Comparison of Formulas for Low-Density Lipoprotein (LDL) Calculation for Predicting the Risk of Metabolic Syndrome

Background: The correlation between serum cholesterol level and the risk of developing atherosclerosis and metabolic syndrome has been well established in previous studies. Serum low-density lipoprotein (LDL-C) measurement is conducted using different methods which are generally divided into two groups, namely direct and indirect. Using indirect methods or calculations such as the Friedewald or Iranian formula for measuring LDL, particularly in developing countries, is quite common. The present study has stepped in to compare the robustness of the extant formulas in prognosticating and determining the incidence of metabolic syndrome. Materials and Methods: In this cross-sectional study, the target population was the community of Fasa cohort study. According to the views of the statistical advisor, 9530 people were included in the study and clinical laboratory examinations were done for each person. Their serum LDL level was measured using the existing formulas. Then, the results of the serum LDL level that was computed with different formulas, were compared with both the status of metabolic syndrome and laboratory tests of individuals. Results: The Iranian formula has the highest area under curve, the sensitivity of 0.73, and specificity of 0.77, higher positive and negative predictive values among other formulas. In Friedewald formula, for example, sensitivity and specificity equal 0.28 and 0.80, respectively. After further analysis, two new models proposed for predicting metabolic syndrome. The results revealed that these two models even outperform the Iranian formula. Conclusion: The Iranian formula for plasma LDL calculation has higher precision and application for predicting and measuring the metabolic syndrome in the Iranian population due to its considerable features. It is required to develop a new formula for each population and even for each sex, if possible. Keywords:Cholesterol; LDL; Lipoproteins; Metabolic Syndrome; Friedwal

KLINIČKE PRIČE I MEDICINSKE ANAMNEZE KOJE JE ZABILJEŽIO RHAZES (865.–925.), IRANSKO‑ISLAMSKI LIJEČNIK SREDNJEGA VIJEKA

Recording medical histories of patients is not a new issue in clinical medicine. However, the method practiced by the Iranian chemist physician, Rhazes, in the ninth century A.D is incredible. Rhazes has written several textbooks in clinical medicine, but a particular one, “Clinical Stories and Medical Histories” (Qesas va hekayat al-marazi), is a classical case book describing precise clinical courses of thirty three patients. Each chapter includes a title, the name and demographic data about a patient, his/her history of present illness, past medical and family history, findings of physical exam, impression and interventions by the physician, including pharmacological or surgical management. The reasons for each decision made by Rhazes as well as the outcomes are clearly discussed. This book review will shed light on the unknown medical practice methods in Islamic-Iranian golden era.Bilježenje medicinske anamneze pacijenata nije novo pitanje kliničke medicine. Kako bilo, metoda koju je prakticirao Rhazes, iranski kemičar i liječnik, u devetom stoljeću zadivljujuća je. Rhazes je napisao nekoliko udžbenika iz kliničke medicine, ali ona kratka, Kliničke priče i medicinske anamneze, klasična je knjiga prikaza slučajeva koja opisuje točan klinički tijek kod trideset i tri pacijenta. Svako poglavlje uključuje naslov, ime i demografske podatke o pacijentu, njenu/njegovu povijest trenutne bolesti, prošlu medicinsku i obiteljsku povijest bolesti, nalaze fizikalnog pregleda, utiske i intervencije liječnika, uključujući farmakološke i/ili kirurške postupke. Razlozi su svake Rhazesove odluke kao i rezultati jasno raspravljeni. Čitanje zabilješki u ovoj knjizi pomaže osvijetliti nepoznate kutke koji se tiču metoda medicinskih praksi u vrijeme rađanja islamskoiranske civilizacije

The Association of Diet Quality Indices with Metabolic Syndrome Components: A PERSIAN Cohort Study in Fasa, Iran

