فرزاد حدائق

Considering hypertension as the most prevalent comorbidity among patients diagnosed with COVID-19, this study intended to investigate clinical characteristics and in-hospital mortality risk factors among COVID-19 patients with hypertension history.

This descriptive-analytical study was conducted on 527 hypertensive patients (277 male and 250 female) a mean age of 64.73±13.13 years infected with COVID-19 and hospitalized at Sayyad Shirazi Hospital, Gorgan Iran from February to September 2020. The patients’ data were extracted from the hospital information system and completed by patients’ medical records and telephone calls. The association between the risk factors and in-hospital mortality was identified by employing the logistic regression analysis in three various models, including model 1 (demographic data and patients’ history), model 2 (model 1 plus vital signs and pulse oximetry measurement at hospital admission) model 3 (model 2 plus laboratory findings at hospital admission). Each model individually described the odds ratios (ORs) with 95% confidence intervals (95% CIs) for every risk factor. Furthermore, a corrected area under the receiver-operating characteristics curve (AUC) was estimated to evaluate the model’s discriminatory power.

Among 527 hospitalized patients, 88 patients (16.6 %) died during 6.48 days of hospitalization, of which 47 patients were men. In model 1, opium consumption (CI95%=1.16-3.85, OR=2.11) and cognitive impairment at admission (CI95%=0.98-5.40, OR=2.30) were significantly associated with higher mortality (AUC=0.65). In model 2, after adding vital signs and oxygen saturation, cognitive impairment association lost its association, and only opium consumption (CI95%=1.09-3.19, OR=1.87) and oxygen saturation (CI95%=0.90-0.95, OR=0.93) were associated with in-hospital mortality. (AUC=0.73). In model 3, after incorporating laboratory findings, with an AUC of 0.79 (CI95%=0.70-0.90), each percent higher oxygen saturation at admission was associated with a 7% decrease in in-hospital mortality (CI95%=0.88-1.00, OR=0.93). Although opium consumption and higher creatinine level lead to higher mortality, the associations were not significant.

Regarding the association of oxygen saturation at admission with in-hospital mortality among hypertensive patients diagnosed with COVID-19, the pulse oximetry measurement data upon admission would be crucial in evaluating these patients.

Melatonin is available as a dietary supplement and is frequently used for sleep disorders. Decrease in cholesterol absorption, increase in LDL oxidation, and decrease in free fatty acids have been associated with melatonin use. The present study aimed to evaluate the effects of melatonin on changes in the lipid profile of patients with type 2 diabetes mellitus.

This double-blind randomized clinical trial was conducted on patients with diagnosis of type 2 diabetes mellitus. They were allocated to receive either 6 mg/d of melatonin or placebo for a minimum of eight weeks. The levels of cholesterol, triglyceride, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were evaluated at baseline and at the end of the study.

The demographic characteristics, baseline lipid profiles, and current medication use were found to be similar in the two groups, except for metformin use (100% vs. 86.11%; P=0.02). There was no significant difference between the two groups in terms of the lipid parameters, such as cholesterol, triglyceride, LDL, and HDL levels (P=0.26, 0.81, 0.21, and 0.66, respectively). There were no serious adverse drug reactions in the two groups during the study.

According to the results of this trial, 6 mg/d of melatonin does not change the lipid profile of patients with type 2 diabetes mellitus.

Control of blood pressure, fasting plasma sugar (FPS) and low-density lipoprotein-cholesterol (LDL-C) reduces to vascular complications of diabetes. In this study we determined the prevalence of diabetic individuals with uncontrolled blood pressure, FPS and LDL-C.

We used data from three national Surveys of Risk Factors of Non-Communicable Disease (SuRFNCD) conducted in 2007, 2011 and 2016. Participants were 4493 adults, aged 25-65 years, who self-reported a previous diagnosis of diabetes. Logistic regression was used to determine p-value for trends of prevalence rates.

From 2007 to 2016, significant reductions in the prevalence of individuals with high blood pressure from 48.2 % to 40.4 % (47.3 % to 37.4 % in men and 53.0 % to 41.5 % in women) and also in those with high LDL-C levels from 75.4 % to 46.7 % (73.2 % to 45.7 % in men and 77.4 % to 48.3 % in women) were observed. Only women showed a significant decrease in the prevalence of those with high FPS.

