Publications by authors named "Nizal Sarrafzadegan"

302 Publications

Salt intake and its sources in children, adolescents and adults in the Islamic Republic of Iran.

East Mediterr Health J 2021 Mar 23;27(3):279-286. Epub 2021 Mar 23.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran.

Background: There is little evidence about salt intake and its food sources in the Iranian population, especially in children and adolescents.

Aims: To investigate salt intake and dietary sources in Isfahan, Islamic Republic of Iran.

Methods: This was a cross-sectional survey conducted in 2014-2015. We randomly selected 1384 adults (50.3% female, 49.7% male) aged > 18 years [mean 37.9 (10.6) years], and 786 children and adolescents (50.9% male, 49.1% female) aged 6-18 years [mean 12.5 (3.4) years]. All participants underwent a dietary assessment for salt intake, using a validated food frequency questionnaire.

Results: The total salt intake was 10.9 (3.4) g/day in adults and 10.3 (2.9) g/day in children and adolescents. Added salt was the primary source of salt intake, followed by bread and cheese in both groups. Salt intake was related significantly to being younger, male, a smoker, less educated and physically active in the adult group. In children and adolescents, it was significantly associated with increasing age, male sex, low physical activity and parents' education level (all P < 0.05).

Conclusions: Salt intake in Isfahan was more than twice that recommended by the World Health Organization. The main source of sodium was added salt, followed bread and cheese. Future national studies are warranted to assess the dietary salt intake and its main sources in different provinces in the Islamic Republic of Iran.
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http://dx.doi.org/10.26719/2021.27.3.279DOI Listing
March 2021

Longitudinal association of dietary fat intake with cardiovascular events in a prospective cohort study in Eastern Mediterranean region.

Int J Food Sci Nutr 2021 Mar 9:1-10. Epub 2021 Mar 9.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

We examined the association of dietary fats intake with the 13-year risk of cardiovascular disease (CVD) among Iranian population. Totally 5432 participants of Isfahan Cohort Study (ICS) aged ≥ 35 years were included in the current study. The frequency of dietary fats including hydrogenated vegetables oil (HVO), non-hydrogenated vegetables oil (nHVO), olive oil, ghee, and animal fats during the preceding year were assessed using a validated food frequency questionnaire. After adjustment for potential confounders, individuals in the top quartile of HVO tended to have 68% greater risk for myocardial infarction compared with those in the first quartile (95% CI: 1.02, 2.78; P = 0.058). No association was found for other dietary fat sources with ischaemic heart disease, stroke, all-cause and CVD mortality after adjustment for all potential confounders. Higher consumption of HVO was associated with increased risk of myocardial infarction.
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http://dx.doi.org/10.1080/09637486.2021.1895725DOI Listing
March 2021

Longitudinal association between an overall diet quality index and latent profiles of cardiovascular risk factors: results from a population based 13-year follow up cohort study.

Nutr Metab (Lond) 2021 Mar 10;18(1):28. Epub 2021 Mar 10.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Cardiovascular diseases (CVDs) are associated with an unhealthy lifestyle, including poor diet. Indices reflecting the overall quality of diets are more effective than single food or nutrient-based approaches in clarifying the diet disease relationship. The present study aims to use latent variable modeling to examine the longitudinal joint relationships between the latent profiles of CVDs risk factors and the diet quality index (DQI).

Methods: A total of 4390 Iranian adults aged 35 and older within the framework of the Isfahan Cohort Study were included in the current secondary analysis. DQI focused on food groups, including fast foods, sweets, vegetables, fruits, fats, and proteins, based on a validated food frequency questionnaire. The score of DQI has a range between 0 (indicating healthy and high diet quality) and 2 (indicating unhealthy and low diet quality). Blood pressure (BP), anthropometric measurements, blood glucose, serum lipids, and high-sensitivity C-Reactive Protein (hs-CRP) were measured according to standard protocols in 2001, 2007, and 2013 to evaluate the profiles of CVDs risk factors. A Bayesian Multidimensional Graded Responses Linear Mixed Model was used for data analysis.

Results: At baseline, the participants' mean ± standard deviation age was 50.09 ± 11.21, and 49.5% of them were male. Three latent profiles of CVDs risk factors were derived: (1) Fit Pre-Metabolic Syndrome (FPMS) profile characterized by normal anthropometric indices and some impaired metabolic risk factors; (2) DysLipoproteinemia Central Obese (DLCO) profile with abdominal obesity and impaired low-density lipoprotein cholesterol as well as other normal risk factors; (3) Impaired Laboratory Inflammatory State (ILIS) profile with impaired high-density lipoprotein cholesterol and hs-CRP and other normal risk factors. In general, higher scores of the extracted latent profiles indicated more impaired function in the related risk factors. After controlling for various potential fixed and time-varying confounding variables, a significant positive longitudinal association was found between FPMS, DLCO, and ILIS profiles and DQI (β (95% CrI): 0.26 (0.03,0.51), 0.14 (0.01,0.27), and 0.24 (0.11,0.38), respectively), demonstrating that lower overall diet quality was associated with more impaired function of the related risk factors.

Conclusions: More adherence to a healthy quality diet is associated with lower levels of all emerging latent profiles of CVDs risk factors. Increasing the knowledge of the community about the importance of the quality of consumed foods may help to prevent CVDs. It is recommended that further investigations, particularly interventional studies, be conducted to confirm our results.
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http://dx.doi.org/10.1186/s12986-021-00560-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948330PMC
March 2021

Reasons for poor blood pressure control in Eastern Sub-Saharan Africa: looking into 4P's (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review.

BMC Cardiovasc Disord 2021 Mar 4;21(1):123. Epub 2021 Mar 4.

Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Aim: Hypertension control in Sub-Saharan Africa (SSA) is the worst (less than one out of ten) when compared to the rest of the world. Therefore, this scoping review was conducted to identify and describe the possible reasons for poor blood pressure (BP) control based on 4Ps' (patient, professional, primary healthcare system, and public health policy) factors.

Methods: PRISMA extension for scoping review protocol was used. We systematically searched articles written in the English language from January 2000 to May 2020 from the following databases: PubMed/Medline, Embase, Scopus, Web of Science, and Google scholar.

Results: Sixty-eight articles were included in this scoping review. The mean prevalence of hypertension, BP control, and patient adherence to prescribed medicines were 20.95%, 11.5%, and 60%, respectively. Only Kenya, Malawi, and Zambia out of ten countries started annual screening of the high-risk population for hypertension. Reasons for nonadherence to prescribed medicines were lack of awareness, lack of access to medicines and health services, professional inertia to intensify drugs, lack of knowledge on evidence-based guidelines, insufficient government commitment, and specific health behaviors related laws. Lack of screening for high-risk patients, non-treatment adherence, weak political commitment, poverty, maternal and child malnutrition were reasons for the worst BP control.

