Arya Atherosclerosis
Volume:5 Issue: 2, Summer 2009

It has been shown that ATP-sensitive potassium (KATP) channels play an important role in physiology of myocardial adaptation to ischemia. In cardiomyocytes, the poreforming subunits of these channels are coded by KCNJ11 gene. It was reported that the common polymorphism E23K of this gene is associated with higher susceptibility to coronary heart disease (CHD) in Chinese patients, but no other reports are available from other ethnic groups. Iranian patients with confirmed CHD, aged over 50 years were compared with healthy controls for allelic and genotypic frequencies of this polymorphism. Patients who did not suffer from diabetes mellitus were entered into this study if they showed coronary stenosis of > 50% in at least one artery in the angiography performed after a coronary event. The subjects and controls were matched for age, gender, blood glucose, body mass index and smoking. No association could be found between CHD and frequencies of G and A alleles, single genotype frequencies of AA, AG, GG, and combine genotypes frequencies of AG + AA versus GG, and AG + GG versus AA. This study did not find any association between coronary heart disease and E23K polymorphism in Iranian patients. But, this finding is not conclusive due to limitation of sample size. A subsequent study with a larger sample size is recommended.

Endothelial dysfunction contributes to the manifestation of stable and unstable coronary syndromes in patients with established coronary artery disease (CAD). Enhanced external counterpulsation (EECP) is a noninvasive therapeutic modality for patients with CAD, non responsive to medical and/or surgical treatment. The aim of this research was to determine the long-term effect of EECP on endothelial function via releasing angiogenic factors, NO (nitric oxide) and VEGF (vascular endothelial growth factor), in patients with CAD. The study was performed on 19 consecutive patients with ischemic coronary artery disease. All subjects were treated with EECP 1-h per day, 5 days a week, over 7 weeks (totally 35 h). Serum level of VEGF and nitrite (stable NO metabolite) concentration was measured before EECP, after 24th day, at the end of course (35th day), and at 1 and 3 months after completion of EECP treatment. After 35 hours of EECP, there was a trend toward increase (31.5 ± 14.7%) in nitrite level compared with baseline (11.12 ± 3.17 vs 9.65 ± 1.36 mg/l) but it wasn’t significant. Results of 1and 3 month follow-up after treatment showed that, the nitrite levels significantly increased compared with the baseline. During the course of EECP therapy, plasma VEGF levels increased progressively. Significant increase in plasma levels of VEGF were began from second sampling session of our study (24th day) and reached to maximum 3 month after EECP therapy. In this prospective study that assessed the effects of EECP on plasma nitrite and VEGF levels, it has been demonstrated that EECP progressively increases nitrite and VEGF levels during the course of therapy. These significant changes continued 3 months after EECP therapy.

Our aim was to test the hypothesis that a one - year, classroom – based education for the third, fourth and fifth elementary school graders could change their knowledge scores about healthy heart. It was a randomized and interventional study in elementary schools of Shahr-ekord, Iran in 2006-2007. A total of 8 elementary schools, categorized by socioeconomic types and male and female setting, were selected and randomized into control or intervention groups. Subjects were 920 third, fourth and fifth graders, aged 9 to 11 years (50% boys and 50% girls). Over a course of 8 weeks, health educators and general practitioner of the elementary schools presented two hours sessions per week on heart function, nutrition, and exercise for healthy heart and living tobacco free for the intervention group. The education program was based on Heart Power! Program, an American Heart Association program. Statistical analysis tests wrere: Mann – Whitney U test and Wilcoxon matched- pairs signed rank test and Bonferroni correction for the two pair wise comparisons Total heart knowledge at post test was increased 40% in the intervention group (P < 0.01). Difference in means of total healthy heart knowledge scores between control and intervention group increased from 12.4 points in baseline to 24.6 points in post test (total score was 30). Attitude in intervention group changed from 32% to 63.9% after post test (P < 0.01). After general and heart examination, we found 69 students with abnormal heart sounds and finally by referred to pediatric cardiologist, for 18 them heart diseases were diagnosed. It can be concluded that the classroom – based cardiovascular health promotion had a significant effect on the healthy heart knowledge. Therefore, schools provide an excellent setting for introducing comprehensive healthy heart education and promotion of cardiovascular health to the general population.

Although much has been discussed regarding the improvement of quality of life with regular physical exercise, we need studies on the cardio respiratory response evaluated on the basis of O2 uptake, transport, and utilization in areas with high concentrations of pollutants in the atmosphere. The purpose of this study was to determine the effect of air pollution on respiratory and cardiac performance of active individuals in the environments with polluted air and non-polluted air. Twenty healthy non-smoker athlete undergraduate male students (Mean ± SD: age 21.70 ± 2.10 yr, height 175.80 ± 6.78 cm, weight 65.58 ± 4.23 kg and BMI 24.44 ± 2.32) volunteered to participate in the study. First, two environments including polluted and non-polluted were determined on the basis of the environmental protection agency. Then, the subjects were performed on a field cooper test. The tests consisted of two phases: phase A, in non-polluted air area and phase B, in polluted air area, with a 7-day interval between phases. Finally, respiratory volumes and capacities were measured. The results of analysis by paired t-test showed that there were significant decreases in all of the respiratory parameters (ERV, IC, FVC, FEV1, MVV, FEV25-75, FEV1/FVC), in polluted air compared with non-polluted air (P < 0.05). The heart rate measures in two group showed that the mean of heart rate in polluted area was (89 ± 4) more than non polluted environment (83 ± 5) and this was significant at P=0.028. Therefore, the acute exposure to polluted air may cause a significant reduction in the respiratory and cardiac performance of active individuals.

