SIRT1 gene is associated with cardiovascular disease in the Iranian population

Sirtuins [SIRT] have recently been identified as the pivotal regulators of lifespan and health. SIRT1 has protective effects against cardiovascular disease [CVD] and through its deacetylase activity it regulates numerous essential pathways including regulating blood pressure, reducing atherosclerosis, heart protection against oxidative stress and inducing cardiac cell survival and growth. Therefore, this study was conducted to evaluate whether two genetic polymorphisms of SIRT1 rs3758391 T/C and rs369274325 G/T are associated with the risk of CVD. A total of 500 Iranian subjects including 250 CVD patients and 250 healthy individuals as the control group were recruited in this case-control study. Genotyping of SIRT1 rs3758391 T/C and rs369274325 G/T polymorphisms were performed using PCR-RFLP and Tetra-ARMS PCR methods, respectively. Our findings indicated a significant difference between two groups regarding the SIRT1 rs3758391 CC genotype in both additive and recessive models. The rs3758391 CC genotype was found to be more frequent in CVD patients than in the controls [19% vs. 6%], suggesting a statistically significant difference in either of additive [CC vs. TT; OR = 3.06, P = 0.001] as well as recessive models [CC vs. TT + CT genotype; OR = 3.72, P = 0.001]. rphism may confer an increased risk of CVD in both additive and recessive models, in this Iranian population

Improvement in prediction of incident type 2 diabetes using the 2003 criteria of impaired fasting glucose: results from a population-based 6.5-year follow-up study in Iran

To investigate whether using the 2003 criteria for impaired fasting glucose [IFG] improves the prediction of Type 2 diabetes mellitus [T2DM] in comparison to the 1997 criteria. A total of 5794 non-diabetic subjects, aged 42 +/- 13 years, were followed for 6.5 years. T2DM was defined based on the WHO 1999 criteria. Cox regression analysis was used to calculate the relative- risk [RR] of developing T2DM. Model discrimination was assessed by calculating the area under the receiver operating characteristic curve [AUC]. During the follow-up, there were 351 new cases of T2DM. In univariate analysis, the RR of the 1997 and 2003 criteria were 9.6 [7.5-12.3] and 8.4 [6.4-10.0] respectively. After adjustment for a full range of diabetes risk factors, the RR of the 2003 criteria was higher compared to that of the 1997 definition [RR [95%CI]: 3.3 [2.6-4.2] vs. 2.4 [1.8-3.2] respectively]. Inclusion of the 2003 criteria in the multivariate model significantly improved discrimination in comparison to the 1997 definition [AUC [95%CI]: 0.78 [0.74-0.83] vs. 0.74 [0.70-0.79], P<0.01]. When fasting glucose is used in community screening for pre-diabetes state, the 2003 IDF criteria yield significantly better results than the original criteria for prediction of future T2DM

effect of life style modification on the occurrence of diabetes type 2 in a 3.5-year study: Tehran lipid and glucose study

Hyperbilirubinemia is a common problem in newborn infants and may progress to kernicterus if not treated. The objective of this study was to determine the therapeutic effect of clofibrate in full-term healthy neonates with non-hemolytic hyperbilirubinemia. A randomized clinical trial was performed on two groups of healthy full-term neonates with jaundice. Clofibrate group, [n=50], received a single dose of oral clofibrate [100mg/kg], plus phototherapy, while the control group [n=50], received only phototherapy. The mean plasma total bilirubin levels at 12, 24, and 48 hours after treatment were significantly lower in the clofibrate treated group, as compared with the control group [p=0.001]. At 48 hours of treatment, 48% of patients in the clofibrate group, had bilirubin levels<12 mg/dl in comparison with 16% of control group [p=0.001]. Treatment with clofibrate also resulted in a shorter duration of hospital stay as compared to the control group [p0.001]. A single oral dose of clofibrate [100mg/kg], along with phototherapy is more effective than phototherapy alone in treatment of non-hemolytic hyperbilirubinemia in full-term healthy newborn infants

Prevalence of coronary heart disease among Tehran adults: Tehran Lipid and Glucose Study

This study is the first report on the prevalence of coronary heart disease [CHD] and its associated risk factors in adult residents of Tehran. Standard supine ECG data were collected for 5984 men and women aged > /= 30 years and coded by Minnesota criteria. All major cardiovascular risk factors were also measured. Based on Rose angina, self-reported history of CHD or ECG-defined CHD, the aged-adjusted prevalence of CHD was 21.8% [22.3% in women and 18.8% in men]. Variables independently associated with CHD were female sex, age, systolic blood pressure, 2-hour postprandial glucose, body mass index, waist-to-hip ratio and LDL/HDL cholesterol ratio

