Arya Atherosclerosis
Volume:6 Issue: 2, Summer 2010

In view of the growing trend of obesity around the world, including in our country, and the effect of reduced physical activity in increasing the incidence of obesity and overweight in children and adolescents and limitations of families in providing transport for their children to attend exercise classes, as well as time limitations of students in taking part in these classes, accessing appropriate methods for presenting physical activity training seems essential. This non-pharmacological clinical trial was performed during six months from May to November 2007 on 105 children and adolescents aged 6-18 years with obesity, randomly assigned to 3 groups of thirty-five. Nutrition and treatment behavior were the same in all groups, but physical activity training in the first group was taking part in physical activity training classes twice a week, in the second group by providing a training CD, and in the third group via face-to-face training. Before and after the intervention, anthropometric indicators were measured and recorded. Mean Body Mass Index (BMI) of participants in physical activity training classes, and the group undergoing training with CD, after the interventions was significantly lower than before the intervention. Our findings demonstrated that training using CDs can also be as effective in reducing BMI in overweight and obese children and adolescents as face-to-face education and participation in physical training classes. Extending such interventions can be effective at the community level.

Leptin and adiponectin are two adipose tissue hormones, whose association with the incidence of cardiovascular diseases is under evaluation. The aim of this study is to determine the relationship between leptin and adiponectin, and coronary artery diseases. 170 patients with angina and indications of coronary angiography underwent angiography. Moreover, serum level of blood lipids, leptin, and adiponectin were measured. The gathered data was evaluated using SPSS software, V. 15, by multivariate variance analysis. Analysis of the data demonstrated that 45.1% of the patients had positive angiographic findings. The serum levels of leptin and adiponectin were significantly lower than the minimum level specified by the kit. However, the two groups, i.e., patients with positive angiographic findings and those with negative findings were not significantly different according to the serum levels of the hormones. Moreover, no significant correlation between the serum levels of the hormones and serum lipids was observed. Various studies have demonstrated that high serum level of leptin and the incidence of coronary artery diseases are correlated. On the other hand, they have reported adiponectin to have cardioprotective role. Confirmation of these findings requires more detailed studies.

Recent studies have confirmed inflammatory factors and metabolic syndrome (MetS) as important cardiovascular disease (CVD) risk factors. Recently measurement of carotid intima-media thickness (IMT), has been used for evaluation of early atherosclerosis. This study was designed to assess the correlation between IMTwith some inflammatory biomarkers, ghrelin and adiponectin in people with and without MetS in a cohort sample in Isfahan province. among participants of Isfahan Cohort Study (ICS) by random sampling, 88 participants were divided into case(with MetS) and control (without MetS) groups. A questionnaire including demographic data and CVD risk factors was completed for all of the participants. Physical examination and blood pressure, height, weight and waist circumference measurements were done for all subjects.Vascular echocardiography was done for evaluation of IMT of each carotid artery of both sides.Interlukin-6(IL-6), Interlukin -10(IL-10), highly sensitive C-reactive protein (hs-CRP), ghrelin and adiponectin levels were measured using ELIZA method.Data were entered in SPSS version15 and analyzed by T– Test, Chi square, pearson correlation and linear regression analyze. The mean of waist circumference, BMI, systolic blood pressure, diastolic blood pressure, hs –CRP and IMT of left carotid artery. was significantly higher in participants with Mets. There was significant correlation between left carotid IMT and IL-6 level in all patients (P=0.03). After adjustment for age and sex, significant relationship in groups with MetS was only reported between left IMT and IL-6(P=0.02). There was no relation between IMT and other inflammatory markers in subjects with and without MetS. Significant correlation between IL-6 and IMT was reported in patients with MetS. While no significant correlation between IL-10, adiponectin and ghrelin with IMT was obserred in metabolic syndrome group.

Glucose-insulin-potassium (GIK) may improve cardiovascular performance after coronary artery bypass graft surgery(CABG). Our study investigated whether an infusion of glucose, insulin and potassium (GIK) during elective coronary artery bypass surgery in diabetic type II patients improved left ventricular performance.Methods. We measured left ventricular ejection fraction and troponin (Tn), a myofibrillar structural protein. In this clinical trial study, after ethics committee approval, 50 Patients with type 2 DM were enrolled into a randomized simple sampling, prospective, double-blinded study.(In the case group,500cc Dextrose water 5%+80 IU regular insulin and40 Meq KCL was infused at the rate of 30 cc/hr). (Patients in control group were put 5% dextrose solution at the rate of 30cc/hr). Venous blood sample were taken before induction of anesthesia, after removal of the aortic clamp and before discharging from hospital. The Mann–Whitney-test was used to test for differences in Tn concentration between groups at each time point. Fisher’s exact test was used to determine whether there was a significant difference in the proportion of patients with a low ejection fraction (<45%) in the case group compared with the control group. Changes in potassium and glucose concentrations over time within groups were examined by ANOVA and paired t-tests. P<0.05 was regarded as significant for all tests.Results.In the study 50 patients with type 2 DM were evaluated in case and control groups. The mean age ±S.D in the case group was 57.7 ±9.9 years and the other group was 61.2 ±8.4 years. The groups were well matched for age, sex and number of bypass grafts. Randomization did not give an equal distribution of male and female patients. There wasn’t any significant difference between ejection fraction in case and control groups before and after CABG (P>0.05). Tn concentration in the case group were 3.3 ±5.0 and mean of Tn concentration in the control group were 3.9 ±5.1.There was not a significant difference in Tn between the two groups before and after CABG (P>0.05). There was not a significant difference in hospitalization time between the two groupsConclusion. The results suggest that GIK does not improved left ventricular performance in routine coronaryartery bypass surgery.

