Document Type : Original Article(s)


1 PhD Candidate, Isfahan Cardiovascular Research Center AND Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute AND Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

3 Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

4 Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


BACKGROUND: The aim of this study was describing the sampling methods and sample size of the Isfahan Healthy Heart Program (IHHP) and its sub-studies in focus.METHODS: The IHHP was carried out between 2000 and 2007 in urban and rural areas in 3 districts, namely Isfahan and Najafabad (as the intervention areas), and Arak (as the reference area), Iran. It consisted of the 3 phases of baseline surveys during 2000-2001, interventions between 2002 and 2005, and post-intervention surveys during 2006-2007 on 4 target groups (adults, health professionals, cardiac patients, children, and adolescents). During 2002 to 2005, 4 evaluation studies were conducted to evaluate short-term results. An ongoing cohort study entitled the Isfahan Cohort Study was performed on those aged ≥ 35 years at baseline in 2001 to access the risk of cardiovascular disease (CVD) occurrence.RESULTS: Using stratified random cluster methods, 12514, 5891, 4793, 6096, 3012, and 9572 adults and 1946, 1999, 1427, 1223, 389, and 1992 adolescents were chosen in the 1st to 3rd phases. Furthermore, simple random sampling was used for selecting 923, 694, 1000, and 2015 health professionals and 814, 452, 420, and 502 cardiac patients. A multistage sampling method was adopted for the collection of samples from parents of preschoolers and primary school children aged 2-10 years, adolescents’ parents, and some teachers. A prospective cohort study was started on 6504 eligible individuals.CONCLUSION: The IHHP, as a comprehensive community-based interventional trial in Iran, among the few population-based studies around the world, has reasonable sampling methods and sample size. 


