Heart Atherosclerotic Disorders Research Articles

There is an association between body fat percentage and metabolic abnormality in normal weight subjects: Iranian large population

BackgroundNormal weight obesity (NWO) is defined by a normal body mass index (BMI) but a high percentage body fat (%BF) composition. We aimed to examine the hypothesis that subjects having NWO are at higher risk for cardio metabolic abnormalities compared to normal body weight subjects with low body fat content. MethodIn this cross sectional study 2439 adults' normal body Mass Index were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study. We measured 6 cardio-metabolic risk factors: Low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), systolic and diastolic blood pressure, and serum C-reactive protein (hs-CRP). Two models were evaluated: in model A, the categorization of individuals utilized cut off values of BMI: 18.5–25 and %BF: > 25 in men and >30 in women; in model B, the cut off values used were BMI: 18.5–25 and BF% with cut-offs depending on age: 20–39 years, >19% and >32%; 40–59 years, >21% and 33% and 60–79 years, > 24% and 35% for men and women were used, respectively. Cardiovascular risk estimates were made using QRISK2. SPSS version 18(SPSS Inc. Chicago, IL, USA) was used for all statistical analyses. GraphPad Prism 6 for figures was used. ResultOf the 2439 individuals with a normal BMI, 38.5% were found to be in high group and 61.5% were placed in normal weight groups for %BF in model A. In model B, 53.8% and 46.2% were found to be in the normal and high groups for %BF. The odds ratio for the presence of a metabolic abnormality for the high %BF group was 1.82 (95% CI, 1.42–2.34) and for high QRISK was 5.79 (95%CI, 4.17–8.02) after adjusted for age, in model A. In model B, the odds ratio for the presence of a metabolic abnormality for the high %BF group was 2.02 (95% CI, 1.68–2.42) and for high QRISK was 6.03 (95%CI, 4.45–8.08) after adjusted for sex. ConclusionIt can be stated that if body fat analysis among normal weight individuals can have an important contribution to the prevention of cardiovascular disease and other obesity-related conditions.

Association between serum zinc and copper levels and antioxidant defense in subjects infected with human T-lymphotropic virus type 1.

IntroductionCopper (Cu) and zinc (Zn) are important trace elements that are also structural ions of superoxide dismutase (SOD), which reduce oxidative stress. Zinc deficiency and excess copper have been reported to be associated with inflammation. The human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus, which is believed to cause systemic inflammation. The aim of this study is to measure levels of Zn, Cu, SOD, and prooxidant–antioxidant balance (PAB) in HTLV-1-positive patients and investigate the association between serum Zn and Cu concentrations and levels of oxidative stress in them.MethodsThe serum samples of 1,116 subjects who had participated in the “Mashhad Stroke and Heart Atherosclerotic Disorder” study, including 279 HTLV-1-positive and 837 HTLV-1-negative patients, were used. Levels of Zn, Cu, SOD, and PAB were measured.ResultsZinc and SOD levels were lower in the HTLV-1-positive group; however, the difference was statistically significant only for the level of SOD (P=0.003). On the other hand, levels of copper and PAB were significantly higher in HTLV-1 positive subjects; P=0.004 and P=0.002, respectively.ConclusionIn HTLV-infected patients, serum Zn concentration is lower and Cu concentration is higher than healthy controls. This altered situation might be either primary or secondary to HTLV-1 infection, which should be investigated in larger studies. We showed that SOD is significantly lower in HTLV-1-infected subjects. As in some other viruses that evolve different mechanisms to potentiate virus replication by changing the physiologic condition of host cells, HTLV-1 too probably decreases the activity of copper–zinc SOD1 by suppressing its gene.

