Association between Nontraditional Risk Factors and Calculated 10-Year Risk of Atherosclerotic Cardiovascular Disease in a Large General Population: Based on the Pars Cohort Study
-
Seyyed Mojtaba Ghorashi
,
Pooria Ahmadi
,
Reza Shahnazar Nezhad Khalesi
,
Amir Fazeli
,
Hossein Molavi Vardanjani
,
Alireza Salehi
,
Negar Omidi
,
Mesbah Shams
,
Amirhossein Babaei
Abstract
Background: While the traditional risk factors of atherosclerotic cardiovascular disease (ASCVD) have been well-established, the evolving role of nontraditional risk factors is not apparent. This study aimed to evaluate the association between nontraditional risk factors and the calculated 10-year ASCVD risk in a general population.
Methods: This cross-sectional study was conducted using the Pars Cohort Study data. All inhabitants of the Valashahr district in southern Iran, aged 40–75 years, were invited (2012-2014). Patients with a history of cardiovascular disease (CVD) were excluded. The demographic and lifestyle data were collected using a validated questionnaire. Multinomial logistic regression analysis was used to evaluate the association between the calculated 10-year ASCVD risk and the nontraditional risk factors of CVD, including marital status, ethnicity, educational level, tobacco and opiate consumption, physical inactivity, and psychiatric disorders.
Results: Of 9264 participants (mean age =52.2±9.0 y; 45.8% male), 7152 patients met the inclusion criteria. In total, 20.2%, 7.6%, 36.3%, 56.4%, and 46.2% of the population were cigarette smokers, opiate consumers, tobacco consumers, ethnically Fars, and illiterate, respectively. The prevalence rates of low, borderline, and intermediate-to-high 10-year ASCVD risks were 74.3%, 9.8%, and 16.2%, respectively. In multinomial regression, anxiety (adjusted odds ratio [aOR], 0.58; P<0.001) was significantly associated with a lower ASCVD risk, whereas opiate consumption (aOR, 2.94; P<0.001) and illiteracy (aOR, 2.48; P<0.001) were significantly associated with a higher ASCVD risk.
Conclusion: Nontraditional risk factors are associated with the 10-year ASCVD risk and, thus, might be considered besides traditional ones for ASCVD in preventive medicine and health policies.
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15. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC, Jr, Stone NJ; Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol 2004;44:720-732.
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18. Alviar C, Rockman C, Guo Y, Adelman M, Berger J. Association of marital status with vascular disease in different arterial territories: a population based study of over 3.5 million subjects. J Am Coll Cardiol 2014;63:(12_Supplement) A1328.
19. Chaturvedi N. Ethnic differences in cardiovascular disease. Heart 2003;89:681-686.
20. Bhatnagar A, Maziak W, Eissenberg T, Ward KD, Thurston G, King BA, Sutfin EL, Cobb CO, Griffiths M, Goldstein LB, Rezk-Hanna M. Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk: A Scientific Statement From the American Heart Association. Circulation 2019;139:e917-e936.
21. Streppel MT, Boshuizen HC, Ocké MC, Kok FJ, Kromhout D. Mortality and life expectancy in relation to long-term cigarette, cigar and pipe smoking: the Zutphen Study. Tob Control 2007;16:107-113.
22. Sajid F, Bano S. Effects of smokeless dipping tobacco (Naswar) consumption on antioxidant enzymes and lipid profile in its users. Pak J Pharm Sci 2015;28(5 Suppl):1829-33.
23. Roayaei P, Aminorroaya A, Vasheghani-Farahani A, Oraii A, Sadeghian S, Poorhosseini H, Masoudkabir F. Opium and cardiovascular health: A devil or an angel? Indian Heart J 2020;72:482-490.
24. Hamer M, O'Donovan G, Stamatakis E. Association between physical activity and sub-types of cardiovascular disease death causes in a general population cohort. Eur J Epidemiol 2019;34:483-487.
25. Hoevenaar-Blom MP, Spijkerman AM, Kromhout D, van den Berg JF, Verschuren WM. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN study. Sleep 2011;34:1487-1492.
26. Kyrou I, Kollia N, Panagiotakos D, Georgousopoulou E, Chrysohoou C, Tsigos C, Randeva HS, Yannakoulia M, Stefanadis C, Papageorgiou C, Pitsavos C; ATTICA Study investigators. Association of depression and anxiety status with 10-year cardiovascular disease incidence among apparently healthy Greek adults: The ATTICA Study. Eur J Prev Cardiol 2017;24:145-152.
