Background The aim of this study was to determine the mean age at which coronary artery disease (CAD) hase decreased in recent years in Iran. This systematic review and meta‐analysis compares the prevalence of different risk factors of premature CAD (PCAD) in patients vs healthy individuals. Methods Medline, Web of Science, Embase and Scientific Information Database were searched for studies about PCAD risk factors in Iran until 28 October 2017. Observational studies of Iranians, comparing risk factors between patients with PCAD and age‐ and sex‐matched healthy subjects, were included. Fixed‐effects and random‐effects model were used for pooling data. Odds ratio (OR) with 95% CI and mean difference were used for effect size estimation among studies. Results Twelve studies were eligible for meta‐analysis. Diabetes mellitus (OR: 2.4, 95% CI: 1.9‐3.03; P = 0.0001, I2 = 25.5%; P = 0.2), family history of CAD (OR: 2.09, 95% CI: 1.22‐3.6; P = 0.007, I2 = 86%; P = 0.0001), dyslipidaemia (OR: 2.05, 95% CI: 1.15‐3.64; P = 0.01, I2 = 54%; P = 0.08), smoking (OR: 1.65, 95% CI: 1.11‐2.46; P = 0.01, I2 = 77.2%; P = 0.000) and hypertension (OR: 1.35, 95% CI: 1.21 to‐1.50; P < 0.001, I2 = 31%, P = 0.1) associated with PCAD. Sensitivity analysis demonstrated that patients with PCAD had significantly lower levels of high‐density lipoprotein (HDL) cholesterol and significantly higher levels of triglycerides compared to healthy subjects (MD: −2.56, 95% CI: −3.54 to −1.58, P < 0.001, I2 = 42%, P = 0.01 and MD: 21.17, 95% CI: 14.73‐27.62, P < 0.001, I2 = 80.12%, P < 0.001, respectively). It should be noted that although high levels of heterogeneity in LDL and HDL values among the studies were observed, when dyslipidaemia was studied as a binary variable, no significant heterogeneity among studies was observed. Conclusion Diabetes mellitus, family history of CAD, dyslipidaemia, smoking, and hypertension were significantly and positively associated with CAD in young adults compared to healthy age‐ and sex‐matched population in Iran.

Background: There are few data regarding the risk factors of premature vs late-onset Coronary Artery Disease (CAD). This study systematically reviews these risk factors in Iranian people. Methods: Medline, Web of Science, Embase and SID (Scientific Information Database; www.sid.ir) databases were searched for studies comparing CAD risk factors in young and older patients in Iran. Data extracted and pooled odds ratio (OR) with 95% Confidence Interval (CI) for each risk factor were calculated. Publication bias was evaluated by Egger’s test. Results: Seven studies (9080 participants) were included in the meta-analysis; analysis was carried out independently for each risk factor. Smoking (Odds Ratio (OR): 2.57, 95% CI: 1.96-3.37; p=<0.001), family history of CAD (OR: 2.45: 95% CI, 1.44-4.15, p<0.001), opium abuse (OR: 2.44: 95% CI, 1.22-4.88; p=0.001) and hyperlipidaemia (OR: 1.4: 95% CI, 1.13-1.73; p=0.001) were more common in premature CAD compared with older CAD patients. In contrast, diabetes mellitus (OR: 0.54: 95% CI, 0.39-0.73; p=0.0001) and hypertension (OR: 0.36, 95% CI: 0.21-0.59; p<0.001) were less prevalent. Conclusion: Risk factors were significantly different between premature and late-onset CAD. Policies regarding smoking and opium cessation and controlling hyperlipidaemia may be useful for the prevention of premature CAD in Iran.

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Background: Water pipe smoking has become a vitally important public health issue in the world with untruthful assumed less harmful effect. Objective: The aim of this study was to systematically review the association of water pipe tobacco smoking and risk of coronary artery disease (CAD). Methods: Up to September 25, 2018, we electronically searched the PubMed, Embase, and ISI Web of Science with no time restriction. We included observational studies and excluded conference abstracts, editorials, case-reports, case series, and reviews. With fixed model effect, we conducted Meta-analysis to evaluate the association between Water pipe smoking and coronary artery disease. Heterogeneity among studies was assessed by I2 square test. Publication bias was assessed by Egger test. P<0.05 set as significant level. Results: Among 248 paper records identified through database search, 52 full texts were eligible for full text assessment whereas 49 papers were excluded. Additionally, three studies were eligible for meta-analysis, which involved 58,960 adults with 1334 in the water pipe smoker group. Risk of CAD was increased in water pipe smokers compared to individuals who had never smoked water pipe but the result did not reach statistical significance (OR=1.18, 95% CI: 0.98- 1.38, p=0.06). We found that heavy water pipe smoking (40 to 50 sessions of water-pipe smoking/year) was associated with CAD compared to lower smokers defined as less than 40 to 50 water pipe/year (OR=2.001, 95% CI: 1.13-2.87). Conclusions: Heavy Water pipe smoking was associated to coronary artery disease on a clinical level. It seems very crucial to increase public awareness on adverse effects of water pipe smoking and its cessation in clinical setting.

Background Personality trait and emotional state may associate with high-risk trauma exposure and subsequently higher rate of emergency admission. Questions/Purposes: This study aimed at comparing emergency and elective orthopedic surgery patients in terms of 1. personality traits and 2. emotional states (anxiety, depression, and stress) intensity. Method This analytic cross-sectional study was carried out in a tertiary hospital, Mashhad, Iran. Patients with orthopedic surgical conditions were included and allocated into two groups, emergency and elective, each including 100 patients. Personality traits were examined by Neuroticism, Extraversion, Openness Five-Factor Inventory (NEO-FFI), and emotional states intensity were measured using the Depression, Anxiety and Stress Scale − 21 Items (DASS-21) questionnaire. NEO-FFI and DASS-21 scores were compared between the two groups. Results Based on our findings, the average score of neuroticism in the emergency group (16.03 ± 9.62) was significantly higher than the elective group (7.74 ± 3.41) (P < 0.001). Additionally, the levels of depression (11.97 ± 6 vs. 9.75 ± 6.62) and stress (12.71 ± 5.13 vs. 10.81 ± 5.03) were significantly higher in the emergency group (P = 0.002 and 0.016, respectively). Conclusion Among patients indicating emergency orthopedic surgery, neuroticism personality and the level of depression and stress is significantly higher than in patients scheduled for elective surgery. This study provides insight into considering different care measures for emergency patients in accordance with their personality character and emotional distress. Level of Evidence: level III