Despite significant improvements during the last decade, achieving goals of these risk factors remains suboptimal among Iranian adults with diagnosed diabetes. Considerable further improvement is needed to control and reduce future vascular complications.

The prevalence of impaired fasting glucose (IFG) is increasing worldwide, affecting people in all age groups, including adolescents. The objective of this study was to explore changes in IFG prevalence during a decade long follow-up in adolescent participants of a population-based cohort study from Iran.

We included 2998 participants, aged 11-19 in study period 1 (1999-2005; 1415 boys, 1583 girls) and 946 participants in study period 2 (2011-2014; 477 boys, 469 girls). Multivariate binary logistic regression models were performed to examine the role of susceptible risk factors in the relationship between study periods with IFG.

A two-fold increase was observed in the prevalence of IFG, from 7% in study period 1 to 16.6% in study period 2. Regarding non-modifiable risk factors, older age and female gender were associated with lower risk for IFG. Among modifiable risk factors in the fully adjusted model, being overweight and obese were significantly associated with IFG, whereas central obesity was not found to be an independent risk factor. Yet, adjusting for general and central obesity could not attenuate the increase in IFG over time.

the prevalence of IFG among Iranian adolescents increased significantly and study period remained a significant factor after all adjustments. We propose the role of other potential risk factors be further investigated.

Higher prevalence and incidence of cardiovascular disease (CVD) has been reported in the Middle-East compared to other regions. Subclinical hypothyroidism and hyperthyroidism have been shown to be related with increased risk for CVD. We aimed to investigate the relation of subclinical thyroid dysfunction with the incidence of CVD among an Iranian population.
After excluding patients with overt hypothyroidism and hyperthyroidism, a total of 3822 participants entered the study (44.1% men). According to their thyrotropin and free thyroxin levels, they were categorized into 3 groups: Euthyroid, subclinical hypothyroidism and subclinical hyperthyroidism. Multivariable Cox proportional hazard models were used to assess the relation of subclinical thyroid dysfunctions with incident CVD.
Mean age (SD) of the participants was 46.4 (12.0) years. At baseline, no significant difference was observed in the frequency of prevalent CVD cases (n=197) between all groups. Since there was no significant interaction between prevalent CVD and thyroid function states with outcomes, participants with prevalent CVD were not excluded. A total of 387 CVD events occurred during a median follow-up of 11.2 years. Even in the age and sex adjusted model, no association was observed between different subclinical thyroid dysfunctions and incidence of CVD. The multivariable hazard ratios (95% CI) of subclinical hypothyroidism and subclinical hyperthyroidism for CVD events as compared with euthyroid state were 1.32 (0.85–2.07) and 0.89 (0.51–1.55), respectively.
Both at baseline and in follow-up, no relation was observed between different subclinical thyroid dysfunctions and the prevalence and incidence of CVD

Chronic kidney disease (CKD) is a common disorder that is associated with increased risk of cardiovascular disease, kidney failure, and other complications. The ageing of populations along with the growing global prevalence of diabetes and hypertension has led to a corresponding worldwide increase in prevalence of CKD. We studied the risk of diabetes, hypertension and interaction of diabetes with hypertension on the incidence of CKD, stratified by gender.
This study is secondary study on the data of Tehran Lipid and Glucose Study. A population of 7342 participants (46.8% male) with a mean age of 46.8 years for males was investigated. At first, they were divided into 4 groups. First group: patients without dabetes and without hypertension; the second group: dabetes and without hypertension; the third group: without diabetes and Hypertension; the forth group: with diabetes and Hypertension were. Then, each group was compared to the first group using multivariate Cox regression analysis adjusted for age, education, smoking, total cholesterol, Triglyceride, HDL, Glomerular filtration rate and Body Mass Index, and trend score.
In men of the second group, diabetes (without hypertension) with HR of 1.94 (CI 95%:1.39-2.69) and in men of third group, hypertension (without diabetes) with HR of 1.58 (1.27-1.96) were risk factors for CKD events. As the same way, the results were in women 1.18 (0.93-1.51) and 1.24 (1.05-1.47). Diabetes and hypertension had not any significant interaction in men and women with the prevalence of chronic kidney disease.
The results of this study indicated that hypertension (regardless of the presence or absence of diabetes) is an independent risk factor for chronic kidney disease in men and women.