27. Gandomkar A, Poustchi H, Moini M, Moghadami M, Imanieh H, Fattahi MR, Ayatollahi SM, Sagheb MM, Anushiravani A, Mortazavi R, Sepanlou SG, Malekzadeh R. Pars cohort study of non-communicable diseases in Iran: protocol and preliminary results. Int J Public Health 2017;62:397-406.
28. Lloyd-Jones DM, Huffman MD, Karmali KN, Sanghavi DM, Wright JS, Pelser C, Gulati M, Masoudi FA, Goff DC Jr. Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients: The Million Hearts Longitudinal ASCVD Risk Assessment Tool: A Special Report From the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2017;69:1617-1636.
29. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993;25:71-80.
30. Executive summary: Standards of medical care in diabetes--2013. Diabetes Care 2013;36(Suppl 1):S4-10.
31. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021-3104.
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33. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995;854:1-452.
34. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC, Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;73:e285-e350.
35. Chen R, Zhan Y, Pedersen N, Fall K, Valdimarsdóttir UA, Hägg S, Fang F. Marital status, telomere length and cardiovascular disease risk in a Swedish prospective cohort. Heart 2020;106:267-272.
36. Abbasi SH, Sundin Ö, Jalali A, Soares J, Macassa G. Ethnic Differences in the Risk Factors and Severity of Coronary Artery Disease: a Patient-Based Study in Iran. J Racial Ethn Health Disparities 2018;5:623-631.
37. Suhadi R, Virginia DM, Setiawan CH. The Effect of Health Education by Pharmacists on 10-Year Atherosclerotic Cardiovascular Disease Risk: A Cluster-Randomized Control Study in a Low Socioeconomic Status Javanese Population. J Prim Care Community Health 2018;9:2150132718773674.
38. Abbasi SH, De Leon AP, Kassaian SE, Karimi A, Sundin Ö, Jalali A, Soares J, Macassa G. Socioeconomic Status and in-hospital Mortality of Acute Coronary Syndrome: Can Education and Occupation Serve as Preventive Measures? Int J Prev Med 2015;6:36.
39. GBD 2015 Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 2017;389(10082):1885-1906.
40. Kulsudjarit K. Drug problem in southeast and southwest Asia. Ann N Y Acad Sci 2004;1025:446-57.
41. Farahani MA, Mohammadi E, Ahmadi F, Maleki M, Hajizadeh E. Cultural barriers in the education of cardiovascular disease patients in Iran. Int Nurs Rev 2008;55:360-366.
42. Nakhaee S, Ghasemi S, Karimzadeh K, Zamani N, Alinejad-Mofrad S, Mehrpour O. The effects of opium on the cardiovascular system: a review of side effects, uses, and potential mechanisms. Subst Abuse Treat Prev Policy 2020;15:30.
43. Omidi N, Sadeghian S, Salarifar M, Jalali A, Abbasi SH, Yavari N, Ghorashi SM, Alidoosti M, Poorhosseini H. Relationship between the Severity of Coronary Artery Disease and Cardiovascular Risk Factors in Acute Coronary Syndrome: Based on Tehran Heart Center's Data Registry. J Tehran Heart Cent 2020;15:165-170.
44. Nalini M, Shakeri R, Poustchi H, Pourshams A, Etemadi A, Islami F, et al. Long-term opiate use and risk of cardiovascular mortality: results from the Golestan Cohort Study. Eur J Prev Cardiol 2021;28:98-106.
45. Tu R, Hou J, Liu X, Li R, Dong X, Pan M, Mao Z, Huo W, Chen G, Guo Y, Li S, Wang C. Physical activity attenuated association of air pollution with estimated 10-year atherosclerotic cardiovascular disease risk in a large rural Chinese adult population: A cross-sectional study. Environ Int 2020;140:105819.
46. Taghva A, Farsi Z, Javanmard Y, Atashi A, Hajebi A, Khademi M. Stigma Barriers of Mental Health in Iran: A Qualitative Study by Stakeholders of Mental Health. Iran J Psychiatry 2017;12:163-171.
2. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1459-1544.
3. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2015;131:e29-322.
4. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2095-2128.
5. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol 2020;76:2982-3021.
6. Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol 2017;70:1-25.