Conclusion: In conclusion, the rate of BP treatment, control, and medication adherence was low in Eastern SSA. Screening for high-risk populations was inadequate. Therefore, it is crucial to improve government commitment, patient awareness, and access to medicines, design country-specific annual screening programs, and empower clinicians to follow individualized treatment and conduct medication adherence research using more robust tools.
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http://dx.doi.org/10.1186/s12872-021-01934-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971125PMC
March 2021

Burden of Ischemic Heart Disease in Central Asian Countries, 1990-2017.

Int J Cardiol Heart Vasc 2021 Apr 7;33:100726. Epub 2021 Feb 7.

School of Population & Public Health, University of British Columbia, Vancouver, Canada.

Background: The burden of ischemic heart disease (IHD) is high. There is limited information on the burden of IHD in identified high risk areas like Central Asia (CA) which is comprised of Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Turkmenistan, Mongolia, Uzbekistan and Tajikistan. This study addresses the burden of IHD in CA at the regional and country levels.

Methods: Using data from the latest iteration of the Global Burden of Disease Study (GBD), this study provides age-adjusted mortality, prevalence, and Disability Adjusted Life Years (DALYs) of IHD by sex in the CA region, and national levels for countries in this region from 1990 to 2017.

Results: The CA region has a higher IHD burden than the rest of the world over the studied period. Amongst the countries within this region, age-standardized mortality and DALY rates in Uzbekistan are the highest not only in CA but worldwide, while Armenia consistently has the lowest IHD burden in CA. Unhealthy diet, high systolic blood pressure and LDL-cholesterol are the risk factors with the highest attributable IHD DALYs.

Conclusion: Increasing burden of IHD over time in CA can be partially explained by the economic crisis in the 1990 There is considerable variation in IHD DALY rates among countries in the CA region. The reasons for such differences are likely multifactorial such as differences in risk factors distribution, health care effectiveness, political, social and economic factors.
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http://dx.doi.org/10.1016/j.ijcha.2021.100726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876559PMC
April 2021

Association between ambient fine particulate matter with blood pressure levels among Iranian individuals admitted for cardiac and respiratory diseases: Data from CAPACITY study.

ARYA Atheroscler 2020 Jul;16(4):178-184

Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The relation between air pollution and cardiovascular diseases (CVDs) risk factors, especially blood pressure (BP) levels, has been less frequently assessed. The aim of this study was evaluating the association between air pollutants of less than 2.5 µm [particulate matter (PM2.5)] and BP indices among individuals admitted with CVDs and pulmonary diseases.

Methods: This cross-sectional study was in context of air pollution associated with hospitalization and mortality of CVDs and respiratory diseases (CAPACITY) study. Data of 792 Iranian patients referring to two hospitals in Isfahan, Iran, for cardiovascular or respiratory problems from March 2011 to March 2012 were used for analysis. BP indices including systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were obtained from patients' medical forms and mean PM2.5 concentrations during 24 hours prior to admission of each patient were obtained from Isfahan Department of Environment (DOE).

Results: Mean ± standard deviation (SD) of participants' age were 62.5 ± 15.9 years. All BP indices on admission were significantly higher in women compared with men. Adjustment of all potential confounders including age, sex, temperature, wind speed, and dew point revealed that increasing one quartile in PM2.5 concentrations had been associated with 1.98 mmHg raising in SBP at the time of admission [95% confidence interval (CI) = 0.41-3.54, P = 0.010]. Women with cardiac diseases had higher all BP indices with increased PM2.5 concentration [SBP: β: 4.30, 95% CI = 0.90-7.70, P = 0.010; DBP: β: 1.89, 95% CI = 0.09-3.69, P = 0.040; MAP: β: 3.09, 95% CI = 0.68-5.51, P= 0.010, respectively).

Conclusion: Our findings suggest that increasing PM2.5 concentration has been positively associated with raising SBP in total population and all BP indices among women with cardiac problems at admission time. Several comprehensive studies are required for confirming these relations.
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http://dx.doi.org/10.22122/arya.v16i4.2032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867310PMC
July 2020

Long-term association of red meat consumption and lipid profile: A 13-year prospective population-based cohort study.

Nutrition 2021 Jan 10;86:111144. Epub 2021 Jan 10.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Objectives: The long-term associations between red meat consumption and lipid profile are not completely known. This longitudinal study assessed the association of red meat consumption with lipid profile in healthy Iranian adults using repeated measurements of red meat intake.

Methods: The population-based longitudinal study was conducted within the framework of the Isfahan Cohort Study on a subsample of 1376 healthy adults, aged ≥35 y, for whom complete information was available in all three phases of the study. A simplified qualitative 48-item food frequency questionnaire, blood pressure, anthropometric measurements, and fasting serum lipids and blood sugar were evaluated in three phases. Mixed-effects linear regression was applied to examine the longitudinal associations between red meat consumption and lipid profile.

Results: After adjustment for potential confounders, each single-serving increase in red meat and organ meat consumption was significantly associated with an increment in triacylglycerol (β = 6.30; 95% confidence interval [CI], 3.97-8.63), total cholesterol (β = 3.03; 95% CI, 2.02-4.04), low-density lipoprotein (β = 3.40; 95% CI, 2.64-4.17), high-density lipoprotein (β = 0.60; 95% CI, 0.28-0.93), ratio of low-density to high-density lipoprotein (β = 0.03; 95% CI, 0.01-0.05), and non-high-density lipoprotein (β = 2.42; 95% CI, 1.41-3.43). However, processed meat consumption had no significant association with lipid profile.

Conclusions: Total red meat intake had a significant, direct association with lipid profile after a 13-year follow-up period in a cohort of the healthy Iranian population.
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http://dx.doi.org/10.1016/j.nut.2021.111144DOI Listing
January 2021

Longitudinal Association of Nut Consumption and the Risk of Cardiovascular Events: A Prospective Cohort Study in the Eastern Mediterranean Region.

Front Nutr 2020 21;7:610467. Epub 2021 Jan 21.

Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.

