Analysing cardiovascular risk factors and related outcomes in a middle-aged to older adults population in Iran: a cohort protocol of the Shiraz Heart Study (SHS)

Can anthropometric indices predict the chance of hypertension? A multicentre cross-sectional study in Iran

OBJECTIVES

This study aims to assess the prevalence of hypertension (HTN), and determine the relationship between HTN and anthropometric indices including fat distribution, body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) in Shiraz Heart Study.

SETTING

In this cross-sectional study, subjects were enrolled in 25 clinics in Shiraz. I.R. Iran between 2019 and 2021.

PARTICIPANTS

A total number of 7225 individuals were selected, aged between 40 and 70 years of whom 52.3% were female. Among the people living in Shiraz, individuals living far from clinics, cases of mental or physical disabilitiy and documented cardiovascular diseases were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome: The association of body composition, WHR, WHtR and BMI with HTN.

SECONDARY OUTCOME

The sensitivity and specificity of the WHtR for the prediction of HTN.

RESULTS

HTN prevalence was 19.3%. Obesity prevalence was estimated to be 28.5%. WHR and lean body mass showed a significant association with HTN (p<0.05). Receiver operating characteristic for WHtR yielded an area under the curve of 0.62 (95% CI 0.61 to 0.64) and 0.63 (95% CI 0.62 to 0.65) for males and females, respectively. The optimal threshold value yielded 0.54 in men and 0.61 in women. The sensitivity was 72.3% and 73.9% in women and men, with specificity of 48.4% and 44.3%, respectively.

CONCLUSION

HTN had a meaningful association with all the noted anthropometric indices. WHtR performed well as a predictor of HTN.

Ten-year atherosclerosis cardiovascular disease (ASCVD) risk score and its components among an Iranian population: a cohort-based cross-sectional study

Background

Atherosclerotic cardiovascular disease (ASCVD) continues to be the first cause of mortality globally. Effective preventive strategies require focused efforts to clarify ASCVD risk factors in different subgroups of a population. This study aimed to identify individuals at higher risk of ASCVD among Shiraz University employees to guide decision-making for primary prevention.

Methods

This cohort-based cross-sectional study was conducted on data of 1191 participants (25–70 years old) from Shiraz University employees selected by systematic random sampling. The 10-year ASCVD risk was calculated with an ASCVD risk score estimator developed by the American College of Cardiology/American Heart Association (ACC/AHA). To analyze the data, descriptive and chi-square tests were used. All statistical analyses were conducted using the SPSS version 16.0 software. The p-value < 0.05 was considered a significant level.

Results

This study demonstrated that 75.3% of the participants had low risk scores, whereas 13.2% and 2.5% of them had intermediate and high risk scores, respectively. Additionally, it revealed that among women 93.7%, 2.7%, and 0.6% had low intermediate and had high risk scores, respectively, whereas among men, 61.5%, 21.1%, and 3.9% had low intermediate and high risk scores, respectively. Based on the results of the chi-square test, men were significantly more prone to ASCVD (38.5%) than women (6.3%) were. Interestingly, 40.9% of known cases of hypertension had uncontrolled blood pressure, and 62.5% of individuals without any history of hypertension, who were considered new cases of hypertension, had abnormal blood pressure. Furthermore, 38.5% of diabetic patients and 1.6% of people who did not have a history of diabetes had abnormal serum fasting blood sugar.

Conclusion

It was revealed that nearly 15.7% of participants were at intermediate and high risk of developing ASCVD in the next 10 years with greater risk in men. Considerably, some of hypertensive and diabetic participants had uncontrolled blood pressure and blood sugar levels, respectively. New cases of diabetes and hypertension were also recognized in our study. Therefore, to address the primary prevention of ASCVD in this population, it is necessary to have plans for targeted interventions, which can be effective in modifying their risk factors.

Potential of four definitions of metabolic syndrome to discriminate individuals with different 10-year cardiovascular disease risk scores: a cross-sectional analysis of an Iranian cohort

OBJECTIVE

We aimed to reveal the potential of four different metabolic syndrome (Mets) definitions to differentiate subjects according to 10-year risk of cardiovascular disease.

DESIGN

A cross-sectional analysis of a prospective cohort.

SETTING

This study used baseline data from the Shiraz Heart Study, a prospective cohort study in Shiraz, Iran. Participants were screened against Mets definitions including modified WHO, National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), American Heart Association (AHA) and International Diabetes Federation (IDF). Also, Framingham risk score (FRS) and atherosclerotic cardiovascular disease (ASCVD) risk score were determined for each participant.

PARTICIPANTS

A total number of 7225 participants of both genders entered the study. They were selected through defined family physician centres in different geographical areas. Urban residents with no migration plan were included. Those who were far from study centres or with disabilities that made them incapable to cooperate were excluded.

RESULTS

Participants were 47.68% (N=3445) male with the mean age of 52.13±8.00 years. The number of subjects with Mets identified by WHO was the lowest (N=1676), while the percentage of subjects with high risk score was the highest, 17.1% (N=282) in FRS and 9.8% (N=162) in ASCVD risk score. There were statistically significant differences in the mean risk scores between participants with and without Mets according to AHA, WHO and NCEP ATP III definitions (p<0.001). In IDF definition, the risk scores of subjects with Mets were not statistically different compared with peers without Mets, neither based on FRS (p=0.247) nor ASCVD risk score (p=0.193).

