Abbasali Karimi

Background: Coronary artery disease (CAD) is the leading cause of death worldwide. Among women, CAD is often underestimated, resulting in underdiagnosis and undertreatment. This study aimed to assess the prevalence of CAD and its risk factors in adult women, using data from the Tehran Cohort Study (TeCS). Methods: We analyzed data from 4478 women with complete CAD information collected during the TeCS recruitment phase. The age‐weighted prevalence of CAD was estimated using the 2016 national census data and previous CAD diagnoses. Logistic regression models were applied to identify factors independently associated with CAD in women. Results: The overall prevalence of CAD was 4.48% (mean age: 53.0 ± 12.37 years), with an age‐weighted prevalence of 4.1% (95% CI: 3.1%–5.4%). Increasing age was strongly associated with CAD, with women aged ≥ 75 years showing markedly higher odds (OR: 11.94, 95% CI: 3.93–36.31, p < 0.001). Hypertension (OR: 2.58, 95% CI: 1.75–3.80, p < 0.001), hyperlipidemia (OR: 2.25, 95% CI: 1.55–3.24, p < 0.001), and diabetes mellitus (OR: 2.07, 95% CI: 1.49–2.88, p < 0.001) were also significant determinants of CAD. Older age groups exhibited a higher prevalence of CAD risk factors. Within the CAD group, a greater proportion of women had multiple comorbid risk factors compared with their non‐CAD counterparts in the same age categories. Conclusion: The prevalence of CAD and its associated risk factors among women in Tehran is substantial. These findings highlight the need for targeted preventive strategies to reduce CAD incidence in vulnerable female populations.

Background Metabolic syndrome (MetS) is a cluster of risk factors that increase the risk of cardiovascular disease and type 2 diabetes. We aim to investigate the prevalence of MetS based on four prevalent criteria and its associated factors among Tehran’s adult residents. Methods We utilized the data from the enrollment phase of the Tehran Cohort Study (TeCS). We included the demographic, anthropometric, and biomedical data of 8,232 adult Tehran residents. MetS was defined using four criteria: World Health Organization (WHO), Adult Treatment Panel III (ATP III), International Diabetes Federation (IDF), and Joint Interim Statement (JIS). Sex and age-adjusted prevalence estimates and associated factors were analyzed using regression models. Results The Participants’ mean age was 53.7 ± 12.72 years, and 54% were women. The sex and age-adjusted prevalence of MetS varied depending on the diagnostic criteria used, with the highest rates reported using the JIS criteria (59.3%), followed by the IDF criteria (46.8%), ATP-III (27.1%), and WHO criteria (11.0%). The prevalence generally increased with age across all criteria in both females and males. Females had a higher prevalence than males, except for the WHO and JIS criteria. Factors associated with higher odds of MetS included older age, female gender, lower education level, and low physical activity level. Tobacco use and opium use were associated with lower odds of MetS based on IDF and JIS criteria. Conclusion MetS is highly prevalent among Tehran adults, with notable variation based on diagnostic criteria. Preventive efforts should address modifiable lifestyle factors.

Background Although alcohol has been illegal in Iran for over four decades, its consumption persists. This study aims to determine the prevalence and determinants of alcohol consumption in Tehran, the Middle East’s third-largest city, using data from the Tehran Cohort Study (TeCS). Methods Our study encompasses data from 8420 individuals recorded between March 2016 and March 2019. We defined alcohol use as the lifetime consumption of alcoholic beverages and/or products. We calculated the age- and sex-weighted prevalence of alcohol use in addition to crude frequencies. We also determined the weighted prevalence of alcohol use in both genders. Multivariable logistic regressions were employed to investigate the adjusted odds ratios for the determinants of alcohol use. Results The mean age of participants was 53.8 ± 12.7 years. The lifetime prevalence of alcohol use was 9.9% (95% confidence interval [95% CI]: 8.3–11.8%) among the total population, with a prevalence of 3.3% (95% CI: 2.4–4.5%) among females and 16.6% (95% CI: 14.3–19.3%) among males. Alcohol use showed a decreasing trend with age in both sexes (women: 4.4% and men: 1.5% per year) as well as in the total population (1.7%). The geographical distribution of alcohol use in Tehran indicated a significantly higher concentration (95% CI: 6.5–13%) in the southern regions compared to other areas. Younger age, higher education levels, smoking, opium use, hyperlipidemia, physical activity, and being overweight determined a higher prevalence of alcohol use. Conclusions The prevalence of alcohol use in Tehran is significant and exceeds previous estimates. Policymakers must address the rising incidence of alcohol use, particularly among the younger population.