Systolic and diastolic blood pressure percentiles by age and gender in Northeastern Iran

Hypertension (HTN) is a major risk factor for coronary artery disease. Its frequency is increasing globally. The aim of our study was to evaluate the reference range of blood pressure (BP) in the Iranian population stratified for age and gender. A total of 1449 subjects without diabetes, CVD, dyslipidemia, HTN history and with a normal BMI (18.5 ≤ BMI<25) were recruited in the present study. Participants were enrolled from the Mashhad stroke and heart atherosclerotic disorder study. Anthropometric indices and demographic data were collected by two health care specialists. A quantile regression model was used to estimate the expected systolic BP (SBP) and diastolic BP (DBP) at specific ages. A P-value of <.05 was considered significant for all analyses. All statistical analyses were performed using R (version 3.4.1) and SPSS software. The population included more men than women (51.6% vs. 48.4%). The mean and standard deviation of age in men (47.5 ± 8.4) was 2 years higher than women (45.63 ± 7.9; P < .001). SBP and DBP were higher in men than women (P < .001). By using a quantile regression model, we concluded that the 5th to 90th percentile of SBP in men, aged 30–69 years, ranged from 95 to 148.08 mm Hg and in women ranged from 86.66 to 140 mm Hg. The 5th to 90th percentile of DBP in men, aged 30–69 years, ranged from 60 to 91.66 mm Hg and in women ranged from 60 to 91.22 mm Hg. We have, for the first time, established the BP percentiles (1st, 5th, 10th, 50th, 90th, 95th, 99th) in an Iranian population stratified by age and gender. These data suggest that a local program for health promotion is necessary for the early identification of HTN in adults aged ≥30 years.

Serum vitamin E as a significant prognostic factor in patients with dyslipidemia disorders

ObjectivesObesity and overweight are among the main causes of cardiovascular disease (CVD) mortality. Dyslipidemia, fatty liver index, is strongly related to CVD. Vitamin E as an antioxidant protects the hepatic cells against oxidative stress and prevents fatty liver disease. The aim of the current study is to evaluate the relationship between anthropometric parameters and fasted lipid profile with serum vitamin E levels. Study designA randomized trial was designed based on data from the Mashhad stroke and heart atherosclerotic disorders (MASHAD: 2010–2020). Methods363 CVD subjects (173 males and 190 females) was selected at random, among 9704 subjects in three regions of Mashhad, northeast of Iran to investigate the specific correlations among their serum vitamin E, lipid profile (TG, HDL-C, LDL-C and TC), and anthropometric features (height, weight, BMI, hip and waist circumferences. ResultThe results indicated the significant relationships between vitamin E, and fasting serum lipid profile in subjects. Serum vitamin E was negatively correlated to TC, TG, and LDL-C and positively related to HDL-C. Also, statistically negative correlations were found between vitamin E and anthropometric parameters (weight, waist and hip circumference, middle Arm, and Systolic Blood Pressure). Moreover, vitamin E ratios such as vitamin E/(TC + TG) and vitamin E/TC values as standardized vitamin E, had significant negative correlation with BMI, the whole of anthropometric parameters, and dyslipidemia risk factors including TC, TG and LDL-C. ConclusionWe found that vitamin E profile was significantly lower in the dyslipidemia subjects. It is generally suggested that vitamin E monitoring might be used as a useful prognostic and therapeutic agent in dyslipidemia disorder.

Association Between Hypertension in Healthy Participants and Zinc and Copper Status: a Population-Based Study.

The prevalence of hypertension (HTN) is increasing globally. It has been shown that there is an association between micronutrient deficiency and HTN. In the current study, we aimed to assess the association between HTN with serum copper and zinc concentrations in a large representative Iranian population. The participants were enrolled into the Mashhad stroke and heart atherosclerotic disorders study (MASHAD study), a cohort study that was initiated in 2010. Anthropometric indices were assessed using standard procedures. Systolic (SBP) and diastolic (DBP) blood pressures were measured using a standard mercury sphygmomanometer. Fasting blood glucose (FBG), lipid profile, uric acid and blood urea nitrogen (BUN), and hs-CRP were measured using routine methods. HTN defined as persons who had SBP ≥ 130mmHg and/or DBP ≥ 85mmHg and/or medication use. Flame atomic absorption (Varian AA240FS) was used to measure serum Zn and Cu concentrations. SPSS software was used for all statistical analyses. A total of 9588 participants were recruited into the MASHAD study project. Participants were divided into two groups; 5695 healthy (non-hypertensive) (mean age 45.85 ± 7.5years) and 3893 hypertensive participants (mean age 51.18 ± 7.67years). Systolic (p < 0.001) and diastolic blood pressure (p < 0.001) were significantly different for different serum copper quartiles. The participants with serum copper levels < 80μg/dl had 1.33 times greater risk of an increased blood pressure than other participants. Participants with serum copper levels > 130μg/dl had a 1.94-fold higher risk of raised blood pressure. Serum zinc was not associated with systolic blood pressure, but individuals in the first quartile level of serum zinc had a diastolic blood pressure that was significantly higher than other quartiles (p = 0.035). Serum copper is associated with blood pressure status in adults in a U-shaped relationship, with a range of serum copper between 80 and 130μg/dl being associated with normal blood pressure.

