Associations of the glycaemic index and the glycaemic load with risk of type 2 diabetes in 127 594 people from 20 countries (PURE): a prospective cohort study

BACKGROUND

The association between the glycaemic index and the glycaemic load with type 2 diabetes incidence is controversial. We aimed to evaluate this association in an international cohort with diverse glycaemic index and glycaemic load diets.

METHODS

The PURE study is a prospective cohort study of 127 594 adults aged 35-70 years from 20 high-income, middle-income, and low-income countries. Diet was assessed at baseline using country-specific validated food frequency questionnaires. The glycaemic index and the glycaemic load were estimated on the basis of the intake of seven categories of carbohydrate-containing foods. Participants were categorised into quintiles of glycaemic index and glycaemic load. The primary outcome was incident type 2 diabetes. Multivariable Cox Frailty models with random intercepts for study centre were used to calculate hazard ratios (HRs).

FINDINGS

During a median follow-up of 11·8 years (IQR 9·0-13·0), 7326 (5·7%) incident cases of type 2 diabetes occurred. In multivariable adjusted analyses, a diet with a higher glycaemic index was significantly associated with a higher risk of diabetes (quintile 5 vs quintile 1; HR 1·15 [95% CI 1·03-1·29]). Participants in the highest quintile of the glycaemic load had a higher risk of incident type 2 diabetes compared with those in the lowest quintile (HR 1·21, 95% CI 1·06-1·37). The glycaemic index was more strongly associated with diabetes among individuals with a higher BMI (quintile 5 vs quintile 1; HR 1·23 [95% CI 1·08-1·41]) than those with a lower BMI (quintile 5 vs quintile 1; 1·10 [0·87-1·39]; p interaction=0·030).

INTERPRETATION

Diets with a high glycaemic index and a high glycaemic load were associated with a higher risk of incident type 2 diabetes in a multinational cohort spanning five continents. Our findings suggest that consuming low glycaemic index and low glycaemic load diets might prevent the development of type 2 diabetes.

FUNDING

Full funding sources are listed at the end of the Article.

Prediction of blood pressure based on anthropometric measurements in adolescents

BACKGROUND

Recently, an important health issue in children is obesity, leading to hypertension. The aim of this study was to determine association of blood pressure with anthropometric variables in adolescents.

METHODS

In this study, 1992 adolescents aged 11-18 years old between 2000 and 2007 were included. Cut point of anthropometric indices of waist circumference (WC), waist-to-stature ratio (WSR) and body mass index (BMI) was identified using Youden's index.

RESULTS

Cut point of BMI for identification of hypertension was 19.69, 25.5, 20.65 and 24.13 for boys at middle and high school, girls at middle and high school, respectively. This measure for WSR was 0.44, 0.50, 0.45 and 0.517 for boys at middle and high school, girls at middle and high school, respectively. Regarding WC, it was 69.50, 96.5, 65.5 and 77.5 for boys at middle and high school, girls at middle and high school, respectively.

CONCLUSIONS

In middle school boys, WSR, WC and BMI are associated with DBP but by increasing age, only BMI and weight are associated with DBP. BMI is the consistent anthropometric determinant of DBP. We also observed the relationship between WSR and SBP in boys, which could be applied as a predictive measure.

Associations of Antibiotics, Hormonal Therapies, Oral Contraceptives, and Long-Term NSAIDS With Inflammatory Bowel Disease: Results From the Prospective Urban Rural Epidemiology (PURE) Study

BACKGROUND & AIMS

Several medications have been suspected to contribute to the etiology of inflammatory bowel disease (IBD). This study assessed the association between medication use and the risk of developing IBD using the Prospective Urban Rural Epidemiology cohort.

METHODS

This was a prospective cohort study of 133,137 individuals between the ages of 20 and 80 from 24 countries. Country-specific validated questionnaires documented baseline and follow-up medication use. Participants were followed up prospectively at least every 3 years. The main outcome was the development of IBD, including Crohn's disease (CD) and ulcerative colitis (UC). Short-term (baseline but not follow-up use) and long-term use (baseline and subsequent follow-up use) were evaluated. Results are presented as adjusted odds ratios (aORs) with 95% CIs.

RESULTS

During a median follow-up period of 11.0 years (interquartile range, 9.2-12.2 y), there were 571 incident IBD cases (143 CD and 428 UC). Incident IBD was associated significantly with baseline antibiotic (aOR, 2.81; 95% CI, 1.67-4.73; P = .0001) and hormonal medication use (aOR, 4.43; 95% CI, 1.78-11.01; P = .001). Among females, previous or current oral contraceptive use also was associated with IBD development (aOR, 2.17; 95% CI, 1.70-2.77; P < .001). Nonsteroidal anti-inflammatory drug users also were observed to have increased odds of IBD (aOR, 1.80; 95% CI, 1.23-2.64; P = .002), which was driven by long-term use (aOR, 5.58; 95% CI, 2.26-13.80; P < .001). All significant results were consistent in direction for CD and UC with low heterogeneity.

CONCLUSIONS

Antibiotics, hormonal medications, oral contraceptives, and long-term nonsteroidal anti-inflammatory drug use were associated with increased odds of incident IBD after adjustment for covariates.

A176 ASSOCIATIONS OF ANTIBIOTICS, HORMONAL THERAPIES, ORAL CONTRACEPTIVES, AND LONG-TERM NSAIDS WITH INFLAMMATORY BOWEL DISEASE: RESULTS FROM THE PROSPECTIVE URBAN RURAL EPIDEMIOLOGY (PURE) STUDY

Background

The pathogenesis of inflammatory bowel disease (IBD) which includes Crohn’s disease (CD) and ulcerative colitis (UC), is believed to involve activation of the intestinal immune system in response to the gut microbiome among genetically susceptible hosts. IBD has been historically regarded as a disease of developed nations, though in the past two decades there has been a reported shift in the epidemiological pattern of disease. High-income nations with known high prevalence of disease are seeing a stabilization of incident cases, while a rapid rise of incident IBD is being observed in developing nations. This suggests that environmental exposures may play a role in mediating the risk of developing IBD. The potential environmental determinants of IBD across various regions is vast, though medications have been increasingly recognized as one broad category of risk factors.

Purpose

Several medications have been considered to contribute to the etiology of IBD. This study assessed the association between medication use and risk of developing IBD using the Prospective Urban Rural Epidemiology (PURE) cohort.

Method

This was a prospective cohort study of 133,137 individuals between the ages of 20-80 from 24 countries. Country-specific validated questionnaires documented baseline and follow-up medication use. Participants were followed prospectively at least every 3 years. The main outcome was development of IBD, including CD and UC. Short-term (baseline but not follow-up use) and long-term use (baseline and subsequent follow-up use) was evaluated. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Result(s)

During the median follow-up of 11.0 years [interquartile range (IQR) 9.2-12.2], we recorded 571 incident cases of IBD (143 CD and 428 UC). Higher risk of incident IBD was associated with baseline antibiotic use [aOR: 2.81 (95% CI: 1.67-4.73), p=0.0001] and hormonal medication use [aOR: 4.43 (95% CI: 1.78-11.01), p=0.001]. Among females, previous or current oral contraceptive use was also associated with IBD development [aOR: 2.17 (95% CI: 1.70-2.77), p=5.02E-10]. NSAID users were also observed to have increased risk of IBD [aOR: 1.80 (95% CI: 1.23-2.64), p=0.002], which was driven by long-term users [aOR: 5.58 (95% CI: 2.26-13.80), p<0.001]. All significant results were consistent in direction for CD and UC with low heterogeneity.

Conclusion(s)

Antibiotics, hormonal medications, oral contraceptives, and long-term NSAID use were associated with increased odds of incident IBD after adjustment for covariates.

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Salim Yusuf is supported by the Heart & Stroke Foundation/Marion W. Burke Chair in Cardiovascular Disease. The PURE Study is an investigator-initiated study funded by the Population Health Research Institute, the Canadian Institutes of Health Research (CIHR), Heart and Stroke Foundation of Ontario, support from CIHR’s Strategy for Patient Oriented Research (SPOR) through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care and through unrestricted grants from several pharmaceutical companies, with major contributions from AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, and GlaxoSmithkline, and additional contributions from Novartis and King Pharma and from various national or local organisations in participating countries; these include: Argentina: Fundacion ECLA; Bangladesh: Independent University, Bangladesh and Mitra and Associates; Brazil: Unilever Health Institute, Brazil; Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network; Chile: Universidad de la Frontera; China: National Center for Cardiovascular Diseases; Colombia: Colciencias, grant number 6566-04-18062; India: Indian Council of Medical Research; Malaysia: Ministry of Science, Technology and Innovation of Malaysia, grant numbers 100 -IRDC/BIOTEK 16/6/21 (13/2007) and 07-05-IFN-BPH 010, Ministry of Higher Education of Malaysia grant number 600 -RMI/LRGS/5/3 (2/2011), Universiti Teknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010); occupied Palestinian territory: the UN Relief and Works Agency for Palestine Refugees in the Near East, occupied Palestinian territory; International Development Research Centre, Canada; Philippines: Philippine Council for Health Research & Development; Poland: Polish Ministry of Science and Higher Education grant number 290/W-PURE/2008/0, Wroclaw Medical University; Saudi Arabia: the Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (research group number RG -1436-013); South Africa: the North-West University, SANPAD (SA and Netherlands Programme for Alternative Development), National Research Foundation, Medical Research Council of SA, The SA Sugar Association (SASA), Faculty of Community and Health Sciences (UWC); Sweden: grants from the Swedish state under the Agreement concerning research and education of doctors; the Swedish Heart and Lung Foundation; the Swedish Research Council; the Swedish Council for Health, Working Life and Welfare, King Gustaf V’s and Queen Victoria Freemasons Foundation, AFA Insurance, Swedish Council for Working Life and Social Research, Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, grant from the Swedish State under the Läkar Utbildnings Avtalet agreement, and grant from the Västra Götaland Region; Turkey: Metabolic Syndrome Society, AstraZeneca, Turkey, Sanofi Aventis, Turkey; United Arab Emirates (UAE): Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority, Dubai UAE.