In most studies, the agreeable risk scores for ST-elevation myocardial infarction (STEMI) consist of thrombolytic in myocardial infarction (TIMI) risk score and modified Gensini risk score. Researchers showed significant relations between TIMI with angiography scores in patients with UA/NSTEMI. We studied this relation in patients with STEMI. We studied CCU patients with STEMI hospitalized in several hospitals of Isfahan, Iran from September 2007 to June 2008. Sampling method of 240 patients was random and simple. Exclusion criteria were incomplete history, nonspecific electrocardiogram changes, left bundle branch block and not accomplished angiography or accomplished angiography after 2 months of STEMI. Questionnaire indices collected on the basis of TIMI (0-14 points). Echocardiography and angiography were done and then, we used Gensini (0-400 points) to review films of angiography. Spearman`s rank test and Pearson correlation coefficient were used to study the relation between these scores. One hundred and sixty one patients were male and their average age was 60.02 years. Averages of TIMI and Gensini scores were 6.30 ± 2.5 and 120.77 ± 50.4, respectively. Study showed significant relation between TIMI, age and LVEF (P <0.001, r=-0.46). Also, between Gensini and age, gender and LVEF significant relation was found (P <0.001). But, a meaningful correlation didn’t exist between TIMI and the gender (P =0.08). Our study proved direct relation between TIMI risk scores and modified Gensini scores (P <0.001, r=0.55). We may decide quickly and correctly in emergency room to distinguish which patients with STEMI could derive a benefit from invasive strategies using TIMI score. Also, TIMI risk score can be a good predictor to determine the extension of coronary artery disease in patients with STEMI. As a result, we suggest determination of TIMI score for any patient entered emergency room. Also, this score should be recorded at the time patient’s discharge.

Iatrogenic Femoral Artery Pseudoaneurysm (FAP) forms when an arterial puncture site fails to seal(inability to apply hemostasis), allowing blood to jet into the surrounding tissues and form a pulsatile hematoma. These lesions lack a fibrous wall and are contained by a surrounding shell of hematoma and the overlying soft tissues. Pseudoaneurysms usually occurs in low puncture situations, because there is suitable mass of soft tissue to contain the bleeding, In contrast high puncture results in free hematoma due to lack of sufficient surrounding tissue. It can present as a new thrill or bruit, pulsatile hematoma, or marked pain or tenderness. Complications of Pseudoaneurysms include rupture, distal embolization, local pain, neuropathy and local skin ischemia.Unlike FAPs of a surgical or post-traumatic nature, catheterization-induced pseudoaneuriysm have usually a benign natural history (80% of cases resolve spontaneously).Several therapeutic strategies have been developed to treat this condition. They include ultrasound-guided compression repair (UGCR), compression repair by mechanical devices, surgical repair, and minimally invasive treatments (thrombin injection, coil embolization and insertion of a covered stents).

Cardiovascular diseases have become an increasing clinical issue worldwide. Acute ischaemic injury and chronic cardiomyopathies lead to permanent loss of cardiac tissue and ultimately heart failure. Current therapies widely aim to attenuate the pathological changes that occur after injury and to reduce risk factors of cardiovascular diseases, however; they do not improve the patient’s quality of life or the prognosis more than moderate.A new challenge in the treatment of the cardiovascular disease is cellular transplantation or cellular cardiomyoplasty. Different types of stem cells have been used for stem cell therapy.Clinical trials using primary bone-marrow-derived cells and skeletal myoblasts have also shown some encouraging results.An additional clinical and pre-clinical study to further enhance the beneficial effects of cell therapy is necessary. Recent studies have shown that there are various pools of putative resident stem cells in an adult heart, raising the hope that these cells can contribute to the treatment of cardiovascular diseases.

Lower extremity complications are the most common problems encountered during trans femoral diagnostic coronary artery angiography. Dissection, thrombosis and perforation of lower extremities arteries although not uncommon in it’s own, very rarely occurs simultaneously, and we did not find any report in the literature. In this report we describe a case of simultaneous occurrence of all these three complications during coronary angiography in one patient. It also represents some of our uncertainties regarding the best management of the patient. In this patient arterial perforation and dissection was managed conservatively, but we applied an invasive treatment (surgical thrombectomy) for arterial thrombosis with excellent short and long term result.