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.

Dietary patterns and mortality from cardiovascular disease: Isfahan Cohort Study.

BACKGROUND/OBJECTIVES: Evidence about the relation between dietary patterns and cardiovascular disease (CVD) is scarce in Middle Eastern countries. This study was performed to examine the association between major dietary patterns and CVD mortality in Iranian adults. SUBJECTS/METHODS: This population-based prospective cohort study was conducted among 4834 randomly selected participants aged ⩾35 years from urban and rural areas of central Iran (2001-2009) (the Isfahan Cohort Study). Dietary intakes were assessed using a food frequency questionnaire, and major dietary patterns were identified by means of exploratory factor analysis. Subjects or their next of kin were interviewed biannually looking for possible occurrence of events. Cardiovascular mortality was defined as fatal myocardial infarction, fatal stroke and sudden cardiac death. RESULTS: During the median follow-up of 9.0 years and 50 282 person-years, we found a total of 118 CVD mortalities. Four major dietary patterns were identified: 'Western', 'Mediterranean', 'Animal fat' and 'Fast food'. Adherence to the Mediterranean dietary pattern was protectively associated with CVD mortality, such that those in the highest quartile were 46% (hazard ratio (HR): 0.54; 95% confidence interval (CI): 0.32-0.91; P-value for trend=0.03) less likely to have incident CVD mortality than those in the lowest quartile. Further adjustment for potential confounders strengthened this association (HR: 0.42; 95% CI: 0.19-0.96; P-value for trend=0.02). We found no significant association between adherence to the Western, animal fat and fast food dietary patterns and CVD mortality. CONCLUSIONS: Adherence to a Mediterranean dietary pattern was associated with reduced risk for cardiovascular mortality even in a developing country setting.