The cumulative incidence of conventional risk factors of cardiovascular disease and their population attributable risk in an Iranian population: The Isfahan Cohort Study


1 Cardiac Rehabilitation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan; Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran

4 Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Cardiovascular diseases (CVDs) are the leading cause of death in Iran. The present study evaluated the 7-year incidence of CVD risk factors among the participants of Isfahan cohort study (ICS).
Materials and Methods: ICS was a longitudinal study on adults over 35 years of age from the urban and rural areas in three counties in central Iran. Data on clinical examination and blood measurements were collected in 2001. Subjects were followed and similar data were collected in 2007. Cumulative incidence was calculated through dividing new cases of each risk factor by the population free of that risk factor at baseline. Incidence proportion was determined for major CVD risk factors including hypertension (HTN), hypercholesterolemia (HC), hypertriglyceridemia (HTg), obesity, diabetes mellitus (DM), metabolic syndrome (MetS), and smoking.
Results: A total number of 6323 adults free of CVDs were recruited. After 7 years of follow-up, 3283 individuals were re-evaluated in 2007. The participants' age was 49.2 ± 10.3 years in 2001 (mean ± SD). The 7-year cumulative incidence of HTN, HC, HTg, overweight, obesity, DM, MetS, and smoking was 22.8%, 37.4%, 28.0%, 26.3%, 7.4%, 9.5%, 23.9%, and 5.9% in men and 22.2%, 55.4%, 33.5%, 35.0%, 18.8%, 11.3%, 36.1%, and 0.7% in women, respectively. Among those with overweight or obesity, 14.7% of men and 7.9% of women decreased their weight up to the normal level.
Conclusions: The present study revealed a high incidence of CVD risk factors especially dyslipidemia, obesity, MetS and HTN. Therefore, the application of life-style modification interventions seems necessary.


Mathers CD, Boerma T, Ma Fat D. Global and regional causes of death. Br Med Bull 2009;92:7-32.  Back to cited text no. 1
World Health Organisation. NCD mortality and morbidit. Geneva: World Health Organisation; 2011.  Back to cited text no. 2
World Health Organisation. Reducing Risks, Promoting Healthy Life. Geneva: World Health Organisation; 2012.  Back to cited text no. 3
Motlagh B, O'Donnell M, Yusuf S. Prevalence of cardiovascular risk factors in the Middle East: A systematic review. Eur J Cardiovasc Prev Rehabil 2009;16:268-80.  Back to cited text no. 4
Talaei M, Sarrafzadegan N, Sadeghi M, Oveisgharan S, Marshall T, Thomas GN, et al. Incidence of cardiovascular diseases in an Iranian population: The Isfahan Cohort Study. Arch Iran Med 2013;16:138-44.  Back to cited text no. 5
Naghavi M, Abolhassani F, Moradi Lakeh M, Jafari N, Vaseghi S, Kazemeini H. National burden of dieases, injuries, and risk factors and disability adjusted life expectancy in Islamic Republic of Iran in 2003. Tehran: Ministry of Health; 2003.  Back to cited text no. 6
Ayatollahi SM, Ghoreshizadeh Z. Prevalence of obesity and overweight among adults in Iran. Obes Rev 2010;11:335-7.  Back to cited text no. 7
Esteghamati A, Meysamie A, Khalilzadeh O, Rashidi A, Haghazali M, Asgari F, et al. Third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007) in Iran: Methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia. BMC Public Health 2009;9:167.  Back to cited text no. 8
Janghorbani M, Amini M, Gouya MM, Delavari A, Alikhani S, Mahdavi A. Nationwide survey of prevalence and risk factors of prehypertension and hypertension in Iranian adults. J Hypertens 2008;26:419-26.  Back to cited text no. 9
Sadeghi M, Roohafza HR, Kelishadi R. Blood pressure and associated cardiovascular risk factors in Iran: Isfahan healthy heart programme. Med J Malaysia 2004;59:460-7.  Back to cited text no. 10
Sadeghi M, Roohafza H, Shirani S, Poormoghadas M, Kelishadi R, Baghaii A, et al. Diabetes and associated cardiovascular risk factors in Iran: The Isfahan healthy heart programme. Ann Acad Med Singapore 2007;36:175-80.  Back to cited text no. 11
Bozorgmanesh M, Hadaegh F, Mehrabi Y, Azizi F. A point-score system superior to blood pressure measures alone for predicting incident hypertension: Tehran lipid and glucose study. J Hypertens 2011;29:1486-93.  Back to cited text no. 12
