Arya Atherosclerosis
Volume:8 Issue: 3, Autumn 2012

This paper presents the complete report of the first Iranian Recommendations on Prevention، Evaluation and Management of High Blood Pressure. The purpose is to provide an evidence-based approach to the prevention، management and control of hypertension (HTN) by adapting the most internationally known and used guidelines to the local health care status with consideration of the currently available data and based on the locally conducted researches on HTN as well as social and health care requirements. A working group of national and international experts participated in discussions and collaborated in decision-making، writing and reviewing the whole report. Multiple subcommittees worked together to review the recent national and international literature on HTN in different areas. We used the evaluation tool that is called “AGREE” and considered a score of > 60% as a high score. We adapted the Canadian Hypertension Education Program (CHEP)، the United Kingdom’s National Institute for Health and Clinical Excellence (NICE) and the US-based joint National Committee on Prevention، Detection، Evaluation and Treatment of High Blood Pressure (JNC7). The key topics that are highlighted in this report include: The importance of ambulatory and self-measurement of blood pressure، evaluation of cardiovascular risk in HTN patients، the role of lifestyle modification in the prevention of HTN and its control with more emphasis on salt intake reduction and weight control، introducing pharmacotherapy suitable for uncomplicated HTN or specific situations and the available drugs in Iran، highlighting the importance of angiotensin-converting enzyme inhibitors، angiotensin-receptor blockers and calcium channel blockers as the first line therapy in many situations، the non-use of beta blockers as the first time treatment except in specific conditions، treating HTN in women، children، obese and elderly patients، the patient compliance to improve HTN control، practical guidelines to improve the patient’s information on knowing their risk and self-care as well as a quick reference guide that can serve as simplified guidelines for physicians. The working team decided to update these recommendations every two years.

Coronary heart disease is the leading cause of mortality worldwide. A high-fat diet، rich in saturated fatty acids and low in polyunsaturated fatty acids، is said to be an important cause of atherosclerosis and cardiovascular diseases. In this experimental study، 40 male rabbits were randomly assigned to eight groups of five to receive normal diet، hypercholesterolemic diet، normal diet plus ghee، normal diet plus olive oil، normal diet plus hydrogenated oil، hypercholesterolemic diet plus ghee، hypercholesterolemic diet plus olive oil، and hypercholesterolemic diet plus hydrogenated oil. They received rabbit chow for a period of 12 weeks. At the start and end of the study، fasting blood samples were taken from all animals to measure biochemical factors including total cholesterol (TC)، low-density lipoprotein (LDL)، high-density lipoprotein (HDL)، triglyceride (TG)، fasting blood sugar (FBS)، and C-reactive protein (CRP). Moreover، aorta، left and right coronary arteries were dissected at the end of the study to investigate fatty streak formation (FSF). Data was analyzed in SPSS at a significance level of 0. 05. In rabbits under normal diet، ghee significantly increased TC، LDL، and HDL compared to the beginning (P < 0. 01) and also to the other two types of fat (P < 0. 05). Moreover، normal diet plus olive oil significantly enhanced FSF in left coronary arteries and aorta compared to normal diet plus ghee. In groups receiving hypercholesterolemic diets، ghee significantly increased HDL and CRP (P < 0. 05) and significantly decreased FBS (P < 0. 01). The hypecholesterolemic diet plus olive oil significantly increased HDL (P < 0. 01). Supplementation of hypecholesterolemic diet with ghee significantly increased HDL and FBS in comparison with hydrogenated oil. Significant increase of FBS was also detected with the use of ghee compared to olive oil. Ghee also significantly reduced FSF in left and right coronary arteries compared to olive oil. FSF in left coronary arteries was significantly lower in the hypecholesterolemic diet plus ghee group compared to the hypecholesterolemic diet plus hydrogenated oil group. According to the achieved results، future clinical trial studies and investigation of other risk factors such as inflammatory factors are required.

Current guidelines recommend cardiac rehabilitation programs (CRP) as a means to improve functional status of patients after coronary revascularization. However، research supporting this recommendation has been limited and positive effects of CRP on diastolic function are controversial. The aim of this study was to examine the effects of an 8-week CRP on left ventricular diastolic function. This randomized، clinical trial included 29 men with ST elevation myocardial infarction (MI) who had received reperfusion therapy، i. e. coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). They were randomized to a training group (n = 15; mean age: 54. 2 ± 9. 04 years old) and a control group (n = 14; mean age: 51. 71 ± 6. 98 years old). Patients in the training group performed an 8-week CRP with an intensity of 60-85% of maximum heart rate. Exercise sessions lasted 60-90 minutes and were held three times a week. At the start and end of the study، all patients performed symptom-limited exercise test based on Naughton treadmill protocol. Pulsed-wave Doppler echocardiography was also used to determine peak velocity of early (E) and late (A) waves، E/A ratios، and the deceleration time of E (DT). Left ventricular diastolic indices (E، A، E/A ratio، DT) did not change significantly after the CRP. Compared to baseline، patients in the training group had significant improvements in functional capacity (8. 30 ± 1. 30 vs. 9. 7 ± 1. 7) and maximum heart rate (118. 50 ± 24. 48 vs. 126. 85 ± 22. 75). Moreover، resting heart rate of the training group was significantly better than the control group at the end of the study (75. 36 ± 7. 94 vs. 79. 80 ± 7. 67; P < 0. 001). An 8-week CRP in post-MI patients revascularized with PCI or CABG led to improved exercise capacity. However، the CRP failed to enhance diastolic function.

