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Objective: Diabetes is an important risk factor for cardiovascular disease. The purpose of this study was to explore the role of diabetes and prediabetes in the risk of cardiovascular disease. Methods: This prospective study was performed on three groups of non-diabetic (n = 7291), prediabetic (n = 438), and diabetic (n = 1713) in the age range of 40–70 years in Kharameh (Iran) in 2014–2021. The participants were followed for 4 years. Demographic information, chronic disease history, behavioral habits, and laboratory parameters were examined. Initially, the incidence density was calculated and the difference between the risk of cardiovascular disease in the three groups was examined using the log-rank test. The Cox regression model was performed to investigate the association between prediabetes and diabetes with the risk of cardiovascular disease. Results: The mean age of the participants was 51.47 years. The density incidence in the three groups of non-diabetic, prediabetic, and diabetic individuals was estimated to be 1.5, 1.5, and 3.9 cases per 100,000 person-days, respectively. There was no statistically significant relationship between prediabetes and the incidence of cardiovascular disease. However, the incidence of cardiovascular disease in diabetics was 2.55, 2.16, and 2 times higher than in non-diabetics in the simple, adjusted for age and sex, and in multiple Cox regression, respectively. Conclusion: Due to the independent role of diabetes in the incidence of cardiovascular disease, diabetic individuals should be screened periodically for cardiovascular conditions. Furthermore, it is very important for these individuals to control the important risk factors that contribute to the incidence of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common malignancy among women. Women with breast cancer need to adapt all aspects of their life following their diagnosis. Aim: To investigate how women with breast cancer make adaptations in their lives to cope with the condition. Methods: A directed content analysis was used for this study and 23 participants were interviewed. The participants included women undergoing a mastectomy and their husbands, oncologists, oncology ward nurses and psychologists. Questions were asked regarding the participants' experiences of their adaptation to a mastectomy and cancer. Results: Data analysis led to the emergence of four dimensions; the physical dimension, self-concept, role-playing and interdependence. These four dimensions consisted of 21 main categories, 59 subcategories and 111 codes. Conclusion: The present study showed that despite the emergence of different coping approaches, women undergoing mastectomy have had various physical and mental problems that lead to role disruption. It is recommended that solutions be adopted to increase the adaptation of these patients. [ABSTRACT FROM AUTHOR]

The risk of cardiovascular and respiratory diseases attributed to satellite-based PM2.5 has been less investigated. In this study, the attributable risk was estimated in an area of Iran. The predicted air PM2.5 using satellite data and a two-stage regression model was used as the predictor of the diseases. The dose-response linkage between the bias-corrected predictor employing a strong statistical approach and the outcomes was evaluated using the distributed lag nonlinear model. We considered two distinct scenarios of PM2.5 for the risk estimation. Alongside the risk, the attributable risk and number were estimated for different levels of PM2.5 by age and gender categories. The cumulative influence of PM2.5 particles on respiratory illnesses was statistically significant at 13–16 µg/m3 relative to the reference value (median), mostly apparent in the middle delays. The cumulative relative risk of 90th and 95th percentiles were 2.03 (CI 95%: 1.28, 3.19) and 2.25 (CI 95%: 1.28, 3.96), respectively. Nearly 600 cases of the diseases were attributable to the non-optimum values of the pollutant during 2017–2022, of which more than 400 cases were attributed to high values range. The predictor's influence on cardiovascular illnesses was along with uncertainty, indicating that additional research into their relationship is needed. The bias-corrected PM2.5 played an essential role in the prediction of respiratory illnesses, and it may likely be employed as a trigger for a preventative strategy. [ABSTRACT FROM AUTHOR]

Background: The current study aims to assess cardiovascular risk factors (CVRFs) among diabetic versus nondiabetic nonalcoholic fatty liver disease (NAFLD) patients. NAFLD is the most common hepatic disorder worldwide which is directly associated with diverse CVRFs such as type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS). Materials and Methods: The current cross-sectional population-based study has been conducted on 1031 NAFLD patients. After excluding 340 prediabetes patients, the NAFLD patients were divided into T2DM and normal blood glucose (NBG). Then, CVRFs were compared between the two groups. Results: Out of 691 NAFLD cases included in the study, 337 (48.8%) patients had T2DM. In the T2DM and NBG groups, the body mass index (BMI) was 31.2 ± 4.6 and 29.9 ± 4.3 kg/m2, respectively (P = 0.001). The waist circumference was 102.2 ± 10.2 and 97.6 ± 10.6 cm, respectively (P < 0.001). The systolic blood pressure was 123.3 ± 15.6 and 119.6 ± 13.6 mmHg, respectively (P = 0.043). The triglyceride levels were 191.9 ± 104.7 and 176.5 ± 89.6 mg/dL, respectively (P = 0.042). Generally, these factors were significantly higher among the diabetic patients. Besides, cardiovascular disease (CVD), hypertension, and MS were statistically more prevalent in NAFLD patients with T2DM (P < 0.001) than nondiabetic NAFLD patients. In multiple logistic regression models, the odds ratio of CVD, hypertension, and MS was 2.18, 2.12, and 6.63 for patients with T2DM compared with NBG, respectively. Adjustment was made for age, sex, BMI, smoking, and physical activity. Conclusion: CVRFs were higher in NAFLD patients with T2DM than NAFLD patients with NBG. [ABSTRACT FROM AUTHOR]

Background: The wounded healer concept refers to healthcare providers who, in the past, have had similar experiences to those of their clients and now draw on these challenging experiences to assist their clients. This study explored the positive traits of nurses with chronic cardiovascular diseases who transitioned to wounded healers. Methods: A qualitative content analysis study was conducted within hospitals in Tehran, Iran, between November 2023 and March 2024. Sampling was conducted using a purposive sampling method in accordance with the study objectives and inclusion criteria. The data were collected through semi-structured face-to-face interviews. Twenty-three participants, comprising 16 females and 7 males, participated in the interviews. Data analysis was conducted by employing a qualitative content analysis approach, including creating codes, subcategories, generic categories, and main categories. MAXQDA v20 software was utilized to facilitate the analysis process. Results: The data analysis revealed one main category that aligned with the research question: the positive traits of a wounded healer nurse, consisting of three generic categories: (1) traits related to interpersonal and professional relationships; (2) traits related to the professional dimension; and (3) traits related to the personal dimension. wounded healer nurses demonstrate positive traits that enhance patient care. Conclusions: The findings of this study have important implications for nursing practice and education. By identifying the positive traits exhibited by nurses as wounded healers affected by chronic cardiovascular diseases, nursing programs can emphasize and strengthen these qualities to convert challenges into opportunities and bridge the theory-practice gap. [ABSTRACT FROM AUTHOR]

