Arya Atherosclerosis
Volume:3 Issue: 1, Spring 2007

INTRODUCTIONThe aim of this study was to measure serum levels of interferon-gamma (IFN-γ) and interleukin-4 (IL-4), the two major cytokines secreted by Th-1 and Th-2 cells, in islet cell autoantibody (ICA)-positive, newly-diagnosed type I diabetic patients. METHODSThe study was conducted on 30 newly diagnosed, ICA-positive type I diabetics and 30 age- and sex-matched healthy controls. Cytokine levels in serum were quantified by indirect sandwich ELISA in pg/ml.RESULTSWe observed no significant difference in concentration of IL-4 in ICA-positive diabetics (median=126.535) compared with healthy controls (median=136.440) (P>0.05). IFN-γ levels were significantly higher in patients (median=11.305) compared with healthy controls (median=8.200) (P<0.05).CONCLUSIONSIncreased levels of IFN-γ in patients may be suggestive of its destructive role in the pathophysiology of type I autoimmune diabetes.

INTRODUCTIONDifferent studies have demonstrated that low levels of high-density lipoprotein (HDL) cholesterol in serum are significantly related to the progression of coronary artery disease (CAD) and its related mortality. This study was performed primarily to assess the effectiveness of supplementing treatment with statins with low-dose (100 mg, bid) fast-release nicotinic acid (the only form of this drug produced in Iran) in increasing HDL; we also aimed to evaluate the effect of this regimen on other lipoproteins, and to investigate any possible side effects.METHODSThis double-blind placebo-controlled randomized clinical trial was conducted on patients who were treated with simvastatin (20 mg/daily) for at least four weeks and did not receive any other lipid-lowering medications. The patients were divided into two groups of 50. The case group was treated with niacin tablets (100 mg, bid) and simvastatin (20 mg/daily). The control group was treated with placebo tablets (bid) and simvastatin (20 mg/daily). All patients underwent two 6-week crossover periods and a 2-week washout period. Liver-function biomarkers (ALK-P, SGPT, SGOT), serum lipids, uric acid, CPK and fasting blood sugar (FBS) were measured before and after each course of treatment. Data were analyzed with chi-square test and paired t-test.RESULTSSerum HDL increased from 42.44±8.5 to 44.01±8.39 mg/dl in the case group, with a mean increase of 2.56 mg/dl (P<0.05). HDL decreased from 41.5±9.1 to 40.9±9.4 mg/dl in the control group (P>0.05). Mean serum HDL was significantly different between the case and control groups (P<0.05). The increase in mean total cholesterol and low-density lipoprotein (LDL) cholesterol in the control group, and the decrease in triglyceride (TG) in both groups were not statistically significant (P>0.05). In follow-up, flushing was reported in 44.4% of case patients, resulting in discontinuation of treatment in 38.5% of patients. Flushing was reported in 5.6% of controls, resulting in discontinuation of treatment in 20% of patients. Muscle pain was reported in 24.4% of the case patients, resulting in discontinuation of treatment in 47.6% of the patients. Only 3.3% of the controls reported muscle pain, which led to discontinuation of treatment by the physician in 66.7% of the patients.CONCLUSIONSLow-dose fast-release niacin led to significant HDL increase; hence we recommend that treatment of dyslipidemic patients with statins be supplemented with low-dose niacin, which is available in Iran.

INTRODUCTIONA number of experimental studies have shown that dietary calcium may help improve hypercholesterolemia induced by high-cholesterol/high-fat diets through saponifying cholesterol/fat in the intestine. Evidence on the effects of calcium on lipid profile is scarce. We evaluated the effect of different levels of dietary calcium, in a cholesterol-free/low-fat diet on serum cholesterol, triglyceride, glucose and insulin, as well as fecal excretion of lipids.METHODSForty-eight male Sprague-Dawely rats were randomly divided to receive three levels of dietary calcium (0.2, 0.5 and 1.2 % W/W) for 10 weeks. Finally, the rats were decapitated and their truncal blood was sampled for biochemical analysis. Fecal fat excretion, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, glucose, and serum insulin were measured. Low-density lipoprotein (LDL) cholesterol was calculated using the Friedwald equation.RESULTSSerum cholesterol and LDL cholesterol of rats receiving a high-calcium diet were significantly lower than those of the other two groups (P<0.05), but serum triglycerides, HDL cholesterol, glucose and insulin and fecal fat excretion were not statistically different in the three groups (P>0.05).CONCLUSIONSOur findings suggest that, even with a low-fat low-cholesterol diet, calcium has hypocholesterolemic effects, i.e. there may be hypocholesterolemic mechanisms, other than intestinal saponification of cholesterol and/or fatty acids, including endogenous mechanisms for dietary calcium.

INTRODUCTIONAlthough coronary artery disease (CAD) becomes symptomatic late in life, early identification and modification of risk factors may reduce its future incidence. METHODSIn this cross-sectional study, 108 subjects aged 6-18 years were randomly selected from among children of patients who underwent coronary angiography at Chamran Heart Center, Isfahan, Iran. The parents were assigned to two groups according to the presence or not of coronary stenosis in angiography. Each group was divided into two subgroups, with or without the metabolic syndrome. All of the subjects were aged below 55 years. In addition to anthropometric measurements, blood pressure, fasting serum glucose, and insulin level were measured and lipid profile was assessed in the children of the patients. The data were analyzed with SPSS using independent t-test, Kruskal-Wallis, chi-square and standard linear multiple regression tests.RESULTSIn the group with stenosis in coronary angiography, the prevalence of the metabolic syndrome components was significantly higher in children of parents with metabolic syndrome than in the other group (24 vs. 18; P=0.003). In the group without stenosis in coronary angiography, the children of parents with metabolic syndrome had higher triglyceride (TG) levels and lower levels of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol, and fasting blood glucose.CONCLUSIONSOur study emphasizes the importance of primordial and primary prevention of cardiovascular disease, especially in children of families with high risk of premature atherosclerosis

