A 10-Year Atherosclerotic Cardiovascular Disease Risk Assessment and 5-Year Follow-Up in the Sabzevar PERSIAN Cohort Center, Northeast Iran
-
Mohammad-Shafi Mojadadi
,
Fatemeh Shahnazari
,
Mohammad Kolyaie
,
Hesamuddin Gordan
,
Amir Raoofi
,
Rahim Golmohammadi
,
Saeideh Sadat Shobeiri
,
Safoora Pordel
Abstract
Background: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality. This study assessed the 10-year ASCVD risk and evaluated 5-year follow-up outcomes among adults in the Sabzevar PERSIAN Cohort Center, northeast Iran.
Methods: Baseline data were collected in 2018, with follow-up completed in 2023. Risk factors including age, gender, blood pressure, cholesterol levels, smoking status, and diabetes were assessed. The 10-year ASCVD risk was calculated using the American College of Cardiology's risk estimator and categorized as low (<5%), borderline (5–7.4%), intermediate (7.5–19.9%), or high (≥20%). A Cox proportional hazards model evaluated the association between age, gender, diabetes, and ASCVD events.
Results: Among 2,871 participants, men had higher blood pressure, while women had higher levels of total cholesterol, HDL, and LDL (P < 0.05). Hypertension was more prevalent in men than in women (P < 0.001). Diabetes was present in 13.8% (n = 397) of participants, with no significant difference between men and women. The distribution of 10-year ASCVD risk was as follows: low (74.58%), borderline (9.3%), intermediate (13.96%), and high (2.16%). Men had a significantly higher ASCVD risk than women (P < 0.001). During the 5-year follow-up, 1.2% (n = 34) of participants experienced ASCVD events. In multivariable analysis, age (P < 0.001), male gender (P < 0.001), and diabetes (P = 0.013) were significant predictors of ASCVD events.
Conclusion: ASCVD risk estimation and early intervention, particularly for older adults and individuals with diabetes, are essential. These findings support targeted prevention efforts in northeast Iran and similar populations.
1. Frostegård J (2013). Immunity, atherosclerosis and cardiovascular disease. BMC Med, 11:1-117.
2. Ajoolabady A, Pratico D, Lin L, et al (2024). Inflammation in atherosclerosis: pathophysiology and mechanisms. Cell Death Dis, 15 (11):817.
3. Bentzon JF, Otsuka F, Virmani R, et al (2014). Mechanisms of plaque formation and rupture. Circ Res, 114 (12):1852-1866.
4. Holmstedt CA, Turan TN, Chimowitz MI (2013). Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurol, 12 (11):1106-1114.
5. Falk E (2006). Pathogenesis of atherosclerosis. J Am Coll Cardiol, 47 (8 Suppl):C7-12.
6. van der Wal AC, Becker AE (1999). Atherosclerotic plaque rupture–pathologic basis of plaque stability and instability. Cardiovasc Res, 41 (2):334-344.
7. Hasandokht T, Salari A, Nikfarjam S, et al (2022). Comparison Between ASCVD Versus WHO Risk Score in Predicting of 10-Year Cardiovascular Risk in an Iranian Adult: A Hospital-Based Cross-Sectional Study. Acta Med Iran, 60(1):56-61.
8. Anderson KM, Odell PM, Wilson PW, et al (1991). Cardiovascular disease risk profiles. Am Heart J, 121 (1 Pt 2):293-298.
9. Lewington S, Clarke R, Qizilbash N, et al (2003). Age-specific relevance of usual blood pressure to vascular mortality. Lancet, 361 (9366):1391-1392.
10. Kannel WB, McGee DL (1979). Diabetes and cardiovascular risk factors: the Framingham study. Circulation, 59 (1):8-13.
11. Rosenblit PD (2019). Extreme atherosclerotic cardiovascular disease (ASCVD) risk recognition. Curr Diab Rep, 19 (8):61.
12. Choi S (2019). The potential role of biomarkers associated with ASCVD risk: risk-enhancing biomarkers. J Lipid Atheroscler, 8 (2):173-182.
