Response to assessing and predicting the trend of cardiovascular risk factors in 40–80-year population based on the Ira-PEN program as an integrated service in primary health care

Dear Editor, It was a delight to read the study entitled "Assessing and predicting the trend of cardiovascular risk factors in 40–80-year population based on the Ira-PEN program as an integrated service in primary health care" in your journal. This study assessed the influence of the Ira-PEN program, an integrated service in Primary Healthcare (PHC), on reducing cardiovascular disease (CVD) mortality rates among individuals aged 40–80 in Ardabil Province. Various measurement tools, including questionnaires and perception scales, were employed to evaluate CVD risk. The study identified a high prevalence of risk factors such as hypertension, pre-diabetes, lipid disorders, and high BMI in the target population. Other studies confirmed similar trends in risk factors.[1] Uncontrolled blood pressure emerged as a significant risk factor for cardiovascular complications, accounting for up to 70% of the CVD burden in the Asia-Pacific region. Additionally, diabetes and high blood pressure were identified as elevating risk levels. In Iran, the Ira-PEN program, following specific instructions and a referral system, effectively identified and provided comprehensive care for patients with diabetes and high blood pressure. Longitudinal studies revealed an increasing prevalence of CVD risk factors over time. Hypertension, smoking, diabetes, and obesity were reported as the most common risk factors. The study emphasized that patient behavior, influenced by unhealthy lifestyles and inactivity, posed a major barrier to heart disease prevention. The prevalence of CVD risk factors in Iran for those over 40 years old was reported. The study demonstrated that the implemented protocol effectively reduced heart disease mortality rates over 4 years, particularly in controlling blood pressure, abdominal obesity, and smoking. However, some factors showed less improvement. Screening for heart diseases in high-risk populations was shown to reduce cholesterol levels and assess risk scores. While certain risk factors like family history and ethnicity are uncontrollable, modifiable factors such as smoking, alcohol consumption, hypertension, obesity, inactivity, diabetes, and unhealthy diet play a pivotal role in prevention.[1] Interventions by healthcare professionals involving risk assessment, lifestyle recommendations, and necessary treatments were highlighted. A multifactorial approach was deemed necessary to address risk factors comprehensively. Early diagnosis and treatment of CVDs were emphasized to alleviate their burden. The Iranian health system's mixed structure, involving public, private, and non-governmental organizations, was described. The study emphasized the importance of tailored training programs and the need for population-wide community-based strategies to improve lifestyle. Analyzing risk assessment results in different populations was deemed crucial for identifying local risk factors and implementing effective long-term planning and intervention measures. The national commitment to reducing premature deaths from CVDs by 25% underscores the need for a coordinated and comprehensive approach. The study found a significant difference in mortality rates over the 4-year period, indicating improved provision of CVD risk assessment services. Managing risk factors and early diagnosis were recommended as effective methods for prevention and treatment. Despite the effectiveness of the risk assessment program in Iran, challenges in care and follow-up were noted. The study identified opportunities in Iran for disease prevention and lifestyle promotion, including an effective PHC structure and national-level diagnostic and therapeutic technologies. Assessing and predicting cardiovascular risk factors in the 40–80-year-old population was highlighted as a strength of the project. One limitation noted was the potential influence of other variables on disease risk, which was not considered in this study. Future research should explore economic and social factors and aim for integrated information on the most common CVD risk factors. The study emphasized the importance of adopting evidence-based policies and implementing interventions to modify behaviors and lifestyles in order to reduce risk factors and ultimately lower the prevalence of CVDs. Recommendations included involving doctors in lifestyle change training, as well as implementing population-wide community-based strategies and electronic self-care interfaces, to promote healthier lifestyles.[1] While this study provides valuable insights into the effectiveness of the Ira-PEN program in reducing CVD mortality rates, it is important to acknowledge certain research gaps. Firstly, the study primarily focuses on the Ardabil Province in Iran, which may limit the generalizability of the findings to other regions or populations with different socio-economic or healthcare contexts. Additionally, it would be better if the study clearly mentioned the influence of "other variables," such as socio-economic status, education level, or access to healthcare, which could potentially be significant determinants of CVD risk. Additionally, the study primarily relied on self-reported data, which can be subject to recall bias and may not always accurately reflect the true prevalence of risk factors. Moreover, while the study highlights the prevalence of specific risk factors, it could have explored the potential interactions or synergistic effects among these factors, which could provide a more nuanced understanding of their combined impact. Additionally, the study might have considered potential changes in risk factors over time or the impact of interventions targeting specific risk factors. Finally, the study may benefit from a longer follow-up period to assess the sustained effectiveness of the Ira-PEN program in the long term, as it is important to note that correlations observed in this research do not imply causation, and further longitudinal studies with larger sample sizes would be beneficial for establishing causal relationships. Despite these research gaps, while important to consider, do not diminish the significance of the study's findings but rather provide avenues for future research by incorporating a more diverse and comprehensive range of variables and populations to further enhance our understanding of CVD prevention and management. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.