Isfahan Cohort Study Research Articles

The association between the serum 25-hydroxyvitamin D level and cardiovascular events in individuals with and without metabolic syndrome.

BACKGROUNDPrevious studies revealed that the level of 25-hydroxyvitamin D [25(OH)D] could be consider as one the risk factors for the occurrence of cardiovascular diseases (CVDs). This study aimed to evaluate the relationship between serum 25(OH)D level and CVD events in individuals with and without metabolic syndrome (MetS) in an Iranian population.METHODSIn this nested case-control study conducted as a part of the Isfahan Cohort Study (ISC), 55 patients with CVD events were selected as case group, and 55 sex- and age-matched individuals without CVD events as control group. These participants were divided into the two main groups based on the presence of MetS at baseline.RESULTSThe level of 25(OH)D in individuals with and without MetS was significantly lower among patients with CVD compared to those without CVD events at the baseline of study and after the follow-up (P = 0.036 and P = 0.039, respectively). The level of 25(OH)D significantly decreased risk of incidence of CVD events in individuals without MetS after adjusting for age, sex, nutrition, and exposure to sunlight [0.19 (0.05-0.73); P = 0.016]. There was not any significant relationship between the amount of 25(OH)D at the baseline and CVD events in individuals with MetS.CONCLUSIONIn individuals with MetS, the level of 25(OH)D is not related to CVD events; as MetS directly influence the pathophysiology of mechanisms which are responsible for CVD events, and maybe this effect obscure the effect of 25(OH)D.

Cardiovascular mortality in a Western Asian country: results from the Iran Cohort Consortium

ObjectivesCardiovascular mortality in Western Asia is high and still rising. However, most data documented on risk prediction has been derived from Western countries and few population-based cohort studies have been...

RISK OF CARDIOVASCULAR DISEASE IN TREATED AND UNTREATED INDIVIDUALS WITH HYPERTENSION

Objective: It is not clear whether controlling blood pressure (BP) through antihypertensive treatment can eliminate the attributable risk of cardiovascular disease (CVD). We aimed to evaluate the residual risk of CVD in treated individuals with hypertension. Design and method: We used the data from the Isfahan Cohort Study, a population-based prospective study of Iranian adults aged 35 years or older at baseline. Of a total 6504, 5432 participants free of a CVD history at baseline with at least one follow-up were included. Participants were stratified to five different BP categories based on baseline BP (cutoffs of systolic/diastolic BP at 120/80 and 140/90 mmHg) and treatment status (yes/no). Cox proportional hazard regression was used to predict the hazard ratio (HR) for CVD events and its corresponding 95% confidence interval (CI). Results: During a median 10.9 years and 49,439 person-years of follow-up, a total of 706 incident CVD events were recorded comprising 563 cases of coronary heart disease (CHD) and 143 stroke. Successfully treated individuals were at higher risk of CVD (HR 1.93, 95% CI 1.28–2.90) and CVD mortality (HR 2.64, 95% CI 1.29–5.40) than the group with optimal BP in a multivariable model. Further adjusting for treatment duration and BP attenuated but did not eliminate the CVD (HR 1.65, 95% CI 1.08–2.52) and CVD mortality (HR 2.17, 95% CI 1.03–4.57) risk. A stronger association was found for CHD (HR 2.58, 95% CI 1.66–4.02) but not for stroke (HR 0.46, 95% CI 0.14–1.56). Both men (HR 2.45, 95% CI 1.27–4.74) and women (HR 1.62, 95% CI 0.95–2.77) with controlled BP had a higher risk of cardiovascular events, although not significant in women. In untreated individuals, the risk of CVD started at 120/80 mmHg (HR 1.38, 95% CI 1.09–1.75) and escalated in individuals with values from 130/85 mmHg to less than 140/90 mmHg (HR 1.94, 95% CI 1.29–2.92). Conclusions: A substantial residual risk of CHD remains despite treatment which could not be explained by usual confounders and BP itself. Hence, despite undeniable benefits of lowering BP, treatment may not totally counterbalance the risk of CVD at the population level.