Patent foramen ovale (PFO) is the most commonly persistent abnormality of fetal origin. PFO has long been recognized as a potential risk factor for ischemic stroke. This study has shown the prevalence of PFO among young patients with cryptogenic stroke. In our case-control study we had 32 patients, 18 to 55 years old with cryptogenic stroke and 64 participants among normal population with matched age and sex in control group. We studied them for stroke risk factors like hypertension, diabetes mellitus, ischemic heart disease, dyslipidemia and then election of PFO by contrast trans-thoracic echocardiography. Data entered in SPSS11 and analyzed by chi-Square and logistic regression. P value less than 0.05 was considered statistically significant. We found that 37.5 % of patients in case group and 7.7 % of patients in controls had PFO and this difference was statistically significant (P = 0.001). They had no significant difference in other atherosclerosis risk factors. In control group we saw small shunt but in stroke group large shunt was more prevalence (P < 0.05). Our findings supported this idea that PFO is a predisposing factor for stroke and it had a higher prevalence among patients with cryptogenic stroke. Besides, large shunt was more concomitant with ischemic attack. Then we suggest any patient with undefined cause of stroke must be evaluated for PFO.

Progressive stroke (PS) and Crescendo Transient Ischemic Attacks (CTIA) is a generally accepted although unproven, indication for urgent intravenous anticoagulation therapy. Consecutive patients with PS and CTIA admitted in Ghaem hospital, Mashhad during 2007 - 2008 enrolled in a prospective clinical study. PS and CTIA patients underwent intravenous heparin therapy with 1000 units per hour without a bolus dose at least for 3 days. PS and CTIA patients who had a contraindication for intravenous heparin therapy, received 80 mg Aspirin per day. Early clinical course including improvement, stabilization, deterioration and development of residual stroke was evaluated in two therapeutic groups of PS and CTIA patients. 170 PS patients (103 males, 67 females) with mean age of 60.4 ± 12.3 years and 88 CTIA patients (50 males, 38 females) with mean age of 60.1 ± 6.8 years were assessed. 141 PS and 64 CTIA patients received short period intravenous heparinization. Distribution of subtypes of early clinical course between two therapeutic groups of PS and CTIA patients, was significantly different; X2 = 10.487, df = 2, P = 0.005 and X2 = 6.72, df = 2, P = 0.035 respectively. Distribution of residual stroke in two therapeutic groups of PS and CTIA patients, was not significantly different; X2 = 1.443, df = 1, P = 0.23, OR = 0.557 (0.212-1.462) and X2 = 1.01, df = 1, P = 0.315, OR = 0.617 (0.24-1.587) respectively. PS and CTIA patients who underwent short period intravenous heparin therapy have significantly more probability of improvement and less probability of deterioration in their early clinical course than PS and CTIA patients who received Aspirin therapy.

Abdominal obesity is a predictor for many cardio-metabolic disorders in different age groups. The use of available information on factors associated with abdominal obesity has been proposed as an effective way of identifying at-risk individuals. This study aimed to assess the effectiveness of a risk scoring system for abdominal obesity in a large and representative population of youths. Waist-to-height ratio (WHtR) is an effective surrogate measure of abdominal obesity in children. This analysis was performed to find out the normal cut off value for WHtR by calculating the risk score.To develop a risk score to identify high-risk individuals for abdominal obesity, we analyzed data from a national survey, entitled CASPIAN Study, that was conducted on a nationally - representative sample of Iranian students aged 6-18 years. The risk equation was determined by a multiple logistic regression analysis, and Receiver Operator Characteristics (ROC) analysis was used to determine the cut-off value for the risk equation. The independent risk factors associated with abdominal obesity were living in rural area, attending public school, positive family history of diabetes and obesity in first and second degree relatives, lower mother’s education level, number of household members; whereas physical activity decreased this risk. The area under curve (AUC) for the ROC was 63% (95% CI: 0.612, 0.643).A CASPIAN study population value ≥ 39 had optimum sensitivity (64%) and specificity (54%) for determining abdominal obesity score. This method can be helpful in screening and prevention of abdominal obesity by identifying those at-risk individuals in a timely manner.

Dietary polyphenols have been shown to possess cardio protective effects. Recently, dietary citrus flavonoids have been associated with reduced risk of coronary heart disease in epidemiological studies. So, this study was designed to determine the effects of Citrus limon Burm. f. juice and peel on cardiovascular risk factors in male rabbits with atherogenic diet. Forty rabbits were randomly divided into four groups and treated 2 months as follows: 1: Hypercholesterolemic diet (HCD), 2 and 3: HCD + lemon juice (5cc daily) and lemon dried peel (1g daily), respectively and 4: normal diet. At the baseline and the end of the study in addition to weight, biochemical factors (FBS, TC, TG, ApoA1, ApoB100, LDL, HDL) were measured in the rabbits. Blood pressure measurements were conducted directly after the intervention. Compared with 4th group total cholesterol was significantly increased during the study in 3 first groups (p = 0.00). Results for HDL and LDL cholesterol were the same (p = 0.00). But compared with control group (first group), only LDL cholesterol mean value was significantly increased in group 2 (lemon juice consumer) after intervention (p<0.05). And for apolipoproteins, only ApoB100 was significantly increased in group 3 (lemon peel consumer) in comparison with control group after the intervention (p < 0.05). Weight and FBS have not been significantly changed between the groups after interventions. Also, blood pressures did not show any significant difference between the groups. We conclude that opposite to high amount of antioxidants in sore lemon, it not only was able to control the hyperlipidemic effects of an atherogenic diet but also increased serum LDL level and Apo B. But decision about antiatherogenic effect of this fruit, will be made after defining pathologic results.