The metabolic syndrome in hypertensive and normotensive subjects: the Isfahan Healthy Heart Programme.

INTRODUCTION: There are numerous correlations between hypertension and the metabolic syndrome, although this is not always the case. The objective of this study was to compare the prevalence of the metabolic syndrome and its different phenotypes among hypertensive and normotensive subjects. MATERIALS AND METHODS: This cross-sectional study was performed on a representative sample of adults living in 3 cities in Iran. Among the 12,514 subjects selected by multi-stage random sampling, 1736 (13.9%) were hypertensive. The prevalence of the metabolic syndrome [according to the Adult Treatment Panel (ATP) III criteria] was significantly higher in hypertensive than normotensive subjects (51.6% versus 12.9%, respectively; OR, 7.15; 95% CI, 6.4 to 7.9). The metabolic syndrome was more prevalent in normotensive and hypertensive subjects living in urban areas than those living in rural areas (14.2% and 53.9% versus 9.5% and 45.6%, respectively, P < 0.05). The mean age of hypertensive subjects, with or without the metabolic syndrome, was not significantly different (55.7 +/- 12 years versus 55.4 +/- 15.5 years, P = 0.6). Hypertension with the metabolic syndrome was more prevalent in women than men (72% versus 28% respectively, P < 0.000), and in subjects living in urban areas than those in rural areas (75.1% versus 24.9%, respectively, P = 0.002). CONCLUSION: The findings of this study indicate the need for metabolic screening in all hypertensive patients, and emphasise the importance of promoting primary and secondary prevention of high blood pressure and associated modifiable risk factors in order to counter the upcoming epidemic of non-communicable disease in developing countries.

Mitochondrial DNA and Y-chromosome variation in the caucasus.

We have analyzed mtDNA HVI sequences and Y chromosome haplogroups based on 11 binary markers in 371 individuals, from 11 populations in the Caucasus and the neighbouring countries of Turkey and Iran. Y chromosome haplogroup diversity in the Caucasus was almost as high as in Central Asia and the Near East, and significantly higher than in Europe. More than 27% of the variance in Y-haplogroups can be attributed to differences between populations, whereas mtDNA showed much lower heterogeneity between populations (less then 5%), suggesting a strong influence of patrilocal social structure. Several groups from the highland region of the Caucasus exhibited low diversity and high differentiation for either or both genetic systems, reflecting enhanced genetic drift in these small, isolated populations. Overall, the Caucasus groups showed greater similarity with West Asian than with European groups for both genetic systems, although this similarity was much more pronounced for the Y chromosome than for mtDNA, suggesting that male-mediated migrations from West Asia have influenced the genetic structure of Caucasus populations.

The effect of fasting in Ramadan on the values and interrelations between biochemical, coagulation and hematological factors.

BACKGROUND: The possible consequences of the long intermittent fasting schedule during Ramadan (one month of food and water intake limited to night hours, a practice that is followed by the majority of the Muslims worldwide) on certain biochemical constituents or coagulation variables have not been extensively documented. PATIENTS AND METHODS: During the month of Ramadan and two months after, we monitored the concentration of different plasma lipoproteins, lipoprotein (a) [Lp(a)], apoproteins A(1) and B, fibrinogen, factor VII activity and some selected hematological factors in 50 healthy subjects who were employees of institutes related to the Isfahan University of Medical Sciences and aged between 30 and 45 years. The effect of fasting in Ramadan on the relationship between biochemical and coagulation variables was also investigated. RESULTS: The values of apoprotein B, Lp(a) and low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio were significantly decreased during Ramadan (P<0.05), while total cholesterol (Tot-C), triglycerides (TG), LDL-C, HDL-C and fasting blood glucose did not change during that month. Among coagulation and hematological factors, fibrinogen level and factor VII activity were significantly decreased during the month (P<0.05). Results also indicated a significant positive association between fibrinogen level and Lp(a), factor VII activity and Tot-C, LDL-C, TG and Apo B during Ramadan. CONCLUSION: Our findings contribute to a better understanding of previous reports, as the metabolic and coagulation changes that are considered as atherosclerosis risk factors are counterbalanced during Ramadan.

The prevalence of coronary artery disease in an urban population in Isfahan, Iran.

OBJECTIVE: Cardiovascular diseases, especially coronary artery disease (CAD), are responsible for the highest mortality rate in Iran. This study was conducted to determine the prevalence of CAD in an urban sample in Isfahan by the Minnesota code of a 12-lead resting electrocardiogram (ECG), the Rose questionnaire on chest pain and a self-reported previous medical history. METHODS AND RESULTS: Among the target sample of 6,470 men and women aged 35-79 years who were randomly selected from 80 random clusters in Isfahan, 5,773 subjects (about 90%) have participated. The WHO (Rose) questionnaires (Q) on chest pain were completed for all participants and 12-lead ECGs were taken. The overall prevalence of CAD based on the Rose Q and/or ECG was 19.4% (95% CI 18.4% to 20.4%) which was significantly higher among women 21.9% (95% CI 20.5% to 23.3%) than men 16.0% (95% CI 14.5% to 17.5%) (p < 0.05). The prevalence of CAD increased with age in both sexes. The prevalence of definite and possible angina based on the questionnaire was higher among women compared to men (p < 0.05), also a greater prevalence of ECG-based possible ischaemia was observed among woman than men (12.3% vs. 7.5%) (p < 0.05). However, definite and possible MI and definite ischaemia based on ECG abnormalities were higher among men than women (p < 0.05). The total prevalence of symptomatic CAD was 9.3% and about 22% of those with symptoms of CAD on Q have some evidence on ECG. The findings also showed that CAD is more common among people with less education, lower income and the unemployed (p < 0.05). CONCLUSION: These findings indicate that there is a high prevalence of CAD among the Iranian population which need more programmes of health promotion and lifestyle changes and further studies to assess the used epidemiological methods for estimating CAD prevalence, especially among women.