13. Zibaeenejad F, Mohammadi SS, Sayadi M, et al (2022). Ten-year atherosclerosis cardiovascular disease (ASCVD) risk score and its components among an Iranian population: a cohort-based cross-sectional study. BMC Cardiovasc Disord, 22 (1):162.
14. Poustchi H, Eghtesad S, Kamangar F, et al (2018). Prospective epidemiological research studies in Iran (the PERSIAN Cohort Study): rationale, objectives, and design. Am J Epidemiol, 187 (4):647-655.
15. Aryaeipour M, Rokni M, Rahimi M, et al (2010). Evaluation of the Stability of Coated Plates with Antigen at Different Temperatures and Times by ELISA Test to Diagnose Fasciolosis. Iran J Parasitol, 5: 41-6.
16. Saz-Lara A, Martínez-Vizcaíno V, Sequí-Domínguez I, et al (2022). The effect of smoking and smoking cessation on arterial stiffness: a systematic review and meta-analysis. Eur J Cardiovasc Nurs, 21 (4):297-306.
17. Duncan MS, Freiberg MS, Greevy RA, et al (2019). Association of smoking cessation with subsequent risk of cardiovascular disease. JAMA, 322 (7):642-650.
18. Pierdomenico SD, Lapenna D, Bucci A, et al (2005). Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens, 18 (11):1422-1428.
19. Holman RR, Paul SK, Bethel MA, et al (2008). 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med, 359 (15):1577-1589.
20. Group UPDS (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet, 352 (9131):837-853.
21. Barrios V, Escobar C, Anguita M, et al (2021). Recommendations to improve lipid control in primary prevention patients. A consensus document of the Spanish Society of Cardiology. REC: CardioClinics, 56 (3):208-217.
22. Lv Y, Cao X, Yu K, et al (2024). Gender differences in all-cause and cardiovascular mortality among US adults: from NHANES 2005–2018. Front Cardiovasc Med, 11:1283132.
23. Masoumi SJ, Sayadi M, Ardekani FM, et al (2025). Gender Difference in Cardiovascular Diseases Risk Factors and Scores among Health Workers: A Cross-sectional Study Based on the Cohort Study of Iran. Res Cardiovasc Med, 14 (1):40-46.
24. Xiang D, Liu Y, Zhou S, Zhou E, Wang Y (2021). Protective effects of estrogen on cardiovascular disease mediated by oxidative stress. Oxid Med Cell Longev, 2021:5523516.
25. Rajendran A, Minhas AS, Kazzi B, et al (2023). Sex-specific differences in cardiovascular risk factors and implications for cardiovascular disease prevention in women. Atherosclerosis, 384:117269.
26. Gallucci G, Tartarone A, Lerose R, et al (2020). Cardiovascular risk of smoking and benefits of smoking cessation. J Thorac Dis, 12 (7):3866-3876.
27. Zhao D, Wang Y, Wong ND, et al (2024). Impact of Aging on Cardiovascular Diseases: From Chronological Observation to Biological Insights: JACC Family Series. JACC Asia, 4 (5):345-358.
28. Tuomilehto J (2004). Impact of age on cardiovascular risk: implications for cardiovascular disease management. Atheroscler Suppl, 5 (2):9-17.
29. Lakatta EG (2002). Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons. Heart Fail Rev, 7:29-49.
30. Tian F, Chen L, Qian ZM, et al (2023). Ranking age-specific modifiable risk factors for cardiovascular disease and mortality: evidence from a population-based longitudinal study. EClinicalMedicine, 64: 102230.
31. Marcos PJT, López PJT, López-González ÁA, et al (2025) Estimation of Cardiovascular Risk Using SCORE2, REGICOR and Vascular Age Scales in Spanish Healthcare Workers: A Retrospective Longitudinal Study. Healthcare (Basel), 13(4):375.
