Prevalence and Risk Factors of Anemia in the MASHAD Cohort Study.

BACKGROUND: Anemia is a serious public health problem which may be associated with cardiovascular diseases (CVDs) and brain damage. This survey aims to determine the prevalence of anemia and its association with demographic and biochemical factors and metabolic syndrome in a human sample derived from the MASHAD cohort study. METHODS: This survey was conducted on a sub-sample of 9847 individuals aged 35 to 65 as part of the MASHAD cohort study. Demographic characteristics and biochemical and anthropometrics indices were recorded. Data were analyzed using SPSS version 20. RESULTS: Anemia was seen in 11.5% of the population. Anemia was significantly more prevalent in younger subject (P<0.001), females (P<0.001) and those with elevated body mass index (BMI) (P<0.001). Mean high-density lipoprotein (HDL) was higher in anemic participant (P=0.032). The incidence of anemia was significantly lower in smokers (P<0.001) and also participant with hypertension (HTN) (P<0.001), diabetes mellitus (DM) (P<0.001) and metabolic syndrome (MetS) (P<0.001). Mean FBG (P<0.001), TG (P<0.001), total cholesterol (P<0.001), LDL (P<0.001) and uric acid (P<0.001) were significantly lower in anemic subjects. Cholesterol, MetS, low-density lipoprotein (LDL), BMI, uric acid, diabetes mellitus and also TG remained significantly different after multivariate analysis between anemic and healthy participants. CONCLUSION: The studied population had a lower prevalence of anemia compared to the previous WHO report for Iranians. Iron deficiency is recognized as the most important cause of anemia in Iran; however, further investigations will be need to confirm this pattern. We demonstrated that anemia is adversely associated with MetS and DM.

Successful transvenous lead extraction of abandoned lead implanted through persistent left superior vena cava.

Persistent left superior vena cava, the most common thoracic venous anomaly, may complicate transvenous lead extraction (TLE). We report a successful case of TLE in a patient with persistent left superior vena cava, despite a long dwelling time and several pocket revisions due to pocket infection. The lead was removed via a hand-powered mechanical extraction sheath, and postoperative complications did not occur. Complicated TLE cases may have a better outcome if performed in a high-volume center with experienced specialists.

Hookah smoking is strongly associated with diabetes mellitus, metabolic syndrome and obesity: a population-based study.

OBJECTIVES: The adverse effects of cigarette smoking have been widely studied before, whilst the effects of hookah smoking has received less attention, although it is a common habit in the Middle East. Here we have investigated the effects of cigarette and hookah smoking on biochemical characteristics in a representative population sample derived from the Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study, from Northeastern Iran. STUDY DESIGN: A total of 9840 subjects from the MASHAD population study were allocated to five groups; non-smokers (6742), ex-smokers (976), cigarette smokers (864), hookah smokers (1067), concomitant cigarette and hookah smokers (41). METHODS: Baseline characteristics were recorded in a questionnaire. Biochemical characteristics were measured by routine methods. Data were analyzed using SPSS software and p < 0.05 was considered significant. RESULTS: After adjustment for age and sex; the presence of CVD, obesity, metabolic syndrome, DM and dyslipidemia were significantly (p < 0.001) related to smoking status. After multivariate analysis, HDL (p < 0.001), WBC (p < 0.001), MCV (p < 0.05), PLT (p < 0.01) and RDW (p < 0.001), and the presence of CVD (p < 0.01), obesity (p < 0.001), metabolic syndrome (p < 0.05) and DM (p < 0.01) remained significant between cigarette smokers and non-smokers. Between hookah smokers and non-smokers; uric acid (p < 0.001), PLT (p < 0.05) and RDW (p < 0.05), and the presence of obesity (p < 0.01), metabolic syndrome (p < 0.001), diabetes (p < 0.01) and dyslipidemia (p < 0.01) remained significant after logistic regression. CONCLUSION: There was a positive association between hookah smoking and metabolic syndrome, diabetes, obesity and dyslipidemia which was not established in cigarette smoking.