Disclosure of Interest

C. Pray: None Declared, N. Narula Grant / Research support from: Neeraj Narula holds a McMaster University Department of Medicine Internal Career Award. Neeraj Narula has received honoraria from Janssen, Abbvie, Takeda, Pfizer, Merck, and Ferring, E. C. Wong: None Declared, J. K. Marshall Grant / Research support from: John K. Marshall has received honoraria from Janssen, AbbVie, Allergan, Bristol-Meyer-Squibb, Ferring, Janssen, Lilly, Lupin, Merck, Pfizer, Pharmascience, Roche, Shire, Takeda and Teva., S. Rangarajan: None Declared, S. Islam: None Declared, A. Bahonar: None Declared, K. F. Alhabib: None Declared, A. Kontsevaya: None Declared, F. Ariffin: None Declared, H. U. Co: None Declared, W. Al Sharief: None Declared, A. Szuba: None Declared, A. Wielgosz: None Declared, M. L. Diaz: None Declared, R. Yusuf: None Declared, L. Kruger: None Declared, B. Soman: None Declared, Y. Li: None Declared, C. Wang: None Declared, L. Yin: None Declared, M. Erkin: None Declared, F. Lanas: None Declared, K. Davletov: None Declared, A. Rosengren: None Declared, P. Lopez-Jaramillo: None Declared, R. Khatib: None Declared, A. Oguz: None Declared, R. Iqbal: None Declared, K. Yeates: None Declared, Á. Avezum: None Declared, W. Reinisch Consultant of: Speaker for Abbott Laboratories, Abbvie, Aesca, Aptalis, Astellas, Centocor, Celltrion, Danone Austria, Elan, Falk Pharma GmbH, Ferring, Immundiagnostik, Mitsubishi Tanabe Pharma Corporation, MSD, Otsuka, PDL, Pharmacosmos, PLS Education, Schering-Plough, Shire, Takeda, Therakos, Vifor, Yakult, Consultant for Abbott Laboratories, Abbvie, Aesca, Algernon, Amgen, AM Pharma, AMT, AOP Orphan, Arena Pharmaceuticals, Astellas, Astra Zeneca, Avaxia, Roland Berger GmBH, Bioclinica, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Covance, Danone Austria, DSM, Elan, Eli Lilly, Ernest & Young, Falk Pharma GmbH, Ferring, Galapagos, Genentech, Gilead, Grünenthal, ICON, Index Pharma, Inova, Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, LivaNova, Mallinckrodt, Medahead, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nash Pharmaceuticals, Nestle, Nippon Kayaku, Novartis, Ocera, Omass, Otsuka, Parexel, PDL, Periconsulting, Pharmacosmos, Philip Morris Institute, Pfizer, Procter & Gamble, Prometheus, Protagonist, Provention, Robarts Clinical Trial, Sandoz, Schering-Plough, Second Genome, Seres Therapeutics, Setpointmedical, Sigmoid, Sublimity, Takeda, Therakos, Theravance, Tigenix, UCB, Vifor, Zealand, Zyngenia, and 4SC, Advisory board member for Abbott Laboratories, Abbvie, Aesca, Amgen, AM Pharma, Astellas, Astra Zeneca, Avaxia, Biogen IDEC, Boehringer-Ingelheim, Bristol-Myers Squibb, Cellerix, Chemocentryx, Celgene, Centocor, Celltrion, Danone Austria, DSM, Elan, Ferring, Galapagos, Genentech, Grünenthal, Inova, Janssen, Johnson & Johnson, Kyowa Hakko Kirin Pharma, Lipid Therapeutics, MedImmune, Millenium, Mitsubishi Tanabe Pharma Corporation, MSD, Nestle, Novartis, Ocera, Otsuka, PDL, Pharmacosmos, Pfizer, Procter & Gamble, Prometheus, Sandoz, Schering-Plough, Second Genome, Setpointmedical, Takeda, Therakos, Tigenix, UCB, Zealand, Zyngenia, and 4SC, P. Moayyedi: None Declared, S. Yusuf: None Declared

Temporal trends and prediction of bovine tuberculosis: a time series analysis in the North-East of Iran

BACKGROUND

Bovine tuberculosis (BTB) is a disease with high economic relevance.

AIMS

This study aimed to determine a fast alert surveillance system for bTB before the outbreak in the epidemic region of Iran.

METHODS

This cross-sectional study was conducted using the Auto-Regressive Integrated Moving Average (ARIMA) model for monthly bTB detections (reactors). These reactor cases result from the positive Tuberculin Purified Protein Derivative (PPD) test on cattle farms for the period between April 2007 and March 2019 in Razavi Khorasan province. Autocorrelation functions (ACF) and partial autocorrelation functions (PACF) plots were used to determine model parameters. The Akaike Information Criteria (AIC) were employed to select the best-fitted model. The root mean square error (RMSE) was applied for the evaluation of the models. Then, the best-fitted model was hired to predict the cases for 12 oncoming months. The data were analysed by STATA (ver. 14) software with a significant level at P≤0.05.

RESULTS

ARIMA (3, 0, 3) 12 was introduced as a recommended fitted model according to white noise residual test (Q=22.87 and P=0.98), lower AIC (541.85), and more precise model RMSE (1.50). However, the forecast values were more than the observed values.

CONCLUSION

The application and interpretation of ARIMA models are straightforward, and may be used as immediate tools for monitoring systems. However, we proposed an Auto-Regressive Integrated Moving Average with Exogenous Input (ARIMAX) model with some measurable exotic factors such as economic fluctuations, climate changes, and pulmonary tuberculosis to introduce a more precise and accurate model for the fast alert surveillance system.

Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries

Objectives

We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.

Methods

We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1—all three drug types were available and affordable, group 2—all three drugs were available but not affordable and group 3—all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors.

Results

Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50).

Conclusion

Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.

Validity and reproducibility of a semi-quantitative food frequency questionnaire for Iranian adults

AIM

To validate a semi-quantitative food frequency questionnaire (SFFQ) and assess the dietary intake of Iranian adults.

METHODS

This study was conducted among 113 healthy adults in Iran. We administered twelve 24-hour dietary recalls (24DRs) during a year as a reference method. The 165-item SFFQ was administered twice, along with the first and last 24DRs. To examine validity and reproducibility of SFFQ, the correlation coefficients (r) and de-attenuated correlation coefficients and intra-class correlation coefficient (ICC) between 24DRs and SFFQ were calculated. The Bland-Altman method was used to assess agreement between the two methods.

RESULTS

De-attenuated correlations varied from 0.42 (polyunsaturated fatty acids) to 0.62 (energy) (all P < .001) for nutrients and from 0.48 (oils and fats) to 0.65 (sweets) for food groups (all P < .05). We found reasonable reproducibility of SFFQ for both nutrients and food groups. ICC (95%CI) varied from 0.47 (0.15-0.74) for saturated fatty acids to 0.64 (0.47-0.76) for energy and from 0.43 (0.15-0.62) for oils and fats to 0.58 for grains (0.31-0.69). According to the Bland-Altman plots, we observed an acceptable level of agreement between the two methods.

CONCLUSIONS

We found reasonable relative validity and acceptable reproducibility of SFFQ. This SFFQ can be used to classify individuals based on their dietary intake in our population.