There are few pieces of evidence on the association between nut consumption and the risk of cardiovascular disease (CVD) in the Eastern Mediterranean Region. This study investigated the relationship of nut consumption with the risk of CVD and all-cause mortality in the Iranian population. This population-based prospective cohort study was carried out in 6,504 randomly selected participants aged ≥35 years in central Iran (2001-2013) in the framework of the Isfahan Cohort Study. Dietary data were collected by a validated 48-item food frequency questionnaire. Subjects or their next of kin were interviewed biannually, looking for the possible occurrence of cardiovascular events and all-cause mortality. During the median follow-up of 135 months and 52,704.3 person-years, we found a total of 751 CVD events. In unadjusted model, participants in the highest quartile of nut intake had a lower CVD risk {hazard ratio (HR) [95% confidence interval (CI)]: 0.57(0.47-0.70); for trend < 0.001}, CVD mortality [HR (95% CI): 0.54 (0.33-0.72); for trend < 0.001], and all-cause mortality [HR (95% CI): 0.24 (0.14-0.42); for trend < 0.001]. In the fully adjusted model, the association was diluted, and no significant relationship was found between nut intake and CVD events and all-cause mortality, except for CVD mortality in the highest quartile vs. the lowest one [HR (95% CI): 0.55 (0.30-0.98)]. Nut intake had an inverse association with the risk of CVD mortality. It is suggested to perform studies to examine the association of individual types of nuts and different preparation methods on CVD risk and mortality.
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http://dx.doi.org/10.3389/fnut.2020.610467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859480PMC
January 2021

Determining genetic variants in children and adolescents suffering from tetralogy of Fallot with a positive family history: methodology.

Acta Biomed 2020 06 26;91(4):e2020096. Epub 2020 Jun 26.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background And Aim: Congenital heart disease (CHD) affects near 1% of all live births and is considered to be the main reason of morbidity and mortality in early childhood. In this study, we investigated molecular genetics factors associated with Tetralogy of Fallot (TOF) using high throughput technologies in the consanguineous families with at least 2 affected individual.

Method: This family study started in March 2017 to May 2018 in pediatric cardiovascular research center, Cardiovascular Research Institute, Isfahan, Iran. After obtaining informed consent, we invited families who had at least 2 individuals in one generation or previous generations with familial marriage history and they were included in the study. Genomic DNA was extracted from peripheral blood lymphocytes of the patient and samples were investigated for structural variations such as deletion or duplication in the genome using single nucleotide polymorphism array (SNP array). In the next step, if the SNP array is negative, next generation study will be performed in the propend and after analyzing the raw data and filtering for rare pathogenic variants.

Results: In this study, totally 5 families were evaluated. All affected and unaffected individuals of each family included in the pedigree.  This study comprised 14 subjects (9 males and 5 females; 8.92 ± 6.21 years old). Baseline characteristics and clinical data of the study subjects are presented in Table 1. The prevalence of consanguineous marriage is 92.2% among parents, 71.4% among mother grandparents and 28.6% among father grandparents. 64.3 % of our participants have sibling with similar disease. The prevalence of atrial septal defect (ASD), ventricular septal defect (VSD), and arrhythmia and TOF was 7.1%.

Conclusion: We found some families with 2 or more CHD and with a high rate of consanguineous marriage and probably suffering from a genetic predisposition. We aim to exam them further with next generation study (NGS) to find any genetic defect and then to exam other CHD's in our region. Key words: gene mutations, children, adolescents, tetralogy of Fallot, family history.
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http://dx.doi.org/10.23750/abm.v91i4.8410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927530PMC
June 2020

The comparison of procedural and clinical outcomes of thrombolytic-facilitated and primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction (STEMI): Findings from PROVE/ACS study.

ARYA Atheroscler 2020 May;16(3):123-129

Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: There is still a controversy in the preferred method of reperfusion in acute ST-segment elevation myocardial infarction (STEMI), when the achievement of well-defined "golden time" is difficult. We sought to evaluate the procedural and in-hospital outcomes of the strategy of "thrombolytic administration and rescue or routine percutaneous coronary intervention (PCI)" versus "primary PCI (PPCI)" strategy in acute STEMI.

Methods: In this observational prospective study, the data of 237 patients with acute STEMI presented or referred to Chamran Cardiovascular Research Center in Isfahan, Iran, were collected (PROVE/ACS study). Baseline characteristics, thrombolysis in myocardial infarction (TIMI) flow grade of infarct-related artery (IRA), left ventricular ejection fraction (LVEF), and in-hospital outcomes were evaluated.

Results: The mean age of patients was 61.4 ± 13.0 years, 86.9% were men, 13.1% were diabetic, and 67.9% had anterior STEMI. Patients in the "thrombolytic then PCI" group were younger, more smoker, more often male with higher body weight and lower systolic blood pressure (SBP). The pre-PCI TIMI flow grade 3 was more often seen in the "thrombolytic then PCI" group (39.4% vs. 21.0%, P < 0.001) and less thrombectomy was performed in this group of patients (12.9% vs. 26.7%, P = 0.011). Time to reperfusion was significantly longer in PPCI group (182.4 ± 233.7 minutes vs. 44.6 ± 93.4 minutes, respectively, P < 0.001). No difference in mortality, mean of LVEF, and incidence of atrial fibrillation (AF) was observed in two groups.

Conclusion: If the PPCI strategy could not be performed in the golden time, the strategy of thrombolytic administration and rescue or routine PCI leads to more initial IRA patency and less thrombectomy with similar clinical outcomes.
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http://dx.doi.org/10.22122/arya.v16i3.1869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778513PMC
May 2020

Relation between Hemoconcentration Status and Readmission Plus Mortality Rate Among Iranian Individuals with Decompensated Heart Failure.

Int J Prev Med 2020 5;11:163. Epub 2020 Oct 5.

Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Hemoconcentration (HC) has been suggested to be a useful biomarker for determination of optimum diuretic therapy in acute heart failure (HF), but role of this factor in rehospitalization and death was still controversial. In this study, we aimed to define relation between HC and readmission and mortality rate among Iranian patients with acute HF.

Methods: This was a prospective cohort study done from March 2017 to March 2018 using data of a HF section of Persian Registry Of cardioVascular diseasE. From a total number of 390 registered HF individuals aged 18 years or older, 69 ones showed alterations in hemoglobin (Hb) levels. Hb levels were measured at admission and discharge time. HC was defined as any increased level in Hb during hospitalization. The relation of HC with readmission and death rate was done using multiple logistic regression and Cox proportional hazard model, respectively.

Results: The mean age of study population was 70.5 ± 11.9 years with the dominant percentage of male participants (66.9%). Patients showing HC during admission did not reveal any significant decreased likelihood of rehospitalization compared to negative ones. In comparison to HC negative patients, those showing increments in Hb levels had a borderline significant lower likelihood of mortality (hazard ratio: 0.82, 95% confidence interval, CI = 0.07-1.18, = 0.08).

Conclusions: Our data suggested that HC was associated marginally with reduced mortality rate 6 months post HF attack and could be utilized as a useful biomarker for risk stratification of HF patients. Several prospective longitudinal population-based studies are necessary proving these associations.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_45_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716610PMC
October 2020

Visceral Obesity and Its Shared Role in Cancer and Cardiovascular Disease: A Scoping Review of the Pathophysiology and Pharmacological Treatments.

Int J Mol Sci 2020 Nov 27;21(23). Epub 2020 Nov 27.

Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London WC1E 6BT, UK.

The association between obesity, cancer and cardiovascular disease (CVD) has been demonstrated in animal and epidemiological studies. However, the specific role of visceral obesity on cancer and CVD remains unclear. Visceral adipose tissue (VAT) is a complex and metabolically active tissue, that can produce different adipokines and hormones, responsible for endocrine-metabolic comorbidities. This review explores the potential mechanisms related to VAT that may also be involved in cancer and CVD. In addition, we discuss the shared pharmacological treatments which may reduce the risk of both diseases. This review highlights that chronic inflammation, molecular aspects, metabolic syndrome, secretion of hormones and adiponectin associated to VAT may have synergistic effects and should be further studied in relation to cancer and CVD. Reductions in abdominal and visceral adiposity improve insulin sensitivity, lipid profile and cytokines, which consequently reduce the risk of CVD and some cancers. Several medications have shown to reduce visceral and/or subcutaneous fat. Further research is needed to investigate the pathophysiological mechanisms by which visceral obesity may cause both cancer and CVD. The role of visceral fat in cancer and CVD is an important area to advance. Public health policies to increase public awareness about VAT's role and ways to manage or prevent it are needed.
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http://dx.doi.org/10.3390/ijms21239042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730690PMC
November 2020

Acute Cardiac Injury in COVID-19: A Systematic Review and Meta-analysis.

Arch Iran Med 2020 11 1;23(11):801-812. Epub 2020 Nov 1.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Coronavirus disease 2019 (COVID-19) has been widespread since late December 2019, with several symptoms related to the upper and lower respiratory system. However, its cardiac manifestations are less frequently studied. We aimed to analyze the available COVID-19 data on acute cardiac injury, using troponin and brain natriuretic peptide (BNP) levels.

Methods: We performed a systematic review on Medline/PubMed, Scopus, and Google Scholar databases until March 25, 2020. Relevant records reporting the incidence of acute cardiac injury as well as troponin and BNP levels were collected from published peer-reviewed articles with further analysis according to the clinical status of the patients (severe, non-severe, and death).

Results: Eleven records of 1394 individuals were included. The mean age of patients with acute cardiac injury was 56.6 ± 33.4 years (males: 54.3%). The incidence of acute cardiac injury was 15% (95% CI: 11, 20%). Further analysis revealed that dead or severe patients had significantly higher percentages of myocardial injury, compared to non-severe ones (peer-reviewed: 44%, 95% CI: 16, 74% vs. 24%, 95% CI: 15, 34% vs. 5%, 95% CI: 1, 12%, respectively). Mean total troponin was 10.23 pg/mL (95% CI: 5.98, 14.47), while 13% (95% CI: 8%, 18%) of patients had elevated levels. Mean BNP was 216.74 pg/mL (95% CI: 3.27, 430.20).

Conclusion: Acute cardiac injury in COVID-19 patients is more frequent than what was expected at the beginning of the outbreak. Meanwhile, further studies are needed to investigate the utility of cardiac biomarkers as diagnostic and prognostic tools for long-term cardiac complications of this infection.
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http://dx.doi.org/10.34172/aim.2020.107DOI Listing
November 2020

Coronary artery disease detection using artificial intelligence techniques: A survey of trends, geographical differences and diagnostic features 1991-2020.

Comput Biol Med 2021 Jan 28;128:104095. Epub 2020 Oct 28.

Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore; Department of Biomedical Engineering, School of Science and Technology, Singapore University of Social Sciences, Singapore; Department of Bioinformatics and Medical Engineering, Asia University, Taiwan.

While coronary angiography is the gold standard diagnostic tool for coronary artery disease (CAD), but it is associated with procedural risk, it is an invasive technique requiring arterial puncture, and it subjects the patient to radiation and iodinated contrast exposure. Artificial intelligence (AI) can provide a pretest probability of disease that can be used to triage patients for angiography. This review comprehensively investigates published papers in the domain of CAD detection using different AI techniques from 1991 to 2020, in order to discern broad trends and geographical differences. Moreover, key decision factors affecting CAD diagnosis are identified for different parts of the world by aggregating the results from different studies. In this study, all datasets that have been used for the studies for CAD detection, their properties, and achieved performances using various AI techniques, are presented, compared, and analyzed. In particular, the effectiveness of machine learning (ML) and deep learning (DL) techniques to diagnose and predict CAD are reviewed. From PubMed, Scopus, Ovid MEDLINE, and Google Scholar search, 500 papers were selected to be investigated. Among these selected papers, 256 papers met our criteria and hence were included in this study. Our findings demonstrate that AI-based techniques have been increasingly applied for the detection of CAD since 2008. AI-based techniques that utilized electrocardiography (ECG), demographic characteristics, symptoms, physical examination findings, and heart rate signals, reported high accuracy for the detection of CAD. In these papers, the authors ranked the features based on their assessed clinical importance with ML techniques. The results demonstrate that the attribution of the relative importance of ML features for CAD diagnosis is different among countries. More recently, DL methods have yielded high CAD detection performance using ECG signals, which drives its burgeoning adoption.
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http://dx.doi.org/10.1016/j.compbiomed.2020.104095DOI Listing
January 2021

Knowledge production in Iranian cardiovascular research centers: A way to reduce the burden of disease.

ARYA Atheroscler 2020 Mar;16(2):72-78

Deputy for Research and Technology, Ministry of Health and Medical Education AND Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: According to the World Health Organization (WHO), non-communicable diseases (NCDs) including cardiovascular diseases (CVDs) will be responsible for almost 70% of all deaths in 2020. Therefore, knowledge production to find suitable ways to prevent, diagnosis, and effectively cover this disease in research centers is mandatory. Therefore, the present study is carried out with the aim to examine the results of studies performed in three years in Iranian cardiovascular centers.

Methods: Iranian cardiovascular research centers with more than three years of activity from 2015 to 2017 were evaluated. Research output, international collaboration, high quality publication, total citation, and average h-index (H) were evaluated and scored.

Results: 23 cardiovascular diseases research centers (CVDRCs) related to 15 universities of Medical Sciences (UMSs) were evaluated. The mean and standard deviation (SD) of age of the research activities in CVDRCs was 11.47 ± 8.60 years. Based on the research ranking, the first three centers were Isfahan Cardiovascular Research Center, Iran, Tehran Heart Center, and Shaheed Rajaei Cardiovascular Medical and Research Center, Iran, respectively, all of which have independent budget line. However, there is not any CVD research center in some provinces such as Zanjan, Kurdistan, Lorestan, and Arak, Iran.

Conclusion: Mission oriented research activities in Iranian cardiovascular research centers may be effective in reducing the burden of CVDs. Moreover, establishment of CVD research centers in high risk areas may be useful.
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http://dx.doi.org/10.22122/arya.v16i2.2022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578524PMC
March 2020

Resistin and prooxidant-antioxidant balance: Markers to discriminate acute coronary syndrome from stable angina.