Lead contamination can affect many body organs including the heart. This study assessed a number of echocardiographic indices to clarify the effects of lead on cardiac function among battery factory workers who are in constant exposure to lead. In a cross-sectional study، 142 male battery factory workers who had been exposed to lead for at least 1 year were evaluated. The subjects aged 25-55 years old and were excluded if they had hypertension، diabetes، or cardiovascular diseases. Demographic characteristics، professional profile، lead exposure، history of respiratory diseases، drugs intake، and lifestyle information of the participants were collected. Height، weight and blood pressure measurements were then performed. Blood tests were also ordered to determine blood lead levels. The subjects finally underwent M-mode and Doppler echocardiography. Linear regression analysis was used to establish the effects of lead on the target indices. All statistical analyses were conducted in SPSS18. The mean age and mean duration of lead exposure of the subjects were 41. 78 ± 13. 58 and 23. 54 ± 14. 44 years، respectively. The mean blood lead level was 7. 59 ± 2. 75 µg/dl. Left ventricular hypertrophy was detected in 12% of the participants. Blood lead levels were not significantly related with echocardiographic indices in the crude model or after adjustments for age alone or for age and other risk factors. Blood lead levels of our participants were below standard values. In addition، no significant relation was found between left ventricular function indices and blood lead levels. The absence of such relations could have been caused by the exclusion of individuals with hypertension or cardiovascular diseases. Structural modifications in battery factories following legislations in Iran might have been responsible for low blood lead levels among the subjects.

Bleeding time test is used to assess the function of platelets in human body. The aim of this project was thus to estimate the sample size required to determine the normal range of bleeding time (BT) in Borujerd (a city in Iran). A pilot study was designed to determine the range of normal BT in a small group of normal people. The total sample size for the next study was then calculated according to the results. In order to determine the sample size، a total of 33 volunteers participated in this study. The normal range of BT was determined by Ivy method. Written informed consents were obtained from all participants and their clinical history was recorded. The sampling was performed once for each participant. However، the results were interpreted by two observers. The study protocol was approved by the Ethics Committee of the research center at Lorestan University of Medical Sciences (Iran). In this study، 33 normal participants (20 women and 13 men) were divided into four age groups of 35-44، 45-54، 55-64 and over 64 years old. Maximum and minimum BTs in men were 209 (in the age group of 35-44 years) and 150 seconds (in the age group of over 64 years)، respectively. On the other hand، the corresponding values in women were 194 (in 55-64 year-old subjects) and 145 seconds (in women over 64 years of age). Considering the aforementioned results، the total sample size for the next study was determined to be 580 normal subjects by two-sample t-test power analysis at a power of 0. 91816. There was a significant difference between the normal range of BT in participants of Borujerd and previously recorded range in other studies. Moreover، normal BT in men decreased by aging. This study did not show any special order in increasing or decreasing BT in women.

Considering rapid global increase in children obesity and high prevalence of dyslipidemia in obese and overweight children، this study aimed to evaluate the effect of an educational course on changes of lipid profile in children. This non-pharmacological clinical trial study was performed on 4-18 year-old children attending outpatient clinics of Isfahan Endocrine and Metabolism Research Center (Iran). Anthropometric measurements were conducted for all children. Fasting blood samples were taken from right hand of the participants at the first laboratory visit. Biochemical tests including measurement of total cholesterol (TC)، triglyceride (TG)، high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were also carried out. Children took part in one educational session in which they were taught about ways and benefits of having regular physical activity once a day and having healthy foods. All children were followed up for about four months and anthropometrics and biochemical tests were repeated. Data was analyzed using SPSS16. A total number of 412 children (245 girls and 167 boys) were divided into four age groups of under 6، 6-9، 10-13، and 14-18 years old. Baseline anthropometric measures were significantly higher in boys. However، there was no difference between boys and girls in baseline lipid profile. Children''s body mass index (BMI) z-score increased in all age groups except for 14-18 year-old boys. In boys older than 10 years، there were significant reductions in LDL-C and TC. In girls over 10 years of age، there was a significant increase in HDL-C. Although anthropometric measurements did not change in children (except for 14-18 year-old-boys)، there was a significant reduction in children''s lipid profile after the study. Our study showed that although one session of interventional education had no significant effects on children''s anthropometric measurements، it could change their lipid profile. Moreover، the intervention was more effective on improving lipid profile in children over 10 years of age. Therefore، effective interventional strategies must be invented and implemented on children based on their age group.

