Incidence and risk factors for cardiovascular mortality in Iranian adults: Findings from a 10year Yazd Healthy Heart Project Study.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide, with a growing burden in low- and middle-income countries. Given the increasing CVD mortality in Iran and the limited evidence on long-term lifestyle determinants, a cohort study is needed to examine the effects of related factors. METHODS: A total of 2,000 adults, including 1,000 men and women aged 20 to 74 years, were enrolled in a population-based cohort study in Yazd, Iran, from 2005 to 2006, with a mean follow-up of 10 years. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD mortality in relation to demographic, economic status, educational, and lifestyle factors. RESULTS: During follow-up, 83 CVD deaths occurred (5.4%). The mortality rate was 6.8% in men and 3.8% in women. After adjustment for hypertension, diabetes, and hypercholesterolemia, significant predictors of CVD mortality included age ≥65 years (HR = 3.63, 95% CI: 2.28-5.77), male sex (HR = 2.29, 95% CI: 1.31-3.34), and smoking (HR = 1.95, 95% CI: 1.21-3.13). In contrast, moderate physical activity was associated with a lower risk of mortality (HR = 0.38, 95% CI: 0.17-0.84), and high school education was also protective (HR = 0.49, 95% CI: 0.25-0.98). In subgroup analyses among men, age ≥65 years, moderate physical activity, and high school education remained significant predictors of CVD mortality (P < 0.05). CONCLUSION: Age 65 years or older, smoking, and male sex increased the risk of CVD mortality in this Iranian cohort. Physical activity and higher educational attainment were associated with a reduced risk of CVD mortality.