Background and Aims: Cardiovascular diseases (CVDs) are one of the major diseases in developing and developed countries and have high prevalence and mortality rates. Pharmacological interventions, especially the use of combination medications, can have preventive effects in patients with CVDs. Recently, in the PolyIran trial, a combination of atorvastatin, hydrochlorothiazide, aspirin, and valsartan or enalapril (Polypill) was shown to be effective in providing survival benefits as a primary prevention strategy. In the present study, we examine the cost‐effectiveness of the use of polypill compared to its individual components (named as medication monotherapy) in the prevention of CVDs in Iran. Methods: This was an economic evaluation study conducted to compare the cost‐utility of polypill with that of medication monotherapy for 10,000 hypothetical cohorts of people over 35 years of age using the Markov model and with a lifetime horizon. The study perspective was patient perspective and direct medical costs, quality‐adjusted life‐years (QALYs), and incremental cost‐effectiveness ratio were estimated. To deal with uncertaintysensitivity analyses were used. Results: The results showed that polypill, with the lowest costs (871 USD) and highest QALYs (14.55), had the most cost‐utility than medication monotherapy. Also, the results showed that the highest sensitivities were related to the utilities of angina and stroke states. At the 21,768 USD threshold, polypill had a 92% probability of being cost‐effective versus other medications. Conclusion: Considering that polypill had the most cost‐utility, it is suggested that health system policymakers pay special attention to polypill in designing clinical guidelines. Also, through covering this medication by health insurance organizations, it is possible to complete the country's medicine pharmacopeia in preventing CVDs. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) is a cluster of risk factors and the Framingham risk score (FRS) is a useful metric for measuring the 10-year cardiovascular disease (CVD) risk of the population. The present study aimed to determine the 10-year risk of cardiovascular disease using the Framingham risk score in people with and without MetS in a large Iranian cohort study. Methods: This cross-sectional study was done using the Fasa cohort. Participants aged ≥ 35 years old were recruited to the study from 2015 to 2016. The FRS was calculated using age, sex, current smoking, diabetes, systolic blood pressure (SBP), total cholesterol, and high-density lipoprotein (HDL) cholesterol. MetS was defined as the presence of three or more of the MetS risk factors including triglyceride (TG) level ≥ 150 mg dl− 1, HDL level < 40 mg dl− 1 in men and < 50 mg dl− 1 in women, systolic/diastolic blood pressure ≥ 130/≥85 mmHg or using medicine for hypertension, fasting blood sugar (FBS) level ≥ 100 mg dl− 1 or using diabetes medication and abdominal obesity considered as waist circumference (WC) ≥ 88 cm for women and ≥ 102 cm for men. Multiple logistic regressions were applied to estimate the 10- year CVD risk among people with and without MetS. Results: Of 8949 participants, 1928 people (21.6%) had MetS. The mean age of the participants with and without Mets was 50.4 ± 9.2 years and 46.9 ± 9.1 years respectively. In total 15.3% of participants with MetS and 8.0% of participants without MetS were in the high-risk category of 10-year CVD risk. Among participants with MetS gender, TG, SBP, FBS and in people without MetS gender, TG, SBP, FBS, and HDL showed strong associations with the predicted 10-year CVD risk. Conclusion: Male sex and increased SBP, TG, and FBS parameters were strongly associated with increased 10-year risk of CVD in people with and without MetS. In people without MetS, reduced HDL-cholestrol was strongly associated with increased 10-year risk of CVD. The recognition of participant's TG, blood pressure (BP), FBS and planning appropriate lifestyle interventions related to these characteristics is an important step towards prevention of CVD. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes (T2D) is a common chronic disease that significantly affects an individual's overall health and well-being. The aim of this study is to investigate the factors that influence the health-related quality of life (HRQoL) of patients with T2D. Methods: This study conducted using data from 6th phase (2015–2017) and 7th phase (2018–2022) of the Tehran Lipid and Glucose Study (TLGS). Data were collected through a combination of interviews, physical examinations, and laboratory tests. Quality of life questionnaire (SF-12) that consists of 12 questions was used to assess physical and mental health functioning. The generalized estimating equation model was used to assess the association between socio-behavioral factors and changes in HRQoL. Results: The study included 498 patients with T2D. The changes in HRQoL in patients with T2D followed a sex-specific pattern. Analysis of the physical component score (PCS) and the mental component score (MCS) showed a non-significant change in the total score during the three-year longitudinal study. However, the role physical (RP) of the PCS and the social functioning (SF) of the MCS showed a statistically significant change during this period. In addition, sex, body mass index (BMI), and having cardiovascular disease (CVD) and chronic kidney disease (CKD) showed a significant association with RP changes, and only job status showed a significant association with SF changes. Conclusions: By recognizing the sex-specific patterns in HRQoL changes and understanding the multifaceted nature of factors such as BMI, CVD and CKD, healthcare professionals can develop targeted interventions that go beyond traditional diabetes management. [ABSTRACT FROM AUTHOR]

Background: Regarding the rapidly increasing prevalence of obesity throughout the globe, it remains a serious public health concern. A subgroup of obesity that does not meet metabolic syndrome criteria is called metabolically healthy obesity (MHO). However, whether the MHO phenotype increases cardiovascular disease (CVD) risk is controversial. This study aimed to evaluate the prevalence of MHO and its 10-year CVD risk in Iranian populations. Methods: Based on the STEPS 2021 project in Iran, we collected data on 18119 Iranians 25 years and older from all 31 provinces after applying many statistical factors. Using the Framingham score, we evaluated the 10-year cardiovascular risk associated with the various MHO definition criteria for Iranian populations. Results: The prevalence of MHO was 6.42% (5.93—6.91) at the national level according to the AHA-NHLBI definition, and 23.29% of obese women and 24.55% of obese men were classified as MHOs. Moreover, the MHO group was younger than the metabolically unhealthy obesity (MUO) group based on all definitions (p < 0.001). The odds ratio of MUO individuals being classified as high-risk individuals by the Framingham criteria for CVD was significantly higher than that of MHO individuals by all definitions, with a crude odds ratio of 3.55:1 based on AHA-NHLBI definition. Conclusion: This study reveals a significant prevalence of MHO in the Iranian population, with approximately 25% of obese individuals classified as MHO. While MHO is associated with a lower risk of cardiovascular disease compared to MUO, MHO carries the potential for transitioning to an unhealthy state. [ABSTRACT FROM AUTHOR]

Background: Apelin is one of the endogenous peptides that play a key role in the homeostasis of cardiovascular diseases. The purpose of the current study was to evaluate the correlation between apelin levels and epicardial fat thickness (EFT) in patients with stable angina and acute myocardial infarction (AMI). Materials and Methods: In a case--control study, 90 patients nominated for angiography were enrolled in the study and divided into three groups: healthy subjects without angiographic findings (Con), stable angina pectoris group (SAP), and acute AMI group. Data collected from all subjects included biochemical, echocardiographic, and angiographical parameters. The Gensini score analyzed the severity of coronary artery disease (CAD). Results: A decrease in adjusted apelin levels was evident in the AMI and SAP groups compared with healthy individuals (for both P < 0.001), especially in the AMI group. In addition, a detectable negative association was identified between apelin and Gensini score (r = -0.288, P = 0.006), Ck-MB (r = -0.300, P = 0.004), EFT (r = -0.300, P = 0.004), and troponin-T (r = -0.288, P = 0.006). Conclusion: Myocardial injury in patients with CAD appears to play a significant role in apelin concentration independent of the role of adipose tissue, which requires further studies. [ABSTRACT FROM AUTHOR]

Objective: Oral and dental health (ODH) is a significant public health concern globally, affecting billions of people. This cross-sectional study aimed to examine the prevalence of dental caries using the DMFT index and investigate its relationship with cardiovascular diseases in the Iranian Kurdish population. Methods: A total of 3,996 individuals aged 35–70 years were included from the Dehgolan prospective cohort study (DehPCS). Clinical examinations were performed to assess decayed (DT), missing (MT) and filled (FT) teeth (DMFT index). Data on demographics, socioeconomic status, medical history, oral hygiene practices were also collected. Cardiovascular disease (CVD) history was self-reported via questionnaires assessing heart disease, heart attack and stroke. Logistic regression was used to assess associations between oral health indicators and self-reported CVD, adjusting for potential confounders. Results: The mean DMFT score was 18.18 ± 19, indicating a high oral disease burden. Specifically, 60.04% had DT, 37.82% had more than 16 MT, and 38.83% had FT. Only 13.21% reported flossing regularly and 43.17% brushed less than daily, showing suboptimal oral hygiene. The overall CVD prevalence was 9.21%. Individuals with high DMFT (≥ 14) scores had approximately two times higher CVD prevalence than those with low DMFT. DMFT decreased by 10.23% with increase in education level, and by 5.87% as economic status increased In adjusted analyses, high DMFT scores (OR = 1.5, 95%CI: 1.2–1.9) and MT (OR = 1.5, 95%CI: 1.1–2.1) were associated with 50–150% increased odds of CVD, though associations weakened after adjusting for age. Among men, DMFT remained a significant predictor for CVD after age adjustment, with an odds ratio of 2.37 (95% CI: 1.22–4.60). Conclusion: This population had substantial oral disease and poor oral hygiene. Higher DMFT scores and MT positively correlated with increased CVD prevalence. Promoting preventive oral care and health education could help reduce dental issues and potentially lower CVD risk. Further research is needed to clarify biological mechanisms linking oral and systemic health. [ABSTRACT FROM AUTHOR]

