Pre-hypertension, pre-diabetes or both: which is best at predicting cardiovascular events in the long term?

The present study aimed to assess the value of pre-diabetes and pre-hypertension in predicting cardiovascular events. A population-based, cross-sectional survey was conducted, representing a large sample of the general Iranian population aged 35 years and older from the Isfahan Province and determined using a random, multistage cluster-sampling 10-year cohort. The five end points considered as study outcome were unstable angina (UA), acute occurrence of myocardial infarction (MI), sudden cardiac death (SCD), brain stroke and cardiovascular disease (CVD). Of the 6323 subjects scheduled for assessment of diabetes state 617 were diabetics and 712 were pre-diabetic. In addition, of these subjects, 1754 had hypertension and 2500 had pre-hypertension. Analysing only pre-hypertension, pre-diabetes and its combination and adjusted for gender and age variables, pre-hypertension and pre-diabetes status together, could only effectively predict occurrence of MI (hazard ratio (HR)=3.21, 95% confidence interval (CI): 1.06-9.76, P=0.04). In the same COX regression models, pre-hypertension status could predict UA and CVD occurrence (HR=2.94, 95% CI: 1.68-5.14, P<0.001 and HR=1.74, 95% CI: 1.23-2.47, P=0.002, respectively). However, pre-diabetes status could not predict any of these events after adjustment for gender and age. Our data provide valuable evidence of the triggering role of pre-hypertension and pre-diabetes together, on appearance and progression of MI even in healthy individuals and the significant predicting value of pre-hypertension on the occurrence of UA and CVD. In this regard, the value of pre-hypertension and pre-diabetes together, and the pre-hypertension state alone, are clearly superior to pre-diabetes state alone in predicting cardiovascular events.

Incidence of acute myocardial infarction in Islamic Republic of Iran: a study using national registry data in 2012.

Population-based data on myocardial infarction rates in the Islamic Republic of Iran have not been reported on a national or provincial scale. In a cross-sectional study, data were collected on 20 750 new cases of myocardial infarction (ICD10 codes I21-22) admitted to hospitals and registered by the Iranian Myocardial Infarction Registry in 2012. The crude and age-adjusted incidence for the 31 provinces and the whole country were directly calculated per 100 000 people using the WHO standard population. Overall, males comprised 72.4% of cases and had a significantly lower mean age at incidence than women [59.6 (SD 13.3) years versus 65.4 (SD 12.6) years]. The male:female incidence ratio was 2.63. The age-standardized myocardial infarction incidence rate was 73.3 per 100 000 in the whole country (95% CI: 72.3%-74.3%) and varied significantly from 24.5 to 152.5 per 100 000 across the 31 provinces. The study provides baseline data for monitoring and managing cardiovascular diseases in the country.

Radial strain assessment of the interventricular septum wall by a new technique in healthy subjects.

The aim of this study was to design a new approach for the acquisition of regional radial strain from the middle portion of the interventricular septum. We designed and wrote a program in Matlab (computer-assisted method) for use on a personal computer so that the septum thickness throughout the cardiac cycle could be measured instantaneously. Computer-assisted and conventional manual methods were used on the same 2D echocardiography image frames. Then, real-time 2D color Doppler myocardial imaging and conventional 2D imaging of the septum walls of 12 healthy participants at rest using apical four-chamber view were acquired. Wall thickness was measured using both the computerized program and velocity data used for tracking the segment and intensity line profile modification automatically. Then, the radial strain was estimated. Bland-Altman statistical analysis shows good agreement between the computer-assisted method and conventional manual method. The average of the peak and mean radial strains from the mid-septum of 12 healthy participants were 63.5 +/- 10.7 and 31.7 +/- 7.5%, respectively. We introduced a simple approach that is capable of radial strain estimation of the septum wall, which cannot be measured by current Doppler based methods in echocardiography systems.