Serum high-sensitive C-reactive protein is associated with dietary intakes in diabetic patients with and without hypertension: a cross-sectional study.

Background Serum high-sensitive C-reactive protein (hs-CRP) concentrations independently predict the development of diabetes, metabolic syndrome and cardiovascular disease. However, the impact of dietary factors on serum high-sensitive C-reactive protein concentrations in diabetic patients has received limited attention. We aimed to investigate the association between dietary factors and high-sensitive C-reactive protein , among diabetic patients with and without hypertension and healthy subjects. Methods In this cross-sectional study, diabetics with ( n = 325) and without hypertension ( n = 599) and healthy individuals ( n = 1220) were recruited in Mashhad, Iran. Dietary intake was assessed by 24-h recall. Biochemical parameters including serum high-sensitive C-reactive protein were measured using standard protocols. Stepwise multiple regression analysis was used to predict whether serum high-sensitive C-reactive protein concentration was associated with dietary constituents. Results High-sensitive C-reactive protein was significantly higher among hypertensive and non-hypertensive diabetic patients compared with healthy subjects ( P < 0.001). The dietary intake of zinc + 6.4% and calcium -3.4% and body mass index +3.9% explained approximately 13.7% of the variation in serum high-sensitive C-reactive protein among diabetic hypertensive patients. Approximately 9.7% of the variation in serum high-sensitive C-reactive protein in diabetic non-hypertensive patients could be explained by body mass index, and intake of sodium, iron and cholesterol. In the healthy subjects, approximately 4.4% of the total variation in serum high-sensitive C-reactive protein concentration could be explained by cholesterol consumption and waist circumference. Conclusion Serum high-sensitive C-reactive protein concentrations were found to be a significant predictor for hypertensive and non-hypertensive diabetic subjects. There was a significant association between dietary factors include zinc, iron, sodium and cholesterol and serum high-sensitive C-reactive protein, while there was an inverse association between dietary calcium and serum high-sensitive C-reactive protein in diabetic hypertensive individuals.

Dietary Intake and Its Relationship to Different Body Mass Index Categories: A Population-Based Study.

BACKGROUND: Obesity is a major public health problem because of its associated diabetes mellitus and cardiovascular disease. We aimed to explore the relationship between dietary macronutrients and adiposity in a cohort study, representative of the city of Mashhad in northeastern Iran. STUDY DESIGN: A cross-sectional study. METHODS: The population sample (9847) derived from Mashhad stroke and heart atherosclerotic disorders (MASHAD: 2010-2020) and was obtained using a stratified-cluster method. The subjects were separated into 4 groups by body mass index status: normal weight, underweight, overweight and obese individuals. Individuals with mean age of 48.33 ±8.26 yr were recruited and anthropometric and biochemical factors were measured in all the subjects. Individual dietary intakes were assessed using 24-h dietary recall Dietplan6. Univariate and multivariate analyses were conducted before and after adjustment for age, gender and energy intake. RESULTS: Obese individuals were significantly less physically active. They had higher levels of serum fasted lipid profile, hs-CRP, uric acid, and glucose, and blood pressures compared to normal weight individuals (P=0.001). There was a significant difference in the dietary intakes of the groups categorized by obese before adjustment for energy intake in the obese compared to the normal weight group. These differences remained statistically significant for Trans fatty acid (P=0.033), lactose (P=0.009), fructose (P=0.025), glucose (P=0.017), sucrose (P=0.021) and maltose (P=0.015) after adjustment for energy intake. CONCLUSION: Our findings demonstrate a significant association between dietary Trans fatty acid and total sugar intake with adiposity in a representative population sample from northeastern Iran.

The relationship between dietary intake and other cardiovascular risk factors with blood pressure in individuals without a history of a cardiovascular event: Evidence based study with 5670 subjects.