Background & Objectives: The Coronavirus disease 2019 (COVID-19) pandemic has posed a devastating global impact, with millions of cases which vary widely in the disease severity. Southeastern Iran has been particularly hard hit, with a high number of patients requiring hospitalization. This study aimed to identify risk factors associated with mortality from COVID-19 among hospitalized patients in this region. Materials & Methods: A case-control study compared hospitalized COVID-19 patients who succumbed to the disease (confirmed by death certificates and positive polymerase chain reaction or PCR tests) with those who recovered, from February 27, 2020, to June 30, 2021. Researchers analyzed data using t-tests and chi-square tests to identify significant factors associated with mortality (p < 0.05). Variables significant at a less stringent level (p < 0.2) were then included in a backward logistic regression model to explore independent predictors of mortality. Results: This retrospective study examined data from 473 patients, of whom 158 were in the case group and 315 were in the control group. Among the case group, 80.4% were elderly, compared to 41% in the control group. A significantly higher proportion of patients in the case group (12.7%) experienced critical symptoms leading to the ICU hospitalization, compared to the control group (7.3%). Multivariable regression analysis identified several factors significantly associated with increased mortality risk. These included ICU hospitalization (OR=5.27, CI: 3.09-8.98), advanced age (OR=4.06, CI: 2.43-6.80), hypertension (OR=4.44, CI: 1.52-12.93), cardiovascular diseases (OR=2.56, CI: 1.1-5.98), and critical symptoms (OR=2.74, CI: 1.92-8.04). Diabetes, pregnancy, nationality, and gender did not statistically increase mortality risk (p-value ≥ 0.05). Conclusion: Advanced age, severe symptoms requiring ICU care, hypertension, and cardiovascular diseases are all critical mortality risk factors in hospitalized COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine postoperative cardiac and noncardiac complications and their association with the use of cardiopulmonary bypass (CPB), surgical outcomes (length of hospital and ICU stays), dependence on mechanical ventilation, and mortality. Methods: This retrospective cross-sectional study was conducted on pediatric patients aged 0 to 18 who underwent open or closed cardiac surgery over a 1-year period. The use of CPB support, CPB duration, cardiac surgery complexity according to the risk-adjusted classification for congenital heart surgery (RACHS-1), and demographics were examined as potential risk factors associated with an increased number of postoperative complications. The study was performed at the Children's Medical Center, a teaching hospital affiliated with Tehran University of Medical Sciences in Iran. Results: A total of 283 surgeries were included in our study. Seventy-six (26.9%) of the study population experienced at least 1 complication. Our analysis revealed that increased CPB durations were associated with higher odds of cardiac complications, with an odds ratio of 1.02 (P=0.002). Moreover, higher RACHS-1 levels were significantly associated with greater numbers of cardiac and noncardiac complications. Additionally, prolonged mechanical ventilation and open-heart surgery intensive care unit (OH-ICU) stays were significantly associated with cardiac and noncardiac complications. Our logistic regression analysis found no association between demographic and clinical risk factors, the number of complications, and mortality. Conclusion: Postoperative complications occurred in 27% of pediatric heart surgeries. Prolonged mechanical ventilation and OH-ICU stays were significantly associated with cardiac and noncardiac complications. However, no significant association was found between postoperative complications and mortality. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is a major cause of death worldwide, although limited data are currently available regarding the impact of consuming ultra-processed food (UPF) on its incidence. Given the increased consumption of UPF in Iran, we aimed to investigate the association between UPF intake and CVD risk. Methods: Individuals without CVD (n = 2050) aged ≥ 30 years old were recruited from the Tehran Lipid and Glucose Study (TLGS). Dietary data were collected using a validated food frequency questionnaire (FFQ) and UPF intakes were assessed based on the Nova food classification. Multivariable Cox proportional hazard models adjusted for potential confounders were used to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for the risk of CVD across tertiles of UPF intake. Results: A 10.1% incidence of CVD occurred over a median follow-up of 10.6 years, with a 22% increase in CVD risk per each 50 g/day UPF intake. Participants with the highest intake of UPF had a 68% greater incidence of CVD compared to those with the lowest intake (HR = 1.68, 95% CI=1.14–2.48) after controlling for potential confounders. Regarding sub-groups of UPF, participants in the 3rd tertile compared to the reference had a significantly increased risk of CVD (HR = 1.56, 95% CI=1.04–2.34). Nevertheless, intake of bread, fast food, sweetened beverages, sweets and desserts, high-fat dairy products, and other UPFs were not associated with greater CVD risk. Conclusion: Our findings support the hypothesis that the incidence of CVD is enhanced with the higher consumption of UPF in a representative sample of the Iranian population. [ABSTRACT FROM AUTHOR]

This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low-density lipoprotein cholesterol (LDL-C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL-C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL-C without comorbidities and risk factors was considered an LDL-C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women. [ABSTRACT FROM AUTHOR]

Objective: This study was an attempt to shed light on the predictive role of intimate partner violence in adhering to treatment regimens in women with chronic illnesses. Method: In a descriptive-analytical study, 400women with chronic illnesses in Bushehr were selected through convenience sampling. The data were collected by distributing a demographic information form and two questionnaires, including the intimate partner violence (IPV) questionnaire and the treatment adherence scale. Results: According to the results, the 40 to 59 years age group (P = 0.046, β = 0.104), the 60 to 79 years age group (P = 0.019, β = 0.122), and the group receiving education about chronic illness (P = 0.031, β = 0.106) showed a direct relationship with treatment adherence, while IPV (P < 0.001, β = 0.284) had a significant inverse relationship with treatment adherence. Conclusion: The results of the study showed that predictors of treatment adherence are IPV in women aged 40 and older with chronic illnesses, and receiving education about chronic illnesses. It is necessary for healthcare providers to consider barriers such as intimate partner violence when providing education in order to increase treatment adherence. To avoid nonadherence, managers and health planners should implement policies to increase the level of awareness of healthcare staff on how to manage care of women with chronic illnesses who are abused by an intimate partner and refer them to counselors and family helpers. [ABSTRACT FROM AUTHOR]

Dyslipidemia, as a metabolic risk factor, with the strongest and most heritable independent cause of cardiovascular diseases worldwide. We investigated the familial transmission patterns of dyslipidemia through a longitudinal family-based cohort, the Tehran Cardiometabolic Genetic Study (TCGS) in Iran. We enrolled 18,729 individuals (45% were males) aged > 18 years (mean: 38.15 (15.82)) and observed them over five 3-year follow-up periods. We evaluated the serum concentrations of total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol with the first measurement among longitudinal measures and the average measurements (AM) of the five periods. Heritability analysis was conducted using a mixed-effect framework with likelihood-based and Bayesian approaches. The periodic prevalence and heritability of dyslipidemia were estimated to be 65.7 and 42%, respectively. The likelihood of an individual having at least one dyslipidemic parent reveals an OR = 6.94 (CI 5.28–9.30) compared to those who do not have dyslipidemic parents. The most considerable intraclass correlation of family members was for the same-sex siblings, with ICC ~ 25.5%. For serum concentrations, heritability ranged from 33.64 to 60.95%. Taken together, these findings demonstrate that familial transmission of dyslipidemia in the Tehran population is strong, especially within the same-gender siblings. According to previous reports, the heritability of dyslipidemia in this population is considerably higher than the global average. [ABSTRACT FROM AUTHOR]

