Arya Atherosclerosis
Volume:1 Issue: 2, Summer 2005

During extrinsic coagulation pathway, a complex is developed between factor VII, calcium and tissue factor (a cell membrane lipoprotein that is exposed after cell injury). Factor VII needs calcium and vitamin K for its biologic activation. Coronary artery disease (CAD) can be induced by increased level and activity of the coagulation factors VII, VIII and IX. In postmenopausal women, estrogen decreases blood lipids and thereby decreases risk of CAD. However, the exact effects of the estrogen on the other predisposing factors of CAD are unknown. This study was conducted to evaluate the effects of oral hormone therapy regimen on fibrinogen and other coagulation factors. Sixty menopausal women with history of hysterectomy were randomly allocated in 2 groups. One group was treated with conjugated estrogen 0.625 mg/day and the other group was treated with conjugated estrogen 0.625 mg/day and medroxyprogesterone 2.5 mg/day. Serum fibrinogen level and activity of coagulation factors VII, VIII and IX and blood lipids level were checked before and 3 months after treatment. In the group treated with estrogen alone, mean factor VII activity showed significant increase 3 months after treatment as compared to before hormone therapy (P<0.05). There were no significant changes in mean activities of coagulation factors VIII, IX and serum fibrinogen level in patients treated with estrogen or estrogen/medroxyprogesterone after treatment (P>0.05). In both groups, hormone therapy significantly decreased serum cholesterol level and LDL-C and increased HDL-C (P>0.00), but serum triglyceride level increased in the group only treated with estrogen. Significant increase of coagulation factor VII and serum triglyceride in estrogen-treated patients is logical. This study confirms that hormone therapy with this protocol does not change mean serum fibrinogen levels and activity of coagulation factor VIII and IX. This may be a genuine finding or may be due to inadequacy of samples, given the wide normal range of coagulation factors and serum fibrinogen. Studies with more prolonged follow-up or more samples are warranted.

Addiction to opioids is a major health challenge in the world today. A few studies have addressed the effects of these substances and the wrong beliefs surrounding their use. This study was designed to compare plasma lipid peroxidation levels, blood lipids, fasting blood sugar (FBS), and glycosylated hemoglobin (HbA1C) in opium addicts and non-addict control subjects. This case-control study was conducted on a sample consisting of 64 men. The control group comprised 32 cigarette smokers who were studied by urine morphine strip test. The case group included 32 opium addicts with a history of vaporing addiction 1 g/daily for at least 3 years. Data were analyzed by T-test using SPSS and EP16 statistical software. This study showed no significant difference in FBS, HBA1C, triglyceride, total ch bloodsu olesterol, HDL-C, LDL-C, and lipid peroxidation between case and control groups. The results of this study show that opium addiction has no effects on gar or other CVD risk factors and increases the level of malondialdehyde, an important CVD risk factor.

Diabetes mellitus is the most common metabolic and endocrine disease. Depressed Heart Rate Variability (HRV) is an early warning sign of diabetic neuropathy. In numerous studies, spironolactone improved HRV and decreased mortality in Congestive Heart Failure (CHF). This study was performed to assess the effect of spironolactone on HRV in diabetic patients. This prospective, randomized, double-blind clinical trial was performed on 62 diabetic patients with autonomic neuropathy at Isfahan Cardiovascular Research Center. Baseline HRV was measured with time domain and frequency domain methods using a Valiance system manufactured by US Biomedical Systems Inc. (2000). The patients were then randomly placed in case and control groups. The control group was given placebo and the case group was given 25mg spironolactone twice daily for two months. HRV was measured at the end of this period and data were analyzed using SPSS. HRV before and after medication was compared with t-test, paired t-test, Wilcoxon test, and Mann-Whitney test. Twenty-nine patients in the control group and thirty-three patients in the case group were assessed. HRV was measured before and after the study. T-test and Mann-Whitney test revealed no significant difference between HRV in the two groups. Paired t-test and Wilcoxon test did not show any significant difference of HRV within the two groups. In this study, spironolactone did not improve HRV in diabetic patients.

Chest pain in unstable angina is associated with EKG changes in T-wave and ST-segment, which may help diagnose the disease. Based on certain references EKG changes prolonged for more than 12 hours may be suggestive of non-Q myocardial infarction. This study was conducted to assess the mean duration of EKG changes in patients with unstable angina. This cross-sectional study was conducted on 34 patients in 2001. The subjects were randomly selected among patients hospitalized in the critical care unit of Isfahan Nour Hospital. New ST-segment T-wave changes and ruling out of acute myocardial infarction by enzymatic tests (Total CPK, CPK-MB, LDH) constituted criteria of inclusion in the study. Subjects with Wolf-Parkinson-White syndrome (WFW), salivary diseases, those taking anti-arrhythmic, anti-angina, or digital medications, patients with left bundle branch block, and those who had recently undergone surgery (all of which may cause T-wave and ST-segment changes) were excluded from the study. The patients were followed up for three months after discharges. EKG changes persisted for 28.65±7 days. Changes of ST-segment and T-wave lasted for 14.7±24 and 30.1±38 days, respectively. The minimum and maximum durations of EKG changes in patients were 1 day and 90 days, respectively. Eight patients underwent angiography; seven displayed abnormal findings. Statistical analysis did not show a significant relationship between the duration of EKG changes and severity of coronary involvement or incidence of future complications. EKG changes in patients with unstable angina who have recently developed these changes may persist for an average duration of one month and may complicate diagnosis. Hence greater importance should be attached to clinical symptoms and further laboratory diagnostic methods should be used.