7. Assadi SN. Cardiovascular disorders risk factors in different industries of iran. Int J Prev Med 2013;4:728-33.
8. Alwan A. Global status report on noncommunicable diseases 2010: World Health Organization; 2011. https://apps.who.int/iris/handle/10665/44579 (01 July 2022).
9. Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P, Quyyumi AA, Taylor HA, Gulati M, Harold JG, Mieres JH, Ferdinand KC, Mensah GA, Sperling LS. Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions. Circulation 2018;137:2166-2178.
10. Wu Y, Liu X, Li X, Li Y, Zhao L, Chen Z, Li Y, Rao X, Zhou B, Detrano R, Liu K; USA-PRC Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology Research Group; China Multicenter Collaborative Study of Cardiovascular Epidemiology Research Group. Estimation of 10-year risk of fatal and nonfatal ischemic cardiovascular diseases in Chinese adults. Circulation 2006;114:2217-2225.
11. Grundy SM, D'Agostino RB Sr, Mosca L, Burke GL, Wilson PW, Rader DJ, Cleeman JI, Roccella EJ, Cutler JA, Friedman LM. Cardiovascular risk assessment based on US cohort studies: findings from a National Heart, Lung, and Blood institute workshop. Circulation 2001;104:491-496.
12. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;74:1376-1414.
13. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC, Jr, Watson K, Wilson PW; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2889-2934.
14. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al; ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020;41:111-188.
15. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC, Jr, Stone NJ; Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol 2004;44:720-732.
16. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2935-2959.
17. Silverman MG, Ference BA, Im K, Wiviott SD, Giugliano RP, Grundy SM, Braunwald E, Sabatine MS. Association Between Lowering LDL-C and Cardiovascular Risk Reduction Among Different Therapeutic Interventions: A Systematic Review and Meta-analysis. JAMA 2016;316:1289-1297.
18. Alviar C, Rockman C, Guo Y, Adelman M, Berger J. Association of marital status with vascular disease in different arterial territories: a population based study of over 3.5 million subjects. J Am Coll Cardiol 2014;63:(12_Supplement) A1328.
19. Chaturvedi N. Ethnic differences in cardiovascular disease. Heart 2003;89:681-686.
20. Bhatnagar A, Maziak W, Eissenberg T, Ward KD, Thurston G, King BA, Sutfin EL, Cobb CO, Griffiths M, Goldstein LB, Rezk-Hanna M. Water Pipe (Hookah) Smoking and Cardiovascular Disease Risk: A Scientific Statement From the American Heart Association. Circulation 2019;139:e917-e936.
21. Streppel MT, Boshuizen HC, Ocké MC, Kok FJ, Kromhout D. Mortality and life expectancy in relation to long-term cigarette, cigar and pipe smoking: the Zutphen Study. Tob Control 2007;16:107-113.
22. Sajid F, Bano S. Effects of smokeless dipping tobacco (Naswar) consumption on antioxidant enzymes and lipid profile in its users. Pak J Pharm Sci 2015;28(5 Suppl):1829-33.
23. Roayaei P, Aminorroaya A, Vasheghani-Farahani A, Oraii A, Sadeghian S, Poorhosseini H, Masoudkabir F. Opium and cardiovascular health: A devil or an angel? Indian Heart J 2020;72:482-490.
24. Hamer M, O'Donovan G, Stamatakis E. Association between physical activity and sub-types of cardiovascular disease death causes in a general population cohort. Eur J Epidemiol 2019;34:483-487.
25. Hoevenaar-Blom MP, Spijkerman AM, Kromhout D, van den Berg JF, Verschuren WM. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN study. Sleep 2011;34:1487-1492.
26. Kyrou I, Kollia N, Panagiotakos D, Georgousopoulou E, Chrysohoou C, Tsigos C, Randeva HS, Yannakoulia M, Stefanadis C, Papageorgiou C, Pitsavos C; ATTICA Study investigators. Association of depression and anxiety status with 10-year cardiovascular disease incidence among apparently healthy Greek adults: The ATTICA Study. Eur J Prev Cardiol 2017;24:145-152.
27. Gandomkar A, Poustchi H, Moini M, Moghadami M, Imanieh H, Fattahi MR, Ayatollahi SM, Sagheb MM, Anushiravani A, Mortazavi R, Sepanlou SG, Malekzadeh R. Pars cohort study of non-communicable diseases in Iran: protocol and preliminary results. Int J Public Health 2017;62:397-406.
