in a six-month period. In addition, 123 out-of-hospital deaths were included that were diagnosed as SCD at the same duration. Among those discharged alive, 126 opium dependents were matched with 126 nondependents [mostly nonusers] according to age and smoking status, and were followed for one year. Opium dependence was measured using the ICD10 criteria and Severity of Dependence Scale [SDS] questionnaire. The method was validated by morphine blood levels. Biochemical measurements, blood pressure, blood cell counts, anthropometrics, and ejection fraction were measured at baseline and repeated at the end of follow-up

Results: there were 118 [17.1%] patients with an average of 17.4 +/- 10.4 years of abuse who met the criteria for opium dependency. Opium dependence decreased the age at event by 3.6 [95% CI: 1.2 – 6.0] years and was independent of smoking [P = 0.003]. In terms of cardiovascular risk factors such as ejection fraction, in addition to post-AMI mortality and morbidity, no significant associations were noted at baseline or after one year of follow-up. The odds ratio of sustained smoking after AMI was 1.92 [95% CI: 1.04 – 3.52] in opium dependents [P = 0.033]

Conclusion: despite public opinion, opium did not improve cardiovascular risk factors, or post-AMI mortality and morbidity. Conversely, there were irrefutable findings regarding the detrimental effects of opium dependence

influence of gender and place of residence on cardiovascular diseases and their risk factors the Isfahan cohort study

To determine the impact of gender and place of residence on cardiovascular disease [CVD] events and related risk factors. In a prospective cohort study, 6323 participants free of CVD [3255 women], with age of more than 35 years from 3 cities [Isfahan, Najafabad, and Arak] and their rural districts in central Iran were followed-up from 2001 to 2007. This study was carried out at the Cardiovascular Research Institute of Isfahan University of Medical Sciences, Isfahan, Iran. Endpoints were defined as fatal- and nonfatal myocardial infarction, sudden cardiac death, unstable angina and stroke that constituted CVD events. Subjects in the rural area had significantly better risk factor profile in terms of most CVD risk factors in both genders, but it was reverse for low density lipoprotein [LDL]-cholesterol in both genders, and smoking in men. Except for smoking, men had an overall better risk factor profile compared to women. The age and risk factors adjusted hazard ratio of living in rural area was 0.71 [95% confidence interval [CI]: 0.51-0.99] for men, and 0.63 [95% CI: 0.44-0.91] for women. The age of CVD occurrence was similar in men and women, and in rural and urban areas. Hypertension was the strongest predictor of these events except for rural men showing that high LDL-cholesterol was the strongest risk factor. The findings in this study documented differences in CVD risk factors affecting the occurrence of CVD events according to gender and place of residence. Such differences should be taken into account in future preventive public health strategies for CVD prevention.