Outbreak Investigation of Officially Reported and Highly Pathogenic Avian Influenza (H5N8 Subtype) in Iran During 2016

On 14 November 2016, an outbreak of highly pathogenic avian influenza (HPA) was reported from a commercial layer farm located in Malard, Tehran Province, Iran. This study aimed to investigate the HPAI H5N8 outbreaks in Iran. The questionnaire was prepared and completed through interviews with farm owners or field observations at the time of disease onset from November 2016 to February 2017. The HPAI H5N8 infection was confirmed in 30 different locations including 10 villages (33.3%), nine-layer farms (33%), two broiler breeder farms (6.67%), one layer breeder farm (3.3%), one turkey farm (3.3%), one partridge farm (3.3%), five national parks (16.7%), and one wetland (3.3%) in 12 provinces of Iran. The cumulative incidence rates of disease in villages, layer farms, broiler breeder farms, layer breeder farms, partridge farms, and turkey farms were 0.02%, 0.87%, 0.55%, 6.25%, 7.14%, and 0.69%, respectively. The findings reflect that among the investigated variables at infected locations, new birds entering the home in villages, live bird markets, inappropriate biosecurity conditions, transporting manure during the breeding period, close proximity of a common road to infected farms, and poultry movement inside (pullet) and outside were the most frequently observed possible risk factors for these outbreaks. In conclusion, attention should be focused on the study of the dynamics and movements of domestic poultry, investigation and modification of the structure of industrial poultry farms, training for all related people, enhancement of passive surveillance, an increase in biosecurity, raising the awareness of the authorities on the importance of the infection, and provision of the required credits and facilities.

Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study

OBJECTIVE

We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income.

RESEARCH DESIGN AND METHODS

The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35-70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 ± 3.0 years.

RESULTS

Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 person-years, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 person-years, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58-2.27] to 1.78 [1.36-2.34]).

CONCLUSIONS

CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.

Association of estimated sleep duration and naps with mortality and cardiovascular events: a study of 116 632 people from 21 countries

AIMS

To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events.

METHODS AND RESULTS

We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self-reported napping time and examined the associations between them and the composite outcome of deaths and major cardiovascular events in 116 632 participants from seven regions. After a median follow-up of 7.8 years, we recorded 4381 deaths and 4365 major cardiovascular events. It showed both shorter (≤6 h/day) and longer (>8 h/day) estimated total sleep durations were associated with an increased risk of the composite outcome when adjusted for age and sex. After adjustment for demographic characteristics, lifestyle behaviours and health status, a J-shaped association was observed. Compared with sleeping 6-8 h/day, those who slept ≤6 h/day had a non-significant trend for increased risk of the composite outcome [hazard ratio (HR), 1.09; 95% confidence interval, 0.99-1.20]. As estimated sleep duration increased, we also noticed a significant trend for a greater risk of the composite outcome [HR of 1.05 (0.99-1.12), 1.17 (1.09-1.25), and 1.41 (1.30-1.53) for 8-9 h/day, 9-10 h/day, and >10 h/day, Ptrend < 0.0001, respectively]. The results were similar for each of all-cause mortality and major cardiovascular events. Daytime nap duration was associated with an increased risk of the composite events in those with over 6 h of nocturnal sleep duration, but not in shorter nocturnal sleepers (≤6 h).

CONCLUSION

Estimated total sleep duration of 6-8 h per day is associated with the lowest risk of deaths and major cardiovascular events. Daytime napping is associated with increased risks of major cardiovascular events and deaths in those with >6 h of nighttime sleep but not in those sleeping ≤6 h/night.

Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals

AIMS

To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes.

METHODS AND RESULTS

Baseline ECGs were collected in 153 152 middle-aged participants (ages 35-70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270-360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30-60 cases per 100 000 persons) (P < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score ≥1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49-3.52] and death (HR 2.97; 95% CI 2.25-3.93); with similar rates in different countries grouped by income level.

CONCLUSIONS

Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF.

Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study

BACKGROUND

Some studies, mainly from high-income countries (HICs), report that women receive less care (investigations and treatments) for cardiovascular disease than do men and might have a higher risk of death. However, very few studies systematically report risk factors, use of primary or secondary prevention medications, incidence of cardiovascular disease, or death in populations drawn from the community. Given that most cardiovascular disease occurs in low-income and middle-income countries (LMICs), there is a need for comprehensive information comparing treatments and outcomes between women and men in HICs, middle-income countries, and low-income countries from community-based population studies.

METHODS

In the Prospective Urban Rural Epidemiological study (PURE), individuals aged 35-70 years from urban and rural communities in 27 countries were considered for inclusion. We recorded information on participants' sociodemographic characteristics, risk factors, medication use, cardiac investigations, and interventions. 168 490 participants who enrolled in the first two of the three phases of PURE were followed up prospectively for incident cardiovascular disease and death.

FINDINGS

From Jan 6, 2005 to May 6, 2019, 202 072 individuals were recruited to the study. The mean age of women included in the study was 50·8 (SD 9·9) years compared with 51·7 (10) years for men. Participants were followed up for a median of 9·5 (IQR 8·5-10·9) years. Women had a lower cardiovascular disease risk factor burden using two different risk scores (INTERHEART and Framingham). Primary prevention strategies, such as adoption of several healthy lifestyle behaviours and use of proven medicines, were more frequent in women than men. Incidence of cardiovascular disease (4·1 [95% CI 4·0-4·2] for women vs 6·4 [6·2-6·6] for men per 1000 person-years; adjusted hazard ratio [aHR] 0·75 [95% CI 0·72-0·79]) and all-cause death (4·5 [95% CI 4·4-4·7] for women vs 7·4 [7·2-7·7] for men per 1000 person-years; aHR 0·62 [95% CI 0·60-0·65]) were also lower in women. By contrast, secondary prevention treatments, cardiac investigations, and coronary revascularisation were less frequent in women than men with coronary artery disease in all groups of countries. Despite this, women had lower risk of recurrent cardiovascular disease events (20·0 [95% CI 18·2-21·7] versus 27·7 [95% CI 25·6-29·8] per 1000 person-years in men, adjusted hazard ratio 0·73 [95% CI 0·64-0·83]) and women had lower 30-day mortality after a new cardiovascular disease event compared with men (22% in women versus 28% in men; p<0·0001). Differences between women and men in treatments and outcomes were more marked in LMICs with little differences in HICs in those with or without previous cardiovascular disease.

INTERPRETATION

Treatments for cardiovascular disease are more common in women than men in primary prevention, but the reverse is seen in secondary prevention. However, consistently better outcomes are observed in women than in men, both in those with and without previous cardiovascular disease. Improving cardiovascular disease prevention and treatment, especially in LMICs, should be vigorously pursued in both women and men.

FUNDING

Full funding sources are listed at the end of the paper (see Acknowledgments).

Trend of salt intake measured by 24-hour urine collection samples among Iranian adults population between 1998 and 2013: The Isfahan salt study

BACKGROUND AND AIM

Few population-based studies conducted in the Eastern Mediterranean region assessed salt intake by the measurement of 24-h sodium urine excretion (24-hUNa). The current study aimed to assess the trend of mean salt intake in Iranian adults between 1998 and 2013.

METHODS AND RESULTS

These cross-sectional studies were performed on 564, 157, 509 and 837 randomly selected healthy adults aged >18 years from Isfahan city, Iran, in 1998, 2001, 2007 and 2013, respectively. BP was measured using a mercury sphygmomanometer according to a standard protocol. Single 24-h urine was collected to assess 24-hUNa as a surrogate of salt intake, and 24-h urinary K (24-hUK). The estimated trend of salt intake was 9.5, 9.7, 9.6 and 10.2 g/day in total population (P < 0.001). The increase in salt intake between 1998 and 2013 was significant only in men, (P < 0.001). The risk of pre-hypertension was 21% and 18% significantly greater in the highest quartiles of UNa/UK after adjustment for potential confounders in 2001 and 2013, respectively, [OR (95% CI): 1.21 (1.03-1.64) and 1.18 (1.02-1.38), respectively].

CONCLUSIONS

This population-based study indicated that mean salt intake was about two times of recommendation in Isfahan city, Iran, and suggest that it would be essential to implement a salt reduction strategy program in Iranian population. Longitudinal national studies with larger samples examining the trend of salt intake are warranted.

Prevalence of Avian Influenza in Live Bird Markets, Bird Gardens, and Zoos in Iran in 2015: A Cross-sectional Study

Avian Influenza (AI) H9N2 is endemic in Iran; therefore, it is necessary to estimate the disease prevalence among birds in live bird markets (LBMs) and assess the risk spread across the country. Accordingly, this study aimed to estimate the prevalence of AI subtypes in LBMs, bird gardens, and zoos during October and November 2015 in Iran and investigate the associated risk factors. Data related to independent variables for birds and premises were collected using a prepared questionnaire which included items about previously known potential risk factors associated with avian influenza infection. Serological testing was carried out to detect the antibodies against H5, H7, and H9. Regarding H5 and H7, the antigens H5N2 and H7N1 were used in this study. Positive samples on the first test were examined with the second antigens, namely H5N1 and H7N7. Moreover, sera with titers &amp;ge;4 (i.e. log2) were considered positive and premises with at least one positive bird were considered as positive units. In total, 87 premises were included in this cross-sectional study. Serum samples were examined utilizing hemagglutination inhibition, and RT-PCR was conducted on swab samples. Regarding the molecular test, the RNA was extracted using the High Pure Viral RNA Kit (Roche, Germany). In addition, real-time RT-PCR was conducted based on the described method. The seroprevalence rates of H9N2 were 83.9% and 31.8% at the premises and bird levels, respectively. Totally, 9.2% of pooled swab samples were positive for H9N2. However, all sera and swab samples were negative for H5 and H7. Hot and humid weather (OR=0.13, 95% CI 0.02 &amp;ndash; 0.78) as well as bird-keeping condition (i.e., enclosed area) (OR=0.11, 95% CI 0.012 &amp;ndash; 1.02) were protective factors for H9N2. High seroprevalence rate of H9 indicates that the disease is endemic in Iranian LBMs. Active surveillance must be carried out in LBMs, especially in the northern provinces of Iran. In addition, cleanliness and improved hygiene would be useful to prevent the spread of disease in LBMs.