[The effect of one kind of plyometric and aerobic exercises on chest expansion and respiratory volumes in high school students]

In adult population, the stretch-shortening cycle exercise [plyometric exercise] is often used to improve muscle power, neuromuscular coordination and vertical jump performance. Unfortunately, there is limited information about effectiveness of this type of exercise on respiratory system. Thus, the purpose of this study was to evaluate the effects of plyometric and aerobic exercise on chest expansion and respiratory volumes in high school students. This clinical trial study was performed in Zahedan, Iran. Sixty girl and boy students, aging between 14-18 years were selected through simple non-probability sampling. Students were assigned randomly as either a stationary bicycle group [n=30] or a roping group [n=30]. Both groups received exercises for 12 sessions, 3 times per week. Immediately before and after exercises the following respiratory capacities and volumes were collected: chest wall expansion [in two axillary and xiphoid level], vital capacity, residual expiratory volume, forced vital capacity and forced expiratory volume in one second. The data were analyzed using independent and paired t-tests. Chest wall expansion in axillary region was increased from 76 +/- 10 cm to 77.4 +/- 10 cm in the bicycle group and from 77.7 +/- 8.1 cm to 78.5 +/- 8.7 cm in the roping group [P<0.001]. Chest wall expansion in xiphoid region was increased from 68.7 +/- 8.9 cm to 70 +/- 8 cm in the bicycle group and from 71.3 +/- 6.6 cm to 72.3 +/- 6.4 cm in the roping group [P<0.001]. In addition, respiratory volumes were significantly increased in both groups [P<0.05]. The results of this study showed that chest wall expansion and respiratory volumes were increased following plyometric exercises such as roping

Correlation of right ventricular DP/DT with functional capacity and RV function in patients with mitral stenosis

Evaluation of right ventricular [RV] contractility and systolic function in patients with right sided heart disease is an essential component of clinical management. The aim of this study was to assess RV systolic function by qualitative and quantitative methods and compare it to rate of ventricular pressure change during the isovolumic contraction period [dP/dt] as RV contractility index in patients with rheumatic mitral stenosis. In 56 consecutive patients with moderate to severe mitral stenosis, RV systolic function, RV dP/dt and dP/dt/Pmax, were calculated and compared. There was significant correlation between RV dP/dt and RV function [P < 0.001] and between RV dP/dt and New York Heart Association [NYHA] functional capacity [P < .001]. The mean of dP/dt was decreased with increasing severity of RV dysfunction [mean dP/dt was 648 +/- 159 for normal RV function, 592 +/- 126 for mild RV dysfunction, 319 +/- 146 for moderate RV dysfunction and 166 +/- 150 for severe RV dysfunction] Severity of tricuspid regurgitation and pulmonary hypertension had no significant effect on RV dP/dt and RV function. RV dP/dt/Pmax had also significant relationship with RV function and functional capacity [P < 0.001]. Measurements of dP/dt and dP/dt/Pmax, are practical methods for estimating RV contractility and results have a good correlation with RV systolic function and functional capacity

[High prevalence of diabetes and abnormal glucose tolerance in urban Iranians aged over 20 years: determining an effective screening strategy for un-diagnosed diabetes]

The aim of this study was to determine the prevalences of diagnosed and undiagnosed diabetes mellitus, impaired fasting glucose [IFG], impaired glucose tolerance [IGT], and combined IFG/IGT and to develop an effective screening strategy for undiagnosed diabetes in a large urban Iranian community. The study population included 9,519 participants of the Tehran Lipid and Glucose Study, aged > 20 years, with full relevant clinical data. Age-standardized prevalence of diabetes and glucose intolerance categories were reported according to the 2003 American Diabetes Association definitions. The numbers needed to screen [NNTS] to find one person with undiagnosed diabetes were estimated from age-adjusted logistic regression models. The prevalences of diagnosed and undiagnosed diabetes, isolated IFG, isolated IGT, and combined IFG/IGT were 8.1%, 5.1%, 8.7%, 5.4% and 4.0% in men and 10%, 4.7%, 6.3%, 7.6%, and 4.5% in women respectively. Un-diagnosed diabetes was associated with family history of diabetes, increased body mass index [BMI >/= 25 kg/m2], abdominal obesity, hypertriglyceridemia, hypertension and low HDL-C levels. Among men, a combination of increased BMI, hypertension, and family history of diabetes led to an NNTS of 1.6 [95%CI: 1.57-1.71] and among women a combination of family history of diabetes and abdominal obesity, yielded an NNTS of 2.2 [95%CI: 2.1-2.4]. Approximately 32% of Tehranian adults had either diabetes or some degree of other glucose tolerance abnormalities. Nearly 40% of total cases with diabetes were undiagnosed. Screening individuals with family history of diabetes, BMI25 kg/m2, abdominal obesity and hypertension may have substantial advantages