Background: /Aims: Visceral adiposity index (VAI) and lipid accumulation product (LAP) are novel anthropometric indices that have shown an association with metabolic syndrome; however, limited data are available regarding the predictive performance of these indices for the incidence of cardiovascular diseases (CVD) and mortality. Methods: This study was performed on the data retrieved from Isfahan Cohort Study (ICS). ICS is an ongoing population‐based cohort study conducted in 3 counties in central Iran. Pearson correlation analysis was performed between LAP, VAI, and metabolic parameters. Cox regression analysis and receiver operative characteristics (ROC) curve analysis were performed in order to evaluate the ability of VAI and LAP for the incidence of CVD, CVD‐associated mortality, and all‐cause mortality. We further compared the predictive performance of VAI and LAP with body mass index (BMI). Results: LAP and VAI were significantly correlated with all metabolic variables, including blood pressure, fasting blood glucose, and lipid profile components. Univariate regression analysis indicated a significant association between LAP and VAI and CVD incidence. In multivariate analysis, only VAI was significantly associated with CVD incidence. Regarding CVD mortality, only VAI in the multivariate analysis revealed a significant association. Interestingly, Both VAI and LAP were negatively associated with all‐cause mortality. ROC curve analysis indicated the superior performance of LAP and VAI for predicting CVD incidence compared to BMI; however, BMI was better in predicting all‐cause mortality. Conclusion: Compared to BMI, LAP and VAI have better predictive performance for the incidence of CVD. In contrast, BMI was superior to VAI and LAP in the prediction of all‐cause mortality. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic. Methods: The study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR). Results: 1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56–0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49–165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63–0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96–0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59–1.72]) and second years (RR 1.27, [1.22–1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30–2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals' EDs. Conclusion: In the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The COVID-19 pandemic, as the most important health challenge in the world today, has made numerous irretrievable damages to the social, economic, and health dimensions of societies, especially in developing countries. An essential measure that can be taken to prevent and control the disease is to identify risk factors related to its prognosis and mortality rate. Therefore, this study aimed at investigating COVID-19 survival and mortality risk factors and their relationship with the demographic characteristics of the subjects diagnosed with the disease. MATERIAL AND METHODS: The present study is cross-sectional and descriptive. The samples consist of 1395 patients diagnosed with COVID-19 admitted to medical centers affiliated with Fasa University of Medical Sciences. The subjects were selected by census sampling. Data were collected using demographic information forms, paraclinical and radiological tests, and clinical examinations. Data were analyzed using SPSS version 18 via descriptive tests, paired t-tests, one-way ANOVA, and post hoc tests. RESULTS: According to the data, the participants' average age was 57.72 ± 4.63 years, and most of them (56.41%) were male. The mortality rate among the participants was estimated to be 13.19%. The results of the study showed a significant relationship between the survival status of patients with COVID-19 and underlying chronic diseases such as diabetes and cardiovascular and renal diseases (p < 0.05). CONCLUSIONS: Identifying high-risk groups is an important measure that health professionals should consider in controlling epidemics. The findings of this study showed that the presence of underlying chronic diseases such as diabetes and cardiac and renal conditions, which are associated with immune system defects, are among the most important factors related to the COVID-19 mortality. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVD) are the most important cause of death in many countries of the world, including Iran. This study aimed to investigate the effect of educational intervention based on the Health Belief Model (HBM) on the promotion of nutritional behaviors to prevent CVD among the all people (aged 30–59 years). Methods: This semi-experimental study was conducted on all people (aged 30–59 years) referring to the primary healthcare centers of Jahorm city, southern Iran, from September 2021 to July 2022. In this study, 100 participants (50 participants for the intervention group and 50 for the control group) were selected using a multistage cluster random sampling method. The data collection tool was a questionnaire with confirmed validity and reliability. Also, the food consumption frequency checklist was used. The educational intervention included holding four sessions, each lasting for 60 min. The methods used for training included lectures, questions and answers, and group discussions. Before the intervention and three months after, the intervention and control groups completed the questionnaire. The obtained data were analyzed by SPSS 17. Results: after the educational intervention, the mean score of knowledge (4.84 ± 0.84; 2.76 ± 1.41; p < 0.001), perceived susceptibility (9.52 ± 1.81; 8.76 ± 1.9; p = 0.004), perceived severity (14.78 ± 1.66; 13.80 ± 2.23; p = 0.015), perceived benefits (10.66 ± 1.79; 7.52 ± 1.99; p < 0.001), perceived barriers (5.92 ± 2.81; 12.68 ± 10.24; p < 0.001) and practice (178.78 ± 14.35; 147.36 ± 13.19; p < 0.001) showed a significant difference between the intervention and control groups. Conclusion: The results showed that the educational intervention effectively improved people (aged 30–59 years) knowledge and HBM constructs to prevent CVD. Also, improving people's performance regarding CVD prevention behaviors will be successful by implementing an educational intervention based on the HBM. [ABSTRACT FROM AUTHOR]

Control of noncommunicable diseases (NCDs) requires the management of behavioral risk factors such as tobacco smoking and alcohol consumption. Alcohol consumption and tobacco use are the main risk factors of NCDs and account for about 1% and 13% of total deaths in Iran, respectively. This study aimed to analyze policies regarding tobacco use and alcohol consumption and understand their content, context, process, and actors in Iran. We conducted a case study design guided by the Walt and Gilson Policy Analysis Framework. This study was conducted in two phases: A review of policy documents on tobacco and alcohol, and scoping review of studies related to the policies identified in the first phase. The contents of tobacco and alcohol control policies are mostly in line with international recommendations including, the MPOWER policy package for tobacco and recommended target areas proposed by World Health Organization (WHO) for alcohol. Political commitment to health promotion, social and religious values, joining international treaties, and the high prevalence of NCDs have been significant factors in the agenda‐setting of alcohol and tobacco policies in Iran. Although the health governance structure and the primary health care system have provided opportunities for implementation of policies, weak cross‐sectoral collaboration and the lack of some stakeholders' support, including the tobacco industry, pose challenges to the successful implementation of tobacco and alcohol policies. Thus, a multi‐sectoral approach is essential to control NCDs in Iran. Key points: The increasing prevalence of noncommunicable diseases, especially cardiovascular disease, political commitment to health promotion, and joining international treaties have been important factors in the formulation of policies to control tobacco use and alcohol consumption in Iran.Policies have been developed in line with the recommendations of international organizations, in particular the World Health Organization.Implementation of tobacco control policies has faced numerous challenges such as tobacco industry involvement in policymaking and lack of financial resources.Although service delivery systems such as primary health care centers, substance misuse centers, and hospitals are available to provide alcohol control services, the high stigma and cultural sensitivity may threaten the successful implementation of these policies. [ABSTRACT FROM AUTHOR]

Objectives: Patient falls are highly prevalent in hospitals, and are considered a complicated challenge. Thus, the present research assessed the prevalence of the fall risk assessment and the correlated factors among elderly inpatients. Methods: The present analytical and cross-sectional research was conducted with 419 elderly patients meeting the inclusion criteria. The data collection instrument consisted of two parts including demographic information and the Johns Hopkins fall risk assessment tool (JHFRA). A convenience sampling method was used to select the elderly patients staying in the general wards of Allameh Bohlool Gonabadi Hospital, Gonabad City, Iran. The data analysis was done in SPSS software, version 23 using descriptive (frequency, Mean±SD) as well as inferential statistics (logistic linear regression analysis). Results: The Mean±SD of participants' age was 72.09±9.46 and the prevalence of the fall risk was 85.9%. Statistically significant correlations were found between the elderly inpatients' fall risk and their age (P=0.001), sex (P=0.012), and cardiovascular diseases (P=0.001). Discussion: Considering the high prevalence of fall risk among elderly inpatients, it is essential to plan for preventing and reducing the rate of elderly inpatients' falls. [ABSTRACT FROM AUTHOR]

Introduction: Acknowledging the considerable influence of undernutrition on health outcomes and HRQOL, this study sought to appraise the nutritional risk status of elderly patients with cardiovascular diseases (CVD) through the utilization of the Nutritional Risk Screening (NRS). Additionally, the investigation aimed to evaluate the correlation between NRS status and HRQOL within the context of patients referred to a cardiac hospital in Tabriz, Iran. Methods: This cross-sectional study was conducted in Tabriz, Iran. The participants were selected randomly from patients referring to Shahid Madani Heart Hospital, a comprehensive university hospital during July to December 2018. A linear regression was used for control of confounding variables (age, gender, education level, marital status, and income levels) and predict the relationship between nutrition risk status and HQRL. Results: Of the 200 patients with CVD participated in this study, 68 (34%) of participants had normal nutrition status, 108 (54%) were at risk for undernutrition, and 24 (12%) had undernutrition. A total of 24 aging patients with undernutrition, 13 (54%) were divorced or widowed. 86% of patients with diabetes were at risk for undernutrition and 13.9% had undernutrition. There were statistically significant relationship between undernutrition and HRQOL dimensions, age, gender, and marital status. Conclusion: The study revealed a correlation between elevated undernutrition scores in patients and factors such as older age, female gender, and marital status of being divorced or widowed. Furthermore, the results imply that a notable elevation in the risk score for undernutrition in patients is significantly linked to impaired HRQOL among elderly individuals with CVD. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) are the leading causes of global deaths. So, it is necessary to know the possible risk factors for each region. We aimed to assess the relationship between the risk of CVDs and sleep duration in the Iranian Arab population. Methods: In this cross-sectional study, data from 8362 participants aged between 35 and 70 from the Hoveyzeh Cohort Study enrollment phase between 2016 and 2018 was analyzed. This study evaluated the association between ten-year CVD risk using the Framingham risk score and sleep duration. Self-reported sleep duration was categorized as short duration (equal to or less than 5 h), standard duration (6–8 h), or prolonged duration (equal to or greater than 9 h). Multivariable logistic regression to adjust for conventional CVD risks was used. Results: Among the assessed participants, 4892 (58.50%) were female, and the mean age was 47.93 (9.01). The average sleep duration was 7.59 (1.56) hours. The low, intermediate-to-high, and high CVD risk individuals were 6461 (77.27%), 1185 (14.17%), and 716 (8.56%), respectively. There was a significant relationship between prolonged sleep duration and lower odds of intermediate-to-high CVD risk in males (OR 0.66, 95% CI: 0.49–0.87, P-value: 0.004). Conclusion: The results of our study showed that longer sleep duration has a protective association with the intermediate to high risk of cardiovascular diseases in males. However, long and short sleep durations have no significant relationship with females' risk of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Precise categorization of the causes of ischemic stroke (IS) is crucial for optimizing stroke treatment and assessing the prognosis of patients. This cross-sectional study aimed to determine the risk factors and various subcategories of IS in Iranian patients. The study included all patients with IS referred to Golestan Hospital (Ahvaz, Iran) for one year. Their demographics and clinical data were collected. The etiology of IS was classified based on the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. A total of 1100 patients with IS were evaluated, 658 were male and 442 were female. They had an average age of 66 years (ranging between 20 and 99 years). The majority of them were in the 61-80 age group. The prevalence of risk factors for IS included hypertension (HTN) (71.4%), diabetes (50.4%), smoking (42.4%), history of previous stroke (28%), dyslipidemia (15.4%), and cardiovascular disease (22.5%). Three months after admission, the mortality rate was 10.7% and the majority of patients exhibited a lower level of disability based on the modified Rankin Score (mRS) compared to the time of admission. The frequency of all risk factors, except for HTN, differed significantly between genders (P<0.05). Furthermore, the prevalence of risk factors varied significantly among different stroke etiologic subgroups (P<0.05). The most common etiological factors identified by TOAST classification were associated with large artery atherosclerosis (LAA) and small artery occlusion (SAO). Significant variations were observed in the prevalence of different etiologic subtypes of stroke among genders and across different age groups. [ABSTRACT FROM AUTHOR]

