To examine, the predictors of incident chronic kidney disease (CKD) in a community-based cohort of Middle East population, during a mean follow-up of 9.9 years. In a sample of 3313 non-CKD Iranian adults ≥20 years the estimated glomerular filtration rate (eGFR) was calculated at baseline and at three year intervals during three consecutive phases. The eGFR <60 mL/min/1.73 m2 was defined as CKD. Multivariate Logistic regression analysis was used to determine the independent variables associated with incident CKD. The incidence density rates of CKD were 285.3 and 132.6 per 10,000 person-year, among women and men, respectively. Female gender per se was associated with higher risk of CKD, compared with males. Among women, age, eGFR, known diabetes, being single or divorced/widowed, hypertension (marginally significant) and current smoking were independent risk factors for CKD; however the intermediate degree of education and family history of diabetes decreased the risk by 40% (P<0.05). Among male subjects, independent predictors of developing CKD included aging and hypertension (with significantly higher risk than in women, P for interaction<0.05), eGFR, new diagnosed diabetes, high normal blood pressure; abdominal obesity decreased the risk of CKD about 30% which was marginally significant. In the Iranian population,>2% of individuals develops CKD each year. Our findings confirmed that sex- specific risk predictors should be considered in primary prevention for incident CKD.

BackgroundData about the risk factors of stroke are sparse in the Middle East populations. We aimed to determine the potential risk factors and their population attributable fraction (PAF) for stroke in an Iranian population.MethodsA cohort Study consisted of 1089 men and 1289 women, with mean (SD) ages of 61.1(7.6) and 59.0(6.7) years, respectively. Cox regression was implemented to estimate the hazard ratio (HR) of each risk factor for stroke events in a stepwise method. We calculated a multivariate adjusted population attributable fraction (PAF) for any risk factors remained in the model.ResultsDuring 9.3 years of follow-up, 69 events of stroke occurred with incidence rates of 4.5 (95% CI: 3.3-6.0) and 2.5 (1.7-3.6) in 1000 person-years for men and women respectively. Among potential risk factors, only age ≥ 65 years (HR: 2.03, CI: 1.24-3.31), male gender (HR: 2.00, CI: 1.16-3.43), hypertension (HR: 3.03, CI: 1.76-5.22), diabetes mellitus (HR: 2.18, CI: 1.34-3.56), and chronic kidney disease (CKD) (HR: 2.01, CI: 1.22-3.33), were independently associated with increased risk of stroke events in the total population. A paired homogeneity test showed that the hazard ratio of CKD did not differ from other independent risk factors. The PAFs were 29.7% and 25% for male gender and age ≥ 65 as non-modifiable and 48.6%, 29.1% and 22.0% for hypertension, CKD and diabetes as modifiable risk factors respectively.ConclusionFollowing this population based study of Iranians, we demonstrated that among modifiable risk factors, CKD as well as hypertension and diabetes are the strongest independent predictors of stroke.

To determine, the predictors of incident metabolic syndrome (MetS) in a community-based cohort of West Asians, during a mean follow-up of 9.3 years, a sample of 2858 non-MetS Iranian adults aged ≥ 20 years were examined at baseline and followed at three year intervals during three consecutive phases. The MetS was defined using the joint interim statement. Cox proportional hazard regression was used to determine the independent variables associated with incident MetS. Overall, 1117 new cases MetS were identified resulting in an incidence rate of 550.9/10000 person years (95% CI: 519.5-584.2). The corresponding incidence rates among women and men were 433.5/10000 person years (95% CI: 398.8-471.2) and 749.2/10000 person years (95% CI: 689.9-813.5), respectively. Baseline-adjusted predictors of developing MetS included all of the MetS components, being overweight or obese in both gender, and family history of diabetes and age only in women. There were significant effect modifications of gender on age (P<0.001), high blood pressure (0.026), high waist circumference (P<0001) and obesity categories (all P ≤ 0.01) in multivariate analysis. After considering HOMA–IR in the model, among women, all of the MetS predictors as well as those with HOMA-IR ≥ 2.23 showed a significant risk for incident MetS [HR: 1.63 (1.16-2.28)]; however, among men all the MetS components (WC was marginally significant) as well as the fourth quartile of HOMA-IR [HR: 1.50 (1.03-2.17)] and being overweight showed a significant risk. Finally, in the pooled analysis, we showed that female gender had lower risk for incident MetS than male [HR: 0.58 (0.47-0.70)]. In the Iranian population, high incidence of MetS, especially among men, was shown. Our findings confirmed that sex- specific risk predictors should be considered in primary prevention for incident MetS.