BACKGROUND AND AIM: Raised blood pressure is a leading cause of morbidity and mortality worldwide; improved nutritional approaches to population-wide prevention are required.We aimed to investigate the relationship between dietary intake and other cardiovascular risk factors with blood pressure in individuals without a history of a cardiovascular event in an Iranian cohort. MATERIAL AND METHOD: A cross-sectional study of 5670 healthy subjects [approximately 40% (n=2179) males and 60% (n=3491) females] was undertaken in a sample from northeastern Iran. Subjects were recruited from an urban population, using a stratified-cluster method and derived from the Mashhad Stroke Heart Atherosclerosis Disorder (MASHAD) study, Mashhad, Iran. The age of the subjects was between 35 and 64 years. None of the subjects had a past history of major disease. RESULTS: The mean ages for the male and female subgroups were 50.1± 8.1years and 48.2 ±7.8 y respectively. Not unexpectedly, subjects without hypertension (HTN) were younger than those with established HTN. Individuals with HTN were significantly more adipose than those without (p<0.01). We found no significant differences in crude or total energy adjusted intake of nutrients between the three groups (p>0.05), except for crude and energy adjusted phosphorus intake (p<0.05) and crude intake of the cholesterol (p<0.05). There was a significant correlation between the dietary intake of total fatty acids, phosphorus and vitamin E with both systolic blood pressure (SBP) and diastolic blood pressure (DBP). PUFA (odds ratio [OR] [95% confidence interval (CI)], 1.56 [1.05-1.06]; P<0.01), sodium (OR [95% CI], 1.00 [(1.00-1.01)]; P<0.01) and phosphorus (OR [95% CI], 1.00 [(1.00-1.01)]; P<0.01)were significant independent predictors of HTN after adjustment for energy intake. CONCLUSION: In our representative population from North-Eastern Iran, it appears that in adults without a history of cardiovascular disease, crude or energy adjusted intake of phosphorus and total fatty acid intake were significant determinants of BP, however we found no association between sodium and potassium intake with BP.

Association of Serum hs-CRP Levels With the Presence of Obesity, Diabetes Mellitus, and Other Cardiovascular Risk Factors.

BACKGROUND: Diabetes mellitus remains one of the major health problems of the 21st century and is associated with comorbidities including obesity and metabolic abnormalities. The study was conducted to evaluate serum high-sensitivity C-reactive protein (hs-CRP) levels, as a marker of inflammation, in a large sample of Iranian population without a history of cardiovascular or inflammatory disease and cancer, and to relate this to fasting blood glucose (FBG) and the presence of diabetes mellitus. METHODS: The study consisted of 7,762 subjects divided into four groups-nonobese/nondiabetic, obese/nondiabetic, nonobese/diabetic and obese/diabetic-based on the BMI classification and their FBG. Anthropometric characteristics were measured and blood was collected for the evaluation of fasted lipid profile, FBG and serum hs-CRP levels. RESULTS: Several clinical and biochemical characteristics were significantly different among the four groups: FBG, P < 0.001; total cholesterol (TC), P < 0.001; and triglyceride (TG), P < 0.001. The subjects with a serum hs-CRP >3 mg/dl had higher TC (P < 0.001), low-density lipoprotein cholesterol (LDL-C, P < 0.001), TG (P < 0.001), fat percentage (P < 0.001), and systolic and diastolic blood pressure (P < 0.001) compared with subjects with a serum hs-CRP <3 mg/dl. Multivariate analysis showed FBG, LDL-C, and waist circumference (WC) associated with increased serum hs-CRP levels (P < 0.001). CONCLUSIONS: FBG, LDL-C, WC and gender are independently associated with serum hs-CRP concentrations.

Mashhad stroke and heart atherosclerotic disorder (MASHAD) study: design, baseline characteristics and 10-year cardiovascular risk estimation.

