Impact of metabolic syndrome on ischemic heart disease - a prospective cohort study in an Iranian adult population: Isfahan Cohort Study.

BACKGROUND: The impact of the metabolic syndrome among populations in the Middle East region is unknown; we therefore examined the association between the syndrome and the risk of ischemic heart disease (IHD) in an Iranian population. METHODS AND RESULTS: The Isfahan Cohort Study (ICS) prospectively followed 6146 Iranian people (51.8% women, aged 35-75 years) from three cities and their rural districts who were initially free of ischemic heart disease. During the 5 year follow-up, 209 (56% men) cases of ischemic heart disease were detected. The metabolic syndrome was defined by the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII). End points were defined as fatal and nonfatal myocardial infarction, sudden cardiac death and unstable angina. A clear dose-response relationship was found between the number of metabolic risk factors and the incidence of IHD, with the hazard ratios increasing dose-dependently from 1.72 (95% CI 0.86-3.46) for only one to 1.97 (1.00-3.90), 2.85 (1.45-5.58) and 4.44 (2.25-8.76) for 2, 3 and ≥4 metabolic syndrome component respectively, relative to those with no component. The adjusted hazard ratio (95% CI) associated with the metabolic syndrome was 1.58 (1.06-2.35) in men and 1.72 (1.08-2.74) in women for IHD. The contribution of metabolic syndrome to the IHD risk was particularly strong among smokers although there was no significant interaction. CONCLUSIONS: The metabolic syndrome by NCEP/ATPIII definition is a major determinant of ischemic heart disease in this middle-aged Iranian population, especially among smokers.

The Isfahan cohort study: rationale, methods and main findings.

A 10-year longitudinal population-based study, entitled the Isfahan Cohort Study (ICS) is being conducted. The ICS commenced in 2001, recruiting individuals aged 35+ living in urban and rural areas of three counties in central Iran, to determine the individual and combined impact of various risk factors on the incidence of cardiovascular events. After 24379 person-years of follow-up with a median follow-up of 4.8 years, we documented 219 incident cases of ischemic heart disease (IHD) (125 in men and 94 in women) and 57 incident cases of stroke (28 in men and 29 in women). The absolute risk of IHD was 8.9 (7.8-10.2) per 1000 person-years for all participants, 10.6 (8.8-12.5) per 1000 person-years for men and 7.4 (6.0-9.0) per 1000 person-years for women. The respective risk of ischemic stroke was 2.3 (1.7-3.0), 2.3 (1.6-3.3) and 2.3 (1.5-3.2) per 1000 person-years. The risk of IHD was approximately 3.5-fold higher in the presence of hypertension, followed by diabetes mellitus and hypercholesterolemia with near 2.5- and twofold higher risk, respectively. This cohort provides confirmatory evidence of the ethnic differences in the magnitude of the impact of various risk factors on cardiovascular events. The differences may be due to varying absolute risk levels among populations and the existing ethnic disparities for using western risk equations to local requirements.

Epidemiology of amyotrophic lateral sclerosis in Isfahan, Iran.

BACKGROUND: Few studies are carried out on the epidemiology of amyotrophic lateral sclerosis (ALS) in Middle East with no reports from Iran. OBJECTIVE: To determine the epidemiological and clinical features of ALS amongst the Iranian population living in Isfahan, Iran. METHODS: Medical records of all hospitals with a neurology department and outpatient neurology clinics in Isfahan province from 2002 to 2006 were reviewed, and all patients with the diagnosis of ALS according to El Escorial diagnostic criteria were extracted and related demographic and clinical data were gathered and analyzed. RESULTS: We found 98 new patients (66 men and 32 women) with definite, probable, or possible ALS. The average annual incidence was 0.42/100,000, with the highest incidence rate amongst those aged 70-74. On 21 March 2006, the crude prevalence was 1.57/100,000. Median survival from onset was 48 months (95% confidence interval 34-61) and survival rates for 1, 3,and 5 years after the onset were 94%, 66%, and 32%, respectively. CONCLUSIONS: The incidence and prevalence of ALS in the Iranian population seems to be lower compared to other populations and the survival of patients was longer than previously reported.