Background: Metabolic syndrome (MetS) is a significant health concern both in developed and developing countries. This cohort Prospective Epidemiological Research Study in Iran (PERSIAN) aimed to determine the association of diet quality, assessed by the Healthy Eating Index-2015 (HEI-2015) and Mediterranean Diet Score (MDS), with MetS components among individuals with MetS in Fasa, southern Iran.Methods: In this cross-sectional study, 907 individuals with MetS aged 35-65 years were recruited from the Fasa PERSIAN Cohort Study, Fasa, Iran. The National Cholesterol Education Program Adult Treatment Panel III (ATP III) and Iranian National Committee of Obesity criteria were used to define MetS. A 125-item food frequency questionnaire wasemployed to evaluate dietary intake. The association between the quartiles of dietary scores and MetS components analyzed by Multivariate linear regression with the backward method.Results: The mean age of the individuals (67.3% female) was 48.75±8.22 years. After adjusting for covariates, the highest HEI-2015 quartile was positively correlated with fasting blood sugar (FBS, β=7.30, 95%CI=1.03, 13.58) and triglyceride levels (β=32.71, 95%CI=9.09, 56.33). The MDShad a significant negative association with the systolic blood pressure (SBP) in both crude and adjusted models (β=-3.14, 95%CI=-6.2, -0.019). The triglyceride (TG, β=26.008, 95%CI=4.32, 47.69) and FBS (β=5.77, 95%CI=0.057, 11.49) levels also were positively correlated with thehighest MDS quartile.Conclusion: The SBP was shown to be inversely associated with the MDS, wherease higher adherence to HEI-2015 and MDS values were also linked with increased FBS and TG levels

Dietary inflammatory index and metabolic syndrome in Iranian population (Fasa Persian Cohort Study)

Metabolic syndrome (MetS) is one of the risk factors for all causes of mortality. Inflammation is an important risk factor for MetS. The present cross-sectional study aimed to investigate the relationship between MetS and pro-inflammatory diet by using the food inflammation index (DII). This study consists of 10,017 participants with an age range of 35 to 70 years. The Fasa Cohort Study (FACS) population (Fars Province, Iran) was used to collect data. The DII was estimated according to Shivappa et al. method using a validated 125-item FFQ. To determine the association between MetS components and DII Logistic regression was used (P>0.05). The overall mean of DII was-0.89 +/- 1.74. However, adjusted multinomial logistic regression indicates each unit increase in waist circumference (WC) (OR 0.98, 95% CI 0.96-0.99) and HDL-C (OR 0.99, 95% CI 0.98-0.99) was associated with significantly decreased odds of being in the 4th DII quartile in men and all participations respectively, there is no statistically significant relationship between MetS and DII. Overall, although people in the highest quartile of inflammatory food consumption had more likely to develop MetS, this relationship was not statistically significant among males and females. Plus:CARDIOVASCULAR RISK; ASSOCIATION; PATTERNS; DISEASE; OBESITY; HEALTH; STRATEGIES; MORTALITY; CANCE

Correlation of resting heart rate with anthropometric factors and serum biomarkers in a population-based study: Fasa PERSIAN cohort study