Serological Survey of Avian Influenza (H9N2) in Commercial Ostrich Farms in Iran, 2015

The aim of this study was to determine the seroprevalence of avian influenzaH9N2 subtype in the industrial ostrich farms and its geographical distribution. This cross-sectional study was conducted from January to June 2015. A total of 40 farms were selected from different provinces of Iran, from each of which 11 ostriches (n=440) were sampled. The sera samples were examined using 4 hemagglutination units of H9N2 antigens. A frequency distribution was used to describe the responses to the survey questions. The mean titers between provinces were compared using one-way analysis of variance. According to the results, 21 (47.5%) out of 40 farms and 108 (24.5%) out of 440 ostriches tested positive in the HI-H9N2 test. There were statistically significant differences between the mean titers of samples in different provinces (P&amp;lt;0.001). The current study was conducted on unvaccinated ostriches. The results showed that H9N2 had a high seroprevalence at both farm and bird levels. The findings of this study can be for the further investigation of infection in ostrich farms in order to consider this species in the surveillance programs of the Iranian Veterinary Organization. The detection and isolation of viruses and epidemiological investigation are necessary for the persistent use of H9N2 vaccines in some ostrich farms.

Does greater individual social capital improve the management of hypertension? Cross-national analysis of 61 229 individuals in 21 countries

Introduction

Social capital, characterised by trust, reciprocity and cooperation, is positively associated with a number of health outcomes. We test the hypothesis that among hypertensive individuals, those with greater social capital are more likely to have their hypertension detected, treated and controlled.

Methods

Cross-sectional data from 21 countries in the Prospective Urban and Rural Epidemiology study were collected covering 61 229 hypertensive individuals aged 35–70 years, their households and the 656 communities in which they live. Outcomes include whether hypertensive participants have their condition detected, treated and/or controlled. Multivariate statistical models adjusting for community fixed effects were used to assess the associations of three social capital measures: (1) membership of any social organisation, (2) trust in other people and (3) trust in organisations, stratified into high-income and low-income country samples.

Results

In low-income countries, membership of any social organisation was associated with a 3% greater likelihood of having one’s hypertension detected and controlled, while greater trust in organisations significantly increased the likelihood of detection by 4%. These associations were not observed among participants in high-income countries.

Conclusion

Although the observed associations are modest, some aspects of social capital are associated with better management of hypertension in low-income countries where health systems are often weak. Given that hypertension affects millions in these countries, even modest gains at all points along the treatment pathway could improve management for many, and translate into the prevention of thousands of cardiovascular events each year.

Ten-year trend in stroke incidence and its subtypes in Isfahan, Iran during 2003-2013

Background: As there was no evidence of long-term studies on stroke trend, stroke subtypes and its relationships to stroke risk factors and demographic characteristics in Iran, we aimed to evaluate the 10-year trend of stroke incidence and stroke subtypes in Isfahan, Iran. Methods: In a hospital-based retrospective study, 24186 cases with the first-ever stroke were analyzed. We assessed the incidence trend of annual stroke and its subtypes [ischemic stroke (IS) subarachnoid hemorrhage (SAH), and intracranial hemorrhage (ICH)] during the years 2003 to 2013 by sex, and studied the association of demographic and major stroke risk factors with incidence and mortality rate of stroke. Results: The mean age was 69.46 ± 14.87 years, and 49.29% of patients were women. IS was the most frequent type among all the types of strokes (76.18%). Stroke and its subtypes had decreasing incidence trend during the study period, except for SAH that increased. In addition, stroke and its subtypes had decreasing mortality trend during the study period, except for SAH that did not change anymore. Stroke mortality and incidence rates were lower in urban inhabitants compared to residents of rural areas [odds ratio (OR) = 0.763, P < 0.001]. Conclusion: Despite the relatively high incidence of stroke over the study period, the incidence rate of stroke, especially ICH subtype, had a decreasing trend over the last decade in Isfahan. However, given the current young population in Iran, we can expect that the incidence of stroke would have an escalating trend in future.

Carotenoids as Potential Antioxidant Agents in Stroke Prevention: A Systematic Review

Stroke and other cerebrovascular diseases are among the most common causes of death worldwide. Prevention of modifiable risk factors is a cost-effective approach to decrease the risk of stroke. Oxidative stress is regarded as the major flexible operative agent in ischemic brain damage. This review presents recent scientific advances in understanding the role of carotenoids as antioxidants in lowering stroke risk based on observational studies. We searched Medline using the following terms: (Carotenoids [MeSH] OR Carotenes [tiab] OR Carotene [tiab] OR "lycopene [Supplementary Concept]" [MeSH] OR lycopene [tiab] OR beta-Carotene [tiab]) AND (stroke [MeSH] OR stroke [tiab] OR "Cerebrovascular Accident" [tiab] OR "Cerebrovascular Apoplexy" [tiab] OR "Brain Vascular Accident" [tiab] OR "Cerebrovascular Stroke" [tiab]) AND ("oxidative stress" [MeSH] OR "oxidative stress"[tiab]). This search considered papers that had been published between 2000 and 2017. Recent studies indicated that high dietary intake of six main carotenoids (i.e., lycopene, <- and®-carotene, lutein, zeaxanthin, and astaxanthin) was associated with reduced risk of stroke and other cardiovascular outcomes. However, the main mechanism of the action of these nutrients was not identified, and multiple mechanisms except antioxidant activity were suggested to be involved in the observed beneficial effects. The dietary intake of six major carotenoids should be promoted as this may have a substantial positive effect on stroke prevention and stroke mortality reduction.

Tobacco control environment: cross-sectional survey of policy implementation, social unacceptability, knowledge of tobacco health harms and relationship to quit ratio in 17 low-income, middle-income and high-income countries

OBJECTIVES

This study examines in a cross-sectional study 'the tobacco control environment' including tobacco policy implementation and its association with quit ratio.

SETTING

545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014.

PARTICIPANTS

Community audits and surveys of adults (35-70 years, n=12 953).

PRIMARY AND SECONDARY OUTCOME MEASURES

Summary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression models.

RESULTS

Average tobacco control policy score was greater in communities from HIC. Overall 56.1% (306/545) of communities had >2 outlets selling cigarettes and in 28.6% (154/539) there was access to cheap cigarettes (<5cents/cigarette) (3.2% (3/93) in HIC, 0% UMIC, 52.6% (90/171) LMIC and 40.4% (61/151) in LIC). Effective bans (no tobacco advertisements) were in 63.0% (341/541) of communities (81.7% HIC, 52.8% UMIC, 65.1% LMIC and 57.6% LIC). In 70.4% (379/538) of communities, >80% of participants disapproved youth smoking (95.7% HIC, 57.6% UMIC, 76.3% LMIC and 58.9% LIC). The average knowledge score was >80% in 48.4% of communities (94.6% HIC, 53.6% UMIC, 31.8% LMIC and 35.1% LIC). Summary scores of policy implementation, social unacceptability and knowledge were positively and significantly associated with quit ratio and the associations varied by gender, for example, communities in the highest quintile of the combined scores had 5.0 times the quit ratio in men (Odds ratio (OR) 5·0, 95% CI 3.4 to 7.4) and 4.1 times the quit ratio in women (OR 4.1, 95% CI 2.4 to 7.1).

CONCLUSIONS

This study suggests that more focus is needed on ensuring the tobacco control policy is actually implemented, particularly in LMICs. The gender-related differences in associations of policy, social unacceptability and knowledge suggest that different strategies to promoting quitting may need to be implemented in men compared to women.

How far cardio metabolic and psychological factors affect salt sensitivity in normotensive adult population?

AIM

To evaluate the prevalence of salt sensitivity and the impact of cardiometabolic and psychological characteristics on salt sensitivity in normotensive population.

METHODS

Of all participants, anthropometric measurements and fasting venous blood samples were collected, and study questionnaires were completed. Salt Sensitivity was defined based on the difference in mean arterial pressure with infusion of 2 L of normal saline followed by a low sodium diet and administration of three doses of oral furosemide the day after.

RESULTS

Of 131 participants, 56 (42.7%) were diagnosed with salt sensitivity. Crude and age and sex adjusted regression analysis showed that low-density lipoprotein cholesterol and depression were positively associated with salt sensitivity (OR = 1.02, 95%CI: 1.01-1.04 and OR = 1.15, 95%CI: 1.00-1.34, respectively).

CONCLUSION

The high prevalence of salt sensitivity and its significant relation with prevalent risk factors necessitates considering its reduction actions at the population level and the need for further research.