Long-term nuts intake and metabolic syndrome: A 13-year longitudinal population-based study

The ability of nuts to improve the conditions of the metabolic syndrome (MetS) is now well established. However, few longitudinal studies examined the impact of nuts on MetS and those that have been ongoing considered baseline measurement of nuts intake. The associations between nuts intake and the risk of MetS was longitudinally assessed in our study using repeated measurements of nuts intake. The population-based longitudinal study was conducted on a sub-sample of the Isfahan Cohort Study (ICS), including 1387 adults, aged≥35 years. A validated food frequency questionnaire was applied to obtain data on the nuts intake. International Diabetes Federation (IDF) criteria were used to define MetS. The longitudinal relation between the trend of nuts intake and the risk and severity of MetS was examined using the Logistic and Cumulative Logit regressions with considering mixed random effects. After adjustment for potential confounders, a statistically significant inverse association was found in severity of MetS (the number of positive criteria) in the second quartile of nuts compared with the lowest quartile (OR: 0.77, 95% PI: 0.63-0.96; P trend: 0.03). Nuts intake was inversely associated with MetS risk among participants in the second quartile compared with the lowest quartile (OR: 0.76, 95% PI: 0.59-0.96; P trend: 0.14). Nuts intake demonstrated a significant, inverse association with the risk and severity of MetS after a 13-year follow-up period in a cohort of the Iranian population.

Usual energy and macronutrient intakes in a large sample of Iranian middle-aged and elderly populations.

The present study aimed to assess the usual distribution of energy and macronutrient intake among a large representative sample of Iranian healthy middle-aged and elderly people. In this cross-sectional study, a second follow-up survey of the Isfahan Cohort Study (ICS) was carried out; 1922 people aged 40 years and older were investigated. Dietary intakes were collected using 24-hour recall and two or more consecutive food records. Distribution of energy and macronutrient intake was estimated using traditional and National Cancer Institute (NCI) methods. The mean usual intake of energy was 1749.2 kcal based on the NCI method. Carbohydrate constituted 59.98% and protein 17.42% of total energy intake. The mean contributions of total fat, saturated fatty acids (SFA), polyunsaturated fatty acids (PUFA) and monounsaturated fatty acids (MUFAs) to energy intake were 25.74%, 9.5%, 4.92 and 7.75%, respectively. Approximately 7% of studied females aged 51-70 years met the recommended or higher levels for fibre. Females had significantly higher compliance of the recommended cholesterol level than males (age range of 40-70 years; P < 0.0001). It appears that Iranian middle-aged and elderly people are advancing towards a high risk of obesity and non-communicable chronic diseases. Nutritional interventions for improving the diet amongst this at-risk population are necessary.

Methods of sampling and sample size determination of a comprehensive integrated community-based interventional trial: Isfahan Healthy Heart Program.

BACKGROUNDThe aim of this study was describing the sampling methods and sample size of the Isfahan Healthy Heart Program (IHHP) and its sub-studies in focus.METHODSThe IHHP was carried out between 2000 and 2007 in urban and rural areas in 3 districts, namely Isfahan and Najafabad (as the intervention areas), and Arak (as the reference area), Iran. It consisted of the 3 phases of baseline surveys during 2000-2001, interventions between 2002 and 2005, and post-intervention surveys during 2006-2007 on 4 target groups (adults, health professionals, cardiac patients, children, and adolescents). During 2002 to 2005, 4 evaluation studies were conducted to evaluate short-term results. An ongoing cohort study entitled the Isfahan Cohort Study was performed on those aged ≥ 35 years at baseline in 2001 to access the risk of cardiovascular disease (CVD) occurrence.RESULTSUsing stratified random cluster methods, 12514, 5891, 4793, 6096, 3012, and 9572 adults and 1946, 1999, 1427, 1223, 389, and 1992 adolescents were chosen in the 1st to 3rd phases. Furthermore, simple random sampling was used for selecting 923, 694, 1000, and 2015 health professionals and 814, 452, 420, and 502 cardiac patients. A multistage sampling method was adopted for the collection of samples from parents of preschoolers and primary school children aged 2-10 years, adolescents’ parents, and some teachers. A prospective cohort study was started on 6504 eligible individuals.CONCLUSIONThe IHHP, as a comprehensive community-based interventional trial in Iran, among the few population-based studies around the world, has reasonable sampling methods and sample size.

