Arya Atherosclerosis
Volume:3 Issue: 3, Autumn 2007

Opioid peptides and exogenous opioids such as morphine have important effects on the cardiovascular system. Today, the opioid system is being considered as a therapeutic target receptor for reducing myocardial ischemia through inhibiting the G protein. Opioid addiction, on the other hand, is one of the major challenges facing humanity and the truth aboutthe effects of opium use on the cardiovascular system is often misted by wrong beliefs. The effect of an exogenous opioid (morphine) on the development and progression of fatty streaks in hypercholesterolemic rabbits was investigated in this study. The rabbits were randomly divided into four groups (five in each group): normal, normal + morphine, high-cholesterol, and high-cholesterol + morphine. Biochemical parameters including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), malondialdehyde, triglyceride (TG), fasting blood sugar (FBS), quantitative chronic reactive protein (CRP), coagulation factor VII, fibrinogen, platelet count, RBC count, WBC count and hemoglobin were measured at the start and end of the study. Pathological studies were conducted on the right and left coronary arteries of the animals to look for evidence of fatty streak formation. The results showed that morphine administration along with a normal diet led to a significant increase in levels of cholesterol, coagulation factor VII, and fibrinogen, while enhancing fatty streak formation in the right and left coronary arteries (P<0.05); it also significantly increased levels of coagulation factor VII, platelets, and weight of rabbits (P<0.05). However, it had no effect on fatty streak formation in the right and left coronary arteries. This study demonstrates that morphine use with both normal and hypercholesterolemic diet increases the risk factors of cardiovascular diseases and atherosclerosis, although it accelerates the development of early atherosclerotic lesions only when administered with normal diet.

It has been demonstrated in recent studies that abnormal levels of adipocytokines may contribute to insulin resistance and type 2 diabetes. The aim of the present study was to compare serum leptin and adiponectin levels in controlled and non-controlled typ 2 diabetes. 117 patients with controlled and non-controlled type 2 diabetes were studied. Patient, were divided into two groups based on their serum HbA1c level; there were 62 patients in the controlled group (6 %< HbA1c≤ 8%) and 55 patients in uncontrolled group (HbA1c>8%). Parameters like age, sex, duration of diabetes and biochemical indicators such as fasting blood sugar, HbA1c, insulin resistance, leptin and adiponectin were determined. Higher leptin and lower adiponectin levels were observed in non-controlled type 2 diabetes. The levels of fasting blood sugar and insulin resistance were significantly higher in the non-controlled group (P<0.05). Leptin and adiponectin may play an important role in the regulation of insulin sensitivity and control of type 2 diabetes.

Dyslipidemia and oxidative stress are thought to be important mechanisms in pathogenesis of disease in hemodialysis patients. This study was designed to investigate the efficacy of oral vitamin E supplementation on lipid profile and oxidative stress in hemodialysis patients. The study group consisted of 26 uremic patients (10 women and 16 men), 16-68 years of age undergoing maintenance hemodialysis three times a week (12 hours/week), lasting a range of 6-108 months, at Vali-e-Asre Hospital in Birjand (Iran). Total Antioxidant Capacity (TAC), lipid peroxidation, cholesterol, triglyceride, high-density lipoprotein and low-density lipoprotein levels were determined before and after oral vitamin E supplementation, 400 mg/d for 90 days. Vitamin E supplementation caused a significant decrease in ThioBarbituric Acid Reactive Substances (TBARS) level as a marker for lipid peroxidation (2.97±0.52 vs. 2.55±0.44, P<0.001) and a significant increase in plasma TAC (1252±348 vs. 1398±372, P<0.01). Although there was a decrease in the level of lipid profile, there were no statistically significant differencesin the means of cholesterol, triglyceride, high-density lipoprotein and low-density lipoprotein before and after vitamin E supplementation among patients. Our results indicated that oral vitamin E supplementation might be able to modify oxidative stress by an increase in TAC, and a decrease in lipid peroxidation; that could be considered as a preventive strategy in hemodialysis patients