[C-Reactive protein in risk prediction of cardiovascular outcomes:Tehran lipid and glucose study]

The main aim of this study was to evaluate the utility of C-reactive protein [CRP] in risk prediction of cardiovascular outcomes. In a nested case-control study, 207 cardiovascular events among participants over 30 years of the Tehran Lipid and Glucose Study [TLGS] were documented during 3 years of follow up. Cases that were free of cardiovascular disease at baseline [126 subjects] were matched to 259 normal controls for age and sex. High sensitivity CRP and traditional cardiovascular risk factors were measured at baseline. Modest correlation was found between CRP and body mass index [r=0.34], waist-to-hip ratio [r=0.22], total cholesterol [r=0.24] and calculated 10-year Framingham coronary risk score [FRS] [r=0.27] [all P values <0.001]. The age and sex adjusted relative risk of cardiovascular events for subjects in the highest quartile of the population distribution of CRP when compared with the lowest quartile was 2.6 [95% CI=1.4-5.1, P=0.006]. After additional adjustment for traditional cardiovascular risk factors the odds ratio decreased to non-significant levels [0.8,95% CI=0.3-1.9]. Addition of CRP did not improve the area under receiver operating characteristic curve of risk functions that was based on traditional cardiovascular risk factors or FRS. It is concluded that for short-term prediction of cardiovascular outcomes in the Iranian population, when traditional cardiovascular risk factors are known measurement of CRP has no additional value

Prediction of cardiovascular disease by metabolic syndrome in individuals aged over 40 yrs according to the ATP III and IDF definition: Tehran lipid and glucose study

Different results have been reported on the association between metabolic syndrome [MS] and cardiovascular diseases [CVD]. The aim of this study is to determine the role of the Adult Treatment Cholesterol Program [ATP III] and International Diabetes Federation [IDF] definitions of metabolic syndrome in predicting CVD. In this cohort study, all individuals aged over 40 yrs, phase I participants of the TLGS, with no histories of CVD were selected. Based on the APT III and IDF criteria of the MS syndrome, they were divided into those with and those without the condition. All of the subjects were followed for a mean duration of 4.9 +/- 0.8 years for occurrence of CVD. The predictive ability of different definitions of the MS was evaluated in different regression models that included only the MS [model 1] and were also adjusted for age, sex, family history of premature CVD and smoking [model 2], serum LDL [model 3] and other components of the MS [model 4]. There were 3777 individuals' aged 54 +/- 10 years 1536 [41%] where normal according to the both criteria of the MS and 1714 [45%] and 1900 [50%] subjects had MS according to the ATP III and IDF criteria respectively. New CVD occurred in 143 individuals [3.7%]. In our study, the MS was the predictor of CVD in the first three models according to ATP III and IDF criteria however, in model 4, none of the definitions of MS predicted CVD. After calculation of the area under the curve [AUC] for model 2 and 3, it was observed that the power of the ATP III criteria in model 2 for prediction of CVD was significantly higher than the IDF [AUC 0.760 vs. 0.735, p < 0.001] but no significant difference was observed between the 2 criteria in model 3. The ATP III and IDF definitions of the MS, it seems can similarly predict CVD after adjustment for the common CVD risk factors and LDL, whereas neither of the 2 definitions had this predictive power after adjustment of their components in addition to the earlier mentioned ones

[ effect of impaired fasting glucose and impaired glucose tolerance in prediction of incident type 2 diabetes: Tehran lipid and glucose study]