Pre-diabetes is a high risk condition for developing type 2 diabetes mellitus and cardiovascular disease. The target of this study is evaluation of incidence rate of pre-diabetes and its risk factors in a long- term follow up in the Tehran Lipid and Glucose Study.
The Tehran Lipid and Glucose Study is a prospective study being accomplished on a characteristic sample of the Tehranian residents at District 13, targeted determining the prevalence and incidence of non-communicable diseases and their risk factors. Four phases of the study have been implemented, including three-year periods from 1999 to 2011. From an overall of 12808, twenty years old and older people at baseline, after excluding participants who did not have the necessary conditions, analyses were accompanied on a 2597 male and 3282 female to estimate pre-diabetes incidence and detect their risk factors.
In men with incident pre-diabetes, age, fasting plasma glucose, 2-hour post-challenge plasma glucose and body mass index in addition to a positive family history of diabetes and The study showed that the incidence of diabetes and its variants in the Iranian people is high.

Considering the importance of CVD risk factors in diabetic and non-diabetic populations and the high prevalence of diabetes and cardiovascular risk factors, we studied the trend of anthropometric indexes, blood pressure, smoking and lipids in diabetic and non-diabetic populations. The data of Tehran Lipid and Glucose Study was used in this investigation. The study population comprised 1045 diabetic and 5136 non-diabetic subjects. To investigate the secular longitudinal trends, the Generalized Estimation Equation method was employed. All statistical models were adjusted for age to eliminate the potential confounding effect of age. The interaction between the diabetes status and each phase of the study was checked in a separate model in GEE. Over a decade, the serum levels of TC, TGs, LDL-C and non HDL-C decreased although about 60% of the diabetic population did not reach the therapeutic goals of non-HDL-C and LDL-C levels until 2011. Control of hypertension was more successful in females, but about 60% of both males and females with diabetes were still hypertensive at the end of follow-up period. Smoking increased during the follow-up. This study showed that among CVD risk factors, healthcare professionals paid more attention to hypercholesterolemia neglecting other risk factors including hypertension and central obesity.

Some studies on chronic diseases have indicated that obesity may result in a paradoxically longer survival. The present study was aimed to investigate the effect of Chronic Kidney Diseases (CKD) and Metabolic Syndrome (MetS) on the incidence of Coronary Heart Disease (CHD). In order to record time to CHD events, a sample of 6,507 individuals (mean age 47.4 years, 43.4% males) was followed for nearly 10 years. Participants were also categorized into four groups according to presence/absence of CKD and MetS. Then, using a Multivariate Cox Regression, the Hazard Ratio (HR) of each group was estimated relative to individuals free of both CKD and MetS separately for obese (BMI≥27.1 Kg/m2) and non-obese persons (BMI<27.1 Kg/m2). HR for non-obese patients with CKD but not MetS was obtained 2.06 (95%CI: 1.28-3.31) in men and 2.56 (1.04-6.31) in women. However, these associations were not significant for obese patients. Furthermore, among non-obese men and women with MetS alone, HR was estimated 2.52 (1.71-3.73) and 4.68 (2.20-9.95), respectively. For obese patients, these values were 1.70 (1.05-2.78) and 1.90 (1.16-3.13), respectively. The results reflect that among those who had MetS alone, the risk of CHD incidence was twice higher in non-obese individuals compared to obese patients.

we investigated the association of different hypertension subgroups including isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), systolic-diastolic hypertension (SDH), controlled blood pressure (CBP), and uncontrolled blood pressure (UBP) for incident CVD and mortality events.
6974 middle age and 882 elderly participants were categorized according to their BP measurements, participants. Cox regression analysis was used to estimate the hazard ratio (HR) for hypertension subgroups, considering those with normotension as the reference.
During more than 10 years of follow-up, in the middle-aged group, 490 CVD and 152 deaths occurred; corresponding rates for the elderly group were 194 and 176, respectively. In middle-aged subjects ISH, SDH and UBP increased the risk of CVD; whereas UBP increased the risk of mortality due to CVD and any cause (HR: 5.66 and HR: 2.95, respectively) and IDH increased only the risk of total mortality in this group (HR; 2.01) (all p-values In both middle-aged and elderly population, ISH, SDH and UBP increase the risk of CVD. Controlling of BP to

