Cardiovascular risk factors in males with hypertriglycemic waist (Tehran Lipid and Glucose Study)

BACKGROUND: Many studies performed on nontraditional risk factors have proposed a metabolic triad including increased serum level of apolipoprotein B, hyperinsulinemia and high small, dense LDL-C as a risk factor of cardiovascular diseases. Hypertriglycemic waist (increased waist circumference as well as high fasting triglyceride level) can be used as a simple criterion to predict the metabolic triad. The aim of this study was to investigate the prevalence of hypertriglycemic waist and the frequency of cardiovascular risk factors in the affected population. MATERIALS AND METHODS: The study was performed on 4169, 18-70 y-old male subjects of the population of Tehran Lipid and Glucose Study (TLGS). The subjects fell into four groups with respect to serum level of fasting triglycerides (Tg) and waist circumference (WC). Subjects of group 1 had serum Tg > or =1.8 mmol/l as well as WC > or =95 cm, while those of group 2 had Tg > or =1.8 mmol/l and WC <95 cm. The triglycerides level was less than 1.8 mmol/l in groups 3 and 4, whereas WC was > or =95 cm and lower than 95 cm, respectively. Cardiovascular risk factors, anthropometric and laboratory variables were compared between the groups. RESULTS: In total, 784 subjects had high serum levels of Tg as well as increased WC. The mean age of subjects was significantly higher in groups 1 and 3 compared to others (37+/-15, 48+/-14, 41+13 and 46+/-13 y of age in groups 4, 3, 2 and 1, respectively, P<0.001). The prevalence of cardiovascular risk factors was significantly higher in group 1 as compared with others. Systolic and diastolic blood pressure, body mass index and WC were significantly higher in group 1 than in the others. Serum total cholesterol, Tg and LDL-C were significantly higher in group 1 compared to others, whereas HDL-C was significantly lower in this group. The prevalence of subjects who had at least four risk factors was 75 and 8% in groups 1 and 4, respectively. CONCLUSION: Hypertriglycemic waist can be used as a simple criterion to predict cardiovascular risk factors.     

C-reactive protein in risk prediction of cardiovascular outcomes: Tehran Lipid and Glucose Study

BACKGROUND: The main aim of this study was to evaluate the additional utility of C-reactive protein (CRP) over traditional cardiovascular risk factors in risk prediction of cardiovascular outcomes. METHODS: 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. Those cases that were free of cardiovascular disease at baseline (126 subjects) were matched to 259 controls for age and sex. High sensitivity CRP and traditional cardiovascular risk factors were measured at baseline. RESULTS: 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 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. CONCLUSION: It seems that for short-term prediction of cardiovascular disease outcomes in the Iranian population, measurement of CRP has no additional value when traditional cardiovascular risk factors are known.     

Adherence to dietary recommendations and risk of metabolic syndrome: Tehran Lipid and Glucose Study

The “Dietary Guidelines for Americans Adherence Index (DGAI) 2005” was developed based on the latest dietary recommendations to assess the contribution of dietary patterns to chronic diseases. The objective of the study was to evaluate the association of dietary patterns as measured by the modified DGAI 2005 with both the prevalence of metabolic syndrome (MetS) and the MetS risk factors. In this population-based cross-sectional study, 2504 adults (1120 men and 1384 women), aged 19 to 70 years, were randomly selected from the third phase of the Tehran Lipid and Glucose Study. Usual dietary intake was assessed using a food frequency questionnaire, and the DGAI score was calculated for all participants. Metabolic syndrome was defined according to Adult Treatment Panel III diagnostic criteria. Generally, mean values for waist circumference, triglyceride, and blood pressure were significantly higher among male compared with female participants (P < .05). Low high-density lipoprotein cholesterol was the most prevalent MetS risk factor among both men (65.4%) and women (72.5%). After mutual adjustment for confounding variables, those in the highest quartile category of DGAI had a 21% lower prevalence of MetS risk factors clustering than those in the lowest quartile (odds ratio [OR], 0.79; confidence interval [CI], 0.63-0.92; P for trend = .02). Being in the highest quartile category of DGAI score was shown to significantly reduce the prevalence of hyperglycemia (OR, 0.64; CI, 0.47-0.86; P for trend < .001), hypertension (OR, 0.76; CI, 0.70-0.93; P for trend = .05), and low high-density lipoprotein cholesterol (OR, 0.69; CI, 0.54-0.94; P for trend < .001). Consuming a diet consistent with new dietary guidelines was associated with lower risk of MetS prevalence and some of its risk factors. Preventive interventions for MetS risk reduction should focus on the overall dietary pattern.     