  1. Gaziano T, Reddy KS, Paccaud F, Horton S, Chaturvedi V. Cardiovascular Disease. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd ed. Washington, DC: World Bank Publications; 2006.
  2. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 3(11): e442.
  3. Khosravi A, Aghamohamadi S, Kazemi E, Pour Malek F, Shariati M. Mortality profile in Iran (29 provinces) over the years 2006 to 2010. Tehran, Iran: Ministry of Health and Medical Education; 2013. [In Persian].
  4. Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 2007; 370(9603): 1929-38.
  5. Talaei M, Sarrafzadegan N, Sadeghi M, Oveisgharan S, Marshall T, Thomas GN, et al. Incidence of cardiovascular diseases in an Iranian population: The Isfahan Cohort Study. Arch Iran Med 2013; 16(3): 138-44.
  6. Pennant M, Davenport C, Bayliss S, Greenheld W, Marshall T, Hyde C. Community programs for the prevention of cardiovascular disease: a systematic review. Am J Epidemiol 2010; 172(5): 501-16.
  7. Farquhar JW, Fortmann SP, Maccoby N, Haskell WL, Williams PT, Flora JA, et al. The stanford five-city project: Design and methods. Am J Epidemiol 1985; 122(2): 323-34.
  8. Luepker RV, Murray DM, Jacobs DR Jr, Mittelmark MB, Bracht N, Carlaw R, et al. Community education for cardiovascular disease prevention: Risk factor changes in the Minnesota Heart Health Program. Am J Public Health 1994; 84(9): 1383-93.
  9. Vartiainen E, Puska P, Pekkanen J, Tuomilehto J, Jousilahti P. Changes in risk factors explain changes in mortality from ischaemic heart disease in Finland. BMJ 1994; 309(6946): 23-7.
  10. Luepker RV, Rastam L, Hannan PJ, Murray DM, Gray C, Baker WL, et al. Community education for cardiovascular disease prevention. Morbidity and mortality results from the Minnesota Heart Health Program. Am J Epidemiol 1996; 144(4): 351-62.
  11. Fortmann SP, Varady AN. Effects of a community-
  12. wide health education program on cardiovascular disease morbidity and mortality: The Stanford Five-City Project. Am J Epidemiol 2000; 152(4): 316-23.
  13. Nissinen A, Berrios X, Puska P. Community-based noncommunicable disease interventions: Lessons from developed countries for developing ones. Bull World Health Organ 2001; 79(10): 963-70.
  14. Kelishadi R, Pashmi M, Ahmadi R, Mohammad Zadeh M, Sadry G, Sarrafzadegan N. Healthy Heart Program: Heart health promotion from childhood. J Qazvin Univ Med Sci 2003; 7(2): 15-26.
  15. Sarraf-Zadegan N, Sadri G, Malek AH, Baghaei M, Mohammadi FN, Shahrokhi S, et al. Isfahan Healthy Heart Programme: A comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol 2003; 58(4): 309-20.
  16. Sarrafzadegan N, Baghaei A, Sadri G, Kelishadi R, Malekafzali H, Boshtam M, et al. Isfahan healthy heart program: Evaluation of comprehensive, community-based interventions for non-communicable disease prevention. Prevention and Control 2006; 2(2): 73-84.
  17. Sadeghi M, Roohafza H, Shirani S, Poormoghadas M, Kelishadi R, Baghaii A, et al. Diabetes and associated cardiovascular risk factors in Iran: The Isfahan Healthy Heart Programme. Ann Acad Med Singapore 2007; 36(3): 175-80.
  18. Sarrafzadegan N, Kelishadi R, Baghaei A, Hussein Sadri G, Malekafzali H, Mohammadifard N, et al. Metabolic syndrome: An emerging public health problem in Iranian women: Isfahan Healthy Heart Program. Int J Cardiol 2008; 131(1): 90-6.
  19. Bahonar A, Khosravi A, Esmaeelian H, Babak A, Sarrafzadeghan N, Rahmati M, et al. Methods of implementing the operational phases of the health professionals education project-Isfahan Healthy Heart Program (IHHP-HPEP). ARYA Atheroscler 2009; 5(3).
  20. Sarrafzadegan N, Kelishadi R, Esmaillzadeh A, Mohammadifard N, Rabiei K, Roohafza H, et al. Do lifestyle interventions work in developing countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran. Bull World Health Organ 2009; 87(1): 39-50.
  21. Baghaei A, Sarrafzadegan N, Rabiei K, Gharipour M, Tavasoli AA, Shirani S, et al. How effective are strategies for non-communicable disease prevention and control in a high risk population in a developing country? Isfahan Healthy Heart Programme. Arch Med Sci 2010; 6(1): 24-31.
  22. Khosravi A, Kiani Mehr G, Kelishadi R, Shirani S, Gharipour M, Tavassoli A, et al. The impact of a 6-year comprehensive community trial on the awareness, treatment and control rates of hypertension in Iran: Experiences from the Isfahan healthy heart program. BMC Cardiovascular Disorders 2010; 10: 61.
  23. Sadeghi M, Ramezani J, Sanei H, Rabeiee K, Gharipoor M, Toghianifar N. Adherence to evidence-based therapies and modifiable risk factors in patients with coronary artery disease-the hlcp project. ARYA Atheroscler 2006; 2(3).