In Nov 2013, the instruction for controlling high cholesterol has been released by the American College of Cardiology (ACC) and the American Heart Association (AHA) which need to be assessed in the different communities. Of total 6275 individual aged 40-75 years who entered at the Tehran Lipids and Glucose Study from March 1999 to 20 March 2010 in first examination cycle, 5153 with the median follow-up of more than ten years were eligible to enter in this study. The 10-year risk of hard cardiovascular disease (Hard CVD) for Statin therapy based on ACC/AHA clinical guideline was calculated and this risk was calculated for each subgroup of the guideline who recommended for statin therapy comparing to the risk in individuals with prevalent CVD. Of nearly 6.5 million urban population of Iran (according to the 1996 census) about 4 million individuals (2.55 million men and 1.4 million women) were eligible for statin therapy. With respect to the urban population growth from the 1996 to the 2011 census (about 2.5 percent increases) the number of individuals for receiving statin increased by 50% (5 million men and 3 million women). Also, the risk in non-diabetic men with calculated risk of 5-7.5% and diabetic women with calculated risk of <5% for hard CVD was lower than 0.2. By removing these people from total eligible population, the burden of statin therapy will reduced about 8% which is about 540.752 persons, according to the Census 1996 and 1.155.079 individuals based on the census 2011. The new guideline of ACC/AHA for statin therapy is relatively reasonable except for some subgroups. To reduce the burden of medical expenses, statin prescription can be ignored by physicians in these subgroups. Of course further research is required to calculate the net benefit for estimating the clinical usefulness of statin therapy in recommended guideline subgroups.

We studied the risk of Chronic Kidney Disease (CKD)، Metabolic Syndrome (MetS)، and their interaction on the incidence of Coronary Heart Disease (CHD). A population of 6568 participants (43. 4% male) with a mean age of 48. 4 years for males and 46. 7 years for females and a median follow-up of 10. 1 years was investigated. They were divided into 4 groups at baseline: CKD-/MetS-، CKD+/MetS-، CKD-/MetS+، CKD+/MetS+. Hazard Ratios (HRs) were calculated for each group and were compared to the first group using multivariate Cox regression analysis adjusted for age، education، smoking، total cholesterol، and the family history of cardiovascular diseases. Men with CKD (without MetS) showed an HR of 1. 74 (CI 95%: 1. 16-2. 60) for CHD events. The measured value was 2. 34 (1. 77-3. 08) for men with MetS (without CKD). The respective results were in women 1. 18 (0. 64-2. 19) and 2. 59 (1. 73-3. 88). CKD and MetS had a significant negative interaction with CHD events (HR=0. 40، 0. 24-0. 66). The interaction was not significant in women (P value=0. 48). The results of this study indicated that CKD without MetS was a risk factor for coronary heart disease in men but not in women.

Few studies have used lifestyle modification to prevent obesity at the community level. The aim of this study was to determine the effects of lifestyle modification education on the prevalence of general and central obesity in adults. We studied 3270 men (1205 and 2065 individuals in the intervention and control groups، respectively) and 4464 women (1670 and 2794 individuals in the intervention and control groups، respectively). They participated in Tehran Lipid and Glucose Study during 1999-2011. Demographic characteristics، behavioral habits، and obesity status of the participants were assessed through four cross-sectional surveys with 3-year intervals. The intervention included education for improving diet and physical activity and decreasing smoking through counseling، lectures، and publications. The mean age of men and women was 44. 2 ± 14. 9 and 42. 1±13. 7 years، respectively. During a median follow-up of 9. 9 years، the intervention had no significant impact on the odds of becoming obese in non-obese men and women. However، it resulted in 0. 27 and 0. 38 decreases in the odds of continuing to be obese in obese men and women، respectively. The changes were only significant in women (P = 0. 003). In addition، the intervention reduced the odds of central obesity by 0. 34 in the women with central obesity (P = 0. 002). However، it had no significant effects on central obesity among other participants. Population-based interventions can be beneficial in reducing the prevalence of general and central obesity in adults. These effects are stronger in women than in men. Thus، implementing interventional programs among non-obese individuals is necessary.