Determinants of serum HDL-C level in a Tehran urban population: the Tehran Lipid and Glucose Study

BACKGROUND AND AIM: Decreased serum high-density lipoprotein cholesterol (HDL-C) is one of the most common lipid disorders in patients with coronary artery disease (CAD). Existing evidence suggests that every 1 mg/dL decrease in serum HDL-C increases the risk of CAD by 2-3%. This study was performed in the year 2000 to study HDL-C determinants in a Tehran population. METHODS AND RESULTS: We studied 9514 subjects (3942 men and 5572 women) aged 20-69 years, who participated in the Tehran Lipid and Glucose Study (TLGS), completed a personal history questionnaire (especially concerning physical activity and cigarette smoking), and underwent a clinical examination including anthropometric and blood pressure measurements. Serum total cholesterol, triglyceride and HDL-C levels were measured, and OGTT was used to define diabetic patients according to WHO criteria. The women had a significantly higher mean HDL-C level than the mean (45 +/- 11 vs 38 +/- 9 mg/dL; p < 0.001); low HDL-C levels (< 35 mg/dL) were observed in 31% of the men and 13% of the women (p < 0.001). Obese subjects (BMI > or = 30 kg/m2) had a significantly lower HDL-C level than the normal subjects (42 +/- 11 vs 44 +/- 11 mg/dL: p < 0.001), and those with truncal obesity (WHR > or = 0.95 in men and > or = 0.8 in women) lower HDL-C levels than the normal subjects (37 +/- 9 vs 39 +/- 10 mg/dL in men and 44 +/- 11 vs 42 +/- 11 mg/dL in women; p < 0.001 for both). Smokers had a significantly lower HDL-C level than non-smokers (38 +/- 10 vs 43 +/- 11 mg/dL; p < 0.001) and a low HDL-C level was twice as common (36.4 vs 18.2%). Passive smokers also had lower HDL-C levels (42 +/- 11 vs 43 +/- 11 mg/dL; p < 0.001). Mean serum HDL-C was significantly lower in hypertriglyceridemic than those with normal triglycerides levels (men: 4 +/- 8 vs 40 +/- 9 mg/dL, p < 0.001; women: 40 +/- 10 vs 47 +/- 11 mg/dL, p < 0.01). Mean HDL-C levels were similar in subjects with different degrees of physical activity, as well as between diabetics and non-diabetics and hypertensive and normotensive subjects. Multiple stepwise regression analysis showed that the determinants of serum HDL-C levels were, in order of entering the model: hypertriglyceridemia (OR 3.4, p < 0.001), male sex (OR 3.1, p < 0.001), cigarette smoking (OR 1.7, p < 0.001), obesity (OR 1.4, p < 0.01), age (OR 0.9, p < 0.05), high WHR (OR 1.2, p < 0.05), and passive smoking (OR 1.1, p < 0.05). Physical activity, hypertension, and diabetes mellitus did not enter the predictive model. CONCLUSION: Apart from age and sex which are constitutional, and unmodifiable variables, the determinants of HDL-C level (hypertriglyceridemia, obesity, truncal obesity, cigarette smoking, and passive smoking) can be used in community CAD prevention programmes.     

Cardiovascular risk factors in the elderly

The relation of total plasma cholesterol to the incidence of coronary heart disease (CHD) was one of the first findings of the Framingham Heart Study. The Framingham data established that a 1% increase in total cholesterol produced a 2% increase in CHD incidence. This relation has now been shown to apply to persons aged 60 to 70 years as well as to younger persons. The risk of CHD associated with various factors, including total cholesterol, low- and high-density lipoprotein and triglyceride levels, uric acid, blood glucose level, fibrinogen level and hypertensive blood pressure, is discussed with particular reference to the elderly. New data from the Framingham group show that increased left ventricular mass may be a significant risk factor for CHD, particularly among the elderly.     