Seasonal and Monthly variation in stroke and its subtypes-10 Year Hospital-Based Study

Background and Objectives:

There is no evidence of long-term studies of seasonal variations in stroke in Iran. Hence, the aim of this study was to determine the seasonal and monthly variation of 28-day mortality in Isfahan, Iran.

Methods:

From 2003 to 2013, In a Hospital-based retrospective study which was conducted by Isfahan Cardiovascular Research Center(ICRC), 24186 cases with first-ever stroke were recruited. Multinomial logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) for seasonal and monthly 28-day mortality for stroke in general and three subtypes of stroke including intracranial hemorrhage (ICH), ischemic (IS) and subarachnoid hemorrhage (SAH).

Results:

In this study, unadjusted and adjusted odds ratios of seasonal 28-day mortality of stroke was highest in the winter and lowest in the summer. Although, differences were not statistically significant. For total and IS stroke, the unadjusted 28-day mortality ratio (UMR) was significant in February (1.19, 95% CI 1.00 -1.42, P= 0.04) as compared to March. Whereas after adjusted, for total stroke, 28-day mortality was significantly lowest in May (0.746, 95% CI 0.575-0.97, p=0.029), June (0.777, 95% CI 0.60-0.99, p=0.49) and July (0.771, 95% CI 0.59-0.99 p=0.049) as compared to March. The AMR between months were not significant in SAH and IS.

Conclusion:

Our findings demonstrate clear obvious monthly variation of 28-day mortality of stroke and its subtypes in Isfahan but no seasonal variations were observed.

Wealth and cardiovascular health: a cross-sectional study of wealth-related inequalities in the awareness, treatment and control of hypertension in high-, middle- and low-income countries

BACKGROUND

Effective policies to control hypertension require an understanding of its distribution in the population and the barriers people face along the pathway from detection through to treatment and control. One key factor is household wealth, which may enable or limit a household's ability to access health care services and adequately control such a chronic condition. This study aims to describe the scale and patterns of wealth-related inequalities in the awareness, treatment and control of hypertension in 21 countries using baseline data from the Prospective Urban and Rural Epidemiology study.

METHODS

A cross-section of 163,397 adults aged 35 to 70 years were recruited from 661 urban and rural communities in selected low-, middle- and high-income countries (complete data for this analysis from 151,619 participants). Using blood pressure measurements, self-reported health and household data, concentration indices adjusted for age, sex and urban-rural location, we estimate the magnitude of wealth-related inequalities in the levels of hypertension awareness, treatment, and control in each of the 21 country samples.

RESULTS

Overall, the magnitude of wealth-related inequalities in hypertension awareness, treatment, and control was observed to be higher in poorer than in richer countries. In poorer countries, levels of hypertension awareness and treatment tended to be higher among wealthier households; while a similar pro-rich distribution was observed for hypertension control in countries at all levels of economic development. In some countries, hypertension awareness was greater among the poor (Sweden, Argentina, Poland), as was treatment (Sweden, Poland) and control (Sweden).

CONCLUSION

Inequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all. These findings show that some, but not all, countries, including those with limited resources, have been able to achieve more equitable management of hypertension; and strategies must be tailored to national contexts to achieve optimal impact at population level.

Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies

BACKGROUND

Several studies reported a U-shaped association between urinary sodium excretion and cardiovascular disease events and mortality. Whether these associations vary between those individuals with and without hypertension is uncertain. We aimed to explore whether the association between sodium intake and cardiovascular disease events and all-cause mortality is modified by hypertension status.

METHODS

In this pooled analysis, we studied 133,118 individuals (63,559 with hypertension and 69,559 without hypertension), median age of 55 years (IQR 45-63), from 49 countries in four large prospective studies and estimated 24-h urinary sodium excretion (as group-level measure of intake). We related this to the composite outcome of death and major cardiovascular disease events over a median of 4.2 years (IQR 3.0-5.0) and blood pressure.

FINDINGS

Increased sodium intake was associated with greater increases in systolic blood pressure in individuals with hypertension (2.08 mm Hg change per g sodium increase) compared with individuals without hypertension (1.22 mm Hg change per g; pinteraction<0.0001). In those individuals with hypertension (6835 events), sodium excretion of 7 g/day or more (7060 [11%] of population with hypertension: hazard ratio [HR] 1.23 [95% CI 1.11-1.37]; p<0.0001) and less than 3 g/day (7006 [11%] of population with hypertension: 1.34 [1.23-1.47]; p<0.0001) were both associated with increased risk compared with sodium excretion of 4-5 g/day (reference 25% of the population with hypertension). In those individuals without hypertension (3021 events), compared with 4-5 g/day (18,508 [27%] of the population without hypertension), higher sodium excretion was not associated with risk of the primary composite outcome (≥ 7 g/day in 6271 [9%] of the population without hypertension; HR 0.90 [95% CI 0.76-1.08]; p=0.2547), whereas an excretion of less than 3 g/day was associated with a significantly increased risk (7547 [11%] of the population without hypertension; HR 1.26 [95% CI 1.10-1.45]; p=0.0009).

INTERPRETATION

Compared with moderate sodium intake, high sodium intake is associated with an increased risk of cardiovascular events and death in hypertensive populations (no association in normotensive population), while the association of low sodium intake with increased risk of cardiovascular events and death is observed in those with or without hypertension. These data suggest that lowering sodium intake is best targeted at populations with hypertension who consume high sodium diets.

FUNDING

Full funding sources listed at end of paper (see Acknowledgments).

Case fatality rate ‎and disability of stroke in Isfahan, Iran: Isfahan stroke registry

BACKGROUND

Few investigators have reported case fatality and disability of Iranian patients with stroke. This study was designed to collect morbidity and case fatality data of hospitalized patients with stroke, and stroke care quality in Isfahan, Iran.

METHODS

From 2006 to 2011, from overlapping sources (discharge diagnoses, attending physicians, and hospitalization wards), all hospitalized patients with possible strokes were enrolled in the study, their hospital records were summarized by experienced personnel and reviewed by a neurologist with stroke experience. Patients were followed by phone calls or visited to their addresses and their 28(th) day functional status was checked by translated modified Rankin Scale (mRS). Forms and methods were derived from the World Health Organization (WHO) Monitoring Trends and Determinants in Cardiovascular Disease and STEPS projects.

RESULTS

A total of 9487 patients were identified to suffer from stroke. Their ages' mean was 68.98 ± 13.63 years, and 50.0% were females. In hospital, case fatality was 16.5% and the 28(th) day case fatality was 25.6%. The greatest case fatality was among intracerebral hemorrhage (ICH) patients and the least among ischemic stroke (IS) ones. Case fatality was greater among female and older patients and those with the previous history of stroke. Among survivors, only 26.9% were functionally independent (mRS < 3) which was the greatest among subarachnoid hemorrhage (SAH) patients and least among ICH patients. None of the patients were admitted to specific stroke units or received thrombolytic therapy.

CONCLUSION

The hospitalized patients with stroke in Isfahan have unfavorable outcome compared with their mates in developed countries. A low quality of stroke care may be responsible, and urgent attention is needed.

The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries

OBJECTIVE

To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing.

METHODS

Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders.

FINDINGS

Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15-1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17-5.67 and IRR: 2.52; CI: 1.23-5.17, respectively). Of the 11,842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24-76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities.

CONCLUSION

Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.

Are there any differences in education levels and changes of cardiovascular risk factors among urban and rural population: Isfahan Healthy Heart Program

BACKGROUND

This study aimed to find the influence of education level on the trends of changes of these risk factors among a great sample of Iranian population.

MATERIALS AND METHODS

This cross-sectional study is a secondary analysis of Isfahan Healthy Heart Program (IHHP). Blood samples were taken to determine the lipid levels including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), low levels of high-density lipoprotein cholesterol (HDL-C), and triglycerides. Education categorized based on training system in Iran as 1-5, 6-12, and more than 12 years training.

RESULTS

The prevalence of diabetes was higher among illiterate participants in both areas. Hypertension was more prevalent in illiterate subjects (2001; 44.0% and 2007; 46.3%) in intervention area (P < 0.001). Dyslipidemia was more prevalent among illiterate people (P < 0.001). In the intervention, illiterates have higher BMI in both 2001 and 2007 (P < 0.001). The prevalence of current smoking was the highest in education level range 6 to 12 years and was steadily decreased in higher education levels (P < 0.001). Subjects with 6-12 years of education have more unhealthy nutritional habits in both areas. In 2001, subjects with 12 years of education or more had more physical activity than other groups (P < 0.001), whereas, in 2007, subjects with 6-12 years of education were more active (P < 0.001).

CONCLUSION

Although the prevalence of diabetes, hypertension obesity, and dyslipidemia are more in illiterate subjects and prevalence of diabetes and hyperlipidemia was sharply decreased with education level, it seems that well educated participants have higher daily physically activity compared with those who have lower education without considering the place or residency.

Association between dietary salt intake and reservation of renal function in patients with mild hypertension

BACKGROUND

It is now hypothesized whether restricted salt intake can be a potential precursor to renal dysfunction in mild hypertension state. We aimed to study the association between salt intake and renal function in patients with mild hypertension.

