Arya Atherosclerosis
Volume:4 Issue: 2, Summer 2008

Studies of the association between the plasma concentration of Lipoprotein (a) and coronary heart disease (CHD) have reported apparently conflicting findings. The objective of the present study is to evaluate the association between serum levels of Lp(a) and ischemic heart disease as well as other cardiovascular risk Factors in a population- based study conducted on local cross sectional. Lp(a) serum wao measured in 142 patients with chronic stable angina, who were under going clinically indicated coronary angiography. Lipid profile, Fasting blood glucose, anthropometric and clinical parameters were analyzed. Lp(a) levels were significantly associated with numbers of coronary artery stenosis in men, but no in women. Also, an direct association between mean levels of Lp(a) and number of coronary artery stenosis in men younger tham 55 years old inverse association in men older tham 55 years old were observed. our multivariate analysis found that Lp(a) was considered an independent predictor for severity of IHD in men, especially in younger individuals.

Regarding the increasing incidence of cardiovascular diseases (CAD) in people younger than 40 years old, without any major risk factors, this study aimed to find if atheroscle-rosis of serum Paraxanase (PON) activity is a probable risk factor. This was a case-control study on 80 non diabetic persons younger than 40 years old, with chest pain. Patients were divided in two groups based on their results of coronary an-giography test: patients with and without CAD (angoi-positive and angio-negative). We also di-vided patients based on major coronary artery disease risk factors in two groups: with and with-out risk factors. We measured and compared PON activity, body mass index (BMI), serum triglyceride (TG), fasting blood sugar (FBS), C- reactive protein (CRP), apolipoprotein A1 and B (APO A1, and APO B), total cholesterol and low and high density lipoproteins (LDL and HDL) together in these groups. In angio-negative and angio-positive groups, the difference between PON activity (121.44 vs. 89.58), HDL (44.58 vs. 37.11), TG (149.31 vs. 199.7), APO B (87.48 vs. 99.50), CRP (4.38 vs. 7.32) was significant (P<0.05). There was not seen any significant difference between two groups regarding LDL, total cholesterol, APOA, and BMI (p >0.05). We didn’t find any rela-tionship between PON activity and HDL levels. This study suggests that low PON activity level might be considered as a risk factor for coronary artery disease, especially in patients who don’t have any other major risk fac-tors. Further studies are needed to evaluate the effect of these risk factors on each other.

Myocardial infarction (MI) is the leading cause of mortality and morbidity both in men and women. Risk factor profiles vary in different ethnic groups, in male and female and in different age groups. This study aimed to evaluate the cardiovascular risk factors in young women with AMI, and to compare it with other age and sex groups, in Birjand, south Khorasan. This descriptive analytic study evaluated the prevalence of classic CHD risk factors in female patients with acute Myocardial Infarction (AMI) aged = < 56 and compared it with fe-male AMI patients aging more than 56 and also with the male patients with AMI. The study group included 311 consecutive female patients (48 patients = < 56 and 263 > 56 years of age) out of 1112 patients who were hospitalized with acute myocardial infarction in Vali Asr hospital, the referral hospital in the capital of south Khorasan province in eastern Iran, from 2002 to 2006. Diabetes was detected to be the most frequent coronary risk factor in younger women (35.4%). The overall prevalence of diabetes was 22.6% in women with AMI. Women with premature coronary artery disease were found to have a higher prevalence of diabetes compared to older women (35.4% versus 20.1% respectively, P < 0.01). Furthermore, the num-ber of diabetics was significantly higher in women than men (29.2% versus 13.9% respectively, P < 0.001). In addition, number of diabetics was significantly higher in younger women than younger men (age =< 56) (35.4% versus 13.3% respectively, P = 0.03). Hypertension was second most common modifiable risk factor in younger female group and the most common risk factor in older female group. Cigarette smoking was found to be the least common risk factor in the younger female group but the most common, in the younger male. The mean age of female MI patients was only 5.6 years more than male MI patients, which is less than the 10 years delay of MI in females reported in the literature. Our findings show a significantly higher prevalence of diabetes in young fe-males compared with both older females and younger males with premature MI. The higher prevalence of DM in young females may be associated with the decreasing difference of mean age between female and male patients with MI. This data may be useful in directing primary and secondary preventive measures.