ARYA Atheroscler 2020 Mar;16(2):46-54

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Resistin and oxidative stress may play a role in the pathogenesis of coronary heart disease (CHD) including acute coronary syndrome (ACS). The aim of this study was to investigate the role of serum resistin and prooxidant-antioxidant balance (PAB) in ACS occurrence in order to differentiate it from stable angina. Moreover, we aimed to determine the correlation between resistin and PAB in patients with ACS and its difference from patients with stable CHD.

Methods: This cross-sectional, descriptive study was conducted on 50 patients with ACS and 50 patients with stable CHD who underwent coronary angiography (CAG). Serum resistin level was measured using enzyme-linked immunosorbent assay (ELISA). PAB and other variables were analyzed using standard methods.

Results: A significant increase in serum resistin and PAB was observed in patients with ACS (2.55 ± 0.13 ng/ml and 123.5 ± 5.58 HK unit, respectively) compared to patients with stable CHD (1.53 ± 0.12 ng/ml and 95.9 ± 2.7 HK unit, respectively) (P < 0.001). In addition, a significant positive correlation was seen between serum resistin and PAB in patients with ACS (r = 0.39; P = 0.005), but this correlation was not found in patients with stable CHD (r = 0.21; P = 0.140). Resistin (r = 0.52; P < 0.001) and PAB (r = 0.55; P < 0.001) were significantly associated with high-sensitivity C-reactive protein (hs-CRP) in patients with ACS, but this association was not found in patients with stable CHD (resistin: r = 0.24; P = 0.090; PAB: r = -0.02: P = 0.910).

Conclusion: High serum resistin or PAB levels, and their association with the occurrence of ACS, can be used as a robust discriminating factor to differentiate ACS from stable CHD.
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http://dx.doi.org/10.22122/arya.v16i2.1944DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578521PMC
March 2020

The effects of Canola oil on cardiovascular risk factors: A systematic review and meta-analysis with dose-response analysis of controlled clinical trials.

Nutr Metab Cardiovasc Dis 2020 11 18;30(12):2133-2145. Epub 2020 Jun 18.

Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Electronic address:

Background And Aims: Canola oil (CO) is a plant-based oil with the potential to improve several cardiometabolic risk factors. We systematically reviewed controlled clinical trials investigating the effects of CO on lipid profiles, apo-lipoproteins, glycemic indices, inflammation, and blood pressure compared to other edible oils in adults.

Methods And Results: Online databases were searched for articles up to January 2020. Forty-two articles met the inclusion criteria. CO significantly reduced total cholesterol (TC, -0.27 mmol/l, n = 37), low-density lipoprotein cholesterol (LDL-C, -0.23 mmol/l, n = 35), LDL-C to high-density lipoprotein cholesterol ratio (LDL/HDL, -0.21, n = 10), TC/HDL (-0.13, n = 15), apolipoprotein B (Apo B, -0.03 g/l, n = 14), and Apo B/Apo A-1 (-0.02, n = 6) compared to other edible oils (P < 0.05). Compared to olive oil, CO decreased TC (-0.23 mmol/l, n = 9), LDL-C (-0.17 mmol/l, n = 9), LDL/HDL (-0.39, n = 2), and triglycerides in VLDL (VLDL-TG, -0.10 mmol/l, n = 2) (P < 0.05). Compared to sunflower oil, CO improved LDL-C (-0.14 mmol/l, n = 11), and LDL/HDL (-0.30, n = 3) (P < 0.05). In comparison with saturated fats, CO improved TC (-0.59 mmol/l, n = 11), TG (-0.08 mmol/l, n = 11), LDL-C (-0.49 mmol/l, n = 10), TC/HDL (-0.29, n = 5), and Apo B (-0.09 g/l, n = 4) (P < 0.05). Based on the nonlinear dose-response curve, replacing CO with ~15% of total caloric intake provided the greatest benefits.

Conclusion: CO significantly improved different cardiometabolic risk factors compared to other edible oils. Further well-designed clinical trials are warranted to confirm the dose-response associations.
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http://dx.doi.org/10.1016/j.numecd.2020.06.007DOI Listing
November 2020

The Association between Occupational Categories and Incidence of Cardiovascular Events: A Cohort Study in Iranian Male Population.

Int J Occup Environ Med 2020 10;11(4):179-187

Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Besides the traditional cardiovascular risk factor, some novel risk factors like occupation and career can play an important role in cardiovascular disease (CVDs) incidence.

Objective: To assess the association between occupational categories and their positions with cardiovascular events (CVEs) in an Iranian male population.

Methods: We followed 2134 men aged 35-65 years for 14 years during the Isfahan Cohort Study (2001-2015) for CVEs including ischemic heart disease and stroke. Firstly, Occupations were classified into 10 categories of International Standard Classification of Occupation (ISCO). Each category was then classified into one of the 4 pre-specified categories, namely high/low skilled white collars and high/low skilled blue collars. White-collar workers referred to managerial and professional workers in contrast with blue collar workers, whose job requires manual labor.

Results: The mean age of studied participants was 46.9 (SD 8.3) years. 286 CVE incidents were recorded; unstable angina had the highest rate (46%); fatal stroke, the lowest (3%). There were no significant difference was observed between white and blue collars in terms of CVE incidence, as well as their high and low skilled subgroups. Hazard ratio analysis indicated a significantly higher risk of CVEs only for low-skilled white-collar workers (crude HR 1.47, 95% CI 1.01 to 2.13); this was not significant after adjustment for confounding variables.

Conclusion: There is no association between occupational categories and incidence of cardiovascular events among Iranian male population.
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http://dx.doi.org/10.34172/ijoem.2020.2053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7740047PMC
October 2020

The Epigenetic Overlap between Obesity and Mood Disorders: A Systematic Review.

Int J Mol Sci 2020 Sep 15;21(18). Epub 2020 Sep 15.

MPH Program, School of Public Health, Central Michigan University, Mount Pleasant, MI 48859, USA.

(1) Background: Obesity and mood disorders are considered as the most prevalent morbidities in many countries. We suppose that epigenetic mechanisms may induce higher rates of obesity in subjects who suffer from mood disorders. In this systematic review, we focused on the potential roles of DNA methylation on mood disorders and obesity development. (2) Methods: This systematic review was conducted in accordance with the PRISMA statement and registered in Prospero. A systematic search was conducted in MEDLINE, Scopus, Web of Science, Cochrane Central database, EMBASE, and CINHAL. We also conducted a Grey literature search, such as Google Scholar. (3) Results: After deduplication, we identified 198 potentially related citations. Finally, ten unique studies met our inclusion criteria. We have found three overlap genes that show significant DNA methylation changes, both in obesity and depression. Pathway analysis interaction for , and confirmed the relation of these genes in both obesity and mood disorders. (4) Conclusions: While mechanisms linking both obesity and mood disorders to epigenetic response are still unknown, we have already known chronic inflammation induces a novel epigenetic program. As the results of gene enrichment, pathways analysis showed that and linked together by inflammatory pathways. Hypermethylation in these genes might play a crucial rule in the co-occurrence of obesity and mood disorders.
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http://dx.doi.org/10.3390/ijms21186758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555814PMC
September 2020

How Different Stressors Affect Quality of Life: An Application of Multilevel Latent Class Analysis on a Large Sample of Industrial Employees.