METHODS

One hundred consecutive hypertensive Iranian patients (with systolic blood pressure 140-160 mmHg and/or diastolic 90-100 mmHg) who were referred to the hypertension research center, Isfahan, Iran, between 2011 and 2014 for screening of hypertension were assessed. Renal function was assessed by measuring serum creatinine (Cr) and creatinine clearance (CrCl). Daily salt intake was assessed on the basis of 24 h urinary sodium excretion.

RESULTS

There was no association between the amounts of sodium intake and serum Cr concentration (r = 0.138, P = 0.174), however, an association was revealed between sodium intake and value of CrCl (r = 0.303, P = 0.003). Multivariable linear regression model showed that sodium intake could effectively predict renal function assessed by CrCl (Beta = 0.070, P = 0.016).

CONCLUSION

There is an association between sodium intake and reservation of renal function in mild hypertension state and thus by restriction of dietary salt intake, reserving renal function, and preventing appearance and progression of renal insufficiency in higher degrees of hypertension can be facilitated.

Ultrasonography of the supramammary lymph nodes for diagnosis of bovine chronic subclinical mastitis

Currently, somatic cell count (SCC) and bacterial culture are considered as the gold standard of detecting subclinical Mastitis. Mastitis leads to proliferation of lymphocytes in the supramammary lymph nodes and subsequent enlargement of ipsilateral lymph node. Ultrasonography can be used to survey these changes. A portable ultrasound machine with a 2-5 MHz convex transducer was used to identify the supramammary lymph node size in 35 cows in a herd with chronic Staphylococcus aureus mastitis. After pre-milking udder preparation, a California mastitis test (CMT) was performed and individual milk samples were taken from each quarter for bacterial culture and somatic cell count (SCC) in accordance with NMC recommendations. The mean length (range 5.77-12.90 cm) and width (range 2.07-7.41 cm) of the lymph node were 9.2 and 4.03 cm, respectively. There was a positive correlation between lymph node size (length and depth) and culture of milk samples on ipsilateral quarters. Also, there was a significant difference correlation between CMT or mean log SCC of each side and size of supramammary lymph node in the same side. This study showed significant changes in supramammary lymph node dimensions in mastitis cases, so ultrasonography of this lymph node is probably a useful method for mastitis detection, especially in situations that test on milk is impossible.

The cumulative incidence of conventional risk factors of cardiovascular disease and their population attributable risk in an Iranian population: The Isfahan Cohort Study

Background:

Cardiovascular diseases (CVDs) are the leading cause of death in Iran. The present study evaluated the 7-year incidence of CVD risk factors among the participants of Isfahan cohort study (ICS).

Materials and Methods:

ICS was a longitudinal study on adults over 35 years of age from the urban and rural areas in three counties in central Iran. Data on clinical examination and blood measurements were collected in 2001. Subjects were followed and similar data were collected in 2007. Cumulative incidence was calculated through dividing new cases of each risk factor by the population free of that risk factor at baseline. Incidence proportion was determined for major CVD risk factors including hypertension (HTN), hypercholesterolemia (HC), hypertriglyceridemia (HTg), obesity, diabetes mellitus (DM), metabolic syndrome (MetS), and smoking.

Results:

A total number of 6323 adults free of CVDs were recruited. After 7 years of follow-up, 3283 individuals were re-evaluated in 2007. The participants’ age was 49.2 ± 10.3 years in 2001 (mean ± SD). The 7-year cumulative incidence of HTN, HC, HTg, overweight, obesity, DM, MetS, and smoking was 22.8%, 37.4%, 28.0%, 26.3%, 7.4%, 9.5%, 23.9%, and 5.9% in men and 22.2%, 55.4%, 33.5%, 35.0%, 18.8%, 11.3%, 36.1%, and 0.7% in women, respectively. Among those with overweight or obesity, 14.7% of men and 7.9% of women decreased their weight up to the normal level.

Conclusions:

The present study revealed a high incidence of CVD risk factors especially dyslipidemia, obesity, MetS and HTN. Therefore, the application of life-style modification interventions seems necessary.

Health volunteers' knowledge of cardiovascular disease prevention and healthy lifestyle following a community trial: Isfahan healthy heart program

BACKGROUND

Health volunteers can have a great effect by training the population about prevention of cardiovascular disease (CVD) and lifestyle modification. This study evaluated the health volunteers' knowledge following the Isfahan Healthy Heart Program (IHHP) that was performed between 2000 and 2006.

MATERIALS AND METHODS

In this study, 491 females were selected among health volunteers in the Isfahan and Najafabad districts as intervention areas and Arak as a reference area through 2000-2001 until 2006. They participated in training courses on CVD, its complications, methods of prevention of risk factors control as well healthy lifestyle promotion. The health volunteers' level of knowledge was assessed before and after training.

RESULTS

Before intervention, there was no significant difference between the scores of health volunteers in the intervention and the control regions in terms of knowledge about recognizing the symptoms, complications and prevention of CVD and relevant risk factors and healthy lifestyle. However, their knowledge scores increased significantly in the fields of CVD (β = 0.13, P = 0.04), hypertension (β = 0.18, P = 0.009), healthy nutrition (β = 0.19, P = 0.007), appropriate physical activity (β = 0.17, P = 0.01) and dealing with stress (β = 0.16, P = 0.02) after trainings.

CONCLUSION

The 6 year interventional program of IHHP showed that training health volunteers on prevention of CVD, their risk factors and modification of lifestyle continued to be effective even in a long time.

Brewer's Yeast Improves Glycemic Indices in Type 2 Diabetes Mellitus

BACKGROUND

Brewer's yeast may have beneficial effects on insulin receptors because of itsglucose tolerance factor in diabetic patients. This study was conducted to investigate the effects of brewer's yeast supplementation on glycemic indices in patients with type 2 diabetes mellitus.

METHODS

In a randomized double-blind controlled clinical trial, 84 adults (21 men and 63 women) aged 46.3 ± 6.1 years old with type 2 diabetes mellitus were recruited and divided randomly into two groups: Supplement group receiving brewer's yeast (six 300mg tablets/day, total 1800 mg) and control group receiving placebo (six 300mg tablets/day) for 12 weeks. Body weight, height, body mass index, food consumption (based on 24h food record), fasting blood sugar (FBS), glycosylated hemoglobin, insulin sensitivity, and insulin resistance were measured before and after the intervention. Data analysis was performed using the Statistical Package for Social Sciences (version 18.0).

RESULTS

The changes in FBS, glycosylated hemoglobin, and insulin sensitivity were significantly different between the two groups during the study (respectively P < 0.001, P < 0.001, P = 0.02 independent sample t-test). There was a significant difference in FBS, glycosylated hemoglobin, and insulin sensitivity at the end of the study between the two groups after removing the effects of baseline values (respectively P = 0.002, P < 0.001, P = 0.02, analysis of covariance). Changes in body mass index, 24h food record, insulin resistance were not significant.

CONCLUSIONS

Dietary supplementation with brewer›s yeast besides the usual treatment of diabetes can ameliorate blood glucose variables in type 2 diabetes mellitus.

Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries

IMPORTANCE

Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods.

OBJECTIVE

To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional study of 153,996 adults (complete data for this analysis on 142,042) aged 35 to 70 years, recruited between January 2003 and December 2009. Participants were from 628 communities in 3 high-income countries (HIC), 10 upper-middle-income and low-middle-income countries (UMIC and LMIC), and 4 low-income countries (LIC).

MAIN OUTCOMES AND MEASURES

Hypertension was defined as individuals with self-reported treated hypertension or with an average of 2 blood pressure measurements of at least 140/90 mm Hg using an automated digital device. Awareness was based on self-reports, treatment was based on the regular use of blood pressure-lowering medications, and control was defined as individuals with blood pressure lower than 140/90 mm Hg.

RESULTS

Among the 142,042 participants, 57,840 (40.8%; 95% CI, 40.5%-41.0%) had hypertension and 26,877 (46.5%; 95% CI, 46.1%-46.9%) were aware of the diagnosis. Of those who were aware of the diagnosis, the majority (23,510 [87.5%; 95% CI, 87.1%-87.9%] of those who were aware) were receiving pharmacological treatments, but only a minority of those receiving treatment were controlled (7634 [32.5%; 95% CI, 31.9%-33.1%]). Overall, 30.8%, 95% CI, 30.2%-31.4% of treated patients were taking 2 or more types of blood pressure-lowering medications. The percentages aware (49.0% [95% CI, 47.8%-50.3%] in HICs, 52.5% [95% CI, 51.8%-53.2%] in UMICs, 43.6% [95% CI, 42.9%-44.2%] in LMICs, and 40.8% [95% CI, 39.9%-41.8%] in LICs) and treated (46.7% [95% CI, 45.5%-47.9%] in HICs, 48.3%, [95% CI, 47.6%-49.1%] in UMICs, 36.9%, [95% CI, 36.3%-37.6%] in LMICs, and 31.7% [95% CI, 30.8%-32.6%] in LICs) were lower in LICs compared with all other countries for awareness (P <.001) and treatment (P <.001). Awareness, treatment, and control of hypertension were higher in urban communities compared with rural ones in LICs (urban vs rural, P <.001) and LMICs (urban vs rural, P <.001), but similar for other countries. Low education was associated with lower rates of awareness, treatment, and control in LICs, but not in other countries.

