Publications by authors named "Elham Jaafari"

2 Publications

  • Page 1 of 1

Polypill for the prevention of cardiovascular disease (PolyIran): study design and rationale for a pragmatic cluster randomized controlled trial.

Eur J Prev Cardiol 2015 Dec 17;22(12):1609-17. Epub 2014 Sep 17.

Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

Background: The complexity of treatment regimens, costs and pill burden decrease the medication adherence and contribute to shortfall in cardiovascular preventive drug coverage. The polypill, a fixed dose combination pill of established drugs, is expected to increase adherence and reduce the costs whilst preventing major cardiovascular events (MCVE).

Design And Methods: The PolyIran trial is a pragmatic cluster randomized trial nested within the Golestan Cohort Study (GCS). Subjects were randomized to either non-pharmacological preventive interventions alone (minimal care arm) or together with a polypill (polypill arm) comprising hydrochlorothiazide, aspirin, atorvastatin and either enalapril or valsartan. This study benefits from the infrastructure of the primary health care system in Iran and the interventions are delivered by the local auxiliary health workers (Behvarz) to the participants. The primary outcome of the study is the occurrence of first MCVE within five years defined as non-fatal and fatal myocardial infarction, unstable angina, sudden death, heart failure, coronary artery revascularization procedures, and non-fatal and fatal stroke.

Trial Status: From February 2011 to April 2013, 8410 individuals (236 clusters) attended the eligibility assessment. Of those, 3421 in the polypill arm and 3417 in the minimal care arm were eligible. The study is ongoing.

Conclusion: The infrastructure of GCS and the primary health care system in Iran enabled the conduct of this pragmatic large-scale trial. If the polypill strategy proves effective, it may be implemented to prevent cardiovascular disease in developing countries.
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December 2015

Vitamin deficiency in Golestan Province, northern Iran: a high-risk area for esophageal cancer.

Arch Iran Med 2010 Sep;13(5):391-4

Digestive Disease Research Center, Shariati Hospital, University of Tehran Medical Sciences, Kargar-e-shomali Ave., Tehran, Iran.

Objective: Dietary factors seem to play a major role in esophageal carcinogenesis in Golestan Province, a high-incidence area for esophageal cancer in northern Iran. The current study was conducted to evaluate previous reports on severe deficiency of vitamin intake in Golestan.

Methods: Using a food frequency questionnaire, food intake data were collected from 30,463 healthy participants in the Golestan Cohort Study. Intake of selected nutrients was compared with recommended daily allowance and lowest threshold intake values.

Results: Vitamin A intake in the majority of participants was lower than recommended values. The proportion of participants with intakes lower than lowest threshold intake was as follows: urban men, 20%; urban women, 31%; rural men, 48%; and rural women, 64%. The pattern of vitamin C deficiency was similar to that of vitamin A, however, vitamin C deficiency was less common. Daily intake of vitamin C lower than the LTI was as follows: urban men, 6%; urban women, 9%; rural men, 13%; and rural women, 19%. On the other hand, protein intake in the majority of the general population in Golestan was higher than recommended values.

Conclusion: Severe deficiency in vitamin intake among women and rural dwellers may partly explain the high incidence of EC among inhabitants in rural areas and the male:female ratio that is approximately 1 in Golestan; while EC is much more common in men in many low-incidence areas.
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September 2010