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Vitiligo is an acquired cutaneous disorder of pigmentation, with an incidence of 0.5% to 2% worldwide. There are three major hypotheses for the pathogenesis of vitiligo that are not exclusive of each other: biochemical/cytotoxic, neural and autoimmune. Recent data provide strong evidence supporting an autoimmune pathogenesis of vitiligo. As vitiligo can have a major effect on quality of life, treatment can be considered and should preferably begin early when then disease is active. Current treatment modalities are directed towards stopping progression of the disease and achieving repigmentation. Therapies include corticosteroids, topical immunomodulators, photo(chemo)therapy, surgery, combination therapies and depigmentation of normally pigmented skin. It seems that traditional Chinese medicine could be more effective than the current treatment for vitligo.

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Background : Symptom-to-balloon time (SBT) and door-to-balloon time (DBT) are both considered important metrics in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). We sought to assess the relationship of SBT and DBT with infarct size and microvascular obstruction (MVO) after pPCI. Methods : Individual patient data for 3115 STEMI patients undergoing pPCI in 10 randomized trials were pooled. Infarct size (% left ventricular mass) was assessed within 1 month after randomization by technetium-99m sestamibi single-photon emission computerized tomography (SPECT, 3 studies) or cardiac magnetic resonance imaging (CMR, 7 studies). MVO was assessed by CMR. Patients were stratified by short (≤2 hours), intermediate (2-4 hours), or long (>4 hours) SBTs, and by short (≤45 minutes), intermediate (45-90 min), or long (>90 minutes) DBTs. Results : Median [IQR] SBT and DBT were 185 [130-269] and 46 [28-83] minutes, respectively. Median [IQR] time to infarct size assessment after pPCI was 5 [3-12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference 2.0%, 95% confidence interval [CI] 0.4-3.5 for intermediate versus short SBT and 4.4%, 95%CI 2.7-6.1 for long versus short SBT) but not according to DBT category category (adjusted difference 0.4%, 95% CI -1.2 to 1.9 for intermediate versus short DBT and -0.1%, 95% CI -1.0 to 3.0 for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference 0.9%; 95% CI 0.3-1.4) but was not different between patients with intermediate versus short SBT (adjusted difference 0.1; 95% CI -0.4 to 0.6). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables. Conclusions : Among 3115 patients with STEMI undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.

Background and Purpose-The purpose of this study was to examine whether metabolic syndrome (MetS), applying different definitions, predicts incident coronary heart disease (CHD) and cerebrovascular events (CVAs) independent of its components. Methods-Among 2548, aged Ն50 years, World Health Organization, International Diabetes Federation, and Joint Interim Statement criteria were used to define MetS. Cox proportional hazards regression was implemented to estimate hazard ratios of incident CVA and CHD. Results-During 9.3 years of follow-up, 72 and 343 cases of CVA and CHD events occurred. The multivariate hazard ratios (95% CI) of incident CVA and CHD were 2.71 (1.57-4.68) and 2.07 (1.63-2.64) for MetS as defined by the Joint Interim Statement, respectively. There was no difference among the 3 definitions of MetS regarding the prediction of the CVA incidence. However, MetS as defined by the Joint Interim Statement predicted CHD better than the International Diabetes Federation definition. After adjustment for components, MetS lost its association with CHD and CVA; in this model, the elevated blood pressure and high fasting plasma glucose (International Diabetes Federation definition) showed significant risk for CVA events; regarding CHD events, the elevated blood pressure, high fasting plasma glucose, and, for World Health Organization definition, obesity and dyslipidemia remained as predictors. Conclusions-All definitions of MetS were associated with CVA and CHD events. After adjusting its components, MetS lost its association with incident CVA and CHD; however, elevated blood pressure for both CVA and CHD events and high fasting plasma glucose for CHD events remained as independent predictors in all definitions. (Stroke. 2012;43: 1669-1671.)