The present study was conducted to investigate the probable changes in blood pressure of workers in coal mines. In this study 91 workers، who worked in forwarding، preparation and exploitation units of coal mines and were in direct contact with carbon dioxide gas (from fireworks)، have been selected as the case group، and 70 workers، who did not have direct contact with this gas، from other units were selected as the control group by simple random sampling method. The inclusion criteria were over 10 years of work experience and the age range of 30 to 45 years. The blood pressure values and their classification were determined based on the Seventh Report of the Joint National Committee on Prevention of Hypertension. Statistical analysis was performed using t-test. The results of this study showed that mean systolic and diastolic blood pressures in the case group were significantly lower than the control group (P < 0. 001). The mean diastolic blood pressure of workers in coal mines is less than other people due to the CO2 gas. A greater control of the existing gas in mines by relevant factors is required. Necessary medical care and support measures should also be considered.

This study tried to develop an Asian Stroke Disability Scale (ASDS) and compared its interrater reliability with modified Rankin Scale (mRS) and Barthel Index (BI). Three items including self-care، mobility، and daily activities were selected as variables for development of the ASDS. The variables were provisionally graded on a 2- to 4-point scale based on the importance of each item. Each of the variables was categorized into 3 categories. Afterward، 125 rater-patient assessments for each scale (mRS، BI، and ASDS) were performed on 25 stroke patients by 5 raters. For categorization of functional impairment as minor or major، the scores of mRS، BI and ASDS were categorized as ≤2، >2; ≥90، <90 and <3، ≥3، respectively. 125 rater-patient assessments for each of the mRS، BI، and ASDS were performed on 25 stroke patients by five raters. The quantitative variability of BI، mRS، and ASDS scores was not significant (P = 0. 379; P = 0. 780; and P = 0. 835، respectively). Interrater variability of mRS، BI، and ASDS scores based on qualitative categorization was not significant (P = 1. 000; P = 0. 978; and P = 0. 901، respectively). Paired interrater variability of mRS، BI، and ASDS scores based on qualitative categorization was not significant (P > 0. 05). The ASDS is easy to use، requires less than 1 minute to complete and is as valid as mRS and BI in assessment of functional impairment of patients with stroke.

Sinus of Valsalva aneurysm (SVA) may be congenital or acquired. They could mimic ventricular tumor symptoms and cause signs and symptoms of ventricular outflow tract obstruction. They may also involve the conduction system and cause palpitations or syncopal episodes. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) serve as quick، noninvasive methods to provide information on size and location of aneurysmal dilatation and cardiac chamber involvement. These methods can identify any associated anomalies or complications. This study presents a patient with unruptured SVA. CASE REPORT: A 46-year-old man، who had been suffering from nonspecific symptoms such as exercise intolerance and weakness for a few months، referred to our clinic in Isfahan (Iran). In TTE، a large mass was observed in the right ventricle. SVA was suspected after meticulous probing. This diagnosis was confirmed by TEE and computed tomography angiography. At open heart surgery، an SVA with a lot of clots it was removed. SVA must be kept in mind when a tumor-like mass is observed in the right ventricle. Detailed evaluation would thus be necessary to rule out SVA and to prevent wrong diagnosis and treatment that can sometimes be catastrophic.

In true aneurysm، the wall of aneurysm is composed of the normal histological components of aorta. A false aneurysm (pseudoaneurysm) represents a rupture which does not contain the normal histological components of aorta. It is a fibrous peel that has formed from a small perforation of aorta. We describe an unusual presentation that has signs which some of them are only manifested in true aneurysm and some others only in pseudoaneurysm. CASE REPORT: An 85-year-old man underwent elective coronary angiography for chest pain work-up. Our evaluation by invasive angiography and CT angiography showed aortic dissection. In surgery we found that dissection flap was composed of some parts of intima and media layers. These signs leaded to confusing symptoms. Localized bulging of ascending aorta had continued to brachiocephalic artery (transverse arch involvement). Dissection flap was composed of some part of intima and media layers. It was a strange case، it was not solely a perivascular hematoma and it did not have all three layers of aorta wall. Partial aorta replacement was performed. The operation and recovery was uneventful. This unusual presentation of disease has not been mentioned in literatures. Our experience can help to manage similar cases. This case was the first unusual presentation of its type.