Arya Atherosclerosis
Volume:2 Issue: 1, Spring 2006

The metabolic syndrome - the clustering of abdominal obesity, dyslipidemia, hyperglycemia and hypertension - is a major public health challenge worldwide [1,2]. The metabolic syndrome is not benign; it is associated with a substantially elevated risk of type 2 diabetes (5-fold) and of cardiovascular disease (CVD) (2-3-fold),1 and its increasing prevalence could possibly reverse the gains made through recent declining CVD mortality.The metabolic syndrome is not a new condition. It was first described in the 1920s by Kylin, a Swedish physician, as the association of hypertension, hyperglycemia and gout [3]. In the 1940s, attention was drawn to upper body adiposity (android or male-type obesity) as the obesity phenotype commonly associated with type 2 diabetes and CVD.4

Some studies have shown that C-reactive protein (CRP) and uric acid may have a role in development of coronary artery disease (CAD); the role cigarette smoking plays in CAD through various mechanisms has also been demonstrated. Hence, the question is raised: does cigarette smoking exert its atherogenic effect through increasing CRP and uric acid levels in the serum? The first step in responding to this question would be to study the relationship between cigarette smoking, CAD, CRP and uric acid levels. As cigarette smoking is highly prevalent in Iran, the present study was conducted to compare mean serum levels of CRP and uric acid in 3 groups of active smokers, passive smokers, and non-smokers, to determine any possible association between cigarette smoking and serum CRP and uric acid levels. The study involved 177 men aged 20-40 years in 3 groups of active smokers, passive smokers, and non-smokers (59 individuals in each group). In addition, fasting blood samples were taken from all subjects to measure serum levels of CRP serologically and uric acid photometrically (using ELAN 2000). Questionnaires on anthropometrics, personal information, disease history, drug use and other related subjects were completed for all the subjects. Mean serum CRP levels were 5.41.9, 3.70.8 and 4.00.8 mg/L for the active smokers, passive smokers, and non-smokers, respectively. The difference between active smokers and the other two groups was statistically significant (P=0.000), while no significant difference was found between passive smokers and non-smokers (P=0.13). Serum levels of uric acid in active smokers, passive smokers, and non-smokers was 7.0+/-1.4, 5.3+/-1.3 and 5.6+/-1.3 mg/dl, respectively. The difference between active smokers and the other two groups was significant (P=0.000). The difference between passive smokers and non-smokers was insignificant (P=0.34). Higher mean serum levels of CRP and uric acid in active smokers seem to confirm the harmful effects of nicotine on the two variables. We recommended studies on the possible role of increased serum CRP and uric acid levels due to cigarette smoking in CVD development.

Rheumatic valvular disease is a common complication of rheumatic fever in children in developing countries. Later in life, rheumatic valvular disease becomes an important modifiable risk factor of stroke. The incidence of rheumatic valvular disease and its complications are unknown in Iran. This is a prospective study of 302 consecutive patients admitted to a tertiary care hospital in Iran, with a diagnosis of non-hemorrhagic stroke between June 2005 and June 2006. All patients underwent diagnostic workup to determine stroke etiology according to clinical indications. Diagnosis and classification of stroke was made based on the PIC criteria. In 302 patients with stroke (mean age: 66.78±14.36 years), 60 patients (20%) (mean age: 65.61±17.48 years) had cardiac sources of embolism (CSE). Rheumatic mitral stenosis was present in 28 (46.6%) of these patients. Atrial fibrillation was documented in 19 patients (67.8%) with rheumatic valvular disease. The remaining 32 patients (53.3%) had other CSE. In the latter group, 8 patients (25%) had non-valvular atrial fibrillation. In the entire group with CSE, a total of 30 patients were candidates for anticoagulation; among them, 14 (46.6%) were anticoagulated, but only 6 (20%) were within therapeutic range at the time of their stroke. Rheumatic valvular disease seems to be the most common CSE in Iran. Many patients with rheumatic or non-rheumatic CSE are not adequately managed for secondary prevention of cardioembolic stroke.

The prevalence of cardiovascular risk factors is increasing in industrialized communities. Dyslipidemia is a modifiable cardiovascular risk factor which is related to diet, especially consumption of hard margarine and hydrogenated fat. The prevalence of cardiovascular diseases and their risk factors varies between communities. We studied the prevalence of consumption of different types of oil and fat in areas of Central Iran. The subjects were selected using randomized cluster sampling and divided into rural and urban groups. A 48-item standard food frequency questionnaire was filled out for every subject by a trained interviewer, who also obtained demographic data. Data were analyzed with SPSS. Different educational groups and the two sexes in urban and rural areas were compared using chi square test and paired t-test. P values below 0.05 were considered as significant. This cross-sectional descriptive study was performed on 12600 adult subjects aged above 19 years in the cities of Isfahan, Najafabad, and Arak. Consumption of olive oil and other types of oil in the urban community of Isfahan was higher than in the rural community. Consumption of animal oil and fat was higher in the rural community of Isfahan. In subjects with high school education and higher, consumption of different types of oil was not found to be different between urban and rural communities, or between men and women. In Arak, no difference was found between rural and urban subjects with high school education and higher in respect of consumption of different types of oil. Among subjects with lower education, however, consumption of olive oil and other types of oil was higher in urban areas and consumption of animal oil and fat was higher in rural men. In Najafabad, no difference was found between different educational groups in respect of the different types of oil consumed; only consumption of animal oil in rural subjects educated below high school diploma was higher than in cities. Among individuals with high school education and higher, no difference was found between rural and urban populations in respect of the types of oil consumed. However, among individuals with low education, consumption of animal oil and fat as well as hard margarine was higher in the rural population, while the urban population consumed higher amounts of oil and olive oil. The pattern of oil and fat consumption in men and women was different in the cities of Najafabad and Arak, but almost similar in Isfahan. Geographical location and education affect the pattern of oil and fat consumption. Unhealthy lifestyle habits are more prevalent in members of the rural population with low education.