Prevalence of hypertension and associated risk factors in Isfahan, Islamic Republic of Iran.

A population-based cross-sectional survey was conducted to determine the mean levels of blood pressure and prevalence rates of hypertension and to identify differences in the prevalence of other risk factors in hypertensive and nonhypertensive people. A total of 8624 men and women > or = 19 years were randomly selected. Overall, 18.0% (16.8% males and 19.4% females) had systemic hypertension. The mean levels of systolic and diastolic blood pressure and the prevalence of hypertension increased with age, but no significant differences were found between the sexes when adjusted for body mass index. There was a high prevalence of obesity, hyperlipidaemia and diabetes mellitus among hypertensive people compared with nonhypertensive. Our study suggests that the prevalence of hypertension in Isfahan is greater than supposed.

Secular trends in cardiovascular mortality in Iran, with special reference to Isfahan.

OBJECTIVE: There has been a general decline in mortality from cardiovascular diseases (CVDs) in most of the developed countries since the beginning of the 1970s. Still, in recent years developing countries have seen an increasing frequency in CVD mortality. However, mortality rate studies in these populations are scarce. Here we report all-cause and CVD mortality rates for men and women aged 25-74 years over a 16-year period in 24 cities in Iran with special reference to the city of Isfahan. METHODS AND RESULTS: The study was based on national death records using the ninth international classification of diseases and age standardization was performed using the total population of Iran in 1985 as a standard. Due to limitations in available data, mortality rates for the specific categories of CVD for the whole country could not be provided. The in-hospital death rates following myocardial infarction in coronary care units (CCUs) and cardiology departments in Isfahan hospitals were also assessed. The completed medical records from hospitals or the relatives of decedents were reviewed by physicians certified in internal medicine, cardiology and neurology to assess the reliability of death certificate data regarding CVD by determining the sensitivity and specificity of the death certificates against the standard of the reviewers. The official circulatory diseases proportional mortality ratio continues to rise since 1981 with a steep increase since 1987, constituting 26.6% and 47.3% of all deaths in 1981 and 1995, respectively. Age-adjusted all-cause and CVD mortality data were decreasing since 1981 and increasing since 1990. During those years age-adjusted CVD, stroke and other CVD mortality rates were decreasing in Isfahan with a slight increase in ischaemic heart disease (IHD) death rates in both sexes. Mortality rates based on sex showed a 38% and 24.8% decline in all-cause and CVD mortality in men between 1981 to 1995, and a 35% and 34.9% decline for female mortality rates for the same period, respectively. The in-hospital death rate following myocardial infarction in Isfahan was increasing between 1993 and 1995 with a slight decrease thereafter. The results of death certification assessment showed a specificity of 0.89 and a sensitivity of 0.43 with the positive and negative predictive values of 0.82 and 0.57, respectively. CONCLUSION: These data indicate that circulatory diseases remain a serious public health threat in Iran. It suggests the ongoing need for more regular, systematic and innovative surveillance data to improve the capability of measuring, explaining and predicting the disease trend on which the national public health policy depends.

Lipid profiles in the Isfahan population: an Isfahan cardiovascular disease risk factor survey, 1994.

A population-based study was conducted in 1994 in Isfahan to define the prevalence of various types of hyperlipidaemia and the mean concentrations of serum total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein (HDL) cholesterol. In all, 2200 people were randomly chosen and classified into five age groups (20-70 years). The data were obtained by questionnaires and anthropometric measurements and serum lipids and fasting blood sugar were measured. The prevalence of hyperlipidaemia was higher in women than men. Multiple linear regression showed only HDL cholesterol and triglycerides to be associated with body mass index. The most prevalent lipid abnormality was HDL cholesterol. Diet modification and physical activity should be encouraged to reduce hyperlipidaemia.

Prevalence of hypertension and associated risk factors in Isfahan, Islamic Republic of Iran

A population-based cross-sectional survey was conducted to determine the mean levels of blood pressure and prevalence rates of hypertension and to identify differences in the prevalence of other risk factors in hypertensive and nonhypertensive people. A total of 8624 men and women > or = 19 years were randomly selected. Overall, 18.0% [16.8% males and 19.4% females] had systemic hypertension. The mean levels of systolic and diastolic blood pressure and the prevalence of hypertension increased with age, but no significant differences were found between the sexes when adjusted for body mass index. There was a high prevalence of obesity, hyperlipidaemia and diabetes mellitus among hypertensive people compared with nonhypertensive. Our study suggests that the prevalence of hypertension in Isfahan is greater than supposed

Lipid profiles in the Isfahan population: an Isfahan cardiovascular disease risk factor survey, 1994

A population-based study was conducted in 1994 in Isfahan to define the prevalence of various types of hyperlipidaemia and the mean concentrations of serum total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein [HDL] cholesterol. In all, 2200 people were randomly chosen and classified into five age groups [20-70 years]. The data were obtained by questionnaires and anthropometric measurements and serum lipids and fasting blood sugar were measured. The prevalence of hyperlipidaemia was higher in women than men. Multiple linear regression showed only HDL cholesterol and triglycerides to be associated with body mass index. The most prevalent lipid abnormality was HDL cholesterol. Diet modification and physical activity should be encouraged to reduce hyperlipidaemia