Determining the factors associated with cardiovascular disease Recurrence: Tehran lipid and glucose study

Background: several studies have emphasized the importance of cardiovascular disease [CVD] prevention. However, there is a dearth of data on the prevention of cardiovascular disease recurrence. The present study was the 1st in Iran to evaluate factors associated with CVD recurrence

Methods: this prospective cohort study was conducted on 483 subjects [> 30 years old] with a history of CVD who participated in the Tehran Lipid and Glucose Study and were followed up for 12 years [1999-2012]. The relationships between the most important established risk factors for CVD and CVD recurrence were evaluated

Results: totally, 258 [53.4%] men and 225[46.5%] women at a mean age of 59.2 +/- 10.7 years were recruited in the study. Our results showed that over the 12-year follow-up, the incidence of a recurrent event [per 100 person-years] was 48.5. Further, after controlling the possible confounding factors, the following variables had a significant relationship with CVD recurrence: age [HR = 1.02; p value = 0. 001], male sex [HR = 1.4; p value = 0.012], smoking [HR = 1.7; p value = 0.004], and increased fasting blood sugar [HR = 2.1; p value = 0.001]

Conclusion: we found that the established variables in the development of CVD [i.e., age, sex, and smoking] played an important role in the risk of CVD recurrence

[Diagnosis and treatment of thyrotoxicosis during pregnancy and Lactation]

Poorly treated or untreated maternal overt hyperthyroidism may affect pregnancy outcome. Thyroid dysfunction and hyperthyroidism is present in about 0.3% and 2-3% of pregnancies respectively. Thyroid hyperfunction and hypofunction are more prevalent and usually go unrecognized. If thyroid dysfunction remained undiagnosed and has not been treated appropriately, would result in serious adverse pregnancy outcomes and treat both mother and her fetus. The aim of this review is to mention many aspects of hyperthyroidism in pregnancy and lactation in depth. Literature review was performed using MEDLINE between years 1960 and 2010, with the terms [Hyperthyroidism and pregnancy], [Anti-thyroid drug and pregnancy], [Radioiodine and pregnancy], [Hyperthyroidism and lactation], [Anti-thyroid drug and lactation], both separately and in conjunction with the terms [fetus], [neonate] and [maternal]. We selected proper study design of survey, case control and cohort studies, and clinical trials and review papers if the authors had at least four articles of their own in the list of references of review paper. The strategy used to search for articles was developed with the assistance of a research librarian. Antithyroid drugs are the main therapy of maternal hyperthyroidism during the lactation. All forms of antithyroid drugs can be used in pregnancy. As there are some reports regarding teratogenicity of methimazole [MMI], Propylthiouracil [PTU] is preferred in the first trimester and should be replaced by MMI after this trimester. Radioiodine is absolutely contraindicated for treatment of hyperthyroidism in pregnancy. Subtotal thyroidectomy in second trimester is indicated if hyperthyroidism is uncontrolled. MMI is the mainstay of the treatment of postpartum hyperthyroidism, in particular during lactation. Management of hyperthyroidism during pregnancy requires special considerations because maternal thyroid disease could have adverse effects on the mother, fetus and neonate

[Association between TNF-alpha promoter G-308A and G-238A polymorphisms and obesity in Tehran lipid glucose study population]

Tumor necrosis factor-alpha [TNF-alpha] is expressed primarily in adipocytes and elevated levels of this cytokine have been linked to obesity and insulin resistance. Therefore, we examined the relationship between the G-308A and G-238A polymorphisms of TNF-alpha gene promoter variants and obesity in an Iranian population. Subjects of the Tehran Lipid and Glucose Study classified into two age groups under and above 18. Adults classified in three groups according to their body mass index and less than 18 years old subjects classified in two groups [under 85th percentile for their age and sex and above 85th percentile]. 244 persons were selected to examine -308 site and 239 persons were selected to examine -238 site. The mentioned polymorphisms were examined with PCR and RFLP methods. The allele frequency of TNF-alpha polymorphism was in the Hardy Weinberg equilibrium and there was no relation between BMI and the frequency of this allele. No association between G-308A and G-238A TNF-alpha promoter polymorphisms and obesity could probably indicate that it is not an important risk factor for obesity and consequently for cardiovascular disease