Cerebral strokes below the age of 45 account for up to 3% of all strokes. Given that atherosclerotic thrombotic factors are the most frequent etiology of cerebrovascular accidents (CVA) second to cardioembolic causes, and that children of families with sequels of premature atherosclerosis are considered to be at risk, we assessed atherosclerosis risk factors and antiphospholipid antibody (APL-Ab) levels in children of patients with young stroke (YS) and without cardioembolic causes in comparison with controls. This cross-sectional study was conducted on 27 children of patients with YS due to non-cardiac causes (case group) and 2 control groups, one with 52 children of patients with stroke after the age of 50, and another with 55 children without the history of stroke in their parents. Findings were analyzed with SPSS using ANOVA. The mean values of systolic and diastolic blood pressure, LDL-C and ApoB100 in the case group were significantly higher and mean HDL-C and ApoA1 were significantly lower in the case group. The number of APL-Ab-positive cases was larger in the case group. The other assessed variables were not different between the two control groups. Atherosclerotic thrombotic risk factors were more prevalent in children of patients with atherosclerotic thrombotic cerebral YS than in controls. Primordial and primary prevention of risk factors should be considered in children of these families.

Leptin, the product of the obese gene (ob), is synthesized by adipose tissue and contributes to the regulation of energy homeostasis and food intake. Recently, immunoreactive leptin was reported to be present in human milk. The aim of this study was to determine any possible link between breast milk leptin concentrations and adiposity in exclusively breast-fed infants. 130 healthy, exclusively breast-fed infants beyond neonatal period and their mothers were included in the study. Infants whose weight for age was above the 75th, and between 25th and 75th percentiles were defined as obese (n=65) and non-obese (n=65), respectively. Anthropometric measurements of infants and mothers were also made and breast milk samples were analyzed for leptin. There was no significant difference between breast milk leptin concentrations of mothers of obese and non-obese infants. Breast milk leptin concentrations significantly correlated with mothers'' body mass index (r=0.54, P<0.001) and weight (r=0.46, P<0.001). There was no significant correlation between breast milk leptin concentrations and weight of infants. Leptin concentrations of human milk are not different in the mothers of obese and non-obese infants. Our findings suggest that milk-borne leptin has no significant effect on adiposity during infancy.

Atherosclerotic renal artery stenosis (RAS) is an important cause of secondary hypertension as well as ischemic nephropathy. Little information is available about the incidence of RAS in hypertensive patients in the Iranian society. This study was performed to determine the prevalence of RAS and its related risk factors in hypertensive patients. A cross-sectional study was conducted on 122 hypertensive patients (80 males and 42 females) aged 33-74 years (mean age: 54±8.5 years), all of whom underwent coronary angiography and selective renal angiography. According to angiographic data, 95 patients (77.9%) had coronary artery disease (CAD) and 27 (22.1%) had normal coronary arteries. RAS was seen in 22 patients (23.1%) with CAD and hypertension, and in 4 patients (14.8%) with hypertension and normal coronary arteries. Overall, 26 patients (21.3%) had RAS, which was classified as significant (14.7%) and non-significant (6.6%). RAS significantly correlated to the female gender (P=0.019), age (P=0.002), diabetes mellitus (P=0.025) and severity of hypertension (P=0.006). The prevalence of significant RAS among hypertensive patients undergoing coronary angiography was 14.7%. Factors like old age, severe hypertension, diabetes mellitus and female gender were clinical predictors of RAS.

This population-based study was conducted to assess the prevalence of overweight and obesity in high schools in the city of Birjand in Khorasan Province, Eastern Iran. In this descriptive study, we attempted to determine the prevalence of overweight and obesity in Iranian adolescents attending high school in Birjand in 2005. A sample of 2230 high school students (1115 boys and 1115 girls) aged 15-18 years was selected via stepwise random sampling in four districts of Birjand. Overweight and obesity were defined based on the 85th and 95th percentiles of BMI for age, respectively, as proposed by the Center for Disease Control (CDC) in 2000. The overall prevalence of overweight and obesity was 6.1% and 2.3%, respectively. The prevalence of overweight was 5% in boys and 7.1% in girls. The prevalence of obesity was 2.8% and 1.8% in boys and girls, respectively. The prevalence rate of overweight and obesity in high schools in the city of Birjand is lower than figures reported by studies conducted elsewhere in Iran and other countries.

Diabetes mellitus in the most common endocrine-metabolic disease in children and is associated with cardiovascular risk factors. This study aimed to compare the lipid profile of diabetic children with controls. In this case-control study, the lipid profiles and lipoprotein levels of 45 children aged 2-18 years with established diabetes were compared with those of 45 healthy controls. Mean apolipoprotein A and triglyceride levels in cases were higher than in controls, while mean apolipoprotein B and lipoprotein-a, as well as LDL, HDL and total cholesterol were higher in controls. Better apolipoprotein levels and lipid profiles in diabetic children compared to controls were likely due to tight nutritional control in diabetic patients under study.