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Background: Diabetes is a strong risk factor for cardiovascular disease (CVD).The relative role of various lipid measures in determining CVD risk in diabetic patients is still a subject of debate. We aimed to compare performance of different lipid measures as predictors of CVD using discrimination and fitting characteristics in individuals with and without diabetes mellitus from a Middle East Caucasian population., Methods: The study population consisted of 1021 diabetic (men = 413, women = 608) and 5310 non-diabetic (men = 2317, women = 2993) subjects, aged > or = 30 years, free of CVD at baseline. The adjusted hazard ratios (HRs) for CVD were calculated for a 1 standard deviation (SD) change in total cholesterol (TC), log-transformed triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), non-HDL-C, TC/HDL-C and log-transformed TG/HDL-C using Cox proportional regression analysis. Incident CVD was ascertained over a median of 8.6 years of follow-up., Results: A total of 189 (men = 91, women = 98) and 263(men = 169, women = 94) CVD events occurred, in diabetic and non-diabetic population, respectively. The risk factor adjusted HRs to predict CVD, except for HDL-C, TG and TG/HDL-C, were significant for all lipid measures in diabetic males and were 1.39, 1.45, 1.36 and 1.16 for TC, LDL-C, non- HDL-C and TC/HDL-C respectively. In diabetic women, using multivariate analysis, only TC/HDL-C had significant risk [adjusted HR1.31(1.10-1.57)].Among non-diabetic men, all lipid measures, except for TG, were independent predictors for CVD however; a 1 SD increase in HDL-C significantly decreased the risk of CVD [adjusted HR 0.83(0.70-0.97)].In non-diabetic women, TC, LDL-C, non-HDL-C and TG were independent predictors.There was no difference in the discriminatory power of different lipid measures to predict incident CVD in the risk factor adjusted models, in either sex of diabetic and non-diabetic population., Conclusion: Our data according to important test performance characteristics provided evidence based support for WHO recommendation that along with other CVD risk factors serum TC vs. LDL-C, non-HDL-C and TC/HDL-C is a reasonable lipid measure to predict incident CVD among diabetic men. Importantly, HDL-C did not have a protective effect for incident CVD among diabetic population; given that the HDL-C had a protective effect only among non- diabetic men.

Objective: To investigate whether cutoff value of 5.6 mmol/l for impaired fasting glucose (IFG) improves the prediction of Type 2 diabetes mellitus (T2DM) in comparison to the 6.1 mmol/l value., Research Design and Methods: A total of 5794 non-diabetic subjects aged 42+/-13 years were followed for 6.5 years. T2DM was defined based on the WHO 1999 criteria. Cox regression analysis was used to calculate the relative risk (RR) of developing T2DM. Model discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC)., Results: During the follow-up, there were 351 incident T2DM. The RR (95% CI) of the 6.1 and 5.6 mmol/l cutoffs were comparable in both univariate and multivariate analysis [9.6 (7.5-12.3) vs. 8.4 (6.4-10.0), respectively in univariate and 2.4 (1.8-3.2) vs. 3.3 (2.6-4.2), respectively in multivariate models]. Using the 5.6 mmol/l cutoff value in the multivariate model significantly improved its discrimination in comparison to the 6.1 mmol/l value [AUC (95% CI): 0.78 (0.74-0.83) vs. 0.74 (0.70-0.79), P<0.01]. Models with impaired glucose tolerance and fasting glucose had the highest AUC of 0.81(95% CI: 0.78-0.85)., Conclusions: The 5.6 mmol/l cutoff value of IFG combined with other diabetes risk factors performs significantly better than the 6.1 mmol/l value for prediction of future T2DM.

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.

Objective: The aim of this study was to evaluate and compare the role of lipid markers including total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol with lipid indices (total/HDL cholesterol, LDL-cholesterol/HDL-cholesterol and non-HDL-cholesterol) as predictors of cardiovascular outcomes in adults over 30 years., Research Design and Method: In a nested case-control study, 207 cardiovascular events among participants 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 (132 subjects) were matched to 264 controls for age and sex. In all subjects, demographic and clinical data including blood pressure and anthropometric measurements as well as serum lipids, fasting and 2-h plasma glucose were obtained from the database of the TLGS. We estimated the relative risk for each lipid parameter in a multiple stepwise regression model after adjustment for family history of premature coronary heart disease, smoking, systolic and diastolic blood pressure, fasting and 2-h plasma glucose and waist-to-hip ratio., Results: The relative risks associated with an increase of approximately 1 SD of independent lipid predictors in the multivariate model were as follows: total cholesterol, 1.6 (1.2-2.1), SD=1.3 mmol/l; LDL-cholesterol 1.5 (1.1-2.0), SD=1 mmol/l; non-HDL-cholesterol 1.6 (1.2-2.1), SD=1.2 mmol/l and cholesterol/HDL-cholesterol 1.5 (1.1-2.0), SD=1.8. Comparison of these four independent variables with receiver-operating characteristic curve analysis showed no significant difference in their predictive power for cardiovascular outcome. There was no association between HDL-cholesterol, triglyceride and LDL/HDL cholesterol and cardiovascular disease outcomes in multivariate analysis., Conclusion: It seems that for short-term prediction of cardiovascular disease outcome, serum total cholesterol is the preferred lipid parameter to measure in the Iranian population.

Background: Sirtuins (SIRT) have recently been identified as the pivotal regulators of lifespan and health. SIRT1 has protective effects against cardiovascular disease (CVD) and through its deacetylase activity it regulates numerous essential pathways including regulating blood pressure, reducing atherosclerosis, heart protection against oxidative stress and inducing cardiac cell survival and growth. Aims: Therefore, this study was conducted to evaluate whether two genetic polymorphisms of SIRT1 rs3758391 T/C and rs369274325 G/T are associated with the risk of CVD. Material and methods: A total of 500 Iranian subjects including 250 CVD patients and 250 healthy individuals as the control group were recruited in this case-control study. Genotyping of SIRT1 rs3758391 T/C and rs369274325 G/T polymorphisms were performed using PCR-RFLP and Tetra-ARMS PCR methods, respectively. Results: Our findings indicated a significant difference between two groups regarding the SIRT1 rs3758391 CC genotype in both additive and recessive models. The rs3758391 CC genotype was found to be more frequent in CVD patients than in the controls (19% vs. 6%), suggesting a statistically significant difference in either of additive (CC vs. TT; OR= 3.06, P =0.001) as well as recessive models (CC vs. TT +CT genotype; OR= 3.72, P = 0.001). Conclusion: Our study for the first time suggests that the SIRT1 rs3758391 T/C polymorphism may confer an increased risk of CVD in both additive and recessive models, in this Iranian population. [ABSTRACT FROM AUTHOR]