Obesity and low mobility are among the risk factors of stroke and cardio-vascular diseases. A pilot double-center study evaluated frequency rate of obesity and low mo-bility in patients with ischemic stroke. This prospective clinical study was conducted on 100 consecutive stroke patients in Mackenzie hospital, Canada and 100 consecutive stroke patients in Ghaem hospital, Iran in 2007. The patients were age and sex matched. Diagnosis of ischemic stroke was made by stroke neurologists. Obesity and low mobility was detected based on the standard method in the two studied groups. Chi-Square and Fisher tests served for statistical analysis and p < 0.05 was declared as significant. 92 males and 108 females with ischemic stroke were investigated. Obesity was pre-sent in 26% of the Canadians and 21% of Iranian stroke patients, df = 1, P = 0.403. Low mobility was reported in 29% of Canadian and 5% of Iranian stroke patients, df = 1, P < 0.0001. The fre-quency rate of obesity was not significantly different in the two groups and in each gender sepa-rately (P > 0.05), while the difference was significant for low mobility, P < 0.05. There is no significant difference in frequency rate of obesity between Cana-dian and Iranian stroke patients. However, low mobility is significantly more frequent in the old Canadian individuals with stroke.

Paroxysmal atrial fibrillation (AF) is a common arrhythmia encountered in clinical practice. Experimental and human mapping studies have demonstrated that perpetua-tion of AF is due to the presence of multiple reentrant wavelets with various sizes in the right and left atria. P-wave dispersion (PWD), defined as the difference between the maximum and minimum P-wave duration, has been proposed as being useful for the prediction of paroxysmal atrial fibrillation (AF). This study was undertaken to examine the effect of left atria (LA) dimen-sion on P-wave dispersion in unselected patients with PAF compared to healthy controls.METHOD AND MATERIALS: In this study, 40 consecutive patients with PAF (25 male, 15 female, mean age 45 ± 9 years) and 40 age and gender matched healthy controls (25 male, 15 female, mean age 46 ± 10 years) were studied. The P wave duration was calculated in all 12 leads of the surface ECG. The difference between the maximum and minimum P wave duration was calcu-lated and defined as P wave dispersion (PWD = Pmax - Pmin). All patients and controls were also evaluated by echocardiography to measure the left atrial diameter and left ventricular ejec-tion fraction (LVEF). P-wave dispersion in patients with PAF and normal LA diastolic diameter (LAD) was longer than in controls with normal LA size (51±9 vs. 34±8 ms, P < 0.002). P-wave dispersion increased in patients with PAF (60±14 vs. 50±7 ms, P < 0.001) and controls (39 ± 9 vs. 33 ± 9 ms, P < 0.004) with increased LAD. In the PAF group, P-wave dispersion correlated with LAD (r = 0.40, P = 0.001) and LA diastolic volume (r = 0.62, P < 0.001). On multivariate logistic re-gression analysis, only P-wave dispersion retained significance on development of PAF. P-wave dispersion increased in patients with PAF and normal LA size. In con-trols with increased LA size, P-wave dispersion increased but did not reach the levels attained in patients with PAF. These findings can be explained by the changes in LA microarchitecture which concurrently decreased atrial myocardial contraction, increased P-wave dispersion and predisposed to PAF.