Electrocardiographic abnormalities improve classification of coronary heart disease risk in women: Tehran Lipid and Glucose Study

ObjectivesTo examine the added value of electrocardiogram (ECG) abnormalities beyond the Framingham risk score (FRS) in risk stratification for coronary heart disease (CHD) in a population of Middle Eastern women.MethodsThe study population consisted of 2568 women aged ≥30 years, free from CHD symptoms and with no major Q or QS wave or complete left-bundle branch block in their baseline ECG. ECG abnormalities included ST depression (Minnesota codes 4.1–4.2), or T-wave items (Minnesota codes 5.1–5.2). Participants were categorized into 3 groups, according to their FRS. Cox regression analysis was used to estimate the hazard ratios (HR) of CHD events for ECG abnormalities among each FRS group. Net Reclassification Index (NRI) was used as the measure of predictive ability added to the FRS by ECG abnormalities.ResultsDuring 9.3 years, 127 CHD events occurred. In the FRS adjusted analysis, the HRs (95%CI) of CHD events were 3.69 (0.87–15.68), 3.82 (2.01–7.23) and 1.39 (0.47–4.16) for ECG abnormalities in each FRS category (i.e. 0–4.9%, 5–19.9 and ≥20%, respectively). Addition of ECG abnormalities to FRS did not significantly increase the C-statistics (0.838), but improved the predictive ability of the FRS by 20.8 (95% CIs 5.0–38.9) using the cut point free NRI.ConclusionAmong women, only in the intermediate risk group, ECG abnormalities were independently associated with increased risk of developing CHD. Addition of the ECG abnormalities to the FRS improved the classification of coronary heart disease risk, especially in this group.     

A 10-Year Cardiovascular Risk in Adults with Different Levels of Spiritual Health: Tehran Lipid and Glucose Study

Background:Previous studies have shown that spiritual experience may reduce cardiovascular disease (CVDs). However, little is known about the relationship between spiritual health and the gender-specific risk of CVDs in communities with different cultures.Methods:A total of 3249 individuals (53.7% female, 75.0% middle-aged) participated in the Tehran Lipid and Glucose Study (TLGS) from 2015 to 2017 were included. Based on the ACC/AHA pooled cohort equation, CVD risk over ten years was examined. Spiritual health was measured using a developed tool for measuring spiritual health in Muslim populations (SHIMA-48). Linear regression models were used to assess the association between spiritual health and ACC/AHA risk scores. The natural logarithm scale was calculated to consider the normal distribution hypothesis of the regression model.Results:The current results suggest a slight but significant increase in the mean of spiritual health in women compared to men in both cognitive/emotional and behavioral dimensions (P < 0.001). In both sexes, a higher prevalence of smoking was observed in participants with lower levels of spiritual health (P < 0.004). In men, compared to those with a low level of spiritual health (the first tertile), the logarithm of the ACC-AHA risk score was reduced by 0.11 (P = 0.004) and 0.18 (P < 0.001) for those in the second and third tertiles of spiritual health, respectively. This result may be attributed to higher cigarette smoking among the latter group. Similar results were not observed in women.Conclusions:Current results indicate a gender-specific association between spiritual health and cardiovascular disease risk. Our findings imply that promoting spiritual health can be considered an effective strategy in future preventive interventions, primarily by controlling the desire to smoke in men.     

