Document Type : Original Article
Authors
1 Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Hypertension Research Center, Isfahan Cardiovascular Research Institute
Abstract
Background: This study aimed to find the influence of education level on the trends of changes
of these risk factors among a great sample of Iranian population. Materials and Methods: This
cross‑sectional study is a secondary analysis of Isfahan Healthy Heart Program (IHHP). Blood
samples were taken to determine the lipid levels including total cholesterol (TC), low‑density
lipoprotein cholesterol (LDL‑C), low levels of high‑density lipoprotein cholesterol (HDL‑C),
and triglycerides. Education categorized based on training system in Iran as 1‑5, 6‑12,
and more than 12 years training. Results: The prevalence of diabetes was higher among
illiterate participants in both areas. Hypertension was more prevalent in illiterate subjects
(2001; 44.0% and 2007; 46.3%) in intervention area (P < 0.001). Dyslipidemia was more
prevalent among illiterate people (P < 0.001). In the intervention, illiterates have higher BMI in
both 2001 and 2007 (P < 0.001). The prevalence of current smoking was the highest in education
level range 6 to 12 years and was steadily decreased in higher education levels (P < 0.001).
Subjects with 6‑12 years of education have more unhealthy nutritional habits in both areas.
In 2001, subjects with 12 years of education or more had more physical activity than other
groups (P < 0.001), whereas, in 2007, subjects with 6‑12 years of education were more
active (P < 0.001). Conclusion: Although the prevalence of diabetes, hypertension obesity, and
dyslipidemia are more in illiterate subjects and prevalence of diabetes and hyperlipidemia was
sharply decreased with education level, it seems that well educated participants have higher
daily physically activity compared with those who have lower education without considering
the place or residency.
Keywords
and diabetes and cardiovascular disease. Diabetes Technol Ther
2012;14(Suppl 1):S59‑67.
2. Ramaraj R, Alpert JS. Indian poverty and cardiovascular disease.
Am J Cardiol 2008;102:102‑6.
3. Zeljko H, Skarić‑Jurić T, Narancic NS, Salihović MP, Klarić IM,
Barbalić M, et al. Traditional CVD risk factors and socio‑economic
deprivation in Roma minority population of Croatia. Coll Antropol
2008;32:667‑76.
4. Dominguez LJ, GaliotoA, FerlisiA, PineoA, PutignanoE, BelvedereM,
et al. Ageing, lifestyle modifications, and cardiovascular disease in
developing countries. J Nutr Health Aging 2006;10:143‑9.
5. Hajsheikholeslami F, Hatami M, Hadaegh F, Ghanbarian A, Azizi F.
Association of educational status with cardiovascular disease:
Teheran Lipid and Glucose Study. Int J Public Health 2011;56:281‑7.
6. Sarraf‑Zadegan N, Sadri G, MenkAfzali H, Baghaei M,
MohammadiFard 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 Cardiologica
2003;58:309‑20.
7. Sarrafzadegan N, Kelishadi R, Baghaei A, Hussein SG, Menkafzali H,
Mohammadifard N, et al. Metabolic syndrome: An emerging public
health problem in Iranian women: Isfahan Healthy Heart Program.
Int J Cardiol 2008;131:90‑6.
8. Shea S, Basch CE. A review of five major community‑based
cardiovascular disease prevention programs. Part II: Intervention
strategies, evaluation methods, and results. Am J Health Promot
1990;4:279‑87.
9. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of
cardiovascular diseases Part I: General considerations, the
epidemiologic transition, risk factors, and impact of Urbanization.
Circulation 2001;104:2746‑53.
10. Bahonar A, Sarrafzadegan N, Kelishadi R, Shirani S, Ramezani MA,
Taghdisi MH, et al. Association of socioeconomic profiles with
cardiovascular risk factors in Iran: The Isfahan healthy heart
program. Int J Public Health 2011;56:37‑44.
11. Gharipour M, Khosravi A, Sadeghi M, Roohafza H, Hashemi M,
Sarrafzadegan N. Socioeconomic characteristics and controlled
hypertension: Evidence from Isfahan Healthy Heart Program. ARYA
Atheroscler 2013;9:77‑81.