Cardiovascular disease is the first cause of death and third place in disease burden in Iran. This study estimates population attributable fraction (PAF) of cardiovascular risk factors in Tehran population. PAF is one of the important parameters of measuring population affect of risk factors and evaluating potential impact of preventive strategies in community level. In this study 5868 participants above 30 years old of Tehran lipid and glucose study (TLGS) were employed and 501 CVD events detected during 10 years follow-up. Direct estimate of adjusted PAFs using logistic regression which is one of less biased exist methods of PAF calculation were applied. Highest modifiable cardiovascular risk factor PAFs, in sequence, was smoking (14.16%), hypertension (11.73%), diabetes (7.32%), hypercholesterolemia (6.85%) and central obesity (5.91%) for men, and hypertension (19.25%), diabetes (18.82%), central obesity(9.88%) and hypercholesterolemia (7.95%), for women. Also PAF of hazardous age and premature family history of CVD, as most important nonmodifiable CVD risk factors, were 36.09%, 16.61% and 3.95%, 7.56% for men and women respectively. According to the difference of risk factors PAFs ranking in men and women, it is suitable that CVD preventive interventions to be prioritized by sex separately. In this regard, besides special attention to control tobacco use in men, hypertension and diabetes in both sexes and high cholesterol in men and central obesity in women respectively, should be given in priority of preventive strategies.

Regression is one of the most important statistical tools in data analysis and study of the relationship between predictive variables and the response variable. in most issues, regression models and decision tress only can show the main effects of predictor variables on the response and considering interactions between variables does not exceed of two way and ultimately three-way, due to complexity of such interactions. To consider such interactions in the regression models, instead of individual variables in the model, we can construct a combination of them and use this combination as a new independent variable into the model Logic regression is a generalized regression and classification method that in this model, predictive variables are Boolean combinations that are made of the original binary variables. Annealing algorithm is used to find such combinations and their coefficients. randomization test or “null model test” is an overall test for signal in the data.also, cross-validation test can be used to determine the size of the logic tree model with the best predictive capability. As an example, we applied Logic Regression to predict diabetes in TLGS study.

Mixed outcomes arise when, in a multivariate model, response variables measured on different scales such as binary and continuous. Artificial neural networks (ANN) can be used for modeling in situations where classic models have restricted application when some of their assumptions are not met. In this paper, we propose a method based on ANNs for modeling mixed binary and continuous outcomes. Univariate and bivariate models were evaluated based on two different sets of simulated data. The scaled conjugate gradient (SCG) algorithm was used for optimization. To end the algorithm and finding optimum number of iteration and learning coefficient, mean squared error (MSE) was computed. Predictive accuracy rate criterion was employed for selection of appropriate model. We also used our model in medical data for joint prediction of metabolic syndrome (binary) and HOMA-IR (continues) in Tehran Lipid and Glucose Study (TLGS). The codes were written in R 2.9.0 and MATLAB 7.6. The predictive accuracy for univariate and bivariate models based on simulated dataset Ι, where two outcomes associated with a common covariate, were shown to be approximately similar. However, in simulated dataset ΙΙ in which two outcomes associated with different covariates, predictive accuracy in bivariate models were seen to be larger than that of univariate models. It is indicated that the predictive accuracy gain is higher in bivariate model, when the outcomes share a different set of covariates with higher level of correlation between the outcomes.

Considering the high prevalence of diabetes mellitus worldwide and in the Middle East countries and high prevalence of cardiovascular disease (CVD) in diabetic patients, this study aimed to compare different abdominal and central obesity measures, as important risk factors of CVD, for prediction of CVD in Iranian men and women with type 2 diabetes.

We followed 1010 patients with type 2 diabetes for a median follow up period of almost 8 years. The hazard ratios (HRs) for CVD were calculated for a 1 standard deviation (SD) change in each anthropometric measure, using Cox proportional regression analysis.

A hundred and eighty-eight cardiovascular events occured in diabetic patients. In the age adjusted model, in diabetic men, waist to hip ratio (WHR), waist to height ratio (WHtR) and waist (WC) were associated significantly with CVD but in the multivariate model, only WHR was a significant and independent predictor of CVD. In diabetic women, in the full adjusted model, WHR was associated significantly with CVD. WC in diabetic women and WHtR in both genders were marginally associated with CVD.

