Arya Atherosclerosis
Volume:19 Issue: 1, Jan 2023

Gender impacts pre-, intra-, and postoperative parameters and outcomes following coronary artery bypass graft (CABG) with conflicting results. This study aimed to identify differences in preoperative, intraoperative, and postoperative parameters. It also seeks to compare the postoperative complications and mortality between two genders who had CABG surgery.  This prospective observational study included patients who had isolated CABG and were divided based on gender. Demographic information, underlying comorbidities, drug history, clinical and laboratory data at the time of referral, operative characteristics, postoperative variables, and mortality outcomes were tracked during hospitalization and six months after discharge.  Three hundred twenty patients were enrolled in the study during its duration. 71% were male. Women were older (62.40±9.03 vs. 59.99±9.81 years, p= 0.011) and had more dyslipidemia (p=0.003), hypertension (p=0.000), and diabetes (p=0.001), whereas men admitted with more myocardial infarction (MI) (p=0.011) and had lower Ejection fraction (EF) (p=0.001). They also had lower EF post-surgery and six months after discharge (p <0.001, 0.006). However, the number of vessels involved was not different between genders (p=0.589), but the number of grafts was higher in men (p=0.008).There was no statistically significant difference in overall mortality rates between the two groups (4.42% and 6.38% in men and women, respectively, p= 0.464). The women had more underlying comorbidities than men. Furthermore, there were some differences in the intra-operative parameters and postoperative complications between the two genders, but there was no difference in postoperative mortality in our setting.

The purpose of this study was to identify the angiotensin-converting enzyme (ACE) gene (I/D) variations in CAD patients and healthy controls in an Iranian population (West Azerbaijan province of Iran). This cross-sectional study included 95 CAD patients and 203 healthy controls. ACE I/D polymorphisms were assessed using PCR, and their frequency was determined.  There were 298 people, 95 CAD patients, and 203 controls, with an average age of 50.96±3.45 and 51.14±10.20. We discovered that the frequency of the D allele was significantly higher in CAD patients than in controls (P = 0.0009). In contrast, the frequency of the I allele was significantly higher in controls than in CAD patients (P = 0.0009). The D allele carriers genotypes (DD + ID) were more frequent in the CAD patients than in the control group (P = 0.008). The ACE II genotype-state carriers were more common in the control group than in CAD patients (P = 0.0084). However, in the case of the ACE ID genotype, no significant differences were not found in the tested groups (P = 0.47). These findings suggest that individuals with the ACE DD genotype are predisposed to CAD, whereas individuals with the ACE II genotype state are protected.

One of the most severe problems that patients with Hypertension (HPN) face are lack of medication adherence, which is influenced by psychological factors. Thus, the current survey sought to compare medication beliefs, cognitive defusion and valued living in hypertensive patients with varying medication adherence. A cross-sectional study with 162 HPN patients from three clinics at Isfahan University of Medical Sciences was conducted in 2019. Participants completed the BMQ (Beliefs about Medicines Questionnaire), MMAS (Morisky Medication Adherence Scale), CFQ (Cognitive Fusion Questionnaire), and VLQ (Valued Living Questionnaire). The data were analyzed using descriptive statistics, chi-square, and analysis of variance (ANOVA).  Only 22.2% of patients scored high in medication adherence (MA). MA levels increased with age in a significant correlation (p=0.03). ANOVA results revealed that the three MA levels (low, medium, and high) had substantial differences in both VLQ subscales (importance of person-valued living and allotted time for values; p=0.002 and p=0.023). However, no significant differences in MA levels were found in the CFQ (cognitive defusion and cognitive fusion) and BMQ subscales (specific necessity, specific concern, general overuse, and general harm). This study discovered that a higher MA is associated with increasing age. In addition, patients with HPN who value living and devote more time to their values have higher MA.

The accumulation of oxidized LDL (ox-LDL) in macrophages in association with platelet activity leads to the formation of foam cells, which play a key role in the pathophysiology of atherosclerosis and coronary artery diseases (CAD). Here, in this study, we aimed to investigate the simultaneous effect of ox-LDL and platelets on foam cell formation, as well as modification in cell markers. 

First, the U937, a human monocytic cell line,  was cultured in RPMI-1640. Then, isolated platelets were co-cultured with the U937 and exposed to ox-LDL (80 µg/ml) to evaluate the impact of ox-LDL on foam cell formation using Oil red O (ORO) staining. Also, the expression of foam cells’ surface markers and CD36, ABCA1, SR-B1, ACAT1, and LXRα genes, which are involved in macrophage metabolism and ox-LDL uptake, was measured by flow cytometry and real-time PCR, respectively. 

Our findings suggest that platelets promoted foam cell formation (ORO-positive cells), accompanied by a higher level of CD163+ M2 macrophages. Furthermore, the expression of CD36, ABCA1, SR-B1, ACAT1, and LXRα genes, which are implicated in cholesterol accumulation in macrophages, was significantly upregulated in the ox-LDL+ platelets group compared to the control (P < 0.05). Moreover, the up-regulation of CD36, ABCA1, and SR-B1 genes in the ox-LDL+ platelets group was more accentuated compared to the ox-LDL group (P < 0.05).