Relationship between platelet count and platelet width distribution and serum uric acid concentrations in patients with untreated essential hypertension.

Hematological parameters have emerged as independent determinants of high serum concentrations of uric acid (UA) and predictive factors in the evaluation of the total cardiovascular risk in patients with essential hypertensive. Here, we have investigated the possible relationships between hematological factors and serum uric acid levels in hypertensive patients recruited as part of Mashhad Stroke and Heart Atherosclerotic Disorders cohort study. Two-thousand three-hundred and thirty-four hypertensive individuals were recruited from this cohort and these were divided into two groups; those with either high or low serum UA concentrations. Demographic, biochemical, and hematological characteristics of population were evaluated in all the subjects. Logistic-regression analysis was performed to determine the association of hematological parameters with hypertension (HTN). Of the 2334 hypertensive subjects, 290 cases had low UA, and 2044 had high serum UA concentrations. Compared with the low UA group, the patients with high serum UA, had higher values for several hematological parameters, whilst platelet counts (PLT) were lower. Multiple linear regression analysis showed that PLT and serum high sensitivity-c reactive protein (hs-CRP) were correlated with serum UA level. Stepwise multiple logistic regression model confirmed that platelet distribution width (PDW) and gender were independent determinant of a high serum UA. PDW and PLT appear to be independently associated with serum UA level in patients with HTN. © 2018 BioFactors, 44(6):532-538, 2018.

Dietary Intake and Its Relationship to Different Body Mass Index Categories: A Population-Based Study.

Obesity is a major public health problem because of its associated diabetes mellitus and cardiovascular disease. We aimed to explore the relationship between dietary macronutrients and adiposity in a cohort study, representative of the city of Mashhad in northeastern Iran. A cross-sectional study. The population sample (9847) derived from Mashhad stroke and heart atherosclerotic disorders (MASHAD: 2010-2020) and was obtained using a stratified-cluster method. The subjects were separated into 4 groups by body mass index status: normal weight, underweight, overweight and obese individuals. Individuals with mean age of 48.33 ±8.26 yr were recruited and anthropometric and biochemical factors were measured in all the subjects. Individual dietary intakes were assessed using 24-h dietary recall Dietplan6. Univariate and multivariate analyses were conducted before and after adjustment for age, gender and energy intake. Obese individuals were significantly less physically active. They had higher levels of serum fasted lipid profile, hs-CRP, uric acid, and glucose, and blood pressures compared to normal weight individuals (P=0.001). There was a significant difference in the dietary intakes of the groups categorized by obese before adjustment for energy intake in the obese compared to the normal weight group. These differences remained statistically significant for Trans fatty acid (P=0.033), lactose (P=0.009), fructose (P=0.025), glucose (P=0.017), sucrose (P=0.021) and maltose (P=0.015) after adjustment for energy intake. Our findings demonstrate a significant association between dietary Trans fatty acid and total sugar intake with adiposity in a representative population sample from northeastern Iran.

Prevalence of combined and noncombined dyslipidemia in an Iranian population.