Risk and Age of Cardiovascular Event in Women with Metabolic Syndrome: Menopause Age in Focus.

There is still a controversy about the causal relationship between menopause status and cardiovascular disease (CVD). The present study aimed to evaluate whether premature menopause would predict higher risk and lower the age of CVD occurrence and how this differs in women with metabolic syndrome (MetS). Using a population-based Isfahan Cohort Study (ICS), 1154 postmenopause women were followed up from 2001 to 2013 for any CVD occurrence. Cox proportional hazards regression analyses were used to estimate the association between menopause age of (≤45, 46-50, 51-55, ≥56 years) and CVD incidence. The menopause age group of 46-50 years was considered as reference group. During 12 years follow-up, 235 CV events were recorded. The mean age of menopause (±standard deviation) was 48.06 ± 5.48 years. The age at menopause was not predictive of total CV events, in women with and without MetS. In women without MetS, a trend with increasing incidence of stroke was observed at menopause age of ≤45 years (age adjusted hazard ratio: 4.84, 95% confidence interval: 0.99-23.5, P = 0.05). Women with menopause age of ≤45 years suffered from CV events, 5.7 years earlier than women with menopause age of ≥56 years (P = 0.11); this difference was 5.3 years in women with MetS (P = 0.4). This study showed that younger age at menopause is not predictive of the occurrence of CV events. It also revealed that age at menopause is not associated with earlier CV events in postmenopause women, with and without MetS.

Correction: PARS risk charts: A 10-year study of risk assessment for cardiovascular diseases in Eastern Mediterranean Region.

[This corrects the article DOI: 10.1371/journal.pone.0189389.].

The relationship between serum vitamin D levels and ankle-brachial index in patients with metabolic syndrome.

BACKGROUNDVitamin D deficiency is a prevalent condition in Iran and previous studies have shown that a low level of serum vitamin D is related to low ankle-brachial index (ABI). In the present study, the relationship of the serum level of vitamin D with ABI, as an index for atherosclerosis of peripheral arteries, was evaluated.METHODSIn this cross-sectional study, data on 91 patients with metabolic syndrome (Mets) from the Isfahan Cohort Study (ICS) were analyzed in order to evaluate the association between serum 25(OH) vitamin D level and ABI. The participants were divided into two groups; group A with desirable serum vitamin D level and group B with abnormal serum vitamin D level. ABI was measured and compared between these groups.RESULTSA crude and adjusted model showed no association between vitamin D level and ABI in patients with MetS.CONCLUSIONIt can be concluded that serum vitamin D level could not affect ABI in patients with MetS.

PARS risk charts: A 10-year study of risk assessment for cardiovascular diseases in Eastern Mediterranean Region.