OBJECTIVE: The Mashhad stroke and heart atherosclerotic disorder (MASHAD) study is a 10-year cohort study that aims to evaluate the impact of various genetic, environmental, nutritional and psychosocial risk factors on the incidence of cardiovascular events among an urban population in eastern Iran. METHODS: The MASHAD study comprises a cohort of 9704 individuals aged 35-65 years using a stratified cluster random sampling design. This cohort will be followed up until 2020, with follow-up examinations being undertaken every 3 years. Ten-year cardiovascular disease (CVD) risk estimation was determined using NCEP ATP III criteria. RESULTS: Overall, 88.4 % of women and 79.2 % of men (P < 0.001) had at least one lipid abnormality. The 10-year risk for CVD of <10, 10-20 and >20 % were observed to be 86.6, 11 and 2.5 %, respectively. Predicted risk of CVD > 10 % using the Framingham algorithm was considerably higher in men compared to women. Overall, 9.5 % [95 % confidence interval (CI) 8.9-10.1 %] of our subjects had prevalent CAD. CONCLUSION: The prevalence of CVD risk factors within our population is high compared to Western countries, indicating the necessity for interventional risk modifications.

Cardiovascular Risk Factors and Nutritional Intake are not Associated with Ultrasound-defined Increased Carotid Intima Media Thickness in Individuals Without a History of Cardiovascular Events.

BACKGROUND: Carotid ultrasound appears to be useful in the assessment of cardiovascular risk. In this study, we have assessed the carotid intima-media thickness (CIMT) in a group of individuals without a history of cardiovascular events. METHODS: A sample of 431subjects (189 [43.9%] males and 242 [56.1%] females) was obtained from an urban population using a stratified-cluster method in Mashhad stroke and heart atherosclerosis disorder study. None of the subjects had a history of the cardiovascular event. Carotid artery duplex ultrasound was used to determine the CIMT in all subjects, and to identify those with an abnormal value (CIMT [+]; i.e., CIMT ≥ 0.8 mm). Dietary intake of participants was assessed using a questionnaire for 24-h dietary recall. The relationship between anthropometric, biochemical and dietary data and CIMT were assessed. RESULTS: The mean age of subjects was 48.7 ± 8.0 years. Of the 431 patients, 118 (27.4%) were found to be CIMT (+). Of the cardiovascular parameters assessed, only age (odds ratio [OR] [95% confidence interval (CI)], 1.11 [0.56-4.34]; P < 0.01) and male gender (OR [95% CI], 1.14 [0.63-2.23]; P < 0.05) were significant independent predictors of ultrasound defined CIMT. Crude and total energy adjusted intake were not associated with the presence of CIMT (+). CONCLUSIONS: It appears that within a relatively young Iranian population of individuals without a history of cardiovascular event, the presence of CIMT (+) defined by duplex ultrasound cut-off value of ≥0.8 mm, did not associate with several modifiable cardiovascular risk factors or measures of dietary intake.

Changes in plasma level of heat shock protein 27 after acute coronary syndrome.

We assessed the association between serum heat shock protein 27 (Hsp-27)concentrations in patients with acute coronary syndrome (ACS) and compared them with healthy participants. Patients with ACS (n = 75) were recruited and their biochemical parameters were compared with 75 healthy participants. Heat shock protein 27 concentrations were measured from blood samples taken on admission and 12 hours after the onset of chest pain. In the patient group, Hsp-27 concentrations (31.62 [20.12-38.51] ng/mL) in the first blood samples were significantly (P < .001) higher than in control samples (20.12 [16.67-28.17] ng/mL). In patients, serum Hsp-27 levels on admission were significantly (P < .001) higher than for the samples collected 12 hours after the onset of chest pain (25.87 [15.52-31.62]); the latter did not differ significantly from samples of healthy controls. In conclusion, serum Hsp-27 concentrations are elevated in the early hours following ACS, but fall to levels near to those in healthy individuals after about 12 hours from the onset of chest pain.