Combination of dyslipidemic phenotypes, including elevated plasma levels of low-density lipoprotein cholesterol (LDL-C), elevated plasma triglycerides (TG), and decreased low-density lipoprotein cholesterol (HDL-C) concentrations, is important because of the association of individual phenotypes with increased risk of cardiovascular disease (CVD). We investigated the prevalence of combined dyslipidemias and their effects on CVD risk in an Iranian large population. A total of 9847 individuals were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study. Anthropometric parameters and biochemical indices were measured in all of the subjects. Different types of combined dyslipidemias including high TG+low HDL-C, high TG+low HDL-C+high LDL-C, low HDL-C+high LDL-C, high TG+high LDL-C, and finally high TG+high LDL-C+low HDL-C were considered. Ten-year CVD risk was calculated using the QRISK2 risk algorithm and adjustments were made as suggested by the Joint British Societies' (JBS2). Logistic regression analyses were performed to determine the association between different combined dyslipidemias and categorical QRISK. A total of 3952 males and 5895 females were included in this current study. Among the included subjects, 83.4% had one form of dyslipidemia, and 16.6% subjects were not dyslipidemic. The mean age was 48.88±7.9 and 47.02±8.54years for dyslipidemic and nondyslipidemic groups, respectively. The results showed that the frequency of dyslipidemia was 98%, 87.1%, and 90% in subjects with metabolic syndrome, CVD, and diabetes, respectively. Our results suggested that around 15.7% of study population were at 10years CVD risk (high ≥20) and it was higher in men than women (P<.001). Moreover, risk of CVD was higher in TG↑ & HDL↓ & LDL↑ group than other groups. Prevalence of dyslipidemia was 83.4% among Iranian adults. The results showed that individuals with increased plasma TG and LDL-C, and low HDL-C levels had the highest 10years CVD risk compared to other combined dyslipidemic phenotypes.

Association of rs6921438 A

BackgroundGenome-wide association studies (GWAS) have identified common variants at the Vascular-Endothelial-Growth-Factor (VEGF) gene locus, which appear to be associated with plasma VEGF concentrations. These factors are among the major risk factors for cardiovascular disease and metabolic syndrome (MetS). We have investigated the association between serum VEGF concentrations and a VEGF genetic variant (rs6921438 A<G) in 852 patients with or without MetS, defined according to International-Diabetes-Federation (IDF) criteria, recruited from the Mashhad Stroke and Heart Atherosclerotic Disorders cohort and their possible relationships with cardio-metabolic risk-factors and diet. MethodsIn total of 852 individuals, genotyping was performed using polymerase-chain-reaction and restriction-fragment-length-polymorphisms. Serum VEGF level was determined in 122 subjects using the EV 3513 cytokine biochip array. Anthropometric and biochemical characteristics, including fasting blood glucose and lipid profile evaluated by univariate and multivariate analyses. The association of the polymorphism with serum VEGF level and its interaction with dietary intake in association with the essential determinants of cardiovascular risk factors were assessed. ResultsAs would be expected, patients with MetS had markedly higher body mass index, waist-circumference, serum total cholesterol, triglyceride, hs-CRP and blood pressure, and lower concentrations of HDL-C, compared to non-MetS individuals (P < 0.05). The association between the rs6921438 single nucleotide polymorphism (SNP) and the presence of MetS and individual features of MetS were not statistically significant. Interestingly we observed a significant association between high serum VEGF levels with the GG and GA genotypes in the individuals with MetS, compared to the wild-type genotype, which was also associated with dietary fat intake. ConclusionOur findings show an association between a VEGF gene polymorphism with serum VEGF concentrations and dietary fat intake, but there was no association with the presence of MetS.

Hookah smoking is strongly associated with diabetes mellitus, metabolic syndrome and obesity: a population-based study