12. Gharipour M, Kelishadi R, Toghianifar N, Tavassoli AA, Khosravi AR,
Sajadi F, et al. Socioeconomic disparities and smoking habits in
metabolic syndrome: Evidence from Isfahan healthy heart program.
Iran Red Crescent Med J 2011;13:537‑43.
13. Mittelmark MB, Hunt MK, Heath GW, Schmid TL. Realistic outcomes:
Lessons from community‑based research and demonstration
programs for the prevention of cardiovascular diseases. J Public
Health Policy 1993;14:437‑62.
14. Shea S, Basch CE. A review of five major community‑based
cardiovascular disease prevention programs. Part I: Rationale,
design, and theoretical framework. Am J Health Promot
1990;4:203‑13.
15. Pirie PL, Stone EJ, Assaf AR, Flora JA, Maschewsky‑Schneider U.
Program evaluation strategies for community‑based health
promotion programs: Perspectives from the cardiovascular disease
community research and demonstration studies. Health Educ Res
1994;9:23‑36.
16. McLaren L, Ghali LM, Lorenzetti D, Rock M. Out of context?
Translating evidence from the North Karelia project over place and
time. Health Educ Res 2007;22:414‑24.
17. Salonen JT, Kottke TE, Jacobs DR Jr, Hannan PJ. Analysis
of community‑based cardiovascular disease prevention
studies‑‑evaluation issues in the North Karelia Project and the
Minnesota Heart Health Program. Int J Epidemiol 1986;15:176‑82.
18. Cirera L, Tormo MJ, Chirlaque MD, Navarro C. Cardiovascular risk
factors and educational attainment in Southern Spain: A study of
a random sample of 3091 adults. Eur J Epidemiol 1998;14:755‑63.
19. Hajsheikholeslami F, Hatami M, Hadaegh F, Ghanbarian A, Azizi F.
Association of educational status with cardiovascular disease:
Teheran Lipid and Glucose Study. Int J Public Health 2011;56:281‑7.
20. Manhem K, Dotevall A, Wilhelmsen L, Rosengren A. Social gradients
in cardiovascular risk factors and symptoms of Swedish men and
women: The Göteborg MONICA Study 1995. J Cardiovasc Risk
2000;7:359‑68.
21. Reddy KK, Rao AP, Reddy TP. Socioeconomic status and the
prevalence of coronary heart disease risk factors. Asia Pac J Clin
Nutr 2002;11:98‑103.
22. Christopher JL, Murray CJL, Lopez AD. The global burden of
disease: Comprehensive assessment of mortality and disability
fromdiseases, injuries and risk factors in 1990 and projected to
2020. Cambridge, MA: Harvard School of Public Health; 1996.
23. Enas EA. High rates of CAD in Asian Indians in the United
Statesdespite intense modification of life style: What next? Curr
Sci 1998;74:1081‑6.
24. Reddy KK, Ramamurthy R, Somasekaraiah BV, Kumara Reddy TP,
Papa Rao A. Free radical and antioxidant status in urban and rural
Tirupati men: Interaction with nutrient intake, substance abuse, obesity
and body fat distribution. Asia Pacific J Clin Nutr 1997;6:296‑311.25. Hajian‑Tilaki KO, Heidari B. Prevalence of obesity, central obesity and
the associated factors in urban population aged 20‑70 years, in the
north of Iran: A population‑based study and regression approach.
Obes Rev 2007;8:3‑10.
26. Ramsay SE, Whincup PH, Hardoon SL, Lennon LT, Morris RW,
Wannamethee SG. Social class differences in secular trends in
established coronary risk factors over 20 years: A cohort study of
British men from 1978‑80 to 1998‑2000. PLoS One 2011;6:e19742.
27. Ramsay SE, Morris RW, Whincup PH, Papacosta AO, Thomas MC,
Wannamethee SG. Prediction of coronary heart disease risk by
Framingham and SCORE risk assessments varies by socioeconomic
position: Results from a study in Britishmen. Eur J Cardiovasc Prev
Rehabil 2011;18:186‑93.
28. Jefferis BJ, Thomson AG, Lennon LT, Feyerabend C, Doig M,
McMeekin L, et al. Changes in environmental tobacco smoke (ETS)
exposure over a 20‑year period: Cross‑sectional and longitudinal
analyses. Addiction 2009;104:496‑503.
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