Harati H, Hadaegh F, Saadat N, Azizi F. Population-based incidence of Type 2 diabetes and its associated risk factors: Results from a six-year cohort study in Iran. BMC Public Health 2009;9:186.  Back to cited text no. 13
Sarrafzadegan N, Talaei M, Sadeghi M, Kelishadi R, Oveisgharan S, Mohammadifard N, et al. The Isfahan cohort study: Rationale, methods and main findings. J Hum Hypertens 2011;25:545-53.  Back to cited text no. 14
Sarraf-Zadegan N, Sadri G, Malek Afzali H, Baghaei M, Mohammadi Fard N, Shahrokhi S, et al. Isfahan healthy heart programme: A comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol 2003;58:309-20.  Back to cited text no. 15
Sarrafzadegan N, Baghaii A, Sadri G, Kelishadi R, Malekafzali H, Boshtam M, et al. Isfahan healthy heart program: Evaluation of comprehensive, community-based interventions for non-communicable disease prevention. Prev Control 2006;2:73-84.  Back to cited text no. 16
Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640-5.  Back to cited text no. 17
Azizi F, Khalili D, Aghajani H, Esteghamati A, Hosseinpanah F, Delavari A, et al. Appropriate waist circumference cut-off points among Iranian adults: The first report of the Iranian National Committee of Obesity. Arch Iran Med 2010;13:243-4.  Back to cited text no. 18
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: An American heart association/National heart, lung, and blood institute scientific statement: Executive Summary. Crit Pathw Cardiol 2005;4:198-203.  Back to cited text no. 19
Grotzinger KM, Stuart BC, Ahern F. Assessment and control of nonresponse bias in a survey of medicine use by the elderly. Med Care 1994;32:989-1003.  Back to cited text no. 20
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet 2005;365:217-23.  Back to cited text no. 21
Vasan RS, Beiser A, Seshadri S, Larson MG, Kannel WB, D'Agostino RB, et 0al. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA 2002;287:1003-10.  Back to cited text no. 22
Sathish T, Kannan S, Sarma PS, Razum O, Thankappan KR. Incidence of hypertension and its risk factors in rural Kerala, India: A community-based cohort study. Public Health 2012;126:25-32.  Back to cited text no. 23
Sun Z, Zheng L, Detrano R, Zhang X, Xu C, Li J, et al. Incidence and predictors of hypertension among rural Chinese adults: Results from Liaoning province. Ann Fam Med 2010;8:19-24.  Back to cited text no. 24
Erceg M, Iviceviæ-Uhernik A, Kern J, Vuletiæ S. Five-year cumulative incidence of hypertension in adult Croatian population: The CroHort study. Coll Antropol 2012;36 (Suppl 1):83-7.  Back to cited text no. 25
Lee JH, Yang DH, Park HS, Cho Y, Jun JE, Park WH, et al. Incidence of hypertension in Korea: 5-year follow-up study. J Korean Med Sci 2011;26:1286-92.  Back to cited text no. 26
Robitaille C, Dai S, Waters C, Loukine L, Bancej C, Quach S, et al. Diagnosed hypertension in Canada: Incidence, prevalence and associated mortality. CMAJ 2012;184:E49-56.  Back to cited text no. 27
Tu K, Chen Z, Lipscombe LL, Canadian Hypertension Education Program Outcomes Research Taskforce. Prevalence and incidence of hypertension from 1995 to 2005: A population-based study. CMAJ 2008;178:1429-35.  Back to cited text no. 28
World Health Organization. Obesity and overweight. Geneva: World Health Organization; 2011. Report No: 311.  Back to cited text no. 29
Milanoviæ SM, Uhernik AI, Fister K, Mihel S, Kovac A, Ivankoviæ D. Five-year cumulative incidence of obesity in adults in Croatia: The CroHort study. Coll Antropol 2012;36 (Suppl 1):71-6.  Back to cited text no. 30
Ortiz-Moncada R, García M, González-Zapata LI, Fernandez E, Alvarez-Dardet C. Incidence of overweight and obesity in a Mediterranean population-based cohort: The Cornellà health interview survey follow-up study (CHIS.FU). Prev Med 2010;50:45-9.  Back to cited text no. 31
Yannakoulia M, Panagiotakos D, Pitsavos C, Lentzas Y, Chrysohoou C, Skoumas I, et al. Five-year incidence of obesity and its determinants: The ATTICA study. Public Health Nutr 2009;12:36-43.  Back to cited text no. 32
Barr E, Cameron A. The Australian Diabetes Obesity and Lifestyle Study (AusDiab). Five Year Follow-up. Results for New South Wales. New South Wales, Australia: International Diabetes Institute; 2005.  Back to cited text no. 33
Zalesin KC, Franklin BA, Miller WM, Peterson ED, McCullough PA. Impact of obesity on cardiovascular disease. Endocrinol Metab Clin North Am 2008;37:663-84, ix.  Back to cited text no. 34