Risk Manag Healthc Policy 2020 20;13:1261-1270. Epub 2020 Aug 20.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Quality of life (QoL) indicates individual's perception of the physical, psychological and social aspects of health. The association between QoL and all stressful life events' dimensions has not been investigated among industrial employees.

Purpose: The present study aimed to investigate the association between stressful life events and QoL in a large sample of Iranian industrial employees.

Material And Methods: In a cross-sectional study, 3063 manufacturing employees in Isfahan, Iran, were recruited. QoL was measured with the Euro-QoL five dimension questionnaire (EQ-5D). Stressful life events were assessed by an Iranian validated stressful life event questionnaire (SLE). Multilevel latent class regression was employed for classifying participants based on QoL and for determining its association with stressful life events.

Results: Two classes of employees, ie, low (comprised 20% of participants) and high QoL (80%), were identified. From 11 dimensions of stressful life events two major domains, socioeconomic and personal stressor profiles, were identified. Multilevel latent class regression results showed that the higher scores of social (OR: 1.14, 95%CI: 1.12-1.16) and personal (OR: 2.36, 95%CI: 1.87- 2.98) stressor domains were significantly associated with increased risk of being in the poor QoL class. Among personal and socioeconomic stressors, health concerns and daily life dimensions had higher significant association with poor QoL.

Conclusion: Results of our study indicated that life stressors have negative impacts on QoL of employees. Personal stressors showed higher negative impact than socioeconomic on QoL. Managing the stressors can play an effective role in improving the QoL of employees, their physical and mental health, and indirectly enhances the organizational performance and job productivity.
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http://dx.doi.org/10.2147/RMHP.S256800DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445524PMC
August 2020

Pathways leading to prevention of fatal and non-fatal cardiovascular disease: An interaction model on 15 years population-based cohort study.

Lipids Health Dis 2020 Sep 5;19(1):203. Epub 2020 Sep 5.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: A comprehensive study on the interaction of cardiovascular disease (CVD) risk factors is critical to prevent cardiovascular events. The main focus of this study is thus to understand direct and indirect relationships between different CVD risk factors.

Methods: A longitudinal data on adults aged ≥35 years, who were free of CVD at baseline, were used in this study. The endpoints were CVD events, whereas their measurements were demographic, lifestyle components, socio-economics, anthropometric measures, laboratory findings, quality of life status, and psychological factors. A Bayesian structural equation modelling was used to determine the relationships among 21 relevant factors associated with total CVD, stroke, acute coronary syndrome (ACS), and fatal CVDs.

Results: In this study, a total of 3161 individuals with complete information were involved in the study. A total of 407 CVD events, with an average age of 54.77(10.66) years, occurred during follow-up. The causal associations between six latent variables were identified in the causal network for fatal and non-fatal CVDs. Lipid profile, with the coefficient of 0.26 (0.01), influenced the occurrence of CVD events as the most critical factor, while it was indirectly mediated through risky behaviours and comorbidities. Lipid profile at baseline was influenced by a wide range of other protective factors, such as quality of life and healthy lifestyle components.

Conclusions: Analysing a causal network of risk factors revealed the flow of information in direct and indirect paths. It also determined predictors and demonstrated the utility of integrating multi-factor data in a complex framework to identify novel preventable pathways to reduce the risk of CVDs.
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http://dx.doi.org/10.1186/s12944-020-01375-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487611PMC
September 2020

Temporal Trends of the Incidence of Ischemic Heart Disease in Iran Over 15 Years: A Comprehensive Report from a Multi-Centric Hospital-Based Registry.

Clin Epidemiol 2020 6;12:847-856. Epub 2020 Aug 6.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: We sought to explore the temporal trend of ischemic heart disease (IHD) incidence rate (IR) in a large city of Iran.

Methods: The study population comprised hospitalized patients who were living in Isfahan, Iran, with first or recurrent IHD during the period of 2001 to 2016. To identify patients, clinical diagnostic codes were applied according to the International Classification of Diseases 10 (ICD-10: I20.0, I21-I25) and the "World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease" diagnostic categories (WHO-MONICA). Using a direct method, we calculated age-, sex-, and place-of-residence-adjusted incidence rates based on multiple reference populations. To examine the long-term trend for the IR, a bootstrap robust zero-truncated negative binomial regression model was used.

Results: A total of 102,254 hospitalized patients, with a mean (SD) age of 61.85 (12.79), were registered between 2001 and 2016. After an initial reduction from 2006 to 2010, crude and adjusted IRs of IHD increased between 2010 and 2016. We further observed a significant increasing long-term temporal trend in the IR with an average annual change of 1.42% to 3.36% over the study period.

Conclusion: Our findings showed a decreasing trend in the IR of IHD between 2006 and 2010, possibly attributed to the comprehensive community-based interventions named "Isfahan Healthy Heart Program" performed from 2001 to 2007, followed by an increase in the adjusted IR of IHD between 2010 and 2016 in Isfahan; this indicates the importance of continuing the preventive measures to preclude the risk factors of cardiovascular diseases in our population.
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http://dx.doi.org/10.2147/CLEP.S259953DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429231PMC
August 2020

Is urinary sodium excretion related to anthropometric indicators of adiposity in adults?

J Res Med Sci 2020 22;25:50. Epub 2020 May 22.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Although increasing salt intake is associated with greater odds of obesity, little is known about its relationship with body fat. We investigated the relation of urinary sodium (UNa) with obesity indices, including Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), a body shape index (ABSI), body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR).

Materials And Methods: A total of 508 free-living adults aged ≥ 19 years were selected through stratified multistage random method as a representative of general population from central parts of Iran and were included in this cross-sectional study. Dietary sodium intake was measured using 24-h UNa (24-UNa) excretion. Weight, height, and WC were measured using standard protocols and calibrated equipment and used to measure obesity indicators, including BMI, WHtR, ABSI, and CUN-BAE. Adjusted univariate multiple logistic regression was used to assess the risk of having greater obesity measures across the tertiles of 24-UNa.

