Sex-specific incidence rates and risk factors of premature cardiovascular disease. A long term follow up of the Tehran Lipid and Glucose Study.
OBJECTIVE
To investigate the risk factors for premature cardiovascular disease (CVD) and to quantify their population attributable fractions (PAFs) among an Iranian population during a median follow-up of 12years.


METHODS
A total of 2235 men and 3703 women, aged ≥30years, free of CVD at baseline were entered into the study. Premature CVD was defined as having a history of CVD events before the age of 55 and 65 for men and women, respectively. Multivariate Cox proportional hazard regression models were used to determine the risk factors associated with premature CVD events.


RESULTS
During the study, incident rates of premature CVD were 4.8 and 3.9 per 1000 person years for men and women, respectively. Low HDL-C [Hazard ratio: 1.74, 95% confidence interval: 1.11-2.74], hypercholesterolemia [3.01: 2.02-4.49], current smoker [1.68: 1.12-2.51], family history of premature CVD [2.04: 1.36-3.07], hypertension [1.65: 0.97-2.81, P=0.06] and type 2 diabetes(T2D) [1.98: 1.16-3.40] were significant predictors among men; the corresponding PAFs were 32.7, 29.4, 19.4, 14.9, 8.7 and 7.9%, respectively. Among women, T2D [3.02: 2.08-4.39], hypercholesterolemia [1.65: 1.19-2.29], being overweight [1.79: 1.01-3.17], hypertension [1.54: 1.01-2.34], family history of premature CVD [1.65: 1.19-2.29], high physical activity [0.67: 0.46-0.96] and prediabetes [1.48: 1.00-2.18] were significant predictors; the corresponding PAFs were 25.4, 22.5, 18.5, 16.8, 11.4, -10.3 and 9.1%, respectively.


CONCLUSIONS
Considering the high burden imposed on health system by cardio-metabolic risk factors, dietary, behavioral and pharmacological interventions are need to be initiated early to prevent premature CVD, taking into account the sex-related differences between risk factors.
Student Research Committee, Prevention of Metabolic Disorders Research Center, Research Institute of Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ali
A
Eslami
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Amirhossein
A
Mozaffary
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Arash
A
Derakhshan
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran.
Fereidoun
F
Azizi
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Davood
D
Khalili
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: fzhadaegh@endocrine.ac.ir.
Farzad
F
Hadaegh
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012727:Sex Characteristics
D001786:Blood Glucose; D008076:Cholesterol, HDL
Incidence; Population attributable fraction; Premature cardiovascular disease; Risk factor