This study was designed to develop a risk assessment chart for the clinical management and prevention of the risk of cardiovascular disease (CVD) in Iranian population, which is vital for developing national prevention programs. The Isfahan Cohort Study (ICS) is a population-based prospective study of 6504 Iranian adults ≥35 years old, followed-up for ten years, from 2001 to 2010. Behavioral and cardiometabolic risk factors were examined every five years, while biennial follow-ups for the occurrence of the events was performed by phone calls or by verbal autopsy. Among these participants, 5432 (2784 women, 51.3%) were CVD free at baseline examination and had at least one follow-up. Cox proportional hazard regression was used to predict the risk of ischemic CVD events, including sudden cardiac death due to unstable angina, myocardial infarction, and stroke. The model fit statistics such as area under the receiver-operating characteristic (AUROC), calibration chi-square and the overall bias were used to assess the model performance. We also tested the Framingham model for comparison. Seven hundred and five CVD events occurred during 49452.8 person-years of follow-up. The event probabilities were calculated and presented color-coded on each gender-specific PARS chart. The AUROC and Harrell’s C indices were 0.74 (95% CI, 0.72–0.76) and 0.73, respectively. In the calibration, the Nam-D’Agostino χ2 was 10.82 (p = 0.29). The overall bias of the proposed model was 95.60%. PARS model was also internally validated using cross-validation. The Android app and the Web-based risk assessment tool were also developed as to have an impact on public health. In comparison, the refitted and recalibrated Framingham models, estimated the CVD incidence with the overall bias of 149.60% and 128.23% for men, and 222.70% and 176.07% for women, respectively. In conclusion, the PARS risk assessment chart is a simple, accurate, and well-calibrated tool for predicting a 10-year risk of CVD occurrence in Iranian population and can be used in an attempt to develop national guidelines for the CVD management.

Whole milk consumption and risk of cardiovascular disease and mortality: Isfahan Cohort Study.

The association between milk intake and cardiovascular disease (CVD) and mortality risk is still controversial but data from Middle-Eastern populations are scarce. We aimed to study these associations in an Iranian population. We used the Isfahan Cohort Study, a population-based prospective study of 6504 adult Iranians. In this analysis, we included 5432 participants free of CVD at baseline with at least one follow-up. Data on whole milk intake and other dietary factors were collected by a food frequency questionnaire at baseline. Cox proportional hazard regression was used to predict risk of CVD events, comprising coronary heart disease (CHD) and stroke, and mortality according to frequency of whole milk intake with adjustment for other potential confounders. During a median 10.9years of follow-up, we documented 705 new cases of CVD comprising 564 CHD and 141 stroke cases. Compared with non-consumers, less than daily intake of whole milk was significantly associated with lower risk of CVD (HR 0.80, 95% CI 0.65-0.97), CHD (HR 0.81, 95% CI 0.65-0.99), and a non-significant lower risk of stroke (HR 0.79, 95% CI 0.50-1.27). Daily intake of whole milk was not significantly associated with CVD (HR 1.25, 95% CI 0.89-1.75), CHD, and stroke, but was associated with higher risk of all-cause mortality (HR 1.54, 95% CI 1.04-2.29). Less than daily intake of whole milk was associated with a statistically significant, although modest, lower risk of CVD compared with non-consumption, but this potential benefit may not extend to daily intake in this population.

Longitudinal association of metabolic syndrome and dietary patterns: A 13-year prospective population-based cohort study

Background and aimsDiet is a potential factor contributing to the development of the Metabolic Syndrome (MetS). This longitudinal study with repeated measurements of dietary intake was thus conducted to examine the longitudinal association between major dietary patterns and risk of MetS. Methods and resultsThe study was conducted within the framework of the Isfahan Cohort Study (ICS), in which 1387 participants were followed from 2001 to 2013. Validated food frequency questionnaire, anthropometric measurements, blood pressure, fasting serum lipids and blood sugars were evaluated in three phases of the study. Mixed effect Logistic and Cumulative Logit regressions were applied to evaluate the longitudinal associations between dietary patterns change and MetS and number of MetS components.Three dietary patterns were identified: Healthy, Iranian and Western dietary patterns. After adjustment for potential confounders, the higher scores of Healthy diet were inversely associated with the risk of MetS and number of MetS components (OR: 0.50, 95% CI: 0.36–0.70, OR: 0.52, 95% CI: 0.39–0.70, respectively). The greater adherence to the Iranian diet was positively associated with the risk of MetS and number of MetS components (OR: 1.28, 95% CI: 1.01–1.65, OR: 1.45, 95% CI: 1.16–1.81, respectively). The Western dietary pattern did not show any significant associations. ConclusionAdherence to a Healthy diet was associated with lower risk of MetS even in a developing country setting. However, the Iranian diet was positively associated with the risk of MetS. These results may guide the development of improved preventive nutrition interventions in this adult population.