Background and Aims: In the current study, we aimed to identify the association between major and minor electrocardiographic abnormalities and cardiovascular risk factors. Methods: We used the Tehran cohort study baseline data, an ongoing multidisciplinary, longitudinal study designed to identify cardiovascular disease risk factors in the adult population of Tehran. The electrocardiograms (ECGs) of 7630 Iranian adults aged 35 years and above were analyzed. ECG abnormalities were categorized into major or minor groups based on their clinical importance. Results were obtained by multivariable logistic regression and are expressed as odds ratios (ORs). Results: A total of 756 (9.9%) participants had major ECG abnormalities, while minor abnormalities were detected in 2526 (33.1%). Males comprised 45.8% of the total population, and 41.8% of them had minor abnormalities. Individuals with older age, diabetes (OR = 1.35; 95% CI: 1.11–1.64), and hypertension (OR = 2.21; 95% CI: 1.82–2.68) had an increased risk of major ECG abnormalities. In contrast, intermediate (OR = 0.69; 95% CI: 0.57–0.84) and high physical activity levels (OR = 0.66; 95% CI: 0.51–0.86) were associated with a lower prevalence of major abnormalities. Male sex, older age, hypertension, and current smoking were also associated with an increased prevalence of ECG abnormalities combined (major or minor). Conclusion: Major and minor ECG abnormalities are linked with important cardiovascular risk factors such as diabetes and hypertension. Since these abnormalities have been associated with poor outcomes, screening patients with cardiovascular risk factors with an ECG may distinguish high‐risk individuals who require appropriate care and follow‐up.

Background: Insufficient physical activity (PA) is a major risk factor for non-communicable diseases (NCDs) and one of the leading causes of premature mortality worldwide. This study examined the prevalence and independent determinants of insufficient PA among adults resident of Tehran utilizing Tehran Cohort Study Data (TeCS). Method: We used the recruitment phase data from the TeCS with complete data on PA. PA was assessed through a Likert-scaled question and categorized into three groups. Utilizing data from the 2016 national census, the age- and sex-weighted prevalence of insufficient PA in Tehran was determined. The adjusted logistic regression model is used to neutralize influencing factors and determine the factors associated with insufficient PA. Result: The weighted prevalence of insufficient PA was 16.9% among the 8213 adult citizens of Tehran, with a greater prevalence among females (19.0% vs. 14.8% among males). Additionally, older age groups, unemployed, housewives, and illiterate educated participants displayed a much higher prevalence of insufficient PA (p < 0.001). Moreover, Tehran’s central and southern districts had higher rates of insufficient PA. Concerning the adjusted regression model, older age (Odds ratio [OR]: 4.26, 95% confidence interval [95% CI]: 3.24–5.60, p < 0.001), a lower education level (p < 0.001), unemployment (OR: 1.80, 95% CI: 1.28–2.55, p = 0.001), being a housewife (OR: 1.44, 95% CI: 1.15–1.80, p = 0.002), higher body mass index (BMI) (OR for BMI > 30: 1.85, 95% CI: 1.56–2.18, p < 0.001), opium consumption (OR: 1.92, 95% CI: 1.46–2.52, p < 0.001), diabetes mellitus (OR: 1.25, 95% CI: 1.06–1.48, p = 0.008), hypertension (OR: 1.29, 95% CI: 1.11–1.50, p = 0.001), and coronary artery diseases (OR: 1.30, 95% CI: 1.05–1.61, p = 0.018), were significantly associated with insufficient PA. Conclusions: The identified associated factors serve as a valuable guide for policymakers in developing tailored intervention strategies to address the needs of high-risk populations, particularly among older adults and females.

Objectives: Using the cardiac surgery database is of high importance in referral centers and can lead to a better quality of care for patients. Tehran Heart Center (THC) is a cardiovascular referral center that was inaugurated in 2001. In this report, we aimed to present the third report of trends in patients' cardiovascular risk factors and surgical procedures from 2002 to 2021 that have been gathered for all THC patients. Methods: This serial cross-sectional study was conducted at Tehran Heart Center from 2002 to 2021. All patients undergoing cardiac surgeries were eligible to enter the study (N = 63,974). Those with miscellaneous types of surgeries were excluded (N = 9556). The distribution of cardiac surgeries (including isolated coronary artery bypass graft (CABG), isolated valve, and CABG + valve surgeries) and their respective in-hospital mortality were recorded. Furthermore, 20-year trends in the prevalence of various cardiovascular risk factors (CVRFs) among the following groups were evaluated: a) isolated CABG, b) aortic valve replacement/repair for aortic stenosis (AS/AVR/r), and c) isolated other valve surgeries (IVS). Results: A total of 54,418 patients (male: 70.7%, age: 62.7 ± 10.8 years) comprised the final study population, with 84.5% prevalence of isolated CABG. Overall, the AS/AVR/r group was in between the CABG and IVS groups concerning CVRFs distribution. Excluding some exceptions for the AS/AVR/r group (in which the small sample size (N = 909) precluded observing a clear trend), all studied CVRFs demonstrated an overall rising trend from 2002 to 2021 in all three groups. Regarding in-hospital mortality, the highest rate was recorded as 4.0% in 2020, while the lowest rate was 2.0% in 2001. Conclusions: Isolated CABG remained the most frequent procedure in THC. Notable, increasing trends in CVRFs were observed during this 20-year period and across various types of cardiac surgeries, which highlights the clinical and policy-making implications of our findings. Graphical

