Evaluation of the Psychometric Properties of the Lebanon Waterpipe Dependence Scale in a Sample of Iranian Waterpipe Smokers.

BACKGROUND: Waterpipe tobacco smoking (WTS) has recently increased in Iran. There is no valid instrument to measure the level of nicotine dependence among its consumers. This study was aimed to investigate the validity and reliability of the Lebanon Waterpipe Dependence Scale-11 (LWDS-11). METHODS: A cross-sectional study was conducted in the year 2017 whereby 367 waterpipe smokers were recruited from Golestan Province of Iran. LWDS-11 scale is composed of 4 subscales: 1) nicotine dependence, 2) negative reinforcement, 3) psychological craving, and 4) positive reinforcement. The validity of the questionnaire was examined using construct validity. Reliability of this scale was examined using test-retest reliability and internal consistency. FINDINGS: The four-factor model for LWDS [comparative fit index (CFI) = 0.985, Tucker-Lewis index (TLI) = 0.979, standardised root mean residual (SRMR) = 0.059, root mean square error of approximation (RMSEA) = 0.049 (0.031, 0.061)] demonstrated good fit to this data. Cronbach's α was 0.825 for total scale and it was 0.818, 0.746, 0.624, and 0.670 for each individual subscale. The test-retest reliability of the scale was 0.925. CONCLUSION: All goodness of fit indices (GFIs) represented a good fit of model. The LWDS-11 scale had an appropriate remarkable validity and reliability for waterpipe consumers to measure the level of nicotine dependence and it appeared to be likely useful for utilizing in the clinical and epidemiological studies.

Serum Lipids and Cardiovascular Disease Mortality in Iranian Population: Joint Modeling of Longitudinal and Survival Data in Tehran Lipid and Glucose Study (TLGS) Cohort.

BACKGROUND: Lipid abnormalities are major risk factors of death from cardiovascular disease (CVD). As well as, lipid markers are time-dependent covariates that change with aging. Previous cohort studies have only investigated baseline measurements of lipid markers on CVD mortality. MATERIALS AND METHODS: The study sample consisted of 4,148 individuals aged over 40 years. Total cholesterol (TC), LDL-cholesterol (LDL-C), and HDL-cholesterol (HDL-C) were measured in five phases. A joint model analysis was used to investigate the association between each longitudinal lipid markers and CVD mortality in men, women and pooled sample. All analysis was performed using the survival and joint modeling packages in R 3.3.3. RESULTS: Totally, 233 CVD deaths occurred during a median follow-up of 12.4 years. For men, CVD mortality increased by 28% (confidence interval [CI]: 14%,44%) for a 10% increased in TC. For women, CVD mortality increased by 43% (CI: 22%, 68%) and 21% (CI:7%, 37%) for 10 % increase in TC and LDL-C and decreased by 18% (CI:7%, 27%) for a 10% increase in HDL-C. CONCLUSION: Association of lipid markers with CVD mortality is different in men and women, such that high levels of TC and LDL-C and low levels of HDL-C are risk factors of CVD mortality in women, but only TC is a risk factor of CVD mortality in men.

Left ventricular hypertrophy and proteinuria in patients with essential hypertension in Andkhoy, Afghanistan.

Left ventricular hypertrophy (LVH) and proteinuria are known as independent predictors of cardiovascular death in hypertension. However, LVH and its association with proteinuria have not been investigated in adult hypertensive patients in Afghanistan. The objective of this research was to determine the prevalence of LVH and the correlation between LVH and proteinuria among the Afghan adult hypertensive population visiting an outpatient clinic in Afghanistan. We retrospectively evaluated 789 hypertensive patients (mean age is 56 years and 46% were men) who visited the clinic between December 2014 and August 2016. Patient characteristics and laboratory and clinical findings were recorded. The rate of LVH among hypertensive patients was 54.4%. Patients with proteinuria had a significantly higher LVH percentage compared to those without proteinuria (73.2% versus 55.8%; P<0.001). There was a significant correlation between LVH and proteinuria among hypertensive patients (r=0.182, P<0.001). Based on a multivariate regression analysis, age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.05), proteinuria (OR, 1.69; 95% CI, 1.19-2.41), and female sex (OR, 0.09; 95% CI, 0.06-0.13) were significant factors. In conclusion, the prevalence of LVH was more than 50% in the Afghan adult hypertensive population. This study indicates that there is a significant relationship between LVH detected by ECG and the presence of proteinuria among such subjects.

Xanthine oxidase inhibition by febuxostat attenuates stress-induced hyperuricemia, glucose dysmetabolism, and prothrombotic state in mice.

Chronic stress is closely linked to the metabolic syndrome, diabetes, hyperuricemia and thromboembolism, but the mechanisms remain elusive. We reported recently that stress targets visceral adipose tissue (VAT), inducing lipolysis, low-grade inflammation with production of inflammatory adipokines, metabolic derangements such as insulin resistance, and prothrombotic state. In the present study, we hypothesized the involvement of VAT xanthine oxidoreductase (XOR), a source of reactive oxygen species (ROS) and uric acid (UA) in the above processes. Restraint stress in mice resulted in upregulation of XOR and xanthine oxidase activity, accumulation of ROS in VAT as well as liver and intestine, increase in serum UA levels, upregulation of NADPH oxidase subunits and downregulation of antioxidant enzymes. Immunohistochemistry and RT-PCR analysis also showed that restraint stress induced VAT monocyte accumulation and proinflammatory adipokine production, resulting in reduced insulin sensitivity and induction of plasminogen activator inhibitor-1 and tissue factor in VAT. Treatment with febuxostat, a potent XO inhibitor, suppressed stress-induced ROS production and VAT inflammation, resulting in improvement of serum UA levels, insulin sensitivity, and prothrombotic tendency. Our results suggest that stress perturbs glucose and UA metabolism, and promotes prothrombotic status, and that XO inhibition by febuxostat might be a potential therapy for stress-related disorders.

Associations between proteinuria and cardiovascular risk factors among hypertensive patients in Andkhoy, Afghanistan.

Proteinuria in hypertension is an early marker of renal disease and a predictor for the progression of end stage renal disease, and cardiovascular diseases. This study was designed to determine the prevalence of proteinuria and its association with cardiovascular risk factors among adult hypertensive patients in Afghanistan. Five hundred fifty-five patients with a high blood pressure recorded in an outpatient clinic in Andkhoy, Afghanistan from December 2014 to May 2015, were included in this study. Data obtained from each patient, included demographic characteristics, body mass index, blood pressure patterns, cardiovascular history, cardiovascular risk factors, comorbidity, and current drug-therapy. Dipstick screening for proteinuria was performed with reagent test strips. The mean age of the patients was 57.9 ± 13.3 years, and a female predominance was observed (n = 333, 60%). The prevalence of proteinuria was 67.2%. The predictors of proteinuria were found to be age ≥65 years (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00-1.04), smoking (OR 1.88, 95% CI 1.17-3.02), heart failure (OR 2.23, 95% CI 1.13-4.41), and diabetes mellitus (OR 3.41, 95% CI 1.49-7.81). In conclusion, this study shows that proteinuria is highly prevalent among hypertensive outpatients in an outpatient clinic in Andkhoy, Afghanistan, especially in those with high cardiovascular risk.