Background: Knowledge, attitudes, and practices (KAP) studies are widely used in public health. This study aimed to investigate and compare KAP among patients with coronary artery disease (CAD) and premature coronary artery disease (PCAD) regarding cardiovascular disease (CVD). Methods: This cross-sectional study was conducted on 100 PCAD patients and 100 CAD patients in a general hospital in Tehran, Iran, between April and October 2022. A valid questionnaire was utilized to gather information, and descriptive analysis and logistic regression were employed for analysis using SPSS, version 23. Results: This study involved 100 CAD and 100 PCAD patients with average ages of 68.09±7.20 and 50.20±7.65 years, respectively. Men accounted for 58% of the PCAD group and 73% of the CAD group. The PCAD group had a higher level of knowledge and exhibited a more positive attitude toward CVD than the CAD group (P=0.007 and P<0.001, respectively). The PCAD patients and those with a family history of chronic diseases had a higher level of knowledge (P=0.045 and P=0.27, respectively) and showed a more positive attitude (P=0.030 and P<0.001, respectively). However, participants with a self-reported history of chronic diseases and those who were employed exhibited a less positive attitude. Occupation was associated with nutritional and smoking status (P=0.037). Conclusion: Higher levels of knowledge and more positive attitudes regarding CVD were observed; still, the study population's behaviors were unsatisfactory. Educational interventions are needed to promote positive health behaviors, emphasizing the link between knowledge and risk reduction and decreased CVD and mortality rates. [ABSTRACT FROM AUTHOR]

Hypertension (HTN) is a global health challenge and increase the risk of cardiovascular disease. Hypertension has a multifactorial course of evolution, with both genetic and environmental factors playing an important role. To date, a number of genes and pathways have been proposed to be associated with HTN, among which is Nitric Oxide pathway. NO levels can be regulated by reactive oxygen species (ROS), superoxide and post-transcriptional mechanisms, including sense-anti sense interactions. NOS3AS gene encodes an antisense RNA (sONE) which is complementary to NOS3 transcript in 662 nucleotides and may regulate NOS3 in a post-transcriptional manner. In this study, we sought to define the role of NOS3AS in the pathophysiology of essential HTN. A total of 131 cases with hypertension and 115 controls were enrolled in the study. Peripheral blood was drawn from all study participants after signing the informed consent form. Three variants (rs71539868, rs12666075 and rs7830) were investigated by Tetra-ARMS PCR method. The results were then statistically analyzed. We found statistically significant association between rs7830 TT genotype, rs12666075 GT and TT genotypes with susceptibility to HTN. We failed to observe association between rs71539868 and susceptibility to HTN. The present study showed a strong association between NOS3AS variants and susceptibility to hypertension in the population of Kermanshah province. Our results may shed more light on the mechanisms of disease development and may also help to better identify genetic predispositions and individuals at risk. [ABSTRACT FROM AUTHOR]

Background: Elevated low-density lipoprotein cholesterol (LDL-C) is a significant risk factor for cardiovascular diseases. LDL-C can be directly measured using various methods, but this requires expensive equipment. Currently, clinical laboratories estimate LDL-C based on Friedewald's formula (FF). We aimed to develop a modified formula based on directly measured LDL-C (D-LDL-C) values in a large population in Southern Iran and compare the results with various other estimation formulas. Methods: The participants of this cross-sectional study were adults aged >18 years living in Southern Iran. Blood samples from 15,200 individuals were collected, and the measured lipid parameters were randomly divided into training (n=10,184) and validation (n=5,016) datasets. A new formula was developed using a linear regression model, and its accuracy was validated. Pearson's correlation and Cohen's kappa were used to determine the relationship between D-LDL-C and calculated LDL-C (C-LDL-C). Results: The developed formula for the estimation of LDL-C was 0.857 total cholesterol (TC)-0.915 high-density lipoprotein cholesterol (HDL-C)-0.115 triglycerides (TG). Based on our proposed formula, for TG<150 and TG≥150 mg/dL, there was a significant correlation between mean values of D-LDL-C and C-LDL-C (r=0.985 and r=0.974, respectively). Compared to other formulas, C-LDL-C obtained from the proposed formula had the highest correlation with D-LDL-C. The agreement between D-LDL-C and C-LDL-C for TC<200, 200-239, and ≥240 mg/dL was 80.8%, 63.2%, and 67.4%, respectively, indicating a higher level of agreement than other formulas. Conclusion: The new formula appears to be more accurate than FF when applied to the population of Southern Iran. [ABSTRACT FROM AUTHOR]

Background: The burden of stroke is high worldwide, especially in low-middle income countries. We aim to explore the temporal trends of the incidence rate (IR) of stroke over 14 years in Iran's central areas. Methods: Stroke registry as part of cardiovascular disease (CVD) registry in Isfahan that focused on hospitalized patients (≥15 years) with first or recurrent stroke from 2001 to 2015. Factors included date of symptoms, demographics, management, survival at 28 days, date of admission, history of stroke, and other CVD and clinical diagnosis according to Computer Tomography Scan. We calculated age-, sex, and place-of-residence-adjusted IR based on multiple reference populations. Data were analyzed by bootstrap robust zero-truncated negative binomial regression models using R Statistical Software. Results: From 19,174 registered patients with stroke assessed by ICD-10; 18,010 (93.93%) cases were identified based on WHO-MONICA. Approximately 51% of hospitalized stroke patients were women. The average annual increase in stroke incidence based on ICD-10 ranged from 1.56% (95% CI, 0.14, 2.97) to 2.67% (95% CI, 1.25, 4.09) for different reference populations. In addition, a similar trend was also observed for stroke IR based on WHO-MONICA during the study period for the whole reference population, with an average annual change of 2.5% (95% CI, 1.28, 3.72) to 3.64 % (95% CI, 2.47, 4.82). Conclusion: Given that temporal trends of stroke have increased in both sexes, especially in Iran's urban areas, prevention programs are needed for public awareness and physician motivation in order to identify risk factors as well as primary and secondary prevention. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular Disease (CVD) is the leading cause of death in developing countries. CVD risk stratification guides the health policy to make evidence-based decisions. Aim: To provide current picture and future trend of CVD risk in the adult Iranian population. Methods: Nationally representative datasets of 2005, 2006, 2007, 2008, 2009, 2011, and 2016 STEPwise approach to non-communicable diseases risk factor surveillance (STEPS) studies were used to generate the 10-year and 30-year risks of CVD based on Framingham, Globorisk, and World Health Organization (WHO) risk estimation models. Trend of CVD risk was calculated from 2000 until 2016 and projected to 2030. Results: In 2016, based on Framingham model, 14.0% of the Iranian, aged 30 to 74, were at great risk (≥20%) of CVD in the next 10 years (8.0% among females, 20.7% among males). Among those aged 25 to 59, 12.7% had ≥45% risk of CVD in the coming 30 years (9.2% among females, 16.6 among males). In 2016, CVD risk was higher among urban area inhabitants. Age-standardized Framingham 10-year CVD risk will increase 32.2% and 19%, from 2000 to 2030, in females and males, respectively. Eastern provinces had the lowest and northern provinces had the greatest risk. Conclusions: This study projected that CVD risk has increased from 2000 to 2016 in Iran. Without further risk factor modification, this trend will continue until 2030. We have identified populations at higher risks of CVD to guide future intervention. [ABSTRACT FROM AUTHOR]