Ischemic Heart Diseases (IHD) is the major cause of mortality and morbidity worldwide. Diabetes Mellitus (DM) is known as one of the main risk factors of IHD. Silent ischemia is seen in diabetic patients more that in others. Identification of these cases is of great value in clinical practice. In this study, ECG changes and their relationship with clinical symptoms of ischemia were evaluated in diabetes type II patients. In a cross-sectional study at Isfahan Endocrinology and Metabolism Research Center on diabetes type II patients (2004), 500 consecutive records out of nearly 5000 active records were selected via a simple sampling method. 12-lead resting ECG was taken from all patients. Minnesota codes were used to study ECG changes. Patients with electrocardiograms suggestive of ischemia or MI but no chest pain were considered as having silent ischemia. A total of 500 subjects (44.4% men and 55.6% women) were studied. EKG changes favoring MI, probable MI, and ischemia were seen in 2%, 12.4%, and 13.6% of patients. Silent ischemia had a prevalence of 85.6%. Of this number, 6.3% had suffered definitive MI based on EKG changes. Silent ischemia is very common in diabetic patients. Alertness to silent ischemia, especially in the elderly can greatly contribute to early detection of CVD and adoption of timely therapeutic measures in these patients. However, as this study was merely based on resting-state EKG changes, the findings may be questionable. Hence, further studies using more accurate ischemia detection methods are warranted.

Hypertension is a major cause of cardiovascular disease and the prevalence of hypertension shows a linear increase with aging so that it increases by 10 percent every 10 years. This study was conducted to investigate the causes of uncontrolled blood pressure in people aged over 65 years. This descriptive case-control study was conducted at Isfahan Amin Hospital in 2003 on two-hundred over-65 subjects diagnosed with hypertension through a routine travel check-up for Mecca pilgrimage. After medical examinations and blood pressure measurement according to WHO standards, the subjects were divided into a case group (controlled blood pressure) and a control group (uncontrolled blood pressure), respectively. A questionnaire was filled in for each subject and the data were analyzed with χ2 and t-student test. The case and control groups had mean ages of 70.7±5.2 and 69.5±4.9 years, respectively. In the case group, less than half of the subjects were taking their antihypertensive medications regularly and 12.5% engaged in self-therapy. Fifty-five percent of subjects in the case group expressed a lack of motivation as the reason for discontinuing therapy. Their knowledge and practice were also found to be significantly lower than the control group (P<0.05). In comparison with other studies, it was observed that the most common causes of uncontrolled blood pressure are poor knowledge, inappropriate practice in avoiding risk factors, and the discontinuation of pharmaceutical antihypertensive therapy.

The use of illicit drugs is increasingly prevalent among young people in many countries. The adverse consequences of drug use by youth includes dependence, overdose, accidents, physical and psychological damage, and premature death. This cross-sectional was conducted on men at least 15 years old in Isfahan. Data were collected using two questionnaires filled out in a prison and in a city square in summer, 2003. The samples numbered 6400 and the variables included age, level of education, job, the prevalence of smoking, the prevalence of cigarette smoking in addicts, the prevalence of illicit drug use in cigarette smokers, age of beginning to smoke, and type of used substance. Data showed the prevalence of illicit drug use to be 5±0.4% in men over 15 years living in Isfahan. The prevalence of opiates use relative to cigarette smoking was 22 %, and the prevalence of cigarette smoking relative to opiates use was 94.5%. Opium and heroin were found to be the most commonly used opioids. The onset age of smoking and addiction was also found to have decreased. These findings must be kept in mind when planning preventive and therapeutic programs.

Lifestyle habits are established from early childhood and persist formany years, almost until the end of life. Thus, healthy lifestyle education should begin in childhood. This study was conducted to train primary and middle school students abouthealthy lifestyle via school campaigns and evaluate the results. One-hundred primary and middle school students were selected. Topics on healthy lifestyle were included in their New Year homework book (Peyk-e-Noroozi). Their knowledge about healthy lifestyle was evaluated via questionnaires. Data were analyzed with SPSS and Student''s t-test (P<0.05). The most significant learning of students from Peyk-e-Noroozi in both primary and middle school was the importance of physical activity and exercise (32% in primary school students and 37% in middle school students, P<0.05). Learning about healthy lifestyle from Peyk-e-Noroozi was significantly higher in primary school students than in middle school students (82% vs. 57%, P=0.04). Our study suggests that healthy lifestyle education via school campaigns and media may have considerable effect on primary and middle school students. Such simple and feasible modes of educations should be integrated with the existing educational curricula.