Low-carbohydrate diet and cardiovascular diseases in Iranian population: Tehran Lipid and Glucose Study

Background and aimsStudies indicated that the risk of cardiovascular disease (CVD) in association to greater adherence to low-carbohydrate diet (LCD) differs in various populations. In this study, we aimed to assess the association of LCD score with the risk of CVD events in a prospective population-based study.Methods and resultsCVD-free participants (n = 2188) were recruited from the Tehran Lipid and Glucose Study (2006–2008) and followed for a mean of 6.7 years. Using a valid and reliable 168 item semi-quantitative food frequency questionnaire, the LCD score was determined based on the percentage of energy as carbohydrate, protein, and fat, which ranged from 0 to 12. Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate the hazard ratios (HRs) and 95% confidence interval (CI) of CVD across tertiles of LCD score in women and men.Mean ± SD age of participants (44.8% male) was 38.8 ± 13.0 years, and median (25–75, interquartile range) of the LCD score was 6 (4–8) at baseline. During follow-up, 77 (3.5%) new cases of CVD were identified. After adjustment for sex, age, body mass index, physical activity, smoking, energy intake, diabetes, and hypertension, there was no association between the LCD score and risk of CVD outcomes in all participants (HR = 0.93; 95% CI: 0.86–1.02) and women (HR = 1.13; 95% CI: 0.94–1.36); however, the LCD score was associated with an 11% reduced incidence of CVD events in men (HR = 0.89; 95% CI: 0.80–0.98), (P for trend: 0.028).ConclusionFindings showed that higher adherence to LCD may be associated with a lower risk of CVD outcomes in men but not in women.     

Prevalence of metabolic syndrome in an urban population: Tehran Lipid and Glucose Study

The aim of the present investigation was to determine the prevalence of the metabolic syndrome among 103,68 of the adults (4,397 men and 5,971 women) aged 20 years and over, participating in the Tehran Lipid and Glucose Study. The metabolic syndrome was defined by the presence of three or more of the following components: abdominal obesity, hypertriglyceridemia, low HDL-C, high blood pressure, and high fasting glucose. The unadjusted prevalence of metabolic syndrome in the study population was 30.1% (CI 95%: 29.2-31.0) and age-standardized prevalence was 33.7% (CI 95%: 32.8-34.6). The prevalence increased with age in both sexes. The metabolic syndrome was more commonly seen in women than in men (42% vs. 24%, P<0.001). Low HDL-C was the most common metabolic abnormality in both sexes. Except for high FPG, all abnormalities were more common in women than in men (P<0.001). Most of those with metabolic syndrome had three components of the syndrome (58%), 33% had four, and 9% had five components. This report on the metabolic syndrome from Iran shows a high prevalence of this disorder. Efforts on promoting healthy diets, physical activity, and blood pressure control must be undertaken.     

Familial clustering of obesity and the role of nutrition: Tehran Lipid and Glucose Study

OBJECTIVE: To clarify the hypothesis that parent's dietary intakes are associated with their offspring's body mass index. DESIGN: Observational analytical cross-sectional survey among inhabitants of district 13 in the east of Tehran. SUBJECTS: A total of 117 healthy families comprising 474 subjects including 240 offspring (3-25 y old). MEASUREMENTS: Weight and height were measured by a standard protocol and body mass index (kg/m(2)) was calculated. Dietary intakes were assessed by means of a 2 day dietary recall questionnaire. RESULTS: The prevalence of overweight was 11.8% in offspring of normal-weight parents, 19.0% in offspring of overweight fathers and normal-weight mothers, 25.4% in offspring of overweight mothers and normal-weight fathers and 40.8% in offspring with both parents overweight. The Offspring's overweight was significantly and independently associated with high-energy intake of both parents (odds ratio; 95% CI 2.7; 1.6-4.5). Adjusted for the sex of parents, the chances of offspring being overweight were higher in overweight (3.8; 1.5-9.2) and high-energy-intake mothers (2.6; 1.2-5.6) and high-energy-intake fathers (2.0; 1.1-3.9) as compared with children of normal-weight parents. High fat intake of husbands was an independent risk factor increasing the chances of their wives being overweight (2.1; 1.5-3.6) and vice versa (1.8; 1.2-2.8). CONCLUSION: The observed familial obesity pattern was shown to be associated with the familial dietary intakes. Hence, familial intervention seems essential to stop the accelerated rise in the prevalence of overweight and obesity in our community.     