Background: The prevalence and burden of substance and opium use have increased worldwide over the past decades. In light of rapid population changes in Tehran, we aimed to evaluate the prevalence of opium and other substance use among adult residents in Tehran, Iran. Method: From March 2016 to March 2019, we utilized data from 8 296 participants in the Tehran Cohort Study recruitment phase (TeCS). We calculated the age-sex-weighted prevalence of substance use and the geographic distribution of substance use in Tehran. We also used logistic regression analysis to determine possible determinants of opium use. Result: We analyzed data from 8 259 eligible participants with complete substance use data and the average age of participants was 53.7 ± 12.75 years. The prevalence of substance use was 5.6% (95% confidence interval [CI]: 4.6- 7.1%). Substance use was more common in males than females (Prevalence: 10.5% [95% CI: 8.6- 12.6%] vs. 0.5% [95% CI: 0.2- 1.2%], respectively). The age-sex weighted prevalence of substance use was 5.4% (95% CI: 4.6-7.1%). Moreover, opium was the most frequently used substance by 95.8% of substance users. Additionally, we found that male gender (Odds ratio [OR]: 12.1, P < 0.001), alcohol intake (OR: 1.3, P = 0.016), and smoking (OR: 8.5, P < 0.001) were independently associated with opium use. Conclusions: We found that the prevalence of substance use in Tehran was 5.6%, and opium was the most frequently used substance. In addition, male gender, lower levels of education, alcohol, and tobacco consumption are the main risk factors for substance use in Tehran. Healthcare providers and policymakers can utilize our results to implement preventive strategies to minimize substance use in Tehran.

Background: Dyslipidemia is among the leading risk factors for cardiovascular diseases (CVDs), with an increasing global burden, especially in developing countries. We investigated the prevalence of dyslipidemia and abnormal lipid profiles in Tehran. Methods: We used data from 8072 individuals aged≥35 from the Tehran Cohort Study (TeCS) recruitment phase. Fasting serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and triglyceride were measured. Dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria, and high LDL/HDL was defined as a ratio>2.5. The age-sex standardized prevalence rates were calculated based on the 2016 national census. Furthermore, the geographical distribution of dyslipidemia and lipid abnormalities was investigated across Tehran’s zip code districts. Results: The age-sex standardized prevalence was 82.7% (95% CI: 80.1%, 85.0%) for dyslipidemia, 36.9% (95% CI: 33.8%, 40.1%) for hypertriglyceridemia, 22.5% (95% CI: 19.9%, 25.4%) for hypercholesterolemia, 29.0% (95% CI: 26.1%, 32.1%) for high LDL-C, 55.9% (95% CI: 52.6%, 59.2%) for low HDL-C, and 54.1% (95% CI: 50.9%, 57.3%) for high LDL/HDL ratio in the Tehran adult population. The prevalence of dyslipidemia, low HDL-C, and high LDL/HDL ratio was higher in the northern regions, hypercholesterolemia was higher in the southern half, and high LDL-C was more prevalent in the middle-northern and southern areas of Tehran. Conclusion: We found a high prevalence of dyslipidemia, mainly high LDL/HDL in the Tehran adult population. This dyslipidemia profiling provides important information for public health policy to improve preventive interventions and reduce dyslipidemiarelated morbidity and mortality in the future.

Purpose Obesity is a chronic low-grade inflammatory condition with increasing global prevalence and is associated with cardiovascular diseases. In this study, we aimed to investigate the prevalence of obesity in the Tehran cohort study (TeCS) population. Methods We used the data collected by systematic random sampling during the recruitment phase of TeCS. The data comprised 4215 households from all districts of the Tehran metropolis, from which 8296 adults aged ≥ 35 years participated between May 2016 and February 2019. Sociodemographic data, medical history, laboratory tests, and anthropometric measurements were gathered from the participants. Participants with missing data were excluded from the final analysis. Finally, the data was analyzed using SPSS version 23, and distribution maps were created by Stata 14.2. Results A total of 8211 participants (53.9% women) with an average age of 53.7 ± 12.6 years were studied. The age-weighted prevalence of overweight and obese among women was (37.5% [95% confidence interval (CI): 34.5, 40.6] and 35.5% [95% CI: 32.6 -38.6]) compared to men (47% [95% CI: 43.6, 50.3] and 22.9% [95% CI: 20.1 -25.8]). The prevalence of substantially increased risk of metabolic complications (SIRMC) based on waist circumference (WC) and waist-to-hip ratio (WHR) was 49.2% (95% CI: 46.3 -52.2) and 75.5% (95% CI: 72.7 -78.1) respectively. Conclusions The prevalence of obesity in Tehran (29.3%) was much higher than in previous reports, particularly among older people, women, and socioeconomically underdeveloped districts. After age 55, more than 80% of women had SIRMC compared to 30% of men.