INTRODUCTIONA positive family history of premature coronary artery disease can prompt the assessment of children of the family for coronary risk factors like hypertension, obesity and dyslipidemia. This study was performed to determine the relationship between lipoprotein (a), apolipoprotein A1 and B100 in patients with a positive history of premature myocardial infarction and their offspring.METHODSThis cross-sectional study was conducted on 91 parents and their offspring (91 children). The parents were randomly selected from among patients with premature myocardial infarction hospitalized in the critical care unit of Vali-e-Asr hospital (Birjand, Iran). Lipoprotein (a), apolipoprotein A1 and B100 were measured in both groups.RESULTSOur study showed a significant relationship between lipoprotein (a) levels in parents and their children. High lipoprotein (a) and high apolipoprotein B100 in parents and their children were also significantly related.CONCLUSIONSWe recommend that lipoprotein (a) and apolipoprotein B100 be measured in children with familial history of premature myocardial infarction

INTRODUCTIONIschemic stroke is rarely seen in childhood. The pediatric causes of stroke are very different from adult causes. METHODSThis population-based study was conducted to determine the incidence, clinical manifestations and etiology of pediatric ischemic stroke in Southern Khorasan, Iran, during 2002-2007. In this province, every child with possible diagnosis of stroke is referred to a stroke neurologist and routinely admitted to the Pediatric Division of Vali-e-Asr tertiary care hospital. The diagnosis of ischemic stroke was made based on the clinical presentation and brain imagery. All of the patients underwent a standard battery of diagnostic investigations.RESULTSSeventeen children with ischemic stroke (7 females, 10 males) were evaluated. The incidence of pediatric ischemic stroke in Khorasan province is 1.8 cases per 100,000 children population per year. Meningoencephalitis-induced vasculopathy constituted 23.5% of the etiology followed by Fallot tetralogy, head trauma, dehydration, migraine, and hypercoagulable state. 23.5% of our patients had uncertain causes of stroke. In-hospital mortality of our pediatric ischemic stroke patients was 11.7%. The incidence and clinical characteristics of pediatric brain infarction in Iran is the same as in other studies. Meningoencephalitis-induced vasculopathy is the most common determined etiology of pediatric ischemic stroke in Southern Khorasan.

Transient ischemic attacks (TIA) are warnings of future stroke. There is no difference in risk factors, pathophysiology and prevention between TIA and brain infarction. Consecutive patients with brain infarction admitted to Ghaem Hospital, Mashhad, Northeastern Iran, were enrolled in a prospective study during 2006. Diagnosis of ischemic stroke was established by a neurologist who also obtained history of TIA and vascular risk factors. All of the stroke patients underwent a standard battery of diagnostic investigations and etiology of ischemic stroke was determined by the Practical Iranian Criteria classification. Fisher’s exact test was used for statistical analysis. 348 stroke patients (186 women, 162 men) were studied. History of TIA was present in 42 patients (29 women, 13 men), i.e. 12% of the stroke patients. TIA was more common in women (df=1, P=0.02). The frequency of hypertension, diabetes and ipsilateral carotid stenosis was not significantly different between patients with history of TIA and other stroke patients (P=0.87, P=0.64 and P=0.61, respectively). Hyper-cholesterolemia and smoking were significantly more frequent in stroke patients with history of TIA (P=0.011 and P=0.014, respectively). The frequency of TIA was not significantly different among patients with lacunar, versus large vessel territory infarcts (df=1, P=0.84). There was no significant difference in the frequency of various stroke etiologies in patients with and without history of TIA (df=4, P=0.61). Stroke patients with history of TIA have vascular risk factors similar to other stroke patients. A positive history of TIA does not affirm any specific etiology of ischemic stroke

Embolism of the femoral artery by an echinococcus cyst is extremely rare and is due to rupture of an intracardiac hydatid cyst. We report the case of a 14-year-old boy who was admitted to our clinic with the diagnosis of arterial occlusion of the right lower extremity. Preoperative angiography revealed an ileofemoral embolic occlusion. During surgery, multiple hydatid cyst components causing femoral artery occlusion were found and excised. This case emphasizes that, in endemic countries, primary vascular echinococcosis should be considered in the differential diagnosis of arterial occlusion

Epidemiological evidence shows that the incidence of acute myocardial infarction (AMI), cardiovascular disease risk factors, and mortality due to AMI in women are different from those in men. The objective of this study was to compare baseline characteristics, risk factors, medical care and mortality of AMI in women and men. In this descriptive-analytical study, we examined data from medical charts and administrative records of patients hospitalized with AMI from 1994 to 2003 in Birjand hospitals. Two trained nurses completed the questionnaires under the supervision of a cardiologist. Data were analyzed with SPSS. Of 918 patients, 71.9% were male and 28.1% were female. The women and men had mean ages of 65.62±10.56 years and 58.98±12.11 years, respectively. The prevalence of hypertension was 50% in women and 24.6% in men (P<0.001). The prevalence of diabetes mellitus was 17% in women and 9.8% in men (P<0.006). The prevalence of smoking was 13.7% in women and 36.3% in men (P<0.001). In-hospital mortality was higher in women but not significant (10.4% in women, 8.6% in men, P=0.42). Fasting blood sugar, cholesterol and diastolic blood pressure were significantly higher in women. Mean age and the prevalence of diabetes and hypertension were higher in women with AMI. We recommend that interventional programs be designed to reduce the risk factors of AMI through education, especially for women