  24. Gharipour M, Kelishadi R, Toghianifar N, Mackie M, Yazdani M, Noori F. Sex based pharmacological treatment in patients with metabolic syndrome: Findings from the Isfahan healthy heart program. Afr J Pharm Pharmacol 2011; 5(3): 311-6.
  25. Najafian J, Toghianifar N, Mohammadifard N, Nouri F. Association between sleep duration and metabolic syndrome in a population-based study: Isfahan Healthy Heart Program. J Res Med Sci 2011; 16(6): 801-6.
  26. Sarrafzadegan N, Rabiei K, Alavi M, Abedi H, Zarfeshani S. How can the results of a qualitative process evaluation be applied in management, improvement and modification of a preventive community trial? The IHHP Study. Arch Public Health 2011; 69: 9.
  27. Sarrafzadegan N, Talaei M, Sadeghi M, Kelishadi R, Oveisgharan S, Mohammadifard N, et al. The Isfahan cohort study: Rationale, methods and main findings. J Hum Hypertens 2011; 25(9): 545-53.
  28. Kelishadi R, Mohammadifard N, Sarrazadegan N, Nouri F, Pashmi R, Bahonar A, et al. The effects of a comprehensive community trial on cardiometabolic risk factors in adolescents: Isfahan Healthy Heart Program. ARYA Atheroscler 2012; 7(4): 184-90.
  29. Mohammadifard N, Sarrafzadegan N, Nouri F, Sajjadi F, Alikhasi H, Maghroun M, et al. Using factor analysis to identify dietary patterns in Iranian adults: Isfahan Healthy Heart Program. Int J Public Health 2012; 57(1): 235-41.
  30. Ahmadi A, Gharipour M, Nouri F, Sarrafzadegan N. Metabolic syndrome in Iranian youths: A population-based study on junior and high schools students in rural and urban areas. J Diabetes Res 2013; 2013: 738485.
  31. Sarrafzadegan N, Gharipour M, Sadeghi M, Nouri F, Asgary S, Zarfeshani S. Differences in the prevalence of metabolic syndrome in boys and girls based on various definitions. ARYA Atheroscler 2013; 9(1): 70-6.
  32. Sarrafzadegan N, Kelishadi R, Sadri G, Malekafzali H, Pourmoghaddas M, Heidari K, et al. Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: The Isfahan Healthy Heart Program. Arch Iran Med 2013; 16(1): 4-11.
  33. Ahmadi A, Gharipour M, Nouri F, Kelishadi R, Sadeghi M, Sarrafzadegan N. Association between adolescence obesity and metabolic syndrome: Evidence from Isfahan Healthy Heart Program. Indian J Endocrinol Metab 2014; 18(4): 569-73.
  34. Najafian J, Mohammadifard N, Naeini FF, Nouri F. Relation between usual daily walking time and metabolic syndrome. Niger Med J 2014; 55(1): 29-33.
  35. Roohafza H, Khani A, Sadeghi M, Bahonar A, Sarrafzadegan N. Health volunteers' knowledge of cardiovascular disease prevention and healthy lifestyle following a community trial: Isfahan healthy heart program. J Educ Health Promot 2014; 3: 59.
  36. Nouri F, Sarrafzadegan N, Mohammadifard N, Sadeghi M, Mansourian M. Intake of legumes and the risk of cardiovascular disease: Frailty modeling of a prospective cohort study in the Iranian middle-aged and older population. Eur J Clin Nutr 2016; 70(2): 217-21.
  37. Mohammadifard N, Sajjadi F, Maghroun M, Alikhasi H, Nilforoushzadeh F, Sarrafzadegan N. Validation of a simplified food frequency questionnaire for the assessment of dietary habits in Iranian adults: Isfahan Healthy Heart Program, Iran. ARYA Atheroscler 2015; 11(2): 139-46.
  38. Hosseini E, Lachat UGent C, Mohammadifard N, Sarrafzadegan N, UGent K. Associations of dietary glycemic index and glycemic load with glucose intolerance in Iranian adults. Int J Diabetes Dev Ctries 2014; 34(2): 89-94.
  39. Mohammadifard N, Mansourian M, Sajjadi F, Maghroun M, Pourmoghaddas A, Yazdekhasti N, et al. Association of glycaemic index and glycaemic load with metabolic syndrome in an Iranian adult population: Isfahan Healthy Heart Program. Nutr Diet 2017; 74(1): 61-6.
  40. Azizi F, Ghanbarian A, Momenan AA, Hadaegh F, Mirmiran P, Hedayati M, et al. Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II. Trials 2009; 10: 5.
  41. Mohammadifard N, Kelishadi R, Safavi M, Sarrafzadegan N, Sajadi F, Sadri GH, et al. Effect of a community-based intervention on nutritional behaviour in a developing country setting: The Isfahan Healthy Heart Programme. Public Health Nutr 2009; 12(9): 1422-30.
  42. Rabiei K, Kelishadi R, Sarrafzadegan N, Abedi HA, Alavi M, Heidari K, et al. Process evaluation of a community-based program for prevention and control of non-communicable disease in a developing country: The Isfahan Healthy Heart Program, Iran. BMC Public Health 2009; 9: 57.
  43. Sarrafzadegan N, Azadbakht L, Mohammadifard N, Esmaillzadeh A, Safavi M, Sajadi F, et al. Do lifestyle interventions affect dietary diversity score in the general population? Public Health Nutr 2009; 12(10): 1924-30.