32. Regitz-Zagrosek V, Gebhard C (2023). Gender medicine: effects of sex and gender on cardiovascular disease manifestation and outcomes. Nat Rev Cardiol, 20 (4):236-247.
33. Tabit CE, Chung WB, Hamburg NM, et al (2010). Endothelial dysfunction in diabetes mellitus: molecular mechanisms and clinical implications. Rev Endocr Metab Disord, 11:61-74.
34. Zhao N, Yu X, Zhu X, et al (2024). Diabetes mellitus to accelerated atherosclerosis: shared cellular and molecular mechanisms in glucose and lipid metabolism. J Cardiovasc Transl Res, 17 (1):133-152.
35. Jialal I, Chaudhuri A (2019). Targeting inflammation to reduce ASCVD in type 2 diabetes. J Diabetes Complications, 33 (1):1-3.
2. Ajoolabady A, Pratico D, Lin L, et al (2024). Inflammation in atherosclerosis: pathophysiology and mechanisms. Cell Death Dis, 15 (11):817.
3. Bentzon JF, Otsuka F, Virmani R, et al (2014). Mechanisms of plaque formation and rupture. Circ Res, 114 (12):1852-1866.
4. Holmstedt CA, Turan TN, Chimowitz MI (2013). Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurol, 12 (11):1106-1114.
5. Falk E (2006). Pathogenesis of atherosclerosis. J Am Coll Cardiol, 47 (8 Suppl):C7-12.
6. van der Wal AC, Becker AE (1999). Atherosclerotic plaque rupture–pathologic basis of plaque stability and instability. Cardiovasc Res, 41 (2):334-344.
7. Hasandokht T, Salari A, Nikfarjam S, et al (2022). Comparison Between ASCVD Versus WHO Risk Score in Predicting of 10-Year Cardiovascular Risk in an Iranian Adult: A Hospital-Based Cross-Sectional Study. Acta Med Iran, 60(1):56-61.
8. Anderson KM, Odell PM, Wilson PW, et al (1991). Cardiovascular disease risk profiles. Am Heart J, 121 (1 Pt 2):293-298.
9. Lewington S, Clarke R, Qizilbash N, et al (2003). Age-specific relevance of usual blood pressure to vascular mortality. Lancet, 361 (9366):1391-1392.
10. Kannel WB, McGee DL (1979). Diabetes and cardiovascular risk factors: the Framingham study. Circulation, 59 (1):8-13.
11. Rosenblit PD (2019). Extreme atherosclerotic cardiovascular disease (ASCVD) risk recognition. Curr Diab Rep, 19 (8):61.
12. Choi S (2019). The potential role of biomarkers associated with ASCVD risk: risk-enhancing biomarkers. J Lipid Atheroscler, 8 (2):173-182.
13. Zibaeenejad F, Mohammadi SS, Sayadi M, et al (2022). Ten-year atherosclerosis cardiovascular disease (ASCVD) risk score and its components among an Iranian population: a cohort-based cross-sectional study. BMC Cardiovasc Disord, 22 (1):162.
14. Poustchi H, Eghtesad S, Kamangar F, et al (2018). Prospective epidemiological research studies in Iran (the PERSIAN Cohort Study): rationale, objectives, and design. Am J Epidemiol, 187 (4):647-655.
15. Aryaeipour M, Rokni M, Rahimi M, et al (2010). Evaluation of the Stability of Coated Plates with Antigen at Different Temperatures and Times by ELISA Test to Diagnose Fasciolosis. Iran J Parasitol, 5: 41-6.
16. Saz-Lara A, Martínez-Vizcaíno V, Sequí-Domínguez I, et al (2022). The effect of smoking and smoking cessation on arterial stiffness: a systematic review and meta-analysis. Eur J Cardiovasc Nurs, 21 (4):297-306.
17. Duncan MS, Freiberg MS, Greevy RA, et al (2019). Association of smoking cessation with subsequent risk of cardiovascular disease. JAMA, 322 (7):642-650.
18. Pierdomenico SD, Lapenna D, Bucci A, et al (2005). Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens, 18 (11):1422-1428.