CONCLUSIONS AND RELEVANCE

Among a multinational study population, 46.5% of participants with hypertension were aware of the diagnosis, with blood pressure control among 32.5% of those being treated. These findings suggest substantial room for improvement in hypertension diagnosis and treatment.

Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan Healthy Heart Program

BACKGROUND

This study evaluated the outcome of a comprehensive, community-based healthy lifestyle program on cardiometabolic risk factors. The Isfahan Healthy Heart Program (IHHP) was a comprehensive action-oriented, multi-component intervention with a quasi-experimental design and reference area.  

METHODS

IHHP targeted the population-at-large (n = 2,180,000) in three districts in central Iran. Data from independent sample surveys before (2000 - 2001) and after (2007) this program were used to compare differences in the intervention area  and reference area over time after controlling for age, education level and income. The samples in 2000 - 2001 and 2007 included 6175 and 4719 participants in intervention area, and 6339 and 4853 in reference area, respectively. Multiple interventional activities were performed based on the four main strategies of healthy nutrition, increased physical activity, tobacco control and coping with stress. 

RESULTS

The prevalence of abdominal obesity, hypertension, hypercholesterolemia, hypertriglyceridemia and high LDL-C decreased significantly in the intervention area versus the reference area in both sexes. However the reduction in overweight and obesity was significant only in females (P < 0.05 for all). There were no significant changes in the prevalence of diabetes mellitus.  In the intervention area, the prevalence of hypercholesterolemia decreased from 23.5% to 12.5% among females without any changes in females in the reference area (p < 0.0001). In males, hypercholesterolemia decreased significantly in both intervention area (18.5% to 9.6%) and reference area (14.4% to 9.8%; p = 0.005). Mean triglyceride levels had a significant decrease in the intervention area and a non-significant decrease in the reference area (p < 0.0001). 

CONCLUSIONS

A comprehensive healthy lifestyle program comprising preventive and promotional activities that considers both population and high risk approaches can be effective in controlling cardiometabolic risk factors in a middle-income country.

Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study

IMPORTANCE

Little is known about adoption of healthy lifestyle behaviors among individuals with a coronary heart disease (CHD) or stroke event in communities across a range of countries worldwide.

OBJECTIVE

To examine the prevalence of avoidance or cessation of smoking, eating a healthy diet, and undertaking regular physical activities by individuals with a CHD or stroke event.

DESIGN, SETTING, AND PARTICIPANTS

Prospective Urban Rural Epidemiology (PURE) was a large, prospective cohort study that used an epidemiological survey of 153,996 adults, aged 35 to 70 years, from 628 urban and rural communities in 3 high-income countries (HIC), 7 upper-middle-income countries (UMIC), 3 lower-middle-income countries (LMIC), and 4 low-income countries (LIC), who were enrolled between January 2003 and December 2009.

MAIN OUTCOME MEASURES

Smoking status (current, former, never), level of exercise (low, <600 metabolic equivalent task [MET]-min/wk; moderate, 600-3000 MET-min/wk; high, >3000 MET-min/wk), and diet (classified by the Food Frequency Questionnaire and defined using the Alternative Healthy Eating Index).

RESULTS

Among 7519 individuals with self-reported CHD (past event: median, 5.0 [interquartile range {IQR}, 2.0-10.0] years ago) or stroke (past event: median, 4.0 [IQR, 2.0-8.0] years ago), 18.5% (95% CI, 17.6%-19.4%) continued to smoke; only 35.1% (95% CI, 29.6%-41.0%) undertook high levels of work- or leisure-related physical activity, and 39.0% (95% CI, 30.0%-48.7%) had healthy diets; 14.3% (95% CI, 11.7%-17.3%) did not undertake any of the 3 healthy lifestyle behaviors and 4.3% (95% CI, 3.1%-5.8%) had all 3. Overall, 52.5% (95% CI, 50.7%-54.3%) quit smoking (by income country classification: 74.9% [95% CI, 71.1%-78.6%] in HIC; 56.5% [95% CI, 53.4%-58.6%] in UMIC; 42.6% [95% CI, 39.6%-45.6%] in LMIC; and 38.1% [95% CI, 33.1%-43.2%] in LIC). Levels of physical activity increased with increasing country income but this trend was not statistically significant. The lowest prevalence of eating healthy diets was in LIC (25.8%; 95% CI, 13.0%-44.8%) compared with LMIC (43.2%; 95% CI, 30.0%-57.4%), UMIC (45.1%, 95% CI, 30.9%-60.1%), and HIC (43.4%, 95% CI, 21.0%-68.7%).

CONCLUSION AND RELEVANCE

Among a sample of patients with a CHD or stroke event from countries with varying income levels, the prevalence of healthy lifestyle behaviors was low, with even lower levels in poorer countries.

The relationship between nut consumption and lipid profile among the Iranian adult population; Isfahan Healthy Heart Program

BACKGROUND/OBJECTIVE

The study was carried out to assess the relationship between nut consumption and lipid profile among Iranian adults.

SUBJECT/METHODS

The study was based on data from the Isfahan Healthy Heart Program across three counties in central Iran in 2007. A cross-sectional survey of 9660 randomly selected adults aged ≥ 19 years were chosen based on sex, age and settlement distributions in each community. Nutritional behaviors were assessed by validated qualitative 48-item food frequency questionnaires, which covered regular intakes of four types of nuts: walnuts, almonds, pistachios and hazelnuts. Analysis of covariance and logistic regression tests were utilized to determine odds ratio (OR) 95% confidence interval of hyperlipidemia according to nut consumption patterns in unadjusted and three-adjusted models.

RESULTS

The results showed a significant link between high nut consumption and lower total cholesterol, triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) levels and apo B/apo A ratio (P<0.05) in female subjects and lower TG, LDL-C and apoB/apoA ratio in male subjects (P<0.05). The frequency of nut consumption was inversely associated with dyslipidemia, especially for those who had consumed nuts ≥ 4 times weekly (0.67 (0.57-0.79)). After adjusting for sex, age and other potential confounders, ORs increased enormously. Except for low apo A and high LDL-C, more frequent nut consumption (4 ≤ times per week) had a significant inverse effect on other dyslipidemia risk factors in all four models.

CONCLUSIONS

We concluded that frequent consumption of nuts, particularly ≥ 4 times a week, may result in lower dyslipidemia occurrences and may exert cardioprotective effects.

How does the impact of a community trial on cardio-metabolic risk factors differ in terms of gender and living area? Findings from the Isfahan healthy heart program

OBJECTIVE

To assess the impact of gender and living area on cardiovascular risk factors in the context of a comprehensive lifestyle intervention program.

DESIGN

Data from independent sample surveys before (2000--2001) and after (2007) a community trial, entitled the Isfahan Healthy Heart Program (IHHP) were used to compare differences in the intervention area (IA) and reference area (RA) by gender and living area.

SETTING

The interventions targeted the population living in Isfahan and Najaf-Abad counties as IA and Arak as RA.

PARTICIPANTS

Overall, 12 514 individuals who were more than 19 years of age were studied at baseline, and 9570 were studied in postintervention phase.

INTERVENTIONS

Multiple activities were conducted in connection with each of the four main strategies of healthy nutrition, increasing physical activity, tobacco control, and coping with stress.

MAIN OUTCOMES

Comparing serum lipids levels, blood pressure, blood glucose and obesity indices changes between IA and RA based on sex and living areas during the study.

RESULTS

In IA, while the prevalence of hypertension declined in urban and rural females (P < 0.05). In IA, the prevalence of hypercholesterolemia and hypertriglyceridemia decreased in both females and males of urban and rural areas except for hypercholesterolemia in rural males (P < 0.01). In RA, the significant changes include both decrease in the hypercholesterolemia among rural males (P < 0.001) and hypertriglyceridemia in urban females (P < 0.01), while hypertriglyceridemia was significantly increased in rural females (P < 0.01).

CONCLUSIONS

This comprehensive community trial was effective in controlling many risk factors in both sexes in urban and rural areas. These findings also reflect the transitional status of rural population in adopting urban lifestyle behaviors.

Lipid Profiles and Serum Visfatin Concentrations in Patients with Type II Diabetes in Comparison with Healthy Controls

BACKGROUND

Visfatin is a new adipocytokine which is largely secreted by visceral adipose tissue and its effects in the development of diabetes and inflammatory reactions are similar to insulin. It acts synergistically with insulin in increasing glucose cellular uptake, stimulating glucose transfer to the muscle and adipose tissue, as well as in preventing hepatic glucose production. Its insulin-like effects are mediated through direct connection and activation of insulin receptors without any change or competition with the insulin.