Determinants of Incident Metabolic Syndrome in a Middle Eastern Population: Isfahan Cohort Study.

To identify the associated risk factors with development of metabolic syndrome (MetS) in a longitudinal prospective cohort study in an Iranian population. A total of 1994 participants, aged ≥35 years, free of MetS, diabetes, and cardiovascular disease at baseline were followed up for 7 years. Physical examination, laboratory studies, and interview about lifestyle factors were performed, and MetS was defined based on harmonized definition at both time points. Logistic regression was used to calculate odds ratio (OR) and corresponding 95% confidence interval (CI). MetS occurred in 27% of subjects with an incidence rate of 39.2 and 46.6 per 1000 person-year in men and women, respectively (P = 0.04). Among the components of MetS, triglyceride (TG) alone (OR 2.59, 95% CI 1.78-3.78) or in combination with waist circumference (WC; OR 5.01, 95% CI 3.59-7.01) was the strongest predictor of incident MetS compared to those free of components. In multivariable analysis, all components were associated with higher risk except fasting plasma glucose in both genders and high-density lipoprotein cholesterol in men. Impaired glucose tolerance was associated with two (95% CI 1.11-3.65) times increased risk in women. The multivariable adjusted OR (95% CI) of overweight and obesity was 1.68 (1.13-2.50) and 2.88 (1.73-4.78) in women and 2.46 (1.74-3.46) and 2.47 (1.38-4.43) in men, respectively. Unhealthy diet [1.57 (1.02-2.41)] and weekly Cola consumption [1.50 (1.05, 2.14)] increased the risk in women only. TG and WC components showed the highest predictive values for MetS incidence, while general obesity was independently associated with it.

The impact of health-related quality of life on the incidence of ischaemic heart disease and stroke; a cohort study in an Iranian population.

The aim of study was to evaluate the impact of health-related quality of life (QoL) on the occurrence of ischaemic heart disease (IHD) and stroke using a validated questionnaire. We followed the 3,283 subjects, aged ≥ 35 years and without history of cardiovascular events (CVE) over four years from 2007 to 2011 from the Isfahan cohort study. The World Health Organization QoL questionnaire (WHOQOL-BREF), which contains four separate domains, was used to assess QoL. Incidence rates of IHD and stroke were recorded during follow-up. Socioeconomic demographic data including marital state, educational level, occupation, income and place of living and metabolic risk factors such as diabetes mellitus (DM), hypertension (HTN), dyslipidaemia, body mass index and smoking were also recorded. More IHD (42%) and stroke (57%) patients were illiterate; while the educational status was significantly different only in the IHD group (P = 0.000). Differences in income and occupation were notable in patients with stroke and IHD, respectively, compared to subjects without them (P < 0.050). DM and HTN were significantly higher in IHD and stroke patients in comparison with subjects without CVE (P = 0.000). Two-way multivariate analyses of covariance test after age, educational status and metabolic risk factors adjustment showed that subjects with stroke had a significantly higher score in all QoL domains in comparison with individuals without stroke (P < 0.050). There was no significant association between QoL domains and IHD incidence (P > 0.050). This study indicates that there is no association between QoL and IHD incidence although there was a significant relationship between higher QoL and incidence of stroke.

Determinants of weight change in a longitudinal study of Iranian adults: Isfahan Cohort Study.