The quality of myocardial protection during Coronary Artery Bypass Grafting (CABG) has a direct effect on post-operative cardiac function, recovery and complications. This study aimed to reveal the benefits of retrograde cardioplegia alone or with antrograde in CABG for myocardial function. A total number of 90 patients that underwent CABG between 2005 and 2006 were assigned randomly into two groups according to myocardial protection technique; Antrograde cold blood cardioplegia (ACBC) and retrograde cold blood cardioplegia (RCBC). The results were assessed considering clinical outcome, assessment of early systolic function by means of cardiac output (CO), stroke, left ventricular and atrial fibrillation and transient atrioventricular block after coming off bypass. The mean of age, gender, diabetes, hypertension, euro score, anatomical pattern of coronary disease, indexed left ventricular mass and ejection fraction (EF) were similar in the two groups. Complete LAD occlusion (95%in cross-sectional area of proximal LAD) of grafts was 95.55% in the RCBC group and 97.77% in the A/RCBC group. There were no patients suffering from severe impairment of left ventricle function and EF less than 35%. The cross-clamp time was same in both groups. The main findings of this study showed no significant difference between RCBC and A/RCBC procedure on myocardial function and EF also in patient with normal condi-tion.

Obesity increased reactive oxygen species generation that it result in oxidative injury on lipids profile and lipoproteins that all of which insert atherosclerotic effect. Nutritional intervention by means of a hypocaloric diet could produce protective effects against the redox unbalance. In this context, the aim of this intervention trial was to estimate the ability of weight loss to improve oxidative stress biomarkers related to lipids peroxidation and lipid profile and apoproteins concentrations of serum in obese women. Thirties eight obese women, 15-45 years old, with body mass index (BMI) > 30 kg/m2 were recruited. The obese women were assigned to energy-restricted dietary treatments for 12 week. Before and after nutritional intervention and 10% weight reduction, anthropometric measurements were taken and fasting blood was drawn. Plasma levels of (MDA) determined with TBAR and triglyceride, total cholesterol and (HDL) cholesterol

cardiovascular diseases are prevalent in diabetic patients and have a worse prognosis than patients without diabetes. Its cause is the high incidence of risk factors. In this study, we investigated the quality of control of cardiovascular risk factors in diabetic patients.METHOD AND MATERIALS: In this observational study, 514 cases of diabetes were studied. These cases included 142 males (%27.6) and 372 females (%72.4) referring to diabetes clinic of Kerman medical university from 1999 to 2007. All data were extracted from the patients’ profile and entered in the forms. Data were analyzed using SPSS v 11.5. The results showed that the mean age of the subjects was 57.18 (± 10.33) and the mean body mass index was 26.29 (±4.66) kg/m2.Based on the first visit, the incidence of obesity, dislipidemia and hypertension was %17.5, %84.6 and %62.2, respectively. Of all the subjects, 32.8% had 2 risk factors, %41.40 had 3 and %18.87 had more than 3 risk factors. The frequency of controlled risk factors such as FBS‚ HbA1C‚ triglyceride‚ cholesterol‚ HDL level more than 40 in males and 50 in females (based on the average of total visits) was%10.1‚%20.6‚%57.4‚%38.9‚%39.8‚respectively. The frequency of systolic and diastolic blood pressure of less than 130/80 mmHg was %67.9 and %52.1. This study shows the high prevalence of cardiovascular risk factors in diabet-ics‚ the poor control over these factors and points out the importance of diagnostic-therapeutic interventions for a more accurate control over cardiovascular risk factors.

Subclavian artery thrombosis is a condition in which the blood flow through the vessel is suddenly obstructed. In fact, occlusion occurs in one of subclavian arteries, espe-cially in the left subclavian artery. A patient with an acute occlusion presents with a cold, pain-ful, cyanosis, pulseless upper extremity.CASE REPORT: A 48 years old lady admitted to Imam Khomeyni hospital (Sari, Iran) with a his-tory of acute left upper limb pain. On examination, her left hand was cold, blue and painful on active and passive movements. Her left axilliary pulse was detected with no brachial or ulnar pulses. Left subclavian angiography showed a large thrombus in the proximal part of her left subclavian artery, the other sites of artery were normal. She had an elbow amputation in Tehran later. Therapeutic intervention is indicated in any symptomatic patient. Rapid diag-nosis and treatment of thrombosis of subclavian artery prevent ischemia and gangrene of upper extremity. Subclavian artery thrombosis is uncommon cause of acute upper extremity ischemia, but should always regard to it. A true history and physical exam could be established rapid diag-nosis and prevented side effects such as gangrene and amputation of upper extremity.