Results: Individuals in the top tertile of 24-UNa in comparison with those in the first tertile had greater body weight (72.02 ± 1.00 vs. 66.02 ± 0.89 kg; < 0.0001), BMI (26.14 ± 0.33 vs. 24.82 ± 0.29 kg/m; = 0.007), and CUN-BAE (29.89 ± 0.42 vs. 28.38 ± 0.78; = 0.036). There was a trend toward an increment in WC by increasing sodium intake ( = 0.073). After controlling for potential confounders, individuals with greater sodium consumption had greater chance for overweight (odds ratio [OR]: 1.004, 95% confidence interval [CI]: 1.001-1.007; = 0.015), abdominal obesity (OR: 1.004, 95% CI: 1.00-1.008; = 0.031), and more body fat (OR: 1.007, 95% CI: 1.003-1.01; = 0.001). No significant association was found for sodium and WHtR and ABSI.

Conclusion: Greater 24-UNa excretion was associated with greater means of body weight, BMI, WC, and CUN-BAE. Although changes in obesity indices per each additional 24-UNa excretion were small, our findings are relevant because of the rising obesity epidemic.
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http://dx.doi.org/10.4103/jrms.JRMS_1048_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377121PMC
May 2020

Dietary habits and the 10-year risk of overweight and obesity in urban adult population: A cohort study predicated on Yazd Healthy Heart Project.

Diabetes Metab Syndr 2020 Sep - Oct;14(5):1391-1397. Epub 2020 Jul 17.

Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Electronic address:

Background And Objective: Overweight and obesity are thought to be associated with increased risk of chronic disease in the Middle East. The present study aimed to determine the association between dietary habits and the incidence of overweight and obesity in urban adult population in the central part of Iran after a 10-year follow-up.

Methods: This cohort study was initiated with 2000 participation aged 20-74 years from Yazd city in Iran based on Yazd Healthy Heart Project (YHHP). The participants without overweight and obesity at the baseline of the study were followed up to 10 years. Demographic data, anthropometric measurements, behavioral and metabolic risk factors of cardiovascular diseases and dietary habits were assessed at baseline and phase II.

Results: After a 10-year follow up, 516 non-overweight and 1068 non-obese participants were included for the final analysis. Once adjustments were made for all potential confounders including age, sex, smoking, economic status, physical activity and education, it was identified that lack of weight control increased the risk of obesity (hazard ratio; 95% CI) in total population (1.9; 1.06, 3.4), as well as the risk of overweight (2.39; 1.07, 5.27) and obesity (2.65; 1.13, 6.25) in men. Moreover, consumption of mayonnaise increased the 10-year risk of overweight in women (6.09; 1.2, 30.99).

Conclusions: As revealed by the present study, unhealthy dietary habits can increase the incidence of overweight and obesity in central part of Iran. Therefore, changing the lifestyle appears to be urgent in reducing the risk of overweight and obesity.
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http://dx.doi.org/10.1016/j.dsx.2020.07.024DOI Listing
July 2020

Visceral obesity and incident cancer and cardiovascular disease: An integrative review of the epidemiological evidence.

Obes Rev 2021 Jan 21;22(1):e13088. Epub 2020 Jul 21.

Department of Epidemiology & Public Health, Institute of Epidemiology & Health Care, University College London, London, UK.

Evidence shows a strong relationship between obesity, cancer and cardiovascular disease (CVD) risk. However, there is not enough evidence of the role of visceral obesity on both CVD and cancer. Visceral obesity may be more pro-oncogenic than total body fat. Therefore, it is important to know whether abdominal obesity can lead to both CVD and cancer. The present integrative review aimed at evaluating epidemiological evidence on the potential connection of visceral obesity in the occurrence of cancer and CVD. The following databases were searched: SCOPUS, PubMed, Science Direct, Lilacs, SciELO, Google Scholar, Web of Science, Scopus and ProQuest. The presence of visceral obesity can increase the risk of some specific cancer types, but there is controversial evidence about CVD risk based on sex-specific and ageing analyses. There is enough evidence that visceral obesity increases the risk of colorectal, pancreatic and gastro-oesophageal cancer. However, for some types of cancer such as breast, endometrial and renal, visceral obesity is a risk only in post-menopausal women. Regarding prostate cancer, the evidence is controversial. Despite the risk of visceral obesity being consistently associated with CVD in adults, this association disappears in sex-specific and older adults analyses. Moreover, in older adults, the results are controversial due to the use of different measures such as waist circumference and visceral adipose tissue. However, the evidence showing visceral obesity as a risk factor to CVD remains controversial. Sex differences, ageing and body mass index (BMI) category can potentially modify this association. Therefore, further epidemiological studies with analyses stratified by sex and samples including older adults aged 65 and older are needed.
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http://dx.doi.org/10.1111/obr.13088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757158PMC
January 2021

Prediction of Cardiovascular Disease Mortality in a Middle Eastern Country: Performance of the Globorisk and Score Functions in Four Population-Based Cohort Studies of Iran.

Int J Health Policy Manag 2020 Jul 15. Epub 2020 Jul 15.

Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Considering the importance of cardiovascular disease (CVD) risk prediction for healthcare systems and the limited information available in the Middle East, we evaluated the SCORE and Globorisk models to predict CVD death in a country of this region.

Methods: We included 24 427 participants (11 187 men) aged 40-80 years from four population-based cohorts in Iran. Updating approaches were used to recalibrate the baseline survival and the overall effect of the predictors of the models. We assessed the models' discrimination using C-index and then compared the observed with the predicted risk of death using calibration plots. The sensitivity and specificity of the models were estimated at the risk thresholds of 3%, 5%, 7%, and 10%. An agreement between models was assessed using the intra-class correlation coefficient (ICC). We applied decision analysis to provide perception into the consequences of using the models in general practice; for this reason, the clinical usefulness of the models was assessed using the net benefit (NB) and decision curve analysis. The NB is a sensitivity penalized by a weighted false positive (FP) rate in population level.

Results: After 154 522 person-years of follow-up, 437 cardiovascular deaths (280 men) occurred. The 10-year observed risks were 4.2% (95% CI: 3.7%-4.8%) in men and 2.1% (1.8-2%.5%) in women. The c-index for SCORE function was 0.784 (0.756-0.812) in men and 0.780 (0.744-0.815) in women. Corresponding values for Globorisk were 0.793 (0.766- 0.820) and 0.793 (0.757-0.829). The deviation of the calibration slopes from one reflected a need for recalibration; after which, the predicted-to-observed ratio for both models was 1.02 in men and 0.95 in women. Models showed good agreement (ICC 0.93 in men, and 0.89 in women). Decision curve showed that using both models results in the same clinical usefulness at the risk threshold of 5%, in both men and women; however, at the risk threshold of 10%, Globorisk had better clinical usefulness in women (Difference: 8%, 95% CI: 4%-13%).