The aim of the current study was to ascertain which impaired glucose homeostasis at baseline is predictive of conversion to type 2 diabetes in an Iranian non-diabetic population. This is a population-based cohort study conducted in 4134 non-diabetic residents of Tehran [the capital city of Iran], aged over 20 years, from 1999 to 2004. Fasting plasma glucose and glucose levels after ingestion of 75 g glucose were measured at baseline [1999-2001] and at follow up [2002-2004] with mean follow up duration of 3.4 years. ADA 1997 and 2004 criteria were used to determine the glucose tolerance status of the participants at baseline and follow up. Using ADA 1997 criteria, the cumulative incidence of diabetes for participants with IFG and IGT, isolated IGT and isolated IFG was 32.3, 10.7 and 9.5% respectively compared with 1.2% for those with normal glucose tolerance at baseline. After application of the new criteria the corresponding incidence rates were 24.8, 6.5 and 5.9% vs. 0.7%. In multivariate logistic regression analysis, the odds ratio for incident diabetes was 1, 6.5[2.5-16.7], 7.7[4.7-12.6] and 28.9[15.6-53.5] in subjects with normal glucose, isolated IFG, isolated IGT and both IFG and IGT respectively using ADA 1997 criteria. The corresponding odds ratios after application of the new criteria were 1, 4.6[2.5-9.0], 6.8[3.6-12.9] and 27.1[15.5-47.5] respectively. In addition to fasting and 2-hour glucose [p<0.001], the waist-to-hip ratio was an important risk factor for developing diabetes [p<0.01]. Both isolated IFG and isolated IGT, and especially combined IFG and IGT, based on either the new or previous ADA criteria are strong predictors for development of type 2 diabetes

[Anticardiolipin antibody in type I diabetic patients]

Type 1 diabetes mellitus is an autoimmune disorder which is associated with different organ specific autontibodies including anticardiolipin antibody [ACLA]. The association of ACLA with diabetes has not been widely reported. The aim of this study was to determine the prevalence of ACLA IgG and IgM and evaluation of their possible association with other auto-antibodies, duration of disease and status of control of blood glucose in type 1 diabetes patients. In a cross sectional study, 48 patients with type 1 diabetes in Bandar Abbas were compared with 41 age and sex matched healthy persons for the presence of ACLA [IgG and IgM], Rheumatoid Factor [RF] and Anti Nuclear Antibody. The mean age of diabetic patients was 20/5 +/- 10 years. High titers of ACLA [IgG and/or IgM] were more common in type 1 diabetic patients than in healthy controls [18% vs. 0%, p<0.01] with no significant difference between males and females [4 and 12% respectively]. Unlike ACLA IgG, the mean value of serum ACLA IgM was significantly higher in type 1 diabetic patients than in controls [6.8 +/- 2.8 vs. 4.5 +/- 2.4 GPLU/ml]. Among type 1 diabetic patients, those with high titers of ACLA [ACLA+] were older and had higher age of onset of diabetes than those with normal titers, but there were no difference in duration of diabetes or level of HbA1c between them. No significant difference was observed in the prevalence of ACLA+or the mean values of ACLA IgG and IgM between recently [<1 years] and previously [>1 years] diagnosed diabetic patients. ACLA+patients were also more likely to show positive RF than the ACLA-group[25 vs. 0%]. The relatively high prevalence of ACLA [+] in type 1 diabetic patients and its association with other autoantibodies may reflect an abnormal immunologic response in some stages of type 1 diabetes. ACLA might be added to the list of autoantibodies that should be measured in type 1 diabetes patients

[Surveying the frequency of neural tube defects and the effective factors in pregnant women refereed to Fatemiyeh Hospital in Shahrud]

After cardiac defects, neural-tube defects [NTD] are the most congenital structural defects with a worldwide incidence of 1.4 to 2 per 1000 live births. This defect is due to failure of the neural tube to close spontaneously between the 3[rd] and 4[th] wk of uterine development. The control of risk factors related to NTD, may reduce the associated psychologic problems. For this case-control study, women referred to delivery room in Fatemiyeh Hospital in Shahrud were enrolled. Totally, 100 women with normal fetus or neonate in a systematic randomized sampling were chosen as a control group. Control group were compared with women who delivered fetus or neonate with NTDs in foresaid time for the following factors: drug use, overt diabetes, getting fever and receiving X-ray around the conception's time. During 4.5 years, 55 women [3.7 in 1000] had fetus or neonate with NTD. According to determined odds ratio, none of the surveyed factors were effective. There were no statistical difference between two groups in folic acid consuming and all women consumed folic acid after third month of pregnancy. Hydramniose, as a complication of NTDs, was more frequent in case group than controls [20.9 vs 0.01, p<0.001]. Although the precise cause of neural tube defects remains unknown, some factors may influence normal development of CNS. In our study none of the surveyed factors were affective, thus, epidemiological studies are recommended. According to studies, more than half of NTDs could be prevented with daily intake of folic acid throughout the conceptional period, so intake of 400microcg folic acid daily [according to CDC and ACOG recommendations] is offered in all women in reproductive age who referred to the health care settings in Iran