Background: Glycemic control reduces the risk of cardiovascular complications among people with diabetes. However, the current status of glycemic control is uncertain among Iranian people with diabetes. This study aims to systematically review the studies on the status of glycemic control among people with type 2 diabetes in Iran. Methods: A systematic literature search was conducted in international databases including Medline database (PubMed), Web of Science, Google Scholar, and Scopus, as well as domestic databases such as Iran Medex, SID, Magiran, Irandoc, and Medlib, up to end of 2020. All observational studies (cross-sectional, case-control, and cohort) were included. Studies that reported the status of glycemic control among people with type 2 diabetes in Iran were selected. Good glycemic control was defined as glycated hemoglobin A1c (HbA1c) less than 7%. Results: A total of 23 eligible studies (15,358 patients) were included in the quantitative analysis. Of 15,358 patients, 5882 had good glycemic control. The pooled prevalence of good glycemic control was 33.1% (95% CI, 25.6–41.1%). Meta-regression showed no significant improvement in glycemic control rate by year. Conclusion: Despite the importance of good glycemic control in the prevention of micro- and macrovascular diabetic complications, the high proportion of Iranian people with type 2 diabetes remains poorly controlled. The result of this meta-analysis indicates the need for better approaches to diabetes management in Iran. [ABSTRACT FROM AUTHOR]

Increased body fat level or obesity is related to dyslipidemia, high blood pressure, insulin resistance, respiratory disorders and type 2 diabetes and increases intracellular inflammatory processes and arterial injuries. The study participants were 39 overweight/obese women living in Ilam City, Iran who were randomly assigned into three group of aerobic exercise group (treadmill at 50–70% heart rate reserve [HRR]) (n = 13), resistance exercise group (8 to 16 repetitions of 7 upper and lower body exercises at 60% to 80% of 1 repetition maximum) and control group. Training was conducted through three sessions per week for 8 weeks. Repeated measures ANOVA with Bonferroni post-hoc tests were employed to analyze the data (P ≤ 0.05). The findings showed that the levels of salusin-α (P = 0.192), salusin-β (P = 0.069), high-density lipoprotein (HDL) (P = 0.862), low-density lipoprotein (LDL) (P = 0.941), triglycerides (TG) (P = 0.287), and body fat percentage and insulin resistance (P = 0.99) did not show any significant difference between aerobic and resistance exercise groups. However, a significant difference was observed between the aerobic and resistance exercise groups in total cholesterol (P = 0.007). In general, the results of the present study show that resistance and aerobic exercises have beneficial effects in the prevention of atherosclerosis cardiovascular diseases in obese and overweight women. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) is a set of conditions that occur together and increase the risk of cardiovascular disease. Previous studies have linked a gluten-free diet (GFD) to obesity and MetS in some populations. However, others have suggested that weight gain is usually regulated only in underweight individuals with celiac disease (CD). Owing to the lack of sufficient data and the importance of GFD in controlling cardiovascular disease, we surveyed the prevalence of MetS and its components before and after a year of GFD in patients referred to the main celiac clinic in southern Iran. Methods: This was a repeated cross-sectional study conducted on 69 patients with a definite diagnosis of cardiovascular disease who were on follow-up and registered at the Shiraz Celiac Clinic. Demographic, anthropometric, and laboratory measurements at the time of diagnosis and one year after the GFD were extracted from their medical records. Results: The participants' mean age was 35.53, and 68.1% were women. The prevalence of MetS increased from 5.8% to 11.6% after a year of the GFD; however, this increase was not statistically significant. Waist circumference (WC) and serum triglyceride levels were significantly elevated during the study period. Conclusion: A GFD may contribute to the development of MetS in patients with cardiovascular disease; however, the rate of MetS is still lower than that in the general population. It is critical to educate patients about these potential risks and encourage them to have a healthy lifestyle that includes a balanced diet and physical activity. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, the implementation of social distancing and public fear of the virus postponed follow-up visits to manage patients’ underlying medical problems, especially cardiovascular diseases and diabetes. Telehealth provides accessible and cost-effective care for vulnerable patients. The aim of this early study was to review the telehealth interventions for patients with cardiovascular and metabolic disorders during Covid-19 outbreak. Materials and Methods: This study used rapid review to provide an accurate review of the articles. Study selection was based on the Preferred Reporting Items for Systematic Reviews (PRISMA) guideline. A systematic review was conducted on studies published from January 2020 to July 30, 2020, in PubMed, Web of Science, Google Scholar, and Scopus databases, and the update was done on October 31, 2020 Results: Technology-based interventions were performed in various countries: two studies in the USA, three in Europe (Italy, Germany, and London), two in Asia (China and Pakistan), and one in South America. Most Telehealth approaches used in the included articles are video consultations using mobile applications such as Skype, face time, and regular phone calls. Conclusion: According to the results, the application of technology in the management of cardiovascular and metabolic disorders can be used to provide healthcare to patients regardless of distance, detection of disease, monitoring disease progression and complications, reducing healthcare costs, saving available resources, preventing readmission of patients, reducing the provider workload, and increasing family participation in disease management, quality of life, and patient satisfaction. [ABSTRACT FROM AUTHOR]

Premature mortality (PM) has emerged as a global health challenge. This is of eminent importance in low- and middle-income countries, where nearly three fourths of the deaths occur. The concerning issue is the early occurrence of fatal events in productive age. Fatal events before the age of 70 are called PM, which mainly result from cardiovascular diseases (CVDs). Iran as a middle--income country greatly suffers from the cardiovascular burden, which accounts for almost 50% of all PM. Despite substantial success in reducing mortality due to communicable diseases across different age ranges, urbanization and pervasiveness of cardiovascular risk factors have increased the death rate in adults in recent years. Undoubtedly, such lifestyles have imposed heavy costs on the healthcare system; it is possible that PM reduction, as one of the fundamental elements of sustainable development goals defined by the World Health Organization (WHO), would not be reached by the due date. Recently, researchers have introduced a cost-effective fixed-dose drug combination, the so-called polypill, in order to attenuate the detrimental effects of hypertension and hyperlipidemia, as two strong cardiovascular risk factors. PolyIran and PolyIran-Liver studies are two pivotal clinical trials that revealed the feasibility of primary and secondary prevention of premature cardiovascular mortality, both in an urban and a rural population. In the present narrative review, we tried to present a comprehensive appraisal on PM status, its underlying reasons, and the impact of polypill strategy on PM prevention in Iran. [ABSTRACT FROM AUTHOR]

The results of previous studies have indicated the effects of temperature changes on health status. The present study was conducted to investigate the effects of diurnal temperature range (DTR) and hospital admission on cardiovascular and respiratory diseases in Dezful, in Iran. In this ecological time-series study, data related to hospital admissions based on ICD-10, meteorological, and climatological data were gathered over a period of six years from 2014 to 2019. A distributed lag nonlinear model combined with a quasi-Poisson regression was then used to assess the impact of DTR on cardiovascular and respiratory hospital admissions. Potential confounders, including wind speed, air pollution, seasonality, time trend, weekends and holidays, days of week, and humidity were controlled. In extreme low DTRs, the cumulative effects of cardiovascular admissions significantly increased in total, and in warm and cold seasons (Lag0–21, P ≤ 0.05). In addition, in extreme high DTRs, the cumulative effects of cardiovascular significantly decreased in total (Lag0–13 and Lag0–21, P ≤ 0.05), and in warm (Lag0–21, P ≤ 0.05) and cold seasons (Lag0–21, P ≤ 0.05). Moreover, respiratory admissions significantly decreased in total (Lag0–21, P ≤ 0.05) and in warm season (Lag0–21, P ≤ 0.05).Our result indicates that extreme low DTRs could increase the risk of daily cardiovascular admissions, and extreme high DTRs may cause a protective effect on daily respiratory and cardiovascular admissions in some regions with high fluctuations in DTR. [ABSTRACT FROM AUTHOR]

Background: Population ageing is considered one of the biggest challenges facing the world, and the status of the elderly in society and their quality of life (QOL) have proved to be a concern in professional and scientific research circles. As a result, the current study sought to investigate the role of pain self-efficacy (PSE) as a moderator in the relationship between sense of coherence (SOC), spiritual well-being, and self-compassion with QOL in Iranian elderly with cardiovascular disease (CVD). Method: This was a correlational study of the path analysis type. The statistical population included all elderly people with CVD who were at least 60 years of age in Kermanshah Province, Iran, in 2022, of whom 298 (181 men and 117 women) were selected using convenience sampling and according to the inclusion and exclusion criteria. The participants answered questionnaires from the World Health Organization on QOL, Paloutzian and Ellison's spiritual well-being, Nicholas's PSE, Antonovsky's SOC, and Raes et al.'s self-compassion. Results: The results of path analysis demonstrated that the hypothesized model of this study has a good fit in the studied sample. There were significant paths between SOC (β = 0.39), spiritual well-being (β = 0.13) and self-compassion (β = 0.44) with PSE. Although there were significant paths between SOC (β = 0.16) and self-compassion (β = 0.31) with QOL, there was no significant path between spiritual well-being and QOL (β = 0.06). Besides, there was a significant path between PSE and QOL (β = 0.35). Finally, PSE was found to mediate the relationship of SOC, spiritual well-being and self-compassion with QOL. Conclusion: The results may provide psychotherapists and counselors working in this field of inquiry with advantageous information to choose or create a useful therapeutic method to work with the elderly with CVD. Meanwhile, other researchers are suggested to examine other variables which may serve a mediating role in the mentioned model. [ABSTRACT FROM AUTHOR]