ObjectivesThe adverse effects of cigarette smoking have been widely studied before, whilst the effects of hookah smoking has received less attention, although it is a common habit in the Middle East. Here we have investigated the effects of cigarette and hookah smoking on biochemical characteristics in a representative population sample derived from the Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study, from Northeastern Iran.Study designA total of 9840 subjects from the MASHAD population study were allocated to five groups; non-smokers (6742), ex-smokers (976), cigarette smokers (864), hookah smokers (1067), concomitant cigarette and hookah smokers (41).MethodsBaseline characteristics were recorded in a questionnaire. Biochemical characteristics were measured by routine methods. Data were analyzed using SPSS software and p < 0.05 was considered significant.ResultsAfter adjustment for age and sex; the presence of CVD, obesity, metabolic syndrome, DM and dyslipidemia were significantly (p < 0.001) related to smoking status. After multivariate analysis, HDL (p < 0.001), WBC (p < 0.001), MCV (p < 0.05), PLT (p < 0.01) and RDW (p < 0.001), and the presence of CVD (p < 0.01), obesity (p < 0.001), metabolic syndrome (p < 0.05) and DM (p < 0.01) remained significant between cigarette smokers and non-smokers. Between hookah smokers and non-smokers; uric acid (p < 0.001), PLT (p < 0.05) and RDW (p < 0.05), and the presence of obesity (p < 0.01), metabolic syndrome (p < 0.001), diabetes (p < 0.01) and dyslipidemia (p < 0.01) remained significant after logistic regression.ConclusionThere was a positive association between hookah smoking and metabolic syndrome, diabetes, obesity and dyslipidemia which was not established in cigarette smoking.

Applying decision tree for detection of a low risk population for type 2 diabetes: A population based study

Introduction: The aim of current study was to create a prediction model using data mining approach, decision tree technique, to identify low risk individuals for incidence of Type 2 diabetes (T2DM), using the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) Study program.&#x0D; Methods: a prediction model was developed using classification by the decision tree method on 9528 subjects recruited from MASHAD database. Moreover, the receiver operating characteristic (ROC) curve was applied.&#x0D; Results: The prevalence rate of T2DM was ~14% in our population. For decision tree model, the accuracy, sensitivity, and specificity value for identifying the related factors with T2DM were 78.7%, 47.8% and 83%, respectively. In addition, the area under the ROC curve (AUC) value for recognizing the risk factors associated with T2DM was 0.64. Moreover, we found that subjects with family history of T2DM, age&gt;=48, SBP&gt;=130, DBP&gt;=81, HDL&gt;=29, LDL&gt;=148 and occupation=other have more than 59% chance of this disorder, while the chance of T2DM in subjects without history with TG&gt;=184, age&gt;=48 and hs-CRP&gt;=2.2, have approximately 51% chance.&#x0D; Conclusion: Our findings demonstrated that decision tree analysis, using routine demographic, clinical, anthropometric and biochemical measurements, which combined with other risk score models, could create a simple strategy to predict individuals at low risk for type 2 diabetes in order to decrease substantially the number of subjects needing for screening and recognition of subject at high risk.

Relationship between serum anti-heat shock protein 27 antibody levels and obesity

BackgroundHeat shock protein 27 (HSP27) is an intracellular molecular chaperone that is expressed at high levels following the exposure of cells to environmental stressors such as heat, toxins, and free radicals. High levels of HSP antigens and antibody titers have been reported in several conditions including cardiovascular disease and cancers. We measured serum anti-HSP27 antibody levels in 993 subjects and assessed the associations between serum anti-HSP27 antibody levels and demographic characteristics including coronary risk factors. MethodsA total of 993 subjects were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study. Demographic, clinical, and biochemical parameters and serum anti-HSP27 antibody titers were determined in all the subjects. ResultsSerum anti-HSP27 antibody levels increased with increasing age in men. No significant differences in levels were detected between men and women. Serum anti-HSP27 antibody levels were significantly higher in obese subjects than in nonobese subjects (P=0.046); however, no significant influence of smoking status was observed. Moreover, serum anti-HSP27 antibody titers were positively associated with age, body mass index, waist/hip ratio, the presence of diabetes mellitus, nonsmoking habit, serum triglycerides, cholesterol, and high-sensitivity c-reactive protein. ConclusionWe have found that serum anti-HSP27 antibody titers are related to several cardiovascular risk factors, necessitating further studies on the value of this emerging marker for risk stratification.

Association of hematocrit with blood pressure and hypertension.