Gestational diabetes mellitus and hypertensive disorder of pregnancy play as spouse-pair risk factors of diabetes and hypertension: Insights from Tehran Lipid and Glucose Study

BackgroundComplicated pregnancies by gestational diabetes mellitus (GDM) and hypertensive disorder of pregnancy (HDP) are relatively common worldwide. The evidence is still inconclusive regarding the role of GDM and HDP as spousal risk factor of diabetes (DM) and hypertension (HTN). This study aimed to determine the spousal risk of development of DM and/or HTN in the context of GDM and/or HDP.MethodsThis population-based cohort study involved couples who participated in Tehran Lipid and Glucose Study. A total of 3650 pairs of spouses were identified, and among them, 2820 met the inclusion criteria. Included participants, followed up 3-year intervals visits from 1999 to 2018. All pairs underwent standard data collection. GDM and HDP were the main exposure of interest in females, and DM and HTN were the main outcomes in both females and their spouses. Cox proportional hazard regression models were used for both females and their spouses, adjusting for age, consanguinity, waist-to-height ratio, physical activity, smoking, and parity.ResultsOf 2820 females, 558 (19.79 %) had histories of GDM or HDP, and 72 (2.55 %) experienced both. Among females who experienced GDM and HDP, 24 (33 %) and 31 (33 %) developed DM and HTN during the follow-up. The corresponding numbers were 89 (16 %) and 191 (34 %) for those who experienced GDM or HPD, and 274 (13 %) and 623 (28 %) for the non-risk factors group. The incidences of DM were 9 (12 %), 100 (18 %), and 373 (17 %) for males whose spouses experienced both GDM and HDP, either one or none of them, respectively. Among males in these groups, 20 (28 %), 150 (27 %), and 630 (29 %) developed HTN, respectively. Females who never had history of GDM and HDP have 34 % (95 % CI: 21, 45) less hazard of being diabetic than their spouses if they have the same age and waist to hip ratio. In cases with histories of both GDM and HDP, the risk of females increases to 3.05 (95 % CI: 1.43, 6.52) times of their spouses. Also, females who had experienced GDM (HR: 3.51, 95 % CI: 2.23, 5.53), or HDP (HR: 2.80, 95 % CI: 1.72, 4.56) were at higher risk of developing DM compared with females who never had GDM or HDP. We found that females with neither GDM nor HDP were more likely than males to be hypertensive in the future by the hazard ratio of 1.21 (95 % CI: 1.06, 1.39).ConclusionsComplicated pregnancies by GDM and/or HDP were associated with increased risk of development DM and HTN in later life of females and their spouses. Further studies are required to confirm these results. Preventive care programs should be considered pregnancy complications as couple-based risk factors for subsequent DM and HTN.     

Fatty acid quality and quantity of diet and risk of type 2 diabetes in adults: Tehran Lipid and Glucose Study

Aim

Studies suggest that fatty acid intake may be an important determinant of type 2 diabetes mellitus (T2DM). This study aims to prospectively examine the association between fatty acid quantity and quality with risk of T2DM in adults.

Inverse association between fruit, legume, and cereal fiber and the risk of metabolic syndrome: Tehran Lipid and Glucose Study

Aims

To evaluate the association between total dietary fiber and its types and sources with the risk of MetS.

Methods

This population-based cross-sectional study was conducted on a representative sample of 2 457 adults (1 327 male and 1 130 female), aged 19-84 years. Dietary intake was assessed using a validated semiquantitative food-frequency questionnaire. Anthropometrics, blood pressure, and fasting blood glucose and lipids were measured according to standard protocols. The MetS was defined according to definition by Adult Treatment Panel III.

Results

Multivariate-adjusted odds ratio of MetS between highest and lowest quartiles was 0.53 (95% CI: 0.39-0.74; P for trend <0.05) for total dietary fiber, 0.60 (0.43-0.84; P for trend <0.05) for soluble fiber, and 0.51 (0.35-0.72; P for trend <0.05) for insoluble fiber. Among sources of dietary fiber, fruit fiber (OR: 0.51; 95% CI: 0.37-0.72), cereal fiber (0.74; 0.57-0.97), and legume fiber (0.73; 0.53-0.99) were inversely associated with the risk of MetS, after adjustment for confounding factors. Intake of vegetable fiber and nut fiber were unrelated to the risk of MetS.