Background: Components of metabolic syndrome (MetS) was reported to contribute to severe and worse outcomes of coronavirus disease 2019 (COVID-19). Hereby, we evaluated the association of MetS and its components with susceptibility to COVID-19. Methods: Here, 1000 subjects with MetS were recruited that were diagnosed via the International Diabetes Federation (IDF) criterion. Real-time PCR was exerted to detect SARS-CoV-2 in the nasopharyngeal swabs. Results: Among the MetS patients, 206 (20.6%) cases were detected to have COVID-19. Smoking (OR = 5.04, 95%CI = 3.53–7.21, P < 0.0001) and CVD (OR = 1.62, 95%CI = 1.09–2.40, P = 0.015) were associated with increased chance of COVID-19 infection in the MetS patients. BMI was significantly higher (P = 0.0001) in MetS cases with COVID-19 than those without COVID-19. Obesity was associated with increased susceptibility to COVID-19 in MetS patients (OR = 2.00, 95%CI = 1.47–2.74, P < 0.0001). Total cholesterol, TG, LDL were significantly higher in the MetS cases with COVID-19 than those without COVID-19. Dyslipidemia was associated with increased chance of COVID-19 (OR = 1.50, 95%CI = 1.10–2.05, P = 0.0104). FBS level was significantly higher in the MetS cases with COVID-19. T2DM was associated with increased risk of COVID-19 in MetS patients (OR = 1.43, 95%CI = 1.01-2.00, P = 0.0384). Hypertension was associated with increased chance of COVID-19 in the MetS patients (OR = 1.44, 95%CI = 1.05–1.98, P = 0.0234). Conclusions: MetS and its components, like obesity, diabetes, dyslipidemia, cardiovascular complications were associated with increased chance of COVID-19 infection development and probably with aggravated symptoms in such patients. [ABSTRACT FROM AUTHOR]

Introduction: Many studies have been published to assess the best anthropometric measurements associated with cardiovascular diseases (CVDs), but controversies still exist. Aim: Investigating the association between CVDs and anthropometric measurements among Iranian adults. Methods: For a total population of 9354 aged 35 to 65, a prospective study was designed. Anthropometric measurements including ABSI (A Body Shape Index), Body Adiposity Index (BAI), Body Mass Index (BMI), Waist to Height Ratio (WHtR), Body Round Index (BRI), HC (Hip Circumference), Demispan, Mid-arm circumference (MAC), Waist-to-hip (WH) and Waist Circumference (WC) were completed. The association between these parameters and CVDs were assessed through logistic regression (LR) and decision tree (DT) models. Results: During the 6-year follow-up, 4596 individuals (49%) developed CVDs. According to the LR, age, BAI, BMI, Demispan, and BRI, in male and age, WC, BMI, and BAI in female had a significant association with CVDs (p-value < 0.03). Age and BRI for male and age and BMI for female represent the most appropriate estimates for CVDs (OR: 1.07, (95% CI: 1.06, 1.08), 1.36 (1.22, 1.51), 1.14 (1.13, 1.15), and 1.05 (1.02, 1.07), respectively). In the DT for male, those with BRI ≥ 3.87, age ≥ 46 years, and BMI ≥ 35.97 had the highest risk to develop CVDs (90%). Also, in the DT for female, those with age ≥ 54 years and WC ≥ 84 had the highest risk to develop CVDs (71%). Conclusion: BRI and age in male and age and BMI in female had the greatest association with CVDs. Also, BRI and BMI was the strongest indices for this prediction. [ABSTRACT FROM AUTHOR]

Background: Many mental problems lead to the occurrence of physical diseases, causing worse consequences of diseases. Despite many studies in the field of personality types and types of mental disorders, this relationship and the mediating role of coping styles in cardiovascular patients are still not well known. Therefore, the present study was conducted to investigate the mediating role of coping styles in the relationship between personality types and mental disorders in cardiovascular patients. Method: The present study is a cross-sectional study that was conducted on 114 cardiovascular patients at the heart center in Bushehr, Iran. The sampling method is simple random sampling. Demographic information form, MCMI-III questionnaire, NEO-FFI questionnaire, and Lazarus and Folkman coping styles questionnaire were used to collect data. Data were analyzed using SPSS 22 and Amos 24 software. Descriptive statistics methods (mean, variance and percentage), Pearson correlation, and structural equation model (SEM) were applied to analyze the data. Results: The findings showed that the two variables of personality types and problem-oriented explain 15.2% of the variable of mental disorders, of which 10.7% is related to the variable of personality types and 4.5% is related to the intermediate variable of problem-oriented. Among the personality types, the neurotic personality type has the biggest role (0.632) and has a direct and significant effect on mental disorders. Also, the personality types of extroversion (-0.460), agreeableness (-0.312), and responsibility (-0.986) exert inverse and significant effects on mental disorders. Conclusion: The results of the present study showed the frequency of personality disorders and other mental disorders among heart patients. Problem-oriented coping style plays a mediating role between personality types and mental disorders. [ABSTRACT FROM AUTHOR]

Considering the association of cardiovascular disease (CVD) with both osteoporosis and sarcopenia, this study aimed to explore the association between a newly developed CVD risk score and osteosarcopenia in the elderly population. Participants in the second phase of the Bushehr Elderly Health (BEH) program were included. Osteosarcopenia was defined as having both osteopenia/osteoporosis and sarcopenia. The 10-year CVD risk score was estimated using the WHO lab-based model. The participants were considered as high-risk if the CVD risk was ≥ 20%. The estimated risks were compared in individuals with and without osteosarcopenia. The association of CVD risk and osteosarcopenia was investigated using a logistic regression model, adjusted by potential confounders. In all, 2392 participants (1161 men) with a mean age of 69.3 (± 6.3) years were studied and 532 [242 (45.5%) men] individuals were diagnosed with osteosarcopenia. The median (IQR) CVD risks were 0.340 (0.214) and 0.229 (0.128) in men with and without osteosarcopenia, respectively (P < 0.001); In women, the corresponding values were 0.260 (0.147) and 0.207 (0.128), respectively (P < 0.001). Adjusted by confounders, CVD risk ≥ 20% in women, increased the odds of osteosarcopenia by 72%. Body mass index showed an inverse association with osteosarcopenia in both men (0.81, 95%CI: 0.78–0.85) and women (0.66, 95%CI: 0.62–0.70). Considering the area under the ROC curve, the models showed a discriminative ability of 82% in men and 89% in women. This study displayed a significant association between WHO CVD risk score and osteosarcopenia. Due to the difficult diagnosis of osteosarcopenia, the high association of cardiovascular risk score with this disease can help identify high-risk individuals and refer them for further diagnostic procedures. Considering the high prevalence of osteosarcopenia and its complications in the older population, comprehensive strategies are needed to find high-risk populations. [ABSTRACT FROM AUTHOR]

Background: A comprehensive strategy to reduce the complications of hypertension (HTN) should include prevention approaches, such as increasing awareness, early diagnosis, and adequate treatment. The present study aimed to assess awareness, treatment, and control of HTN and their related factors in Kherameh, Iran. Methods: This cross-sectional study was performed on 10 663 individuals aged between 40 and 70 years using the Kherameh cohort data. HTN was defined as either systolic/diastolic blood pressure ≥140/90 mmHg or taking medications. Logistic regression was used to investigate the relationship between awareness, treatment, and control of HTN and demographic factors, comorbidities, and a family history of diseases. Results: Out of 10 663 participants, 4719 (44.3%) were men, and the average age of the participants was 51.94±8.27 years. The rates of the prevalence, awareness, treatment, and control of HTN were 27.7% (95% CI, 26.86 to 28.54), 80.3% (95% CI, 79.56 to 81.04), 78% (95% CI, 77.22 to 78.78), and 53.6% (95% CI, 52.66 to 54.54), respectively. Age, gender, body mass index, and cardiovascular disease were associated with all the dependent variables in the regression model. Additionally, occupation, diabetes, chronic diseases, a history of cardiovascular disease in first and second-degree relatives and a history of chronic diseases in second-degree relatives were related to all the dependent variables except for treatment. Conclusion: A high percentage of the patients were aware of their disease, but a smaller proportion were on medication. Consequently, about half the patients had blood pressure below 140/90 mmHg. [ABSTRACT FROM AUTHOR]