28. Lloyd-Jones DM, Huffman MD, Karmali KN, Sanghavi DM, Wright JS, Pelser C, Gulati M, Masoudi FA, Goff DC Jr. Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients: The Million Hearts Longitudinal ASCVD Risk Assessment Tool: A Special Report From the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2017;69:1617-1636.
29. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993;25:71-80.
30. Executive summary: Standards of medical care in diabetes--2013. Diabetes Care 2013;36(Suppl 1):S4-10.
31. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021-3104.
32. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1-266.
33. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995;854:1-452.
34. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC, Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;73:e285-e350.
35. Chen R, Zhan Y, Pedersen N, Fall K, Valdimarsdóttir UA, Hägg S, Fang F. Marital status, telomere length and cardiovascular disease risk in a Swedish prospective cohort. Heart 2020;106:267-272.
36. Abbasi SH, Sundin Ö, Jalali A, Soares J, Macassa G. Ethnic Differences in the Risk Factors and Severity of Coronary Artery Disease: a Patient-Based Study in Iran. J Racial Ethn Health Disparities 2018;5:623-631.
37. Suhadi R, Virginia DM, Setiawan CH. The Effect of Health Education by Pharmacists on 10-Year Atherosclerotic Cardiovascular Disease Risk: A Cluster-Randomized Control Study in a Low Socioeconomic Status Javanese Population. J Prim Care Community Health 2018;9:2150132718773674.
38. Abbasi SH, De Leon AP, Kassaian SE, Karimi A, Sundin Ö, Jalali A, Soares J, Macassa G. Socioeconomic Status and in-hospital Mortality of Acute Coronary Syndrome: Can Education and Occupation Serve as Preventive Measures? Int J Prev Med 2015;6:36.
39. GBD 2015 Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 2017;389(10082):1885-1906.
40. Kulsudjarit K. Drug problem in southeast and southwest Asia. Ann N Y Acad Sci 2004;1025:446-57.
41. Farahani MA, Mohammadi E, Ahmadi F, Maleki M, Hajizadeh E. Cultural barriers in the education of cardiovascular disease patients in Iran. Int Nurs Rev 2008;55:360-366.
42. Nakhaee S, Ghasemi S, Karimzadeh K, Zamani N, Alinejad-Mofrad S, Mehrpour O. The effects of opium on the cardiovascular system: a review of side effects, uses, and potential mechanisms. Subst Abuse Treat Prev Policy 2020;15:30.
43. Omidi N, Sadeghian S, Salarifar M, Jalali A, Abbasi SH, Yavari N, Ghorashi SM, Alidoosti M, Poorhosseini H. Relationship between the Severity of Coronary Artery Disease and Cardiovascular Risk Factors in Acute Coronary Syndrome: Based on Tehran Heart Center's Data Registry. J Tehran Heart Cent 2020;15:165-170.
44. Nalini M, Shakeri R, Poustchi H, Pourshams A, Etemadi A, Islami F, et al. Long-term opiate use and risk of cardiovascular mortality: results from the Golestan Cohort Study. Eur J Prev Cardiol 2021;28:98-106.
45. Tu R, Hou J, Liu X, Li R, Dong X, Pan M, Mao Z, Huo W, Chen G, Guo Y, Li S, Wang C. Physical activity attenuated association of air pollution with estimated 10-year atherosclerotic cardiovascular disease risk in a large rural Chinese adult population: A cross-sectional study. Environ Int 2020;140:105819.
46. Taghva A, Farsi Z, Javanmard Y, Atashi A, Hajebi A, Khademi M. Stigma Barriers of Mental Health in Iran: A Qualitative Study by Stakeholders of Mental Health. Iran J Psychiatry 2017;12:163-171.
| Files | ||
| Issue | Vol 18 No 1 (2023): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v18i1.12578 | |
| Keywords | ||
| Atherosclerotic Cardiovascular Disease Risk Factors Opium Educational Status | ||
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How to Cite
1.
Ghorashi SM, Ahmadi P, Shahnazar Nezhad Khalesi R, Fazeli A, Molavi Vardanjani H, Salehi A, Omidi N, Shams M, Babaei A. Association between Nontraditional Risk Factors and Calculated 10-Year Risk of Atherosclerotic Cardiovascular Disease in a Large General Population: Based on the Pars Cohort Study. J Tehran Heart Cent. 2023;18(1):24-32.