BACKGROUND: There is a positive association between raised resting heart rate (RHR), and all causes of mortality and shorter life expectancy. Several serum biomarkers and some anthropometric factors can affect the resting heart rate. This study aimed to investigate the determinants of resting heart rate in a large random sample of the Iranian population. MATERIAL AND METHODS: It is a standardized, retrospective study and the subjects were chosen from the baseline survey of the Prospective Epidemiological Research Study in IrAN (PERSIAN) Fasa non-communicable disease cohort study. It was conducted from winter 2014 to summer 2019 and after obtaining informed consent from a random sample, all the eligible subjects were enrolled. All anthropometric factors and biologic laboratory factors were collected and analyzed by implement smoothly clipped absolute deviation (SCAD) linear regression and SCAD quantile regression. The comparisons between males and females were done via independent T-test. RESULTS & CONCLUSION: A total number of 9975 persons from 35 to 90 years old were included. The overall median resting heart rate was 74 (interquartile range:66-80). Mean age has no important difference between males and females (P = 0.79) but, resting heart rate was significantly higher in females (76.6 versus 71.4, P < 0.001). All anthropometric factors except wrist circumference were higher in females (P < 0.05). Age has an adverse effect on resting heart rate and also, there was a direct association between resting heart rate and systolic blood pressure and blood glucose. Alpha-blockers (coefficient = 5.2) and Beta1-blockers (coefficient = - 2.2) were the most effective drugs with positive and negative effects on resting heart rate respectively. Lower hemoglobin, obesity, and more body mass index, and more low-density lipoprotein were associated with more resting heart rate. Continuing the monitoring of this sample via our cohort study and put to action multinational prospective researches with large sample sizes and long follow-ups can lead to more precise results and better scientific judgments

Emerging immunopharmacological targets in multiple sclerosis.

Inflammatory demyelination of the central nervous system (CNS) is the hallmark of multiple sclerosis (MS), a chronic debilitating disease that affects more than 2.5 million individuals worldwide. It has been widely accepted, although not proven, that the major pathogenic mechanism of MS involves myelin-reactive T cell activation in the periphery and migration into the CNS, which subsequently triggers an inflammatory cascade that leads to demyelination and axonal damage. Virtually all MS medications now in use target the immune system and prevent tissue damage by modulating neuroinflammatory processes. Although current therapies such as commonly prescribed disease-modifying medications decrease the relapse rate in relapsing-remitting MS (RRMS), the prevention of long-term accumulation of deficits remains a challenge. Medications used for progressive forms of MS also have limited efficacy. The need for therapies that are effective against disease progression continues to drive the search for novel pharmacological targets. In recent years, due to a better understanding of MS immunopathogenesis, new approaches have been introduced that more specifically target autoreactive immune cells and their products, thus increasing specificity and efficacy, while reducing potential side effects such as global immunosuppression. In this review we describe several immunopharmacological targets that are currently being explored for MS therapy

Socioeconomic inequalities in prevalence, awareness, treatment and control of hypertension: evidence from the PERSIAN cohort study

Background Elevated blood pressure is associated with cardiovascular disease, stroke and chronic kidney disease. In this study, we examined the socioeconomic inequality and its related factors in prevalence, Awareness, Treatment and Control (ATC) of hypertension (HTN) in Iran. Method The study used data from the recruitment phase of The Prospective Epidemiological Research Studies in IrAN (PERSIAN). A sample of 162,842 adults aged > = 35 years was analyzed. HTN was defined according to the Joint National Committee)JNC-7(. socioeconomic inequality was measured using concentration index (Cn) and curve. Results The mean age of participants was 49.38(SD = +/- 9.14) years and 44.74% of the them were men. The prevalence of HTN in the total population was 22.3%(95% CI: 20.6%; 24.1%), and 18.8%(95% CI: 16.8%; 20.9%) and 25.2%(95% CI: 24.2%; 27.7%) in men and women, respectively. The percentage of awareness treatment and control among individuals with HTN were 77.5%(95% CI: 73.3%; 81.8%), 82.2%(95% CI: 70.2%; 81.6%) and 75.9%(95% CI: 70.2%; 81.6%), respectively. The Cn for prevalence of HTN was -0.084. Two factors, age (58.46%) and wealth (32.40%), contributed most to the socioeconomic inequality in the prevalence of HTN. Conclusion The prevalence of HTN was higher among low-SES individuals, who also showed higher levels of awareness. However, treatment and control of HTN were more concentrated among those who had higher levels of SES, indicating that people at a higher risk of adverse event related to HTN (the low SES individuals) are not benefiting from the advantage of treatment and control of HTN. Such a gap between diagnosis (prevalence) and control (treatment and control) of HTN needs to be addressed by public health policymakers

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe