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The association between obesity, cancer and cardiovascular disease (CVD) has been demonstrated in animal and epidemiological studies. However, the specific role of visceral obesity on cancer and CVD remains unclear. Visceral adipose tissue (VAT) is a complex and metabolically active tissue, that can produce different adipokines and hormones, responsible for endocrine-metabolic comorbidities. This review explores the potential mechanisms related to VAT that may also be involved in cancer and CVD. In addition, we discuss the shared pharmacological treatments which may reduce the risk of both diseases. This review highlights that chronic inflammation, molecular aspects, metabolic syndrome, secretion of hormones and adiponectin associated to VAT may have synergistic effects and should be further studied in relation to cancer and CVD. Reductions in abdominal and visceral adiposity improve insulin sensitivity, lipid profile and cytokines, which consequently reduce the risk of CVD and some cancers. Several medications have shown to reduce visceral and/or subcutaneous fat. Further research is needed to investigate the pathophysiological mechanisms by which visceral obesity may cause both cancer and CVD. The role of visceral fat in cancer and CVD is an important area to advance. Public health policies to increase public awareness about VAT’s role and ways to manage or prevent it are needed.

Atrial fibrillation (AF)/atrial flutter (AFL) is the most common cardiac tachyarrhythmia, with an increasing trend in its burden in recent years. However, the burden of AF/AFL in Iran remains unclear. This study aimed to estimate the burden of AF/AFL and its attributable risk factors from 1990 to 2019 at national and subnational levels. Using the comparative risk assessment method of the Global Burden of Disease (GBD) Study 2019, we extracted data on AF/AFL incidence, prevalence, deaths, disability-adjusted life years (DALYs), and their age-standardized rates from 1990 to 2019 and analyzed them based on by age, sex, and socio-demographic index (SDI). The percentage contribution of AF/AFL major risk factors was calculated. Moreover, the AF/AFL burden in 2050 was projected using the United Nations world population prospect data. In 2019, there were 339.1 (259.4–433.7) thousand AF/AFL patients in Iran, with 30.2 (23.2–38.5) thousand new cases, 1.7 (1.5–2) thousand deaths and 48 (37.7–60.5) thousand DALYs. Females and 50–69-year-old patients recorded a higher burden for AF/AFL; however, the increasing trend was more pronounced in males and more than 85-year-old patients. High systolic blood pressure and elevated body mass index (BMI) were the predominant attributable risk factors for AF/AFL-related deaths and DALYs. It is estimated that in 2050, the number of AF/AFL patients will increase to 1.1 million people, the incidence of AF/AFL will increase to 91 thousand patients, and the number of AF/AFL-related deaths and DALYs will surge to 7.2 and 170.8 thousand, respectively. Despite advancements in prevention and treatment, AF/AFL remains a major public health problem in Iran. Given its largely preventable and treatable nature, more cost-effective strategies are required to target modifiable risk factors, especially within susceptible age and sex groups.

Background Mental health disorders (MHD) impose a considerable burden on public health systems. With an increasing worldwide trend in urbanization, urban mental health stressors are affecting a larger population. In this study, we evaluated the epidemiology of mental health disorders in the citizens of Tehran using the Tehran Cohort Study (TeCS) data. Methods We utilized data from the TeCS recruitment phase. A total of 10,247 permanent residents of Tehran metropolitan (aged 15 years and older) were enrolled in the study from March 2016 to 2019 via systematic random sampling from all 22 districts of Tehran. The participant's demographic, socioeconomic, and medical characteristics were evaluated by conducting comprehensive interviews. The standardized Persian version of the General Health Questionnaire version 28 was utilized to assess the mental status of the patients according to four central mental health disorders. Results Almost 37.1% of Tehran residents suffered mental health problems (45.0% of women and 28.0% of men). The greatest incidence of MHDs was seen in the 25–34 and over 75 age groups. The most common mental health disorders were depression (43%) and anxiety (40%), followed by somatization (30%) and social dysfunction (8.1%). Mental health disorders were more frequent in the southeast regions of the city. Conclusions Tehran residents have a significantly higher rate of mental health disorders compared to nationwide studies, with an estimated 2.7 million citizens requiring mental health care services. Awareness of mental health disorders and identifying vulnerable groups are crucial in developing mental health care programs by public health authorities.

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.

Introduction Percutaneous coronary intervention (PCI) has been the main treatment of coronary artery disease (CAD). In this review, we aimed to compare the performance of machine learning (ML) vs. logistic regression (LR) models in predicting different outcomes after PCI. Methods Studies using ML or deep learning (DL) models to predict mortality, MACE, in-hospital bleeding, and acute kidney injury (AKI) after PCI or primary PCI were included. Articles were excluded if they did not provide a c-statistic, solely used ML models for feature selection, were not in English, or only used logistic or LASSO regression models. Best-performing ML and LR-based models (LR model or conventional risk score) from the same studies were pooled separately to directly compare the performance of ML versus LR. Risk of bias was assessed using the PROBAST and CHARMS checklists. Results A total of 59 studies were included. Meta-analysis showed that ML models resulted in a higher c-statistic compared to LR in long-term mortality (0.84 vs. 0.79, P -value = 0.178), short-term mortality (0.91 vs. 0.85, P  = 0.149), bleeding (0.81 vs. 0.77 P  = 0.261), acute kidney injury (AKI; 0.81 vs. 0.75, P  = 0.373), and major adverse cardiac events (MACE; 0.85 vs. 0.75, P  = 0.406). PROBAST analysis showed that 93% of long-term mortality, 70% of short-term mortality, 89% of bleeding, 69% of AKI, and 86% of MACE studies had a high risk of bias. Conclusion No statistical significance existed between ML and LR model. In addition, the high risk of bias in ML studies and complexity in interpretation undermines their validity and may impact their adaption in a clinical settings.

Metabolic syndrome (MetS) poses an additional risk for the development of coronary artery disease and major adverse cardiac and cerebrovascular events (MACCE). In this study, we investigated the association between MetS and its components and MACCE after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). The presence of MetS was calculated at baseline using the NCEP-ATP III criteria. The primary outcome was MACCE and its components were secondary outcomes. Unadjusted and adjusted Cox Regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CI) of the association between MetS or its components and MACCE and its components. A total of 13,459 ACS patients who underwent PCI (MetS: 7939 and non-MetS: 5520) with a mean age of 62.7 ± 11.0 years (male: 72.5%) were included and median follow-up time was 378 days. Patients with MetS had significantly higher MACCE risk (adjusted HR [aHR] 1.22, 95% CI 1.08–1.39). The only component of MACCE that exhibited a significantly higher incidence in MetS patients was myocardial infarction (aHR 1.43, 95% CI 1.15–1.76). MetS components that were significantly associated with a higher incidence of MACCE were hypertension and impaired fasting glucose. Having three MetS components did not increase MACCE (aHR 1.12, 95% CI 0.96–1.30) while having four (aHR 1.32, 95% CI 1.13–1.55) or five (aHR 1.42, 95% CI 1.15–1.75) MetS components was associated with a higher incidence of MACCE. MetS was associated with a higher risk of MACCE in ACS patients undergoing PCI. Among MACCE components, myocardial infarction was significantly higher in patients with MetS. Impaired fasting glucose and hypertension were associated with a higher risk of MACCE. Identifying these patterns can guide clinicians in choosing appropriate preventive measures.

There are conflicting results regarding the relationship between overweight/obesity and the outcomes of coronary artery bypass graft surgery (CABG), termed \"the obesity paradox\". This study aimed to evaluate the effects of body mass index (BMI) on the midterm outcomes of CABG. This historical cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016. The patients were divided into five categories based on their preoperative BMIs (kg/m.sup.2 ): 18.5[less than or equal to]BMI<25, 25[less than or equal to]BMI<30, 30[less than or equal to]BMI<35, 35[less than or equal to]BMI<40, and BMI[greater than or equal to]40. Patients with BMIs below 18.5 kg/m.sup.2 were excluded. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. For the assessment of the linearity of the relationship between continuous BMI and the outcomes, plots for time varying hazard ratio of BMI with outcomes were provided. Of 17 751 patients (BMI = 27.30 ±4.17 kg/m.sup.2) who underwent isolated CABG at our center, 17 602 patients (mean age = 61.16±9.47 y, 75.4% male) were included in this study. Multivariable analysis demonstrated that patients with pre-obesity and normal weight had similar outcomes, whereas patients with preoperative BMIs exceeding 30 kg/m.sup.2 kg/m.sup.2 had a significantly higher risk of 5-year all-cause mortality and 5-year MACCEs than those with pre-obesity. Additionally, a positive association existed between obesity degree and all-cause mortality and MACCEs. Further, BMIs of 40 kg/m.sup.2 or higher showed a trend toward higher MACCE risks (adjusted hazard ratio, 1.32; 95% confidence interval, 0.89 to 1.95), possibly due to the small sample size. A nonlinear, albeit negligible, association was also found between continuous BMI and the study endpoints. Our findings suggest that preoperative obesity (BMI>30 kg/m.sup.2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs. These findings indicate that physicians and cardiac surgeons should encourage patients with high BMIs to reduce weight for risk modification.

