Iranian Journal of

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Background: Atherosclrosis is a process that initiated with hypercholestrolemia and fatty streak formation. Previous studies showed oxidative modification of LDL render immunogenic and autoantibodies to epitopes of oxidized LDL. Oxidized LDL (OX-LDL), has antigenic properties. Antibodies against oxidized LDL have been proposed to be independent predictors of atherosclerosis development. The main aims of the current study were to compare antibody titers to different types of oxidized LDL (Cu+2-LDL, Malondialdehyde-LDL) and Native-LDL between angiographically documented coronary patients, non-documented patients and healthy subjects. Correlation between autoantibodies against oxidized LDL and increased risks of cardiovascular diseases has been shown. Methods: As a case-control study, we evaluated angiographically documented coronary patients, non-documented patients and healthy subjects to measure anti-OX-LDL autoantibody levels. Enzyme-linked immunosorbent assay was used to measure anti-OX-LDL autoantibodies. ANOVA test used for statistical analysis. Results: Titers of anti-Malondialdehydo-LDL autoantibodies were 3.55±0.415, 0.361±0.20, 0.093±0.078 respectively in each group (P<0.005). There was not statistically meaningful difference, between native-LDL and Cu+2-LDL antibodies. Conclusion: It seems the titre of autoantibodies against OX-LDL considered as a predictor of progression of atherosclerosis. Our data provide further support for a role of oxidatively modified LDL in atherogenesis.

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Background: The aim of this study was to determine the best Anthropometric indices for prediction of the risk of type 2 Diabetes in lower and higher 60 years old population in Tehran.
Methods: As a prospective study among 4479 non-diabetic men and women over 20 years from the participants of Tehran Lipid and Glucose Study (TLGS) who had complete data of blood pressure, plasma glucose in the fasting state and 2 hours after ingestion of 75 g glucose (2-hPG) as well as fasting serum lipids, anthropometric measurement including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and demographic data at baseline and were followed for a mean duration of 3.6 years. Subjects reevaluated for measurement of fasting Glucose and 2-hPG at follow-up. Diabetes and its associated risk factors were defined according to the ADA criteria. Different measurements of general and central obesity were defined based on the WHO criteria. Logistic regression analysis with stepwise conditional method was used to estimate the Odds Ratio (OR) with 95% CI. Results: A total of 166 new cases of type 2 diabetes (3.7%) were diagnosed during 3.6 years of follow-up, with an approximately one percent per year incidence rate (men=3.7% and women =3.7%, P= 0.95). Diabetic subjects of follow-up were significantly more obese than nondiabetics considering their BMI, WC and WHR. In subjects aged< 60 years high WC was a predictor of diabetes only in model 1 and 2, while general obesity and high WHR predicted diabetes risk in all the 3 models. In these 3 models the OR of general obesity were 5.3(2.9-9.5), 3.4(1.8-6.3), 2.4(1.1-5.1) and the OR of high WHR were 3.5(2.1-5.8), 3.4(1.4-5.8) and 2.6(1.3-4.9), respectively. In subjects aged≥ 60 years general obesity predicted diabetes only in models 1 and 2, while high WHR was a predictor of diabetes risk only in model 1. In this age group, high WC predicted diabetes in all models 1, 2, 3 with the OR of 4.6 (2.3-4.1), 4.5 (2.3-8.9) and 3.8 (1.8-7.7), respectively.
Conclusion: General obesity and high WHR in young Iranian subjects (< 60years) and high WC in older ones (≥ 60 years) are the important anthropometric indices for prediction of type 2 diabetes. Age should be considered when using different anthropometric indices for predicting the risk of type 2 diabetes.

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Background: The risk of metabolic risk factors increases in Middle-Eastern adults within the normal limits of BMI. There is a report that 30.1% of the Iranian population had metabolic syndrome but no reports on the prevalence of this syndrome among individuals within the various BMI categories are available. The present study estimates the prevalence of metabolic syndrome in adult population with normal levels of BMI (18.5-24.9 kg/m2). Methods: In this population-based cross-sectional study, a representative sample of 3444 subjects (1737 males and 1707 females) aged≥20 years with normal body mass index (BMI= 18.5-24.9 kg/m2 for both genders) were included. Demographic data were collected anthropometric indices and blood pressure were measured according to standard protocol. Biochemical analysis was conducted on fasting blood samples. The metabolic syndrome was defined according to the ATP Ш guidelines as the presence of three or more of the metabolic factors. Means and proportions, and multivariate odds ratios that quantify the association between metabolic syndrome and normal BMI quartiles, controlling for age, physical activity, smoking and education were presented. Results: The overall prevalence of the metabolic syndrome in normal weight men and women were 9.9% (CI 95%: 8.49-11.30) and 11.0% (CI 95%: 9.5-12.4, P=0.2), respectively. Men had slightly lower BMI than women (22.4±1.8 vs. 22.5±1.7 kg/m2, P<0.001), while their WC was higher (79.8±6.6 vs.79.3±7.7 cm, P<0.001). The prevalence of high WC and low HDL was higher in women, while high blood pressure, high triglyceride levels and having at least two metabolic risk factors were more prevalent in men. Individuals at the highest category of normal BMI had significantly higher odds for being at risk for metabolic syndrome compared to those at first category (OR 5.21 for men and 2.15 for women). There was a significant increasing trend in odds for having all the metabolic syndrome components except for high FBS and high WC in men. Women revealed a similar increasing trend except for high FBS across normal BMI quartiles.
Conclusion: Normal weights Iranians have excess cardiovascular risk. Therefore interventions for prevention of diabetes and cardiovascular disease could be considered in normal weight population. On the other hand, the cut-points of BMI, suggested by WHO, may be inappropriate for the Iranian adult population.

