https://orcid.org/0000-0001-7476-0414
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ABSTRACT
Objectives: The aim of this study was to evaluate temporal trends of salt intake with stroke incidence, stroke subtypes, and blood pressure in an adult population.
Methods: Data were extracted from Isfahan Salt Study. The stroke incidence rate, average salt intake, systolic and diastolic blood pressure in adults, aged over 18 years were considered from 2000 to 2014. The Average Annual Percent Changes (AAPC), parallelism, and the coincidence of trends were estimated, using a permutation test.
Results: The trend of salt intake was increased from 2010 to 2014 (AAPC = +1.59, P-value = 0.004). The trend of the stroke incidence rate was nonlinear with two change points in 2003 and 2009. The overall stroke incidence rate increased by 6.65% per year (95% CI: 1.66, 11.8, P-value = 0.015). The temporal trend changes of stroke incidence rate were steeper in patients who aged 40–45 and over 50 years (+6 to +11.5%) than in patients who aged 19–40 and 45–50 (range: −3.3% to 0). The parallelism hypothesis of longitudinal changes between salt intake and ischemic stroke was accepted in patients, aged <50 years (P-value = 0.871).
Conclusions: The average salt intake and its cone-shaped variance over 15 years of the study, indicated that salt intake reduction programs and policies were effective to stop associating intake increase until 2007, however, associated intake was increased since that time, which necessitates performing preventive programs. More importantly, the trend of salt intake and ischemic stroke was similar in patients who aged <50 years, regardless of considering their blood pressure.
Disclosure statement
No potential conflict of interest was reported by the authors.
Additional information
Notes on contributors
Shahram Arsang-Jang
Shahram Arsang-Jang received the B.S. degree in Public Health from Shiraz University of Medical Sciences, M.Sc. in Biostatistics from Tarbiat Modarres University, and Ph.D. in Biostatistics from Isfahan University of Medical Sciences. His research line is modeling longitudinal data, Bayesian methods focusing on genomic data analysis.
Marjan Mansourian
Marjan Mansourian received the B.S. and M.S. degrees from University of Isfahan, and Isfahan University of Medical Sciences, Isfahan, Iran, in 2003 and 2006, respectively. She received her Ph.D. (in Biostatistics) from Tarbiat Modarres University, Tehran, Iran in 2011. She was a visiting researcher at Politenico di Torino and Universitat Politècnica de Catalunya BarcelonaTech (UPC) in 2011, and 2012, respectively. Her research line is generalized linear models focusing on longitudinal data modeling and survival analysis. She is now an associate professor in the department of biostatistics and epidemiology, Isfahan University of Medical Sciences. She has been serving the following post-graduate courses in the department: survival analysis, Bayesian modeling, meta-analysis. I am a nutrition faculty and head of Nutrition Department at Isfahan Cardiovascular Research Institute. I received my doctorate in nutrition epidemiology from the Isfahan University of Medical Sciences. My research interests focus on community nutrition, clinical nutrition and CVD prevention. I have published more than 100 scientific papers in peer review journal regarding various aspects of diet and non-communicable diseases particularly cardiovascular diseases and their risk factor. I have been cooperated in writing and publishing three books. I have been a significant contributor to the field of dietary salt reduction at the population level and done extensive research in salt intake area. In this regard, I have carried out several studies in order to help with setting policies for salt reduction intake in Iran.
Noushin Mohammadifard
Noushin Mohammadifard, I am a nutrition faculty and head of Nutrition Department at Isfahan Cardiovascular Research Institute. I received my doctorate in nutrition epidemiology from the Isfahan University of Medical Sciences. My research interests focus on community nutrition, clinical nutrition and CVD prevention. I have published more than 100 scientific papers in peer review journal regarding various aspects of diet and non-communicable diseases particularly cardiovascular diseases and their risk factor. I have been cooperated in writing and publishing three books. I have been a significant contributor to the field of dietary salt reduction at population level and done extensive research in salt intake area. In this regard, I have carried out several studies in order to help with setting policies for salt reduction intake in Iran.
Shahram Oveis-Gharan
I am Shahram Oveisgharan, MD, a neurologist who is working at Rush Alzheimer's Disease Center as an assistant professor. My main research interests are related to ALzheimer's disease (AD) and other dementia-related pathologies and diseases including vascular or Transactive response DNA-binding protein 43 (TDP-43).
Nizal Sarrafzadegan
Dr. Nizal Sarrafzadegan is a professor of Internal Medicine & Cardiology, Isfahan University of medical Sciences in Iran, and Affiliate Professor of the Faculty of Medicine, School of Population and Public Health (SPPH) in the University of British Columbian (UBC) in Vancouver, Canada. She is currently teaching a post graduate course on ‘NCD Epidemiology and Prevention’ in the SPPH. She is the founder director of Isfahan Cardiovascular Research Institute (ICRI), a WHO collaborating center in the EMR. She started her studies on Cardiovascular Diseases (CVD) prevention, healthy lifestyle promotion and rehabilitation of cardiac patients since 1992 and published more than 450 articles and chapter books in peer-reviewed journals. She took part in more than 80 international meetings as international invited speaker or WHO advisor. She is the founder and President of the ‘Iranian Heart Foundation’, founder and Co-Chair of the ‘National Network of CVD research’ and the ‘Food, Industry and Healthy Community’ in Iran. Her academic career combines a clinical background with a strong interest in public health and preventive medicine, specifically implementation and evaluation. She has numerous multidisciplinary collaborations with investigators at the international level, got multiple national and international grants and supervised Ph.D. students at national or international levels. Prof. Sarrafzadegan worked with the WHO on Non-Communicable Disease (NCD) and CVD prevention and management as technical advisor, have strong collaboration with the ‘World Heart Federation’, the ‘International Atherosclerosis Society’, the ‘World Hypertension League’, the ‘International Council of Cardiovascular Disease Prevention and Rehabilitation’, the ‘Global and EMRO-NCD alliance’ etc. She is a member in the editorial or advisory board of peer-reviewed journals including the Journal of American College of Cardiology, the Nature Reviews Cardiology, International Journal of Cardiology among others. She is the founder and was the president of the ’The Eastern Meditranean Network of Heart health’. Prof. Sarrafzadegan won the 2016 WHO/EMR award for NCD prevention and control because of her extensive research in cardiovascular disease. Her current fields of research include Improving hypertension control, Early detection and managment of Familial hypercholesterolemia, CVD registry at national level, Presonalized medicine and epigenetics in Cardiology, developing simplified risk assessment models to predict CVD, shared aspects of cancer&CVD, Air Pollution and CVD.