Background Machine learning (ML) has shown promising results in all fields of medicine, including preventive cardiology. Hypertensive patients are at higher risk of mortality after coronary artery bypass graft (CABG) surgery; thus, we aimed to design and evaluate five ML models to predict 1‐year mortality among hypertensive patients who underwent CABG. Hyothesis ML algorithms can significantly improve mortality prediction after CABG. Methods Tehran Heart Center's CABG data registry was used to extract several baseline and peri‐procedural characteristics and mortality data. The best features were chosen using random forest (RF) feature selection algorithm. Five ML models were developed to predict 1‐year mortality: logistic regression (LR), RF, artificial neural network (ANN), extreme gradient boosting (XGB), and naïve Bayes (NB). The area under the curve (AUC), sensitivity, and specificity were used to evaluate the models. Results Among the 8,493 hypertensive patients who underwent CABG (mean age of 68.27 ± 9.27 years), 303 died in the first year. Eleven features were selected as the best predictors, among which total ventilation hours and ejection fraction were the leading ones. LR showed the best prediction ability with an AUC of 0.82, while the least AUC was for the NB model (0.79). Among the subgroups, the highest AUC for LR model was for two age range groups (50–59 and 80–89 years), overweight, diabetic, and smoker subgroups of hypertensive patients. Conclusions All ML models had excellent performance in predicting 1‐year mortality among CABG hypertension patients, while LR was the best regarding AUC. These models can help clinicians assess the risk of mortality in specific subgroups at higher risk (such as hypertensive ones).

Background The prevalence of type 2 diabetes mellitus has increased in the past decades. We investigated the prevalence of diabetes and its awareness, treatment, and control among adult residents of Tehran. Methods We used the recruitment phase data of the Tehran Cohort study, enrolling a random sample of adult residents of Tehran aged ≥35 years. Diabetes was defined as self-report, current use of glucose-lowering medications, and/or fasting plasma glucose (FPG) ≥126mg/dl. Impaired fasting glucose (IFG) was defined as an FPG of 100-125mg/dl. Awareness was defined as diabetes self-report, treatment as receiving glucose-lowering medications, and glycemic control as FPG <126mg/dl. The age- and sex-weighted estimates were calculated using the 2016 national census. Logistic regression models were used to determine the factors associated with diabetes awareness, treatment, and control. Results A total of 8151 participants were included. Age- and sex-weighted prevalence of diabetes mellitus and IFG were 16.7% (95% CI: 15.1–18.4) and 25.1% (95% CI: 23.1–27.1), respectively. Diabetes was more prevalent in the eastern and central districts of Tehran. Advanced age (OR per 1-year increase: 1.026, 95% CI: 1.021-1.030), male sex (OR: 1.716, 95% CI: 1.543-1.909), higher BMI levels (OR for BMI ≥35 vs. <20 kg/m 2 : 4.852, 95% CI: 3.365-6.998), pre-existing hypertension (OR: 1.552, 95% CI: 1.378-1.747), dyslipidemia (OR: 1.692, 95% CI: 1.521-1.883), and chronic kidney disease (OR: 1.650, 95% CI: 1.019-2.673) were associated with an increased odds of diabetes mellitus. On the contrary, diabetes mellitus was less likely in current tobacco (OR: 0.872, 95% CI: 0.765-0.994) and alcohol users (OR: 0.836, 95% CI: 0.703-0.994) compared to non-users. Among diabetic individuals, 82.8% were aware of their condition, 71.9% received treatment, and 31.7% of treated patients had adequate glycemic control. Advanced age and pre-existing comorbidities, including hypertension and dyslipidemia, were associated with higher diabetes awareness and treatment. Furthermore, advanced age, higher levels of education, and female sex were determinants of better glycemic control among treated diabetic participants. Conclusion There is a high prevalence of diabetes and IFG among adult residents of Tehran. Additionally, more than two-thirds of treated diabetics living in Tehran remain uncontrolled.

Microvascular angina (MVA), historically called cardiac syndrome X, refers to angina with nonobstructive coronary artery disease. This female-predominant cardiovascular disorder adds considerable health-related costs due to repeated diagnostic angiography and frequent hospital admissions. Despite the high prevalence of this diagnosis in patients undergoing coronary angiography, it is still a therapeutic challenge for cardiologists. Unlike obstructive coronary artery disease, with multiple evidence-based therapies and management guidelines, little is known regarding the management of MVA. During the last decade, many therapeutic interventions have been suggested for the treatment of MVA. However, there is a lack of summarization tab and update of current knowledge about pharmacologic management of MVA, mostly due to unclear pathophysiology. In this article, we have reviewed the underlying mechanisms of MVA and the outcomes of various medications in patients with this disease. Contrary to vasospastic angina in which normal angiogram is observed as well, nitrates are not effective in the treatment of MVA. Beta-blockers and calcium channel blockers have the strongest evidence of improving the symptoms. Moreover, the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, statins, estrogen, and novel antianginal drugs has had promising outcomes. Investigations are still ongoing for vitamin D, omega-3, incretins, and n-acetyl cysteine, which have resulted in beneficial initial outcomes. We believe that the employment of the available results and results of the future large-scale trials into cardiac care guidelines would help reduce the global cost of cardiac care tremendously.