Conclusion: Original Globorisk and SCORE models overestimate the CVD risk in Iranian populations resulting in a high number of people who need intervention. Recalibration could adopt these models to precisely predict CVD mortality. Globorisk showed better performance clinically, only among high-risk women.
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http://dx.doi.org/10.34172/ijhpm.2020.103DOI Listing
July 2020

Association between shift work and obesity in a large sample of Iranian steel industry workers.

Arh Hig Rada Toksikol 2019 Sep;70(3):194-200

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Obesity is associated with several chronic diseases, and previous research suggests that shift work could be associated with the risk of overweight and obesity, but the results remain inconclusive. Furthermore, only a few studies report related findings for industrial workforce with high job-related stress. The aim of this cross-sectional study was to see if such association exists in a large sample of 3063 industrial workers in a developing country. The sample was selected among 16,000 steel company workers through multistage cluster sampling. We took anthropometric measurements, including body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). Information about potential confounders was collected with a self-administered questionnaire. The association between shift work and both general and abdominal obesity was established with multinomial and binary logistic regression analysis. The study sample consisted of 1683 (54.9 %) rotational shift workers and 1380 (45.1 %) day workers. Shift work was significantly associated with higher risk of overweight after adjusting for the impacts of potential confounders (OR=1.2; 95 % CI:1.04-1.4) but not with abdominal obesity. This study established that shift work was an independent risk factor for overweight in industrial shift workers. Modification of working schedules is recommended, particularly for prolonged, continuous shift work.
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http://dx.doi.org/10.2478/aiht-2019-70-3266DOI Listing
September 2019

High Sensitivity C-Reactive Protein Predictive Value for Cardiovascular Disease: A Nested Case Control from Isfahan Cohort Study (ICS).

Glob Heart 2020 02 6;15(1). Epub 2020 Feb 6.

Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, IR.

Background: High sensitivity C-reactive protein (hs-CRP) was proven to be an independent risk factor for cardiovascular diseases (CVDs). The aim of this study was to investigate the benefits of assessing hs-CRP among individuals with different cardiovascular risk factors.

Methods: This nested case-control study was obtained from the Isfahan Cohort Study (ICS). Anyone who has been suffering from any CVDs, including myocardial infarction, unstable angina, sudden cardiac death and stroke was put in the case group. Density sampling method was utilized to choose the control group who had no aforementioned CVDs during follow-up. Four quartiles of hs-CRP (Q1: 0.1-2.3, Q2: 2.4-3, Q3: 3.1-4 and Q4: 4.1-14 mg/l) were assessed defining odds ratios (OR) of CVDs prediction in different CVDs risk factor categories. Confidence intervals of 95% are put in brackets.

Results: A total of 502 cases and 538 controls were recruited. All hs-CRP quartiles showed increased CVDs likelihood compared to normal subjects in terms of diabetes mellitus (DM) and hypertension (HTN). Second quartile showed a 1.93 [1.33-2.81] and 3.34 [1.36-8.17] increased risks in patients with hypertriglyceridemia or dyslipidemia, respectively. Smokers in the third quartile group revealed increased CVDs risk. The fourth quartile showed significant increased risks in patients suffering from hypercholesterolemia (OR = 1.91 [1.33-2.74]), high LDL-C (OR = 1.88 [1.33-2.66]), and hypertriglyceridemia (OR = 2.31 [1.57-3.41]).

Conclusions: Our findings suggested that assessing hs-CRP is beneficial for predicting CVDs in patients with HTN and DM. Furthermore, specific patients with lipid abnormalities or history of smoking benefits from checking hs-CRP.
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http://dx.doi.org/10.5334/gh.367DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218777PMC
February 2020

The burden of cardiovascular and respiratory diseases attributed to ambient sulfur dioxide over 26 years.

J Environ Health Sci Eng 2020 Jun 21;18(1):267-278. Epub 2020 Apr 21.

2Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Developing countries, particularly those with a rapid development, are experiencing increasing pollution by sulfur dioxide (SO). Despite the considerable SO exposure effect on health, there is little evidence regarding this fact in Iran, as one of the largest oil and gas producing countries in the world. The present study, therefore, was designed to investigate the burden of cardiovascular and respiratory diseases attributed to the SO exposure in Iran, over a 26-year period.

Materials And Methods: All measured SO levels were collected from 92 air quality monitoring stations (AQMSs) in 29 cities, during 1996-2013. Since the study years were from 1990 to 2015, and also due to missing data at existing stations, the spatiotemporal model was used to estimate the exposure to this gas during this period. To calculate the burden of cardiovascular and respiratory diseases, the population attributable fraction (PAF) value was calculated, and the SO-attributed mortality and years of life lost (YLL) were determined per province, and in the whole country.

Results: The results of this study showed that the SO concentration was increased from 22.00 ppb (7.69-67.28) in 1990 to 27.81 ppb (9.88-82.27), in 2015. The lowest annual value of 11.53 ppb (4.68-32.06) and the highest value of 45.11 ppb (16.58-1226) were estimated at 2004 and 1997, respectively. There was a sinusoidal trend in the gas concentration changes. The highest occurrence of SO-attributed deaths due to cardiovascular and respiratory diseases were 0.080 (0.024-0.168) and 0.076 (0.026-0.165), and the lowest levels were 0.017 (0.004-0.044) and 0.047 (0.017-0.124), respectively.

Conclusions: According to the results in our country, the SO trend was sinusoidal during 26 years, with a recurrent rise occurring after each declining period. It is recommended to design the sustainable national method policies and programs with the continuous evaluation and modification for the reduction of fossil fuel consumption and further implementation in the use of clean energy.
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http://dx.doi.org/10.1007/s40201-020-00464-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203314PMC
June 2020

Rationale and Design of the Persian CardioVascular Disease Registry (PCVDR): Scale-Up of Persian Registry Of CardioVascular DiseasE (PROVE).

Curr Probl Cardiol 2021 Mar 12;46(3):100577. Epub 2020 Mar 12.

We aimed to present the methodology of a national registry entitled "Persian CardioVascular Disease Registry (PCVDR)." Persian Registry Of cardioVascular diseasE (PROVE) was a demonstration registry conducted in Isfahan since 2014 to test the feasibility and practicality of PCVDR in Iran. Built on that experience, the first phase of PCVDR that consist of angiography and percutaneous coronary intervention (PCI) registry at national level started in March 2017. Currently, PCVDR is in place in 19 hospitals, located in 7 provinces. Five questionnaires including basic information, angiography, and PCI techniques, discharge and follow-up were completed for registered patients. Since beginning until October 7th, 2019, the number of angiography and PCI cases registered in all provinces were 37,120 and 16,277, respectively. Of all PCI cases registered, 11,846 patients (72.8%) were followed up until 12 months. We expect that this registry be expanded to cover most hospitals and centers with cardiology departments in the country.
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http://dx.doi.org/10.1016/j.cpcardiol.2020.100577DOI Listing
March 2021