19. Holman RR, Paul SK, Bethel MA, et al (2008). 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med, 359 (15):1577-1589.
20. Group UPDS (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet, 352 (9131):837-853.
21. Barrios V, Escobar C, Anguita M, et al (2021). Recommendations to improve lipid control in primary prevention patients. A consensus document of the Spanish Society of Cardiology. REC: CardioClinics, 56 (3):208-217.
22. Lv Y, Cao X, Yu K, et al (2024). Gender differences in all-cause and cardiovascular mortality among US adults: from NHANES 2005–2018. Front Cardiovasc Med, 11:1283132.
23. Masoumi SJ, Sayadi M, Ardekani FM, et al (2025). Gender Difference in Cardiovascular Diseases Risk Factors and Scores among Health Workers: A Cross-sectional Study Based on the Cohort Study of Iran. Res Cardiovasc Med, 14 (1):40-46.
24. Xiang D, Liu Y, Zhou S, Zhou E, Wang Y (2021). Protective effects of estrogen on cardiovascular disease mediated by oxidative stress. Oxid Med Cell Longev, 2021:5523516.
25. Rajendran A, Minhas AS, Kazzi B, et al (2023). Sex-specific differences in cardiovascular risk factors and implications for cardiovascular disease prevention in women. Atherosclerosis, 384:117269.
26. Gallucci G, Tartarone A, Lerose R, et al (2020). Cardiovascular risk of smoking and benefits of smoking cessation. J Thorac Dis, 12 (7):3866-3876.
27. Zhao D, Wang Y, Wong ND, et al (2024). Impact of Aging on Cardiovascular Diseases: From Chronological Observation to Biological Insights: JACC Family Series. JACC Asia, 4 (5):345-358.
28. Tuomilehto J (2004). Impact of age on cardiovascular risk: implications for cardiovascular disease management. Atheroscler Suppl, 5 (2):9-17.
29. Lakatta EG (2002). Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons. Heart Fail Rev, 7:29-49.
30. Tian F, Chen L, Qian ZM, et al (2023). Ranking age-specific modifiable risk factors for cardiovascular disease and mortality: evidence from a population-based longitudinal study. EClinicalMedicine, 64: 102230.
31. Marcos PJT, López PJT, López-González ÁA, et al (2025) Estimation of Cardiovascular Risk Using SCORE2, REGICOR and Vascular Age Scales in Spanish Healthcare Workers: A Retrospective Longitudinal Study. Healthcare (Basel), 13(4):375.
32. Regitz-Zagrosek V, Gebhard C (2023). Gender medicine: effects of sex and gender on cardiovascular disease manifestation and outcomes. Nat Rev Cardiol, 20 (4):236-247.
33. Tabit CE, Chung WB, Hamburg NM, et al (2010). Endothelial dysfunction in diabetes mellitus: molecular mechanisms and clinical implications. Rev Endocr Metab Disord, 11:61-74.
34. Zhao N, Yu X, Zhu X, et al (2024). Diabetes mellitus to accelerated atherosclerosis: shared cellular and molecular mechanisms in glucose and lipid metabolism. J Cardiovasc Transl Res, 17 (1):133-152.
35. Jialal I, Chaudhuri A (2019). Targeting inflammation to reduce ASCVD in type 2 diabetes. J Diabetes Complications, 33 (1):1-3.
| Files | ||
| Issue | Vol 54 No 10 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i10.20145 | |
| Keywords | ||
| Atherosclerosis Cardiovascular diseases Risk assessment Longitudinal studies PERSIAN cohort Iran | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mojadadi M-S, Shahnazari F, Kolyaie M, Gordan H, Raoofi A, Golmohammadi R, Shobeiri SS, Pordel S. A 10-Year Atherosclerotic Cardiovascular Disease Risk Assessment and 5-Year Follow-Up in the Sabzevar PERSIAN Cohort Center, Northeast Iran. Iran J Public Health. 2025;54(10):2275-2283.
