Socioeconomic disparities and smoking habits in metabolic syndrome: evidence from Isfahan healthy heart program

The metabolic syndrome [Mets] consists of major clustering of cardiovascular disease [CVD] risk factors. This study determines the association of socioeconomic determinants and smoking behavior in a population-based sample of Iranians with Mets. This cross-sectional survey comprised 12600 randomly selected men and women aged >/= 19 years living in three counties in central part of Iran. They participated in the baseline survey of a community-based program for CVD prevention entitled" Isfahan Healthy Heart Program" in 2000-2001. Subjects with Mets were selected based on NCEP- ATPIII criteria. Demographic data, medical history, lifestyle, smoking habits, physical examination, blood pressure, obesity indices and serum lipids were determined. The mean age of subjects with Mets was significantly higher. The mean age of smokers in both groups was higher than non-smokers but with lower WC and WHR. Marital status, age and residency were not significantly different in smokers with Mets and non-smokers with Mets. Smoking was more common in the middle educational group in the income category of Quartile 1-3. Mets was significantly related to age, sex and education. Middle-aged and elderly smokers were at approximately 4-5 times higher risk among Mets subjects. Low education decreased the risk of Mets by 0.48; similarly in non-smokers, 6-12 years of education decreased the risk of Mets by 0.72. More educated persons had a better awareness and behavior related to their health and role of smoking. In the lower social strata of the Iranian population, more efforts are needed against smoking habits

Relationship between serum lactate levels and morbidity outcomes in cardiovascular patients after CABG

To evaluate the relationship between postoperative serum lactate levels and outcome in patients undergoing open heart surgery and verify the clinical impact of hyperlactatemia[HL] and low lactemia[LL] during CABG in terms of postoperative morbidity and mortality rate. Descriptive study. Sina Heart Centre [non-university hospital in Isphan, Iran] from fall 2005 to fall 2006. Hundred consecutive patients undergoing cardiac surgery with cardiopulmonary bypass were admitted in the study. Post operative lactate concentration and other metabolic parameters were determined. Evaluation of lactate concentrations, pH values and base excess during the first 24 post operative hours were assessed. Hyperlactatemia was defined as a peak arterial blood lactate concentration exceeding 3 mmol/l. Pre- and intraoperative factors were tested for independent association with the peak arterial lactate concentration and HL. The postoperative outcome of patients with or without hyperlactatemia was compared. We found positive effect of time on lactate and pH levels. On day 1, HL and LL patients had comparable lactate concentrations, which remained significantly higher than those of HL patients. HL is frequent after cardiac surgery. Based on our analyses, postoperative measurement of lactate level appears to be clinically useful. A threshold of 3 mmol/L at ICU admission was able to identify a subpopulation of patients at higher postoperative risk. Sequential determinations identified patients at higher risk for major complication and thus the need for closer surveillance of their therapeutic responses and their metabolic consequences

Cardiovascular disease risk factors, metabolic syndrome and obesity in an Iranian population

As part of the Isfahan Healthy Heart Program, we evaluated the prevalence of cardiovascular disease risk factors in Iranians with generalized and abdominal obesity. We carried out a crosssectional study on 3694 participants aged >/= 19 years. Overall, 36.6% of men and 35.9% of women were overweight; 11.2% of men and 28.1% of women were obese. Mean body mass index [BMI], waist circumference [WC] and waist/hip ratio [WHR] increased with age up to 65 years. Total serum cholesterol, triglycerides and 2-hour post-load plasma glucose increased with BMI, WC and WHR in both sexes. Prevalence of metabolic syndrome was 19.8% in females with normal BMI, 48.1% in overweight females and 63.2% in obese females. In males, corresponding values were 3.7%, 18.0% and 40.1%

Pharmacological treatment, lifestyle modification and awareness in coronary artery and cerebrovascular disease patients

Cardiovascular diseases [CVD] and cerebrovascular diseases [CeVD] are a large and growing problem in low- and middle-income populations. Secondary prevention which can reduce the risk of recurrent CVD includes changes in lifestyle, pharmacological interventions and revascularization procedures. The aim of the first phase of this project was to perform situation analysis and identify gaps in secondary prevention of major cardiovascular diseases. This study estimated the physicians' awareness and the patients' knowledge and behavior towards CVD and CeVD complications. It also assessed the efficacy of methods for decreasing recurrent events. A sample of consecutive patients was selected from the outpatient units of the health care facilities selected for the study. Stratified random sampling of primary and secondary private and public health care facilities in cities and villages was performed to select 449 eligible cases. We selected 257 men and 192 women. The inclusion criteria were as follows: Age above 21 years, established diagnosis of cardiovascular and/or cerebrovascular disease defined as any of the following alone or in combination with others: previous myocardial infarction, stable/unstable angina, percutaneous transluminal coronary angioplasty [PTCA], coronary artery bypass graft [CABG], stroke, transient ischemic attack [TIA] or carotid arterectomy. The patients were included if their first event had occurred more than a month, but no earlier than three years ago. The prevalence of high systolic and diastolic blood pressure was 40.1% and 26.9% respectively in MI patients, and 70.1% and 51.2% respectively in CeVD patients. In most of the patients fasting blood sugar and total cholesterol were within the normal range. Among MI patients, 93.9%, 68.5% and 48.2% were already taking aspirin, beta-blockers and statins respectively. Among CeVD patients, 79.9%, 61.1% and 23.2% were taking aspirin, beta-blockers and statins, respectively. Blood pressure had been managed in 94.9% and 93.7% of MI and CeVD patients, respectively. Among MI patients, 85.8% and 83.2% had correct behavior towards blood sugar and cholesterol control and 68% had adequate knowledge of the risk of recurrent events. Secondary prevention of vascular disease should be regarded as a key component of public health strategies to reduce the rising burden of CVD and CeVD in Iran

[ situation of new risk factors of cardiovascular disease in urban population of Isfahan]

During recent years, many epidemiological studies on risk factors of cardiovascular disease [CVD] have been performed among which are fibrinogen, activity of factor VII, lipoprotein [a], and homocysteine as new CVD risk factors. Through completed studies, it is found that in urban population of Isfahan more than one risk factor [hypertension, smoking, hypercholesterolemia, diabetes and obesity are seen in 32% of men and a descriptive cross-sectional study was performed in 1998-99 and 409 subjects [175 men, 234 women] were randomly sample. Then each subject underwent a blood test, electrocardiography, medical examination and daily physical activity assessment. Nutrient intakes were obtained through assessment of food consumption as 3-day recall. Personal information and anthropometric measurements were also recorded. Fast blood sugar and serum lipids were measured by auto analyzer Elan 2000; lipoprotein [a] by ELISA; hemocystein by HPLC; fibrinogen by turbidimetry and factor VII by calculating coagulation time compared to standard time. Statistical analyses were done by t-tests. The results showed that mean fibrinogen, factor VII, lipoprotein [a], and hemocystein were 244.9+/-7 mg/dl, 118.3+/-58 per cent. 13.3+/-13 mg/dl and 11.5+/-3 micro mol/lit respectively in studied population. By comparing these new CVD risk factors over the world, it was determined that their- levels were in the normal range in urban population of Isfahan. The level of fibrinogen and hemocystein are higher and lower in women than those in men, respectively that is compatible with many other studies