Conclusions

Total dietary fiber, soluble- and insoluble fiber, fruit fiber, cereal fiber and legume fiber were associated with a protective effect for the presence of MetS among this Tehranian population.     

老年高血压糖尿病前期患者心血管危险因素分析

目的调查老年高血压合并糖尿病前期患者心血管危险因素分布。方法收集年龄≥60岁、既往无糖尿病病史、且入院空腹血糖(FPG)<7.0mmol/L的高血压患者388例,以空腹血糖受损(IFG)诊断标准为FPG≥5.6mmol/L,分为A组260例(FPG<5.6mmol/L)、B组65例(5.6mmol/L≤FPG<6.1mmol/L)及C组63例(6.1mmol/L≤FPG<7mmol/L),比较3组各种心血管危险因素分布的差异。结果 338例患者中,IFG患病率33.0%。与A组比较,B组和C组高血压≥2级或高血压高危、左心室舒张功能障碍、颈动脉增厚比例等无明显变化(P>0.05)。结论尽管未发现IFG与其他心血管危险因素有关,但糖代谢异常在此类患者中的影响应予重视。     

Haplotype analysis of Apo AI-CIII-AIV gene cluster and lipids level: Tehran Lipid and Glucose Study

Iranian populations show an increased tendency for abnormal lipid levels and high risk of Coronary artery disease. Considering the important role played by the ApoAI-CIII-AIV gene cluster in the regulation of the level and metabolism of lipids, this study aimed at elucidating the association between five single nucleotide polymorphisms on the Apo11q cluster gene and lipid levels. A cross-sectional study of 823 subjects (340 males and 483 females) from the Tehran lipid and glucose study (TLGS) was conducted. Levels of TG, Chol, HDL-C, Apo AI, Apo AIV, Apo B, and Apo CIII were measured, and the selected segments of the APOAI-CIII-AIV gene cluster were amplified by PCR and the polymorphisms were revealed by RFLP using restriction enzymes. The allele frequencies for each SNP between males and females were not significantly different. The distribution of Genotypes and alleles was in Hardy-Weinberg equilibrium except for Apo AI (+83C>T). The results showed a significant association between TG, HDL-C, HDL(2), Apo AI, and Apo B levels and the presence of some alleles in the polymorphisms studied. After haplotype analysis not only did the association between these variables and SNPs remain but also levels of Chol and LDL-C were added. This study demonstrates that the level of lipids such as TG, HDL-C, HDL(2), Apo AI, and Apo B, maybe regulated partly by genetic factors and their haplotype within the Apo11q gene cluster.     

Contribution of Glomerular Filtration Rate to 10‐Year Cardiovascular and Mortality Risk Among Hypertensive Adults: Tehran Lipid and Glucose Study

The authors tested the hypotheses that (1) estimated glomerular filtration rate (eGFR) predicts cardiovascular disease (CVD) or mortality risk among hypertensive patients, (2) associations are curvilinear, and (3) diabetes modifies these associations. Data from a 10‐year follow‐up of 3179 hypertensive patients 18 years and older were analyzed. Measurements included eGFR and CVD risk factors, and outcomes were CVD and mortality. Cox models were developed to estimate the hazard ratios (HRs) for different endpoints for a 1‐standard deviation (SD) increment in eGFR. The nonlinearity in associations was examined by cubic spline method. Mean (SD) age of the participants (59.0% women) was 56.3 (12.3) years. During follow‐up (10‐year), 629 incident cases of CVD (296 women) and 320 deaths (130 women) were documented. The incidence rate of different outcomes decreased across increasing eGFR quintiles. Among men, irrespective of their diabetes status, eGFR was inversely associated with risk of mortality. Among women, irrespective of their diabetes status, eGFR did not predict mortality. Neither among men nor among women did eGFR predict CVD or coronary heart disease. No evidence was found for nonlinearity in these associations. eGFR was independently associated with mortality among hypertensive men with or without diabetes. When information on traditional CVD risk factors was available, eGFR provided no additional predictive value for CVD.