METHODS

This case-control study was conducted among 64 women consisting of 32 diabetic patients, and 32 age-matched healthy controls. The case group consisted of 32 post-menopausal diabetic women, aged 45-65 years. Those patients were eligible who had a history of at least five years of type II diabetes, without any complications of diabetes, and who were treated only by oral glucose-lowering medications. Those individuals with C-reactive protein (CRP) test of 3+ and above were excluded from the study. Results were compared with age- and sex- matched controls.

RESULTS

Average visfatin level was significantly higher in diabetic patients than in controls (4.3 ± 1.06ng/dl vs. 3.15 ± 0.74ng/dl, respectively< 0.001). The mean values of anthropometric indexes and lipid profile were not significantly different between diabetic patients and controls

CONCLUSION

This study documented an inverse relationship between circulating level of visfatin and fasting blood glucose. This finding may suggest the role of increased visfatin level and increase in synthesis and secretion of the cytokines from adipocytes. These findings may be useful for primary and secondary preventive issues in diabetic and pre-diabetic individuals.

Sensibilisation of asthmatic patients to extracted antigens from strains of Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger

OBJECTIVE

The main purpose of this study sought to evaluate the frequency of sensitivity of Iranian asthmatic patients to three regional Aspergillus species of fumigatus, flavus and niger, by detection of antigen-specific IgE in the patients' sera.

PATIENTS AND METHODS

Crude extracts were prepared following the disruption of fungi cell walls by the application of glass beads and their protein fractions were isolated by SDS-PAGE. After electrotransfer of protein bands into the nitrocellulose membrane, IgE-immunoblotting was performed against the sera from 32 asthmatic patients in addition to 20 healthy controls.

RESULTS

Our results interestingly showed that all of the studied Iranian asthmatic patients were sensitive to A. fumigatus and A. flavus antigens. This frequency was 65.6% in the case of A. niger, however, all control samples were negative. Age/sex analysis generally indicated higher sensitivities of young patients (<30 years old) to Aspergillus species with a statistical significance in the case of A. niger (P=0.02) and additionally more sensitivity of females. Using Immunoblotting assay, 23 IgE-reactive allergenic components from A. fumigatus, 15 from A. flavus and 13 from A. niger in a broad molecular weight spectrum were identified, among which several fragments were not previously reported.

CONCLUSION

Overall, this study found a high frequency of sensitivity of Iranian asthmatic patients to regional isolates of A. fumigatus, A. flavus and A. niger, which suggested the importance of these species in development of asthma. Moreover, we reported allergenic profiles of Iranian isolates in different patterns not previously observed.

The effects of a comprehensive community trial on cardiometabolic risk factors in adolescents: Isfahan Healthy Heart Program

BACKGROUND

This study aimed to assess the effects of a 6-year-long community-participatory program including school-based interventions on mean values and prevalence of cardiometabolic risk factors among adolescents.

METHODS

The interventions of this community trial, conducted from 2000 to 2007 in Iran, targeted the whole population (of nearly two millions) living in two cities considered as the intervention area (IA) in comparison with a reference area (RA). Data from surveys conducted before and after interventions was used to compare the differences between the secondary school students of the IA and RA.

RESULTS

The prevalence of hypercholesterolemia and hypertriglyceridemia declined significantly in girls and boys in the IA (P < 0.01). The prevalence of high LDL-C decreased significantly in the girls in the RA (P = 0.002). Among both sexes in the IA, the prevalence of low HDL-C increased significantly (P < 0.001), whereas it decreased in the girls and boys in the RA (P = 0.04). Although in the IA, the prevalence of overweight and obesity decreased significantly in girls (P = 0.001), it increased in boys (P = 0.001) as well as in the girls of the RA (P = 0.01).

CONCLUSION

By performing school-based interventions, our study was successful, at least in part, in controlling some cardiometabolic risk factors in adolescents. Such modifications may have long-term impacts on non-communicable diseases prevention in adulthood.

The effects of omega-3 on blood pressure and the relationship between serum visfatin level and blood pressure in patients with type II diabetes

BACKGROUND

Hypertension is a condition normally detected in people with type II diabetes.It eventually leads to cardiovascular diseases in the patient. Visfatin is an adipocytokine which issecreted from adipose tissue and can affect the inflammatory reaction and also serum lipidlevels. Additionally, omega-3 inhibits the accumulation of fat and formation of insulinresistance. The current study tried to investigate the effects of omega-3 on blood pressurecompared to placebo and the relationship between serum visfatin levels and blood pressure.

METHODS

A total number of 71 women with type II diabetes were randomly assigned to2 groups to receive either omega-3 capsules or placebo capsules. In the first step, aquestionnaire consisting age, height, weight, waist and hip circumferences, and systolic anddiastolic blood pressure was filled out for each subject. Blood samples were then collected forlaboratory tests. The next step was to conduct 8 weeks of intervention. All variables, except age,were measured again after the intervention. Hip circumference was considered as the maximumcircumference of the buttocks. Waist circumference was measured by placing a tape horizontallyacross the abdomen at the end of a normal exhalation. Laboratory tests included the assessmentof visfatin, glucose, and glycated hemoglobin (HbA1c) concentrations. Lipid profile, i.e. lowdensity lipoprotein (LDL), high density lipoprotein (HDL), triglyceride (TG), and cholesterol,was also assessed. Using SPSS18, data obtained from the study was analyzed by a variety ofappropriate statistical tests.

RESULTS

There was a significant change in mean differences of systolic and diastolic bloodpressure. Blood pressure showed a significant reduction in the omega-3 group compared to theplacebo group. However, no significant changes were observed in systolic and diastolic bloodpressure before and after the intervention (P > 0.05).

CONCLUSION

Based on the results of this study, a daily consumption of omega-3 is suggestedfor patients with type II diabetes.

Risk factors of atherosclerosis in male smokers, passive smokers, and hypertensive nonsmokers in central Iran

BACKGROUND

Some studies showed that smoking follows an upward trend in Asian countries as compared with other countries. The purpose of this study was to examine the effect of cigarette smoking on cardiovascular diseases and risk factors of atherosclerosis in patients with hypertension.

METHODS

This study was conducted on 6123 men residing in central Iran (Isfahan and Markazi Provinces) that participated in Isfahan Healthy Heart Project (IHHP). Subjects were randomly selected using cluster sampling method. All the subjects were studied in terms of their history of cardiovascular disease, demographic characteristics, smoking, blood pressure, physical examination, pulse rate, respiratory rate, weight, height, waist circumference, and blood measurements including LDL-C, HDL-C, total cholesterol, triglyceride, fasting blood sugar and 2-hour post prandial test.

RESULTS

While 893 subjects suffered from hypertension, 5230 subjects were healthy. The hypertension prevalence was 2.5 times more in urban areas compared to rural areas that showed a significant difference as it increased to 3.5 times smoking factor was considered. The prevalence of risk factors of atherosclerosis and also cardiovascular complications in patients with hypertension were significantly higher than healthy people. Furthermore, they were higher in smokers with hypertension and those exposed to the cigarette smoke than nonsmokers.

CONCLUSION

Smoking and passive smoking had an increasing effect on the prevalence of risk factors of atherosclerosis and consequently the incidence of cardiovascular diseases in patients with hypertension.

The Relationship between Weight and CVD Risk Factors in a Sample Population from Central Iran (Based on IHHP)

BACKGROUND

Atherosclerosis is one of the leading causes of mortality all around the world. Obesity is an independent risk factor for atherosclerosis and cardiovascular diseases (CVD). In this respect, we decided to examine the effect of the subgroups of weight on cardiovascular risk factors.

METHODS

This cross-sectional study was done in 2006 using the data obtained by the Iranian Healthy Heart Program (IHHP) and based on classification of obesity by the World Health Organization (WHO). In this study, the samples were tested based on the Framingham risk score, Metabolic Measuring Score (MMS) and classification of obesity. Chi-square and ANOVA were used for statistical analysis.

RESULTS

12514 people with a mean age of 38 participated in this study. 6.8% of women and 14% of men had university degrees (higher than diploma). Obesity was seen in women more than men: 56.4% of women and 40% of men had a Body Mass Index of (BMI) ≥ 25 Kg/m2. 13% of the subjects had FBS > 110 and13.9% of them were using hypertensive drugs. In this study, we found that all risk factors, except HDL cholesterol in men, increased with an increase in weight. This finding is also confirmed by the Framingham flowfigure for men and women.

CONCLUSION

One of every two Americans, of any age and sex, has a Body Mass Index of (BMI) ≥ 25 Kg/m2. Obesity associated CVD and other serious diseases. Many studies have been done in different countries to find the relationship between obesity and CVD risk factors. For example, in the U.S.A and Canada they found that emteropiotic parameters, blood presser and lipids increased by age(of both sexes). Moreover, another study done in China, which is a country in Asia like Iran, shows that BMI has an indirect effect on HDL cholesterol, LDL cholesterol and triglyceride. This data is consistent with the results of the current study. However, In China they found that this relationship in men is stronger than women, but our study reveals the opposite.