The extensive rise in the prevalence of obesity is a matter of great concern and poses a global threat to people's health. Obesity and overweight are considered to be the consequence of a collection of conditions including genetic, social, environmental, behavioral, and physical factors. The aim of this study was to investigate the determinants of weight change over seven years in a prospective study in an Iranian population. The Isfahan Cohort Study (ICS) is an ongoing longitudinal study started in 2001. A total of 6504 adults aged ≥ 35 years participated in this study. Subjects were followed every 2 years by phone calls. The interview and measurements were repeated in 2007 for 3284 subjects with the same protocol as the baseline study. Obesity indices, including body mass index (BMI) and waist circumference (WC) were measured at both time points. For the purpose of data analysis, multiple multinomial logistic regression, Chi-square, and ANOVA tests were used. In males, weight gain was more frequent from normal to overweight (11.7%), while in females, weight gain was observed more from overweight to obesity (11.4%). Younger individuals gained weight more than older individuals (P < 0.001); it was the same for lower education level (P = 0.007). Weight gain was negatively (OR: 0.98, 95% CI: 0.97-0.99 in male and OR: 0.96, 95% CI: 0.95-0.98 in female) and weight loss was positively (OR: 1.03, 95% CI: 1.01-1.05 in male and OR: 1.02, 95% CI: 1.01-1.04 in female) associated with age in both sexes. Education more than 12 years in women and between 6-12 years in men was negatively associated with weight gain while smoking was positively related to weight loss in females and weight gain in males. Our data showed that multiple factors affect weight change, among which age, smoking, and education are important determinants in Iranian adults.

Cardiovascular disease events and its predictors in women: Isfahan Cohort Study (ICS).

Introduction: As a lack of validated data about cardiovascular (CV) events and its risk factors (RFs) in women of Eastern Mediterranean region, we aimed to evaluate common predictors of CV events among Iranian women. Methods: Isfahan cohort study (ICS) is a prospective cohort that followed 6323 residents (51.3% women, aged 35-75 years) from three counties and their rural districts in central Iran. Common cardiovascular disease (CVD) RFs namely hypertension (HTN), diabetes mellitus, dyslipidemia, abdominal obesity, smoking, low apolipoproteins A ( apo-A) and high apolipoprotein B (apo-B) were evaluated. End points (CV events) were defined as fatal and nonfatal myocardial infarction, sudden cardiac death (SCD), unstable angina and stroke. Results: After 9 years of follow-up, 265 CV events were detected. The mean age of women with CV event was 57.6±10.9; about 8 years older than those without event. All CV RFs were significantly more prevalent in women with CV event except for low HDL cholesterol, overweight and low apo-A. HTN, diabetes, high triglyceride (TG), high LDL-C and obesity were significantly associated with CV events after adjustment for age, smoking and menopausal status (hazard ratios [95% CI]: 2.56 [1.93, 3.95], 2.43 [1.76, 3.35], 2.02 [1.49, 2.74], 1.59 [1.20, 2.11] and 1.49 [1.16-1.92], respectively), while low HDL cholesterol and abdominal obesity were not predictors for CV events (hazard ratios [95% CI]: 1.26 [0.96, 1.65], 1.71 [0.99, 2.96], respectively). Conclusion: In ICS, HTN, diabetes mellitus and high triglyceride are strong predictors for CV events in Iranian women. As almost all strong risk markers of CVD events are preventable, health policy makers have to give urgent consideration to make preventive public health strategies.

Anxiety but not depression is associated with metabolic syndrome: The Isfahan Healthy Heart Program.

Background:Only a few studies have carried out to evaluate the association of depression and anxiety with metabolic syndrome (MetS). The aim of this study was to investigate whether the depression and anxiety are associated with MetS and its different components.Materials and Methods:This cross-sectional study forms part of the prospective Isfahan Cohort Study. A total of 470 participants were chosen. Anxiety and depression symptoms were measured using hospital anxiety and depression scale (HADS). The MetS was diagnosed according to the American Heart Association and National Heart, Lung, and Blood Institute. One-way analysis of variance and binary logistic regression were used.Results:The mean age of participants was 55.7 ± 9.3. The prevalence of MetS in female participants with symptoms of depression (P < 0.0001), concurrent anxiety and depression (P = 0.004), anxiety (P < 0.0001), and asymptomatic individuals (P = 0.001) was significantly different when compared to male participants. Moreover, the analysis showed that having anxiety symptoms is in a negative relationship with MetS (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.12–0.78). In addition, with each 10-year increase in age, the probability of MetS will decrease 40% (OR = 0.59; 95%Cl = 0.53–0.72). Body mass index (OR = 1.29; 95%CI = 1.21–1.37), and gender (higher age for women) (OR = 0.34; 95%CI = 0.11–0.98) had positive relationship with MetS.Conclusion:The study findings revealed that the prevalence of MetS in patients with anxiety was lower than the healthy subjects, while no significant association was found between depression, concurrent depression, an anxiety with MetS.