Hypertension (HTN) is a risk factor for stroke, renal failure, and cardiovascular disease. The association between biochemical and hematological parameters with high blood pressure may provide a more precise approach to risk prediction conferred by HTN in these patients. The aim of current study was to explore whether biochemical and hematological parameters are associated with HTN in a cohort study with a 7-year follow-up. A total of 9808 individuals were enrolled and recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study, and biochemical and hematological factors were measured in all subjects. Univariate and multivariate logistic regression analysis were performed to determine the association of biochemical and hematological parameters with HTN. Several biochemical parameters including fasting plasma glucose (FBG), serum high-sensitivity C-reactive protein (hs-CRP), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and uric acid were increased in hypertensive participants. In contrast, serum high-density lipoprotein cholesterol (HDL-C) was lower in hypertensive individuals. Furthermore, we demonstrated that hematological parameters including white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin (HGB), hematocrit (HCT), and mean corpuscular hemoglobin (MCH) were higher in the hypertensive group compared to the control group. But mean corpuscular volume (MCV), and red cell distribution width (RDW), were decreased in the hypertensive group. Furthermore, our results strongly suggested that among these parameters, hematocrit was the independent risk factor for hypertension in the population. We demonstrated the association of altered biochemical and hematological factors with hypertension supporting the value of emerging markers for early prediction of high blood pressure in prone individuals.

Zinc Finger 259 Gene Polymorphism rs964184 is Associated with Serum Triglyceride Levels and Metabolic Syndrome.

Metabolic syndrome (MetS) is characterized by a cluster of cardiovascular risk factors that include: abdominal obesity, dyslipidaemia, hypertension, insulin resistance and impaired glucose tolerance. Recent genome wide association studies have identified several susceptibility regions involved in lipid metabolism that are also associated with MetS. We have explored the association of 9 genetic polymorphisms involved in lipid metabolism and hypertension, including: MTHFR C677T, SELE L554F, FGB - 455G>A, GNB3 C825T, ZNF259 C>G, PSRC-1 A>G, CETP I405V, LPL S447X and LPA C>T in 97 subjects with MetS and 96 individuals without MetS who were recruited randomly from Mashhad stroke and heart atherosclerotic disorder (MASHAD) study using a stratified cluster random sampling technique. Anthropometric parameters and biochemical measurements were determined in all the subjects. Genotyping was carried out followed by univariate and multivariate analyses. The subjects with MetS had a higher triglyceride and lower HDL- C. CG+ GG genotypes of ZNF259 polymorphism (rs964184 C>G) and TT+CT genotypes of MTHFR C677T (rs1801133) were associated with MetS, and individuals carrying the G allele for ZNF259 or the T allele for MTHFR polymorphisms were associated with MetS (e.g, odds ratio (OR) for CG+GG genotypes vs. CC wild type: 2.52, CI=1.33-4.77; P=0.005). However, after multiple comparison adjustment, this relationship remained significant only for CG+ GG genotypes of ZNF259 polymorphism. Moreover, the ZNF259 CG+ GG genotypes were associated with increased serum concentrations of triglycerides and LDL-C, compared to the wild type. These data support the necessity for further studies in larger multicenter settings.

Mashhad stroke and heart atherosclerotic disorder (MASHAD) study: design, baseline characteristics and 10-year cardiovascular risk estimation

The Mashhad stroke and heart atherosclerotic disorder (MASHAD) study is a 10-year cohort study that aims to evaluate the impact of various genetic, environmental, nutritional and psychosocial risk factors on the incidence of cardiovascular events among an urban population in eastern Iran. The MASHAD study comprises a cohort of 9704 individuals aged 35-65 years using a stratified cluster random sampling design. This cohort will be followed up until 2020, with follow-up examinations being undertaken every 3 years. Ten-year cardiovascular disease (CVD) risk estimation was determined using NCEP ATP III criteria. Overall, 88.4 % of women and 79.2 % of men (P < 0.001) had at least one lipid abnormality. The 10-year risk for CVD of <10, 10-20 and >20 % were observed to be 86.6, 11 and 2.5 %, respectively. Predicted risk of CVD > 10 % using the Framingham algorithm was considerably higher in men compared to women. Overall, 9.5 % [95 % confidence interval (CI) 8.9-10.1 %] of our subjects had prevalent CAD. The prevalence of CVD risk factors within our population is high compared to Western countries, indicating the necessity for interventional risk modifications.