Transesophageal echocardiography (TEE) is superior to Transthoracic echocardiography (TTE) in detection of atrial septal defects and aneurysm, aortic atheroma, left atrial thrombus and mitral valve abnormalities. TEE is indicated in young adults with cryptogenic ischemic stroke who are suspected of having cardioembolic mechanism despite non-diagnostic TTE. A prospective clinical study was conducted in patients with ischemic stroke or TIA who had TTE done in Ghaem hospital, Mashhad during 2006-2007. Ischemic cerebrovascular events were detected by stroke neurologist. TEE was performed with VIPI3/GE device, USA and a 7 MHz transesophageal probe by an echocardiologist. Patients who did not have TTE before TEE were excluded. Comparison of TEE to TTE results was performed by the echocardiologist and stroke neurologist in each patient. Influence of TEE on therapeutic decisions in each patien was evaluated. Forty-seven patients (20 females, 27 males) with a mean age of 42.6±7.3 years were studied. Cardiac and aortic abnormalities were detected in TEE of 35 cases (35/47; 74%) with ischemic cerebrovascular events. Cardiac abnormalities of 17 cases (36%) were only detectable by TEE. These seventeen cases included 7 patients with PFO, 1 case with ASD, 6 cases with aortic atheroma and 2 patients with clot in the left atrium. Comparing the preventive stroke strategies before and after TEE revealed that it was changed only in two cases (2/47; 4.3%) due to performing TEE. These included one patient with a small high-risk PFO and another case with dehicense of mechanical mitral valve. TEE revealed cardiac or aortic abnormalities in one-third of the patients with cerebral ischemia and has not been detected by TEE previously. The influence of TEE in therapeutic decisions of patients with ischemic cerebrovascular events is very low.

No unique technique has proved efficient enough in controlling post cardiothoracic surgery pain. A variety of agents and techniques have been used to control pain following cardiothoracic surgery; interpleural regional analgesia is one such technique. There are many nerve endings in the pleural cavity. The local anesthetic action of meperidine administered interpleurally was evaluated in this study. In a double blind clinical trial, 90 patients undergoing coronary artery bypass graft surgery were randomized into four groups as intravenous meperidine (G1), interpleural meperidine (G2), interpleural meperidine and bupivacaine (G3) and interpleural bupivacaine (G4) groups. At the end of surgery, interpleural catheter was placed in all groups and the medication was prescribed. In the cardiac intensive care unit, narcotic requirements and pain scores were registered. Collected data were analyzed by appropriate tests including t-test and chi-square test. P values below 0.05 were considered as significant. There were no significant differences in age, weight, sex and ASA (American Society of Anesthesiologists) class between the four groups. At all time periods, the pain levels measured by the visual analogue score (VAS) were significantly lower in the G3 and G4 groups (P<0.05).The total narcotic requirements in the first 24 hours of postoperative period were significantly lower in the G3 and G4 groups (P<0.05). In spite of analgesic effects of subarachnoid meperidine, intraarticular morphine and interpleural bupivacaine, interpleural meperidine does not change pain scores or narcotic requirements postoperatively.

Depression seems to be an independent risk factor for cardiovascular disease (CVD). Little is known about the effects of treatment of depression on CAD risk factors. The objective of this study was to determine whether cardiac risk is altered following 8 weeks of treatment of depression with fluoxetine. A secondary aim was to examine whether an omega-3 fatty acid eicosapentaenoic acid (EPA) plus fluoxetine affected the change in CAD risk compared with fluoxetine alone. Forty patients with a diagnosis of major depression were randomly allocated to receive daily 20 mg fluoxetine plus either 1 g EPA or its placebo for 8 weeks. The 24-item Hamilton Rating Scale for Depression (a validated scoring system usually used in studies of antidepressant medication) was utilized to evaluate clinical symptoms of patients. Cardiac risk was estimated using fasting plasma or serum levels of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol LDL-C, cortisol and C-reactive protein (CRP) at baseline and at week 8. Depression severity was decreased significantly in both groups. CRP and cortisoldecreased significantly after treatment. EPA plus fluoxetine did not affect the change in CRP and cortisol compared to fluoxetine alone. Total cholesterol did not change significantly after 8 weeks of treatment. LDL-C/HDL-C ratio increased after treatment without difference between treatment groups.