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

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

The impact of health-related quality of life on the incidence of ischaemic heart disease and stroke; a cohort study in an Iranian population

Objective The aim of study was to evaluate the impact of health-related quality of life (QoL) on the occurrence of ischaemic heart disease (IHD) and stroke using a validated questionnaire.Methods We followed the 3,283 subjects, aged ≥ 35 years and without history of cardiovascular events (CVE) over four years from 2007 to 2011 from the Isfahan cohort study. The World Health Organization QoL questionnaire (WHOQOL-BREF), which contains four separate domains, was used to assess QoL. Incidence rates of IHD and stroke were recorded during follow-up. Socioeconomic demographic data including marital state, educational level, occupation, income and place of living and metabolic risk factors such as diabetes mellitus (DM), hypertension (HTN), dyslipidaemia, body mass index and smoking were also recorded.Results More IHD (42%) and stroke (57%) patients were illiterate; while the educational status was significantly different only in the IHD group (P = 0.000). Differences in income and occupation were notable in patients with stroke and IHD, respectively, compared to subjects without them (P < 0.050). DM and HTN were significantly higher in IHD and stroke patients in comparison with subjects without CVE (P = 0.000). Two-way multivariate analyses of covariance test after age, educational status and metabolic risk factors adjustment showed that subjects with stroke had a significantly higher score in all QoL domains in comparison with individuals without stroke (P < 0.050). There was no significant association between QoL domains and IHD incidence (P > 0.050).Conclusion This study indicates that there is no association between QoL and IHD incidence although there was a significant relationship between higher QoL and incidence of stroke.

Do Cardiometabolic Risk Factors Relative Risks Differ for the Occurrence of Ischemic Heart Disease and Stroke?

Background:The effects of the risk factors of ischemic heart disease (IHD) and stroke on the occurrence of these diseases differ between different populations.Objectives:To study the difference in the effects of different cardiovascular (CVD) risk factors on the incidence of IHD and stroke in an Iranian adult population.Patients and Methods:The Isfahan Cohort Study (ICS) is a longitudinal study that followed up 6323 subjects older than 35 years with no history of CVD since 2001. Of the original sample, only 5431 participants were contacted and followed up until 2011. The end points were the occurrence of IHD (defined as fatal and non-fatal myocardial infarction, unstable angina, and sudden cardiac death) and stroke. After 10 years of follow-up, 564 new cases of IHD and 141 new cases of stroke were detected. The relative risks (RRs) of cardiometabolic risk factors such as hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, high low-density lipoprotein cholesterol (LDL-C) level, low high-density lipoprotein cholesterol (HDL-C) level, current smoking, obesity, high waist-to-hip ratio, family history of CVD, and metabolic syndrome were compared between IHD and stroke patients. The ratio of relative risks (RRR) was calculated for comparing two RRs and estimated adjusted RRR was calculated by using generalized linear regression with a log link and binomial distribution.Results:The RRs of the occurrence of IHD and stroke in diabetic patients were 1.94 and 3.26, respectively, and the difference was statistically different (P = 0.016). The RR of high LDL-C was significantly higher for IHD than for stroke (P = 0.045), while all the other risk factors showed similar RRs for IHD and stroke, with no significant difference in their RRR, including hypertension. Diabetes and hypertension had the highest RRs for IHD, followed by diabetes, metabolic syndrome, and hypertension for stroke.Conclusions:The effect of diabetes mellitus on stroke was more significant than on IHD, and the effect of high LDL-C level was more significant on IHD than on stroke, other risk factors, including hypertension, have similar RRs for IHD and stroke. Health care professionals need more training regarding the RRs of these risk factors in the Iranian society, and health decision makers should consider it in their future policies.