Owing to the positive effector role of platelets in the formation of foam cells and CD163+ cells, it could be assumed that platelets play a dual role in the development of these cells.

The reliability and validity of echocardiography are critical issues. Day and age, defining normal cases necessitates expressing natural physiological differences, including ethnicity.  We are persuaded to evaluate average values in mitral and tricuspid valves in the Iranian population because only a few studies have been conducted to obtain average measures in echocardiography. This six-month study was conducted in a tertiary center’s echocardiography lab. This study included 87 healthy Iranian volunteers who had no health issues. The tricuspid and mitral valves were examined using three and two-dimensional echocardiography. The investigated indicators produced normal data. The cases were divided into six age groups with a 12-year age gap.  The participants ranged in age from 18 to 90, with 35 males (40/2 %) and 52 females (59/8%). By comparing tricuspid and mitral valve indices, this study found a difference between men and women (P-value<0.05). Furthermore, a difference in MV3D1, MV2CH1, MVPLAX1, MV3D2, MV4CH1, MV2CH1, MV ALAX2, MV2CH2, MV TENTING AREA, MV AREA indices at the mitral valve, and SAX2 TV4CH1, TV4CH2, TVSAX1, TVRVIF2 indices at the tricuspid valve was observed in various age groups (P-value<0.05). Our findings confirmed that gender and age impacted echocardiographic parameters, with a trend of decreasing measurements after 65 years of age and the most significant dimensions obtained after 42 years of age.

Autonomic nervous system dysfunction in diabetic patients can result in an atypical presentation of cardiovascular disease that can be missed. We aimed to use single-photon emission computed tomography (SPECT) to assess cardiovascular disease (CAD) in diabetic patients with atypical pain to determine whether the pain above reflects the CAD. 

Diabetic patients with atypical cardiac symptoms were referred to the SPECT department. Demographic data such as age, gender, diabetes status, and other underlying diseases were gathered. A myocardial perfusion scan was then performed. The results were recorded to evaluate the risk of myocardial ischemia and the degree of coronary artery involvement in a non-invasive manner. 

The study included 222 (177 female) subjects with mean ages of 63.01±11.62 and 59.41±9.19 in positive and negative SPECT, respectively. The most common symptoms were atypical chest pain (51.8%), followed by shortness of breath (50.5%), nausea, and syncope (0.9%). Cardiac parameters, such as the summed stress score (SSS), summed rest score (SRS), total perfusion deficit in stress (TPD-s), total perfusion deficit in rest (TPD-r), were significantly higher in the group with coronary artery involvement (P<0.001). However, ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volumes (ESV) parameters were not (P=.0.328, 0.351, and 0.443, respectively).

The mere presence of diabetes does not necessitate any additional diagnostic tests beyond those required for the general population, and it is possible to follow a diagnostic course similar to that of the general population.

The occurrence of obstructive sleep apnea (OSA) and its health-related issues, especially cardiovascular diseases (CVD), are increasing in developing countries. With a 3-year follow-up study, the present study aimed to determine the incidence of cardiovascular events in patients with OSA in an Iranian population.

In this prospective cohort study, 415 adults (300 patients with OSA and 115 patients without OSA) with a history of snoring and/or witnessed apneas or other suspected sleep breathing disorders were consecutively enrolled and followed up for three successive years to evaluate the development of cardiovascular events including acute coronary syndrome, cerebrovascular accidents (including ischemic or hemorrhagic strokes or transient ischemic attacks), death due to cardiac causes and all-cause mortality. 

415 patients were studied with a mean age of 56.2 ±15.7 years, 211 (50.8) of whom were male. Cardiovascular events developed in 15 participants (5%) of the OSA group, and 3 participants (2.6 %) of the OSA negative group. No significant differences were observed between the two groups in terms of the incidence of any of these events (P-value> 0.05). Using multiple logistic regression model (with P-value <0.2 as the significance level), age, OSA, and history of CVD remained as significant predictors for the development of cardiac composite events (incidence of CVD, CVA, death due to cardiac causes, and all-cause mortality) with the odds ratios of (95% confidence interval) 1.03 (1.01, 1.06), 2.41 (1.02, 5.76), and 7.40 (2.91, 18.67), respectively.

The present study showed that OSA is associated with a more than twofold increased risk of cardiovascular events. Thus, obstructive sleep apnea should be considered an independent cardiovascular risk factor.

Ehlers-Danlos syndrome (EDS) is a hereditary collagen vascular disorder characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Vascular EDS (vEDS) is a subtype of EDS which is characterized by vascular fragility.

This is a case report of a young man with vEDS hospitalized for myocardial infarction. He was presented with a coronary dissection and developed aortic dissection, coronary rupture, and cardiac tamponade until death. 

This case report highlights how patients with vEDS and acute coronary syndrome show a higher risk of vascular complications compared with other patients, and their admission to the institution with a cardiac surgery room could be helpful and safe for better management of the complications. Non-invasive methods could be useful to exclude other vascular diseases, before the emergency coronary intervention.