CONCLUSIONS

IDF was not the appropriate definition for discrimination of subjects with Mets and/or those at high risk of future cardiovascular events. AHA, WHO and NCEP ATP III definitions were effective to discriminate subjects with Mets from peers without Mets.

Pathways leading to prevention of fatal and non-fatal cardiovascular disease: An interaction model on 15 years population-based cohort study

BACKGROUND

A comprehensive study on the interaction of cardiovascular disease (CVD) risk factors is critical to prevent cardiovascular events. The main focus of this study is thus to understand direct and indirect relationships between different CVD risk factors.

METHODS

A longitudinal data on adults aged ≥35 years, who were free of CVD at baseline, were used in this study. The endpoints were CVD events, whereas their measurements were demographic, lifestyle components, socio-economics, anthropometric measures, laboratory findings, quality of life status, and psychological factors. A Bayesian structural equation modelling was used to determine the relationships among 21 relevant factors associated with total CVD, stroke, acute coronary syndrome (ACS), and fatal CVDs.

RESULTS

In this study, a total of 3161 individuals with complete information were involved in the study. A total of 407 CVD events, with an average age of 54.77(10.66) years, occurred during follow-up. The causal associations between six latent variables were identified in the causal network for fatal and non-fatal CVDs. Lipid profile, with the coefficient of 0.26 (0.01), influenced the occurrence of CVD events as the most critical factor, while it was indirectly mediated through risky behaviours and comorbidities. Lipid profile at baseline was influenced by a wide range of other protective factors, such as quality of life and healthy lifestyle components.

CONCLUSIONS

Analysing a causal network of risk factors revealed the flow of information in direct and indirect paths. It also determined predictors and demonstrated the utility of integrating multi-factor data in a complex framework to identify novel preventable pathways to reduce the risk of CVDs.

Fragmented QRS as an early predictor of left ventricular systolic dysfunction in healthy individuals: a nested case-control study in the era of speckle tracking echocardiography

BACKGROUND

Several studies addressed the association between fragmented QRS (fQRS) on 12-lead EKG and left ventricular (LV) dysfunction in patients with a variety of cardiovascular disorders. We tested such association in healthy individuals.

METHODS

Out of 500 healthy participants without -overt cardiovascular disease from the Shiraz Heart Study cohort, we identified 20 subjects with fQRS (cases) and 20 peers without fQRS (controls). Global LV longitudinal strain (GLS) was measured by speckle tracking echocardiography in the two groups. Comparison was made between case and control groups by using chi-square or independent sample t-test or ANOVA.

RESULTS

Age, gender, ejection fraction, LV volume and dimensions did not differ between the case and the control groups. Overall, 14 subjects out of 40 had reduced GLS (≤20%) and 10 of them (25%) had fQRS. GLS was significantly lower in the group with fQRS than in the control group (19.9 ± 1.8 vs 21.4 ± 1.6; p = 0.009).

CONCLUSIONS

Healthy subjects with fQRS present regional LV systolic dysfunction, assessed by GLS, in the presence of a normal ejection fraction. These data suggest that fQRS may be a promising tool to identify apparently healthy subjects with regional LV systolic dysfunction.

Magnitude of the Quality Assurance, Quality Control, and Testing in the Shiraz Cohort Heart Study

To determine the conclusive integrity in the Shiraz Cohort Heart Study (SCHS) project, management began quality assurance (QA) and quality control (QC) of the collected data throughout the study end-points. The QA is a focused process that prevents and detects data collection errors and verification of intended requirements in the SCHS. The QC is a subset of QA intended to capture errors in processing data through testing and preventive processes to identify problems, defects, or intended requirements. SCHS involved 10,000 males and females aged 40-70 over a 10-year follow-up period with cardiovascular diseases (CVDs) in the city of Shiraz, Iran. The study measured events and access to preventive care in Shiraz city. The SCHS identified unique barriers to select national study models in developing standardized measures related to variations in ethnicity, religion, cross-cultural considerations, and others. A suggested response to this problem was to develop a mechanism to standardize elements of the questionnaire, study design, and method of administration. This action was based on the geographically normal distribution of the Family Physician Health and Medical Services in Shiraz. Important QA and QC decisions were developed and adopted in the construction of the SCHS and follow-up to ensure conclusive integrity.

"Playing with Little Behaviors"; Physical Activity Promotion by Gamified Education in Young Boys

Background:

Physical activity is affecting every aspect of our life. A sedentary lifestyle can be the risk factor for noncommunicable diseases (NCD) or premature death all over the world. Several studies demonstrate that school-based physical activity promotion is an important solution to make healthy behaviors, especially in children and adolescents. In this vein, the current research evaluates a model for physical activity, which is promoted through a game among high school students.

Methods:

In this study, 47 high school's 10^th-grade boys from Tehran were requited. The game scenario included the suggestion of some behaviors which can increase daily physical activity by each student, like or dislike each behavior by other students, counting likes, selecting the most-liked behaviors, and rewarding their proposers. After a week, the behavioral recall was assessed and compared with a control group who had been heard these behaviors in the class without gamification.

Results:

The participants in the game could recall physical activity behaviors significantly more than peers in the control group.

Conclusions:

The findings show gamification could significantly improve the effectiveness of education for normal behaviors in physical activity.