Talaei M, Thomas GN, Marshall T, Sadeghi M, Iranipour R, Oveisgharan S, et al. Appropriate cut-off values of waist circumference to predict cardiovascular outcomes: 7-year follow-up in an Iranian population. Intern Med 2012;51:139-46.  Back to cited text no. 35
Santos AC, Severo M, Barros H. Incidence and risk factors for the metabolic syndrome in an urban South European population. Prev Med 2010;50:99-105.  Back to cited text no. 36
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4-14.  Back to cited text no. 37
Ubink-Veltmaat LJ, Bilo HJ, Groenier KH, Houweling ST, Rischen RO, Meyboom-de Jong B. Prevalence, incidence and mortality of type 2 diabetes mellitus revisited: A prospective population-based study in The Netherlands (ZODIAC-1). Eur J Epidemiol 2003;18:793-800.  Back to cited text no. 38
Wang Z, Hoy WE, Si D. Incidence of type 2 diabetes in Aboriginal Australians: An 11-year prospective cohort study. BMC Public Health 2010;10:487.  Back to cited text no. 39
Fox CS, Pencina MJ, Meigs JB, Vasan RS, Levitzky YS, D'Agostino RB Sr. Trends in the incidence of type 2 diabetes mellitus from the 1970s to the 1990s: The Framingham Heart Study. Circulation 2006;113:2914-8.  Back to cited text no. 40
Valdés S, Botas P, Delgado E, Alvarez F, Cadórniga FD. Population-based incidence of type 2 diabetes in northern Spain: The Asturias Study. Diabetes Care 2007;30:2258-63.  Back to cited text no. 41
Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Meigs JB, et al. Population-based incidence rates and risk factors for type 2 diabetes in white individuals: The Bruneck study. Diabetes 2004;53:1782-9.  Back to cited text no. 42
Forouhi NG, Luan J, Hennings S, Wareham NJ. Incidence of Type 2 diabetes in England and its association with baseline impaired fasting glucose: The Ely study 1990-2000. Diabet Med 2007;24:200-7.  Back to cited text no. 43
Leibson CL, O'Brien PC, Atkinson E, Palumbo PJ, Melton LJ 3 rd . Relative contributions of incidence and survival to increasing prevalence of adult-onset diabetes mellitus: A population-based study. Am J Epidemiol 1997;146:12-22.  Back to cited text no. 44
Panagiotakos DB, Pitsavos C, Skoumas Y, Lentzas Y, Papadimitriou L, Chrysohoou C, et al. Abdominal obesity, blood glucose and apolipoprotein B levels are the best predictors of the incidence of hypercholesterolemia (2001-2006) among healthy adults: The ATTICA study. Lipids Health Dis 2008;7:11.  Back to cited text no. 45
Costa J, Borges M, Oliveira E, Gouveia M, Carneiro AV. Incidence and prevalence of hypercholesterolemia in Portugal: A systematic review. Part I. Rev Port Cardiol 2003;22:569-77.  Back to cited text no. 46
Kwon HS, Park YM, Lee HJ, Lee JH, Choi YH, Ko SH, et al. Prevalence and clinical characteristics of the metabolic syndrome in middle-aged Korean adults. Korean J Intern Med 2005;20:310-6.  Back to cited text no. 47
Erem C, Hacihasanoglu A, Deger O, Kocak M, Topbas M. Prevalence of dyslipidemia and associated risk factors among Turkish adults: Trabzon lipid study. Endocrine 2008;34:36-51.  Back to cited text no. 48
Li G, de Courten M, Jiao S, Wang Y. Prevalence and characteristics of the metabolic syndrome among adults in Beijing, China. Asia Pac J Clin Nutr 2010;19:98-102.  Back to cited text no. 49
Ford ES, Li C, Zhao G, Pearson WS, Mokdad AH. Hypertriglyceridemia and its pharmacologic treatment among US adults. Arch Intern Med 2009;169:572-8.  Back to cited text no. 50
Centers for Disease Control and Prevention (CDC). Current cigarette smoking prevalence among working adults - United States, 2004-2010. MMWR Morb Mortal Wkly Rep 2011;60:1305-9.  Back to cited text no. 51
Langley TE, Szatkowski LC, Wythe S, Lewis SA. Can primary care data be used to monitor regional smoking prevalence? An analysis of The Health Improvement Network primary care data. BMC Public Health 2011;11:773.  Back to cited text no. 52
Mackay DF, Haw S, Pell JP. Impact of Scottish smoke-free legislation on smoking quit attempts and prevalence. PLoS One 2011;6:e26188.  Back to cited text no. 53
Samardziæ S, Vuletiæ G, Tadijan D. Five-year cumulative incidence of smoking in adult Croatian population: The CroHort study. Coll Antropol 2012;36:99-103.  Back to cited text no. 54
Menezes AM, Lopez MV, Hallal PC, Muiño A, Perez-Padilla R, Jardim JR, et al. Prevalence of smoking and incidence of initiation in the Latin American adult population: The PLATINO study. BMC Public Health 2009;9:151.  Back to cited text no. 55