Adhesion molecules like E-selectin have important role in pathogenesis of atherosclerosis. C1901T and G98T polymorphisms of E-selectin gene and E-selectin serum level may affect the risk of coronary artery disease (CAD). A total of 145 normal individuals and 154 patients diagnosed with CAD from the Lur population of Iran undergoing coronary angiography were enrolled. Genetic polymorphisms of E-selectin were determined using PCR-RFLP. Serum level of soluble E-selectin was measured using Elisa. T allele in C1901T polymorphism was significantly associated with an increased risk of atherosclerosis (P = 0.018). No significant association was observed for G98T polymorphism. The mean serum level of soluble E-selectin in the patient group was significantly higher than the control group (P < 0.001). Allele type in C1901T polymorphism plays a role in increasing the risk of developing CAD. Furthermore, since serum E-selectin level is associated with systemic inflammation, it contributes to the increased risk of the disease. [ABSTRACT FROM AUTHOR]

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Many studies have assessed the prevalence of alcohol consumption in Iran. In this study, we investigated the prevalence of alcohol consumption in different groups. We searched international and databases including PubMed, Web of Science, Scopus and we searched two main Farsi-language index databases including Scientific Information Database (SID) and the Irandoc. Grey literature search was also performed in Google Scholar, PsycINFO, ProQuest Dissertation and Theses without time limit until June 2020. All studies that reported the prevalence of alcohol consumption among Iranians were included in current study. From 9,038 screened studies, 109 studies with 925,480 participants were included. The pooled prevalence of alcohol consumption was estimated 24% (95% CI: 18.0–31.0), 12% (95%CI: 10.0–14.0), 14% (95%CI: 13.0–15.0), 19% (95%CI: 13.0–26.0), 15% (95%CI: 3.0–28.0) among prisoners, general population, students, drivers, and street children, respectively. This systematic review indicated higher prevalence of alcohol consumption in prisoners, drivers, and street children than the general population and other subgroups. The distribution of the alcohol prevalence studies in different groups and provinces were heterogeneous. The lack of studies among some groups and in regions warrants further, attention. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery plays a vital role in human health. Hypothyroidism is a common disorder that affects 4 - 10% of the world's population. One of the important challenges of cardiac surgery in hypothyroid patients is their perioperative management. Objectives: In this study, we determined the effects of hypothyroidism on complications after cardiac surgery. Methods: In this retrospective cohort study, patients who underwent cardiac surgery in Birjand, Iran, during 2016 - 2021 and had TSH > 5 μU/mL in adults ≤ 50 and TSH > 10 μU/mL in adults > 50 years old were included as the case group. Also, adults ≤ 50 with TSH 0.3 -- 5 μU/mL and adults > 50 years old with TSH 0.3 -- 10 μU/mL were included as the control group. The complications and outcomes of cardiac surgery were extracted from the patient files. Results: This study involved 30 patients with hypothyroidism and 90 controls. The two study groups were comparable regarding gender, type of cardiac surgery, history of diabetes, hypertension, heart failure, myocardial infarction (MI), and dyslipidemia (P > 0.05). The frequency distribution of cardiac and pulmonary complications, delirium, acute kidney injury (AKI), sepsis, and mortality ratio was not significantly different between the two groups (P > 0.05); the mean systolic and diastolic blood pressure before and after the surgery, duration of mechanical ventilation, cardiopulmonary bypass time, aortic clamp time, duration of ICU hospitalization, and amount of use of dopamine, epinephrine, and norepinephrine were also similar (P > 0.05). Conclusions: Hypothyroidism did not affect the frequency of complications and outcomes after cardiac surgery. Thus, achieving a euthyroid status in hypothyroid patients is unnecessary before cardiac surgery, and there is no need to postpone elective cardiac surgery until hypothyroidism is corrected. [ABSTRACT FROM AUTHOR]

Background: The main objective of this study was to construct and validate a composite socioeconomic status indicator containing material capital, human capital, and social capital (CAPSES scale) and also appropriate it for CVDs in a large population-based study. Methods: This cross-sectional study, the Urban HEART-2 project, was conducted in Tehran, Iran, in 2011. A total of 34,116 households covering 118,542 individuals were assessed in this study. A 14-parts questionnaire was completed for all selected households. All the gathered data were based on the participants' self-reports. Literacy, wealth index, expenditure, skill level, and Townsend index were used as SES indexes. CVDs, including Hypertension, Myocardial infarction, and stroke, were considered the main outcomes. A structural equation model (SEM) was used to construct a CAPSES scale and a composition index of SES. Criterion validity and Construct validity were used to assess this scale. Results: A total of 91,830 subjects consisting of 33,884 (49%) men were included in this analysis. The mean age of the participants was 41.5 ± 11.37 years. Among the assessed participants, 5904(6.4%) reported hypertension, 1507(1.6%) myocardial infarction, and 407(0.4%) strokes. The overall weighted prevalence of self-reported cardiovascular events (hypertension, stroke, and MI) was 8.03% (95%CI: 7.8–8.2). Inverse associations were seen between the CAPSES scale and its domains with CVDs, adjusted for sex, age, BMI, smoking, and diabetes by a multiple logistic regression model. Conclusion: The CAPSES scale was significantly associated with stroke and hypertension. Our findings showed that the CAPSES index could be useful for public health research. [ABSTRACT FROM AUTHOR]

Background: The dietary approaches to stop hypertension (DASH) encourages high fruit, vegetable, and lean protein consumption and low salt, red meat, and fat intake to prevent or treat hypertension. However, besides hypertension, adherence to this diet has been shown to decrease other cardiovascular risk factors. Methods: This study assessed the relationship between the DASH diet and cardiovascular risk factors in a cross-sectional study of 2,831 adults chosen by multistage cluster sampling from 27 counties of Khuzestan province, Iran. DASH scores were calculated using data obtained from a qualitative food frequency questionnaire. Regression models were used to evaluate the association of DASH scores and common cardiovascular risk factors. Results: Significant trends were observed across quintiles of DASH scores for systolic blood pressure, fasting blood sugar, triglyceride, total cholesterol, and its components (p < 0·05). After adjusting for potential confounders such as sex, age, ethnicity, residence, wealth score, physical activity, energy intake, and family history of heart disease, the multiple regression analysis for each cardiovascular risk factor revealed that being in the highest quintile of total DASH score (OR = 0.72, 95% CI 0.52-0.99) was negatively associated with hyperglycemia. Conclusions: This study showed a positive relationship between DASH diet adherence and lower serum levels of glucose, triglycerides, and cholesterol. Prospective studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: The efficacy of endoscopic retrograde cholangiopancreatography (ERCP) has increased significantly over time. However, there are few studies evaluating the success rate of ERCP in Iran. Materials and Methods: We aimed to evaluate the success rate, adverse events, and mortality of ERCP in an academic medical center. This cross-sectional study was conducted over 2 years between February 2018 and January 2020 and 347 patients were enrolled. The success rates and causes of procedure failure were recorded by the endoscopists. The patients were followed up for all adverse events until discharge. Results: Eventually, 302 patients ended the study. The most common indication for ERCP was CBD stone (73.2%). The ERCP procedure was successful in 240 (79.5%) patients. Unsuccessful outcomes were due to cardiovascular conditions (n=7) and endoscopic problems (n=34). Of 34 cases of impossible cannulation, in 32 (10.6%) cases, the papilla was found but cannulation was not possible and in 2 (0.7%) cases it was not possible to access the papilla. The mean (SD) age of the patients with unsuccessful ERCP was significantly higher than successful cases (P=0.001). The times of cannulation, cannulation attempts, and dye injection were significantly higher in unsuccessful procedures as compared with successful procedures (P=0.014, P=0.001, and P=0.001, respectively). The mean time of cannulation (minute) was 5.05 in successful ERCPs and 11.99 in unsuccessful cases (P=0.014). Failure of ERCP was significantly associated with adverse events during ERCP (P=0.001). The most common adverse event was post-ERCP pancreatitis (PEP) (14.6%) and severe cases were 3.6%. PEP was significantly associated with sex (P=0.034). There was no mortality during the study. Conclusion: We found that ERCP could be a safe and effective procedure, especially for patients under 65 years. The overall success rate and adverse events were compatible with the available data in the literature. [ABSTRACT FROM AUTHOR]