Central obesity measures were stronger than the general obesity parameter for prediction of CVD in adults with type 2 diabetes mellitus and WHR was the most important anthropometric measure in these patients in both genders.

The metabolic syndrome includes risk factors for non-communicable diseases such as central obesity, hyperglycemia, dyslipidemia and hypertension accompanied by pro-inflammatory and hypercoagulability states. The aim of this study was to determine the effects of weight change on incident metabolic syndrome.

This was a prospective cohort study, the population of which included all participants of the TLGS, phases one and two, >20 yrs and above, free of metabolic syndrome, based on the Iranian waist circumference, and NHLBI. Iranian waist circumference was defined with different cutoff points, according to cross sectional and outcome-based studies. Data was obtained by interviews, questionnaires, observation, and physical and laboratory examinations.The incidence of metabolic syndrome after 3.1 years of follow up was determined. Percent of weight change (PWC) was divided in five quintiles. Using the logistic regression test, odds ratio and 95% confidence interval of incident metabolic syndrome and its components for these quintiles, after adjusting for confounders, were calculated.

Age adjusted incidences of metabolic syndrome after a 3.1 year follow up, according to Iranian WC outcome were 20.6% (males 26%, females 20.9%) and for Iranian WC cross sectional and NHLBI were 26.2% (males 34.4%, females 26.1%) and 23.7% (males 24.4%, females 29.4%) respectively. For both genders, based on Iranian W.C and NHLBI, a weight reduction of at least 1.3%, compared to baseline, in women had a protective effect against incident metabolic syndrome. In men a weight gain of at least 1.4% since baseline resulted in an increase in the odds ratio. In women, weight gain of at least 1.3% since baseline, based on the Iranian WC cross sectional, NHLBI and at least 4% based on Iranian W.C-outcome resulted in progressive incidence of metabolic syndrome. These reductions of at least 1.3% in males and 2.5% in females, decreased the relative risk of abdominal obesity, but had no effect on other components of metabolic syndrome, including: hypertriglyceridemia, low HDL, hyperglycemia, and hypertension. Although in both sexes, increase in weight resulted in abdominal obesity, the cut off points according to various definitions were different.

Considering the preventive effect of weight loss against incident metabolic syndrome and abdominal obesity, we recommend educational programs to enhance awareness regarding overweight and obesity and motivate individuals to lose weight.

Detection of population at risk of type II diabetes, as a multi-factorial disease, is an important issue because of its individual and social impacts. To date, several studies have been conducted to predict the incidence of diabetes, using different statistical methods. However, despite its clinical importance, it is highly difficult to consider all interactions among risk factors, in ordinary statistical models. This study aimed to extract appropriate logic combination of type 2 diabetes risk factors employing the recently introduced method, Logic regression. The study population was selected from a cohort of the Tehran Lipid and Glucose Study (TLGS). Data for 3523 participants, aged 20 years and over (57.8% female and 42.2% male) were entered into analysis, for which logistic logic regression method was used. The model parameters were estimated using the Annealing algorithm. To avoid overestimation, the optimal number of logic combinations was determined by the cross-validation method. Deviance, sensitivity and specificity measures were computed to evaluate the logic model and its comparison to ordinary logistic regression the latter accommodated only the main effects. The prediction power of the two models was compared by Area under ROC curve. R software version 2.8.1 was employed for analyses. Logistic logic regression with the 4 Boolean combination including 5 variables was fitted using the Annealing algorithm and resulted in in deviance of 1203.30. This model had better fit compared to other logic models and also ordinary logistic regression with forward procedure (deviance=1206.88). The Boolean combination of the above model included impaired fasting glucose (OR=5.53, 95%CI: 4.03-7.59), IGT (OR=5.54, 95%CI: 3.96-7.49), family history of diabetes (OR=1.89, 95%CI: 1.38-2.63), and interaction of high triglycerides or abnormal waist circumference (OR=2.4, 95%CI: 1.73-3.32) all p-values <0.001. The area under ROC curve for the model was 0.843 (95%CI: 0.813-0.874). This study showed that the logic regression as a newly introduced method has the ability of recognizing and modelling the interactions between different risk factors. Therefore, it is recommended as an appropriate tool for screening of the multi-factorial diseases such as diabetes.