Outcomes of a longitudinal population-based cohort study and pragmatic community trial: findings from 20 years of the Tehran lipid and glucose study

Context: the Tehran lipid and glucose study [TLGS] is one of the oldest population-based longitudinal cohort studies, providing knowledge about the incidence and risk factors of some non-communicable diseases [NCDs] in West Asia which hitherto was relatively scarce. We reviewed the methods and results related to the outcome measurements of this study

Evidence Acquisition: we reviewed all the TLGS papers which reported the incidence of NCDs

Results: the TLGS was initiated in 1999 - 2001 on a population in district no. 13 of Tehran with the same age distribution of the overall Tehran population and with a middle socioeconomic status. Totally, 15005 individuals, aged >/= 3 years, participated in the first examination; reexaminations were conducted in a triennial manner and 3550 individuals were added in the second examination. All participants were also followed up annually and asked about any medical event leading to hospitalization or death. A part of participants was assigned to an educational program for lifestyle modification. High incidence of cardiovascular disease [CVD], premature CVD, diabetes and hypertension [around 19, 6, 10 and 31 in men and 11, 5, 11 and 29 in women per 1000 person-year, respectively] besides the high incidence of pre-diabetes and pre-hypertension [around 46 and 76 in men and 37 and 49 in women per 1000 person-year, respectively] showed a worrying situation. Fortunately, the results of the community interventions were promising with around 20% reduction in the risk of metabolic syndrome up to six years

Conclusions: these precise detections of different outcomes in the TLGS provided valuable evidences for prediction and prevention of NCDs in Iran with some novelties in the middle-income countries in the world. The Tehran thyroid study [TTS] and the Tehran cardiometabolic genetic study [TCGS], conducted in the framework of the TLGS, are among few studies aiming to determine the natural course of thyroid function and to identify patterns of genetic polymorphisms related to cardiometabolic outcomes, respectively

Long-term continuous methimazole or radioiodine treatment for Hyperthyroidism

There is no general agreement as to which treatment is best for hyperthyroidism. The objective of this study is to investigate the effectiveness of continuous methimazole [MMI] treatment and to compare the results of neuropsychological testing in patients receiving long-term continuous MMI to those on replacement thyroxine following radioiodine-induced [RAI] hypothyroidism. We enrolled 239 patients with diffuse toxic goiter who had recurrences of hyperthyroidism. Of these, 104 patients were randomized into two groups, MMI and treatment with thyroxine following RAI hypothyroidism. The remaining 135 patients voluntarily enrolled into either of the two groups. From all patients, 59 MMI-treated patients and 73 patients in the RAI group completed follow up. Thyroid function tests, serum lipids and lipoproteins, echocardiography, bone mineral density [BMD] and seven neuropsychology tests were performed at the final visit. In the RAI group compared to the MMI-treated group during a mean of 14 years follow up, there were more incidences of elevated TSH [> 5 mU/L; adjusted relative risk [RR] 1.23; 95% confidence interval [CI] 1.04-1.47], increased triglycerides [> 150 mg/dL; RR 2.20; 95% CI 1.34-3.62], HDL-C [< 40 mg/dL; RR 3.46; 95% CI 1.40 - 8.53], and early diastolic annular velocity [< 12.2 cm; RR 3.91; 95% CI 1.42-10.74], in addition to a decreased early diastolic to annular velocity ratio [< 6.7; RR 7.14; 95% CI 1.38-34.48]. The MMI group scored better in neuropsychology tests that included mood, direction, logical memory, repeated numbers, and intelligence quotient [IQ]. Long-term MMI treatment was superior to RAI therapy in patients with diffuse toxic goiter when mood, cognition, cardiac function and occurrence of thyroid dysfunction were compared

Prevalence of metabolic syndrome by the Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions and their association with coronary heart disease in an elderly Iranian population

<p><b>INTRODUCTION</b>To determine the prevalence of the metabolic syndrome (MS) in an Iranian elderly population and show its association with coronary heart disease (CHD).</p><p><b>MATERIALS AND METHODS</b>This is a cross-sectional study on 720 Iranian men and women aged > or = 65 years who participated in the Tehran Lipid and Glucose Study (TLGS). Logistic regression analysis was used to estimate the odds ratio (OR) of developing CHD in model 1, an age-adjusted model; model 2, adjusted for age, smoking status, premature history of CHD and low-density lipoprotein (LDL) cholesterol; and model 3, adjusted for mentioned variables plus the MS components.</p><p><b>RESULTS</b>The prevalence of MS was 50.8%, 41.8% and 41.9% based on the Adult Treatment Panel (ATPIII), the World Health Organisation (WHO), and the International Diabetes Federation (IDF) definitions, respectively. The IDF definition showed high agreement with the ATPIII definition. Age-adjusted OR (95% CI) of the MS for CHD was 1.6 (1.2 to 2.2) by both the ATPIII and WHO definitions and 1.4 (1.0 to 1.9) by the IDF definition. IDF-defined MS lost its association with CHD in model 2. In model 3, obesity (WHO definition) and high blood pressure (ATPIII and WHO definitions) were associated with CHD.</p><p><b>CONCLUSIONS</b>In an elderly Iranian population MS is highly prevalent. ATPIII and WHO definitions seem to be more pertinent than IDF for screening CHD risk. None of these definitions showed association with CHD when considering their components.</p>

[Triglyceride/HDL- cholesterol ratio [TG/HDL- C] beside the total cholesterol is a predictor for coronary heart disease in an Iranian men population]

Triglyceride/HDL-cholesterol ratio [TG/HDL-C] has been shown as an indicator for metabolic syndrome [MetS]. This study aimed to detect the role of this ratio to predict coronary heart disease [CHD] outcome in an Iranian men population with high prevalence of MetS. 1824 men >/= 40 years old, free of clinical cardiovascular disease at baseline, were included in the study from February 1999 to August 2001. Serum level of total cholesterol [TC], HDL-C, TG, and risk factors of CHD; including age, systolic blood pressure, diastolic blood pressure, body mass index, diabetes, smoking and family history of cardiovascular diseases were measured at initial phase of study. During a median follow up of 6.5 years until March 2007, a total of 163 new CHD events occurred. According to a Cox proportional hazard modeling, after adjustment for TC and other risk factors, men in the top quartile of TG/HDL-C relative to first quartile had a significant hazard ratio [HR] of 1.85 [95% Cl, 1.07-3.17]. Combined HR for TC and TG/HDL-C [men in the top quartiles of both TC and TG/HDL-C relative to first quartiles] after adjustment for other risk factors was 6.13 [95% Cl, 2.37-15.86]. The evaluation of both TG/HDL-C ratio and TC should be considered for CHD risk prediction in Iranian male population