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Background: The aim of this study was to determine the level of agreement between the impaired fasting glucose (IFG) and abnormal glucose tolerance before and after application of the new IFG definition and to evaluate the impact of adding common clinical data on this agreement.
Methods: A cross sectional population based study was carried out in an Iranian urban population which enrolled 8766 men and women over 20 years. Fasting and 2-hour plasma glucose were measured in all subjects excluding those with previously diagnosed diabetes and fasting plasma glucose ≥126 mg/dl. The diagnostic parameters and kappa coefficient between the previous and revised definitions of IFG for detecting impaired glucose tolerance (IGT) and dysglycemia (IGT and diabetes) were calculated. Logistic regression and ROC curve analysis were used to determine the independent clinical risk factors and their optimal cut-points associated with IGT and dysglycemia. Results: After using the new criteria, sensitivity of IFG for detecting IGT or dysglycemia increased but specificity and positive likelihood ratio (LR+) decreased and the κ slightly improved (0.16 to 0.29 for IGT and 0.24 to 0.35 for dysglycemia). Adding the clinical data to the revised criteria considerably improved the agreement between IFG with IGT and dysglycemia (κ increased from 0.286 to 0.470 for IGT and from 0.354 to 0.574 for dysglycemia). This also increased the LR+ from 3.86 to 14.5 and from 4.46 to 17.4 respectively for detecting IGT or dysglycemia.
Conclusion: The new IFG definition in combination with common clinical risk factors most likely predicts IGT and dysglycemia.

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Background: Atherosclerosis is the leading cause of mortality in the developed and some developing countries. Some people believe that opium abuse has beneficial effects for reducing blood lipids and atherosclerosis prevention. In this study, the effect of oral opium addiction on lipid profile and atherogenesis in normal and hypercholesterolemic rabbits was studied.

Methods: Thirty two male Newzeland White rabbits were used in this study. They were divided into four groups including control, hypercholesterolemic, addicted, and hypercholesterolemic addicted and were studied for three months. The blood samples were obtained and lipid profile was determined at the beginning of the study and at the end of every month thereafter. After 90 days aorta was removed to assess for lesion formation.

Results: The levels of cholesterol, triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), and atherogenic index (total cholesterol/HDL-C) in the hypercholesterolemic and hypercholesterolemic addicted rabbits were increased significantly (P<0.001). These increases in lipids and aorta lesion areas were higher in hypercholesterolemic addicted group than hypercholesterolemic group.

Conclusion: These findings suggest that oral opium abuse affects cholesterol metabolism and depending on the dietary condition can have an aggravating effect on atherosclerosis. The protective effect of morphine on cardiac disease is not probably through the modulation of lipid metabolism.

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In April 2005, the International Diabetes Federation (IDF) has formulated a new worldwide definition of the metabolic syndrome in a global consensus statement built on earlier WHO, the ATPIII definitions. The aim of this study was to estimate the prevalence of this syndrome using the IDF definition among Iranian adults and to compare it with the prevalence estimated using the two other definitions. 

Methods: The prevalence of the MES was determined according to the three different definitions in 10368 men and women aged≥20 years participated in the cross-sectional phase of the Tehran Lipid and Glucose Study (TLGS). To assess the degree of agreement between different MES definitions, the k test was used. 

Results: The prevalence of MES (95% confidence interval) was 32.1% (31.2-33.0) by the IDF definition, 33.2% (32.3-34.1) by the ATPIII and 18.4% (17.6-19.2) according to the WHO definition. The sensitivity, specificity and concordance of the IDF definition for detecting MES were 91%, 89% for the ATPIII definitions and 73%, 77% for the WHO definition, respectively. The k statistics for the agreement of the IDF definition was 66.3±0.01 with the ATPIII and 39.5±0 with the WHO definition.

Conclusion: In the Iranian population, the IDF definition for MES has a good concordance with the ATP III definition and a low concordance with the WHO definition.

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Background: The aim of this study was to examine the prevalence of the metabolic syndrome (MetS) and its association with coronary heart disease (CHD) in Iranian older individuals.

Methods: In this cross-sectional study, the prevalence of the MetS was determined according to the Third Adult Treatment Panel (ATPIII), the World Health Organization (WHO) and the International Diabetes Federation (IDF) definitions in 720 men and women aged≥65 years. Logistic regression analysis was used to estimate the Odds Ratio (OR) of developing CHD in model 1 an age adjusted model, in model 2 adjusted for age, smoking status, premature history of CHD and LDL cholesterol and in model 3 adjusted for mentioned variables in model 2 plus the components of the MetS according to each definition.

Results: The prevalence of MetS was 50.8%, 41.9% and 41.8% by ATPIII, IDF and the WHO definitions, respectively. IDF had high agreement with the ATPIII definition. In model 2, the ATPIII and the WHO definitions of MetS were associated with CHD by the odds ratio of 1.6 (1.1-2.2) and 1.7 (1.9-2.4), respectively. In model 3, obesity (WHO definition) and high blood pressure (ATPIII and WHO definitions) were associated with CHD.

Conclusion: As defined by the ATPIII and WHO definitions, the MetS was associated with CHD even after adjustment for the conventional CHD risks, but after further adjustment for their components none of these definitions showed association with CHD.