Arya Atherosclerosis
Volume:9 Issue: 1, Oct 2013

The main aim of this study was to evaluate the association between serum cholesterol level and body mass index (BMI) in northern Iran. This was a cross-sectional study carried out on the 1995 subjects (997 males and 998 females) aged 25-65 years that were selected using multistage cluster sampling method. Plasma cholesterol was measured in the morning after a 12-hour fasting and was determined by auto-analyzer. Hypercholesterolemia (HC) was defined by a total plasma cholesterol level over 200 mg/dl. Weight and height were measured and BMI 25-29.9 kg/m2 and ≥ 30 kg/m2 was classified overweight and obesity, respectively. Mean of age was 44.2 ± 11.5 years (44.3 ± 11.5 in men and 44.1 ± 11.2 in women) and plasma total cholesterol level was 203.1 ± 41.8 mg/dl. The HC was detected in 49.1% with higher rate in women (57.0%) than men (44.7%). In men at age 25-35 years, the odds ratio was 3.42 (1.60-7.29) in obese group and 1.90 (1.03-3.50) in overweight group compared to normal weight. In women, at age 35-45 years, the risk of HC in obese group was 3.01 (1.58-5.73) and in overweight group it was 2.06 (1.58-5.73), while in men aged 35-45 years the relative risk was 4.03 (2.22-7.34) in overweight and 3.58 (1.77-7.25) in obese group. In women after age 45 years, higher BMI was not a risk factor for HC. There was a positive association between BMI and serum cholesterol level. In early middle age, obese individuals were at risk of HC more than overweight subjects. In men, after age 35 years, the risk of HC increased in overweight group while in women there was no statistically significant association between BMI and HC.

Long QT is a cardiac electrical disorder. One of the symptoms of long QT caused by fatal ventricular arrhythmia is seizure. In some studies it was indicated that up to 35% of seizures induced by long QT may be misdiagnosed as other causes of seizure. In a case-control study, patients experiencing primary seizure with unknown etiology and referring for clinical diagnosis were selected as the case group. The control group consisted of patients hospitalized for other reasons except seizure. Corrected QT Interval (QTc) was measured for each patient on an electrocardiogram, and the two groups were compared. Long QT was defined as a QT more than 0.46 seconds. Among 508 subjects who were recruited in this study 254 children were in the case group and 254 were in the control group. There were 66 children experiencing seizure and long QT in the case group. In the control group, 48 children with long QT were observed; the difference was statistically significant (P = 0.02). Syncope and sudden death were not significantly different between the two groups. The present study showed that children with unknown causes of seizure have more frequently long QTc, which implies the possibility of an arrhythmic origin of some seizures. Therefore, it is advised to get an electrocardiography for patients with unknown causes of seizure.

Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. In this study, we sought to evaluate the safety and tolerance of continuous atrial pacing after CABG. We hypothesized that a strategy of temporary atrial pacing after CABG would reduce the incidence of postoperative AF. During 2012, CABG candidates over 18 years of age at Sina Hospital (Isfahan, Iran) were recruited. Before surgery, the participants were randomly assigned to two groups of ventricular pacing and left atrial ventricular pacing (atrial pacing). The primary end point of the study was the initial occurrence of AF or atrial flutter with a ventricular rate greater than 100 beats per minute for 10 consecutive minutes or completion of the 48-hour monitoring period. We evaluated 64 consecutive CABG candidates with sinus rhythm. They were assigned to two groups of ventricular pacing and atrial ventricular pacing. (n = 32 in each group). Three patients in the ventricular pacing group (10%) and six in the atrial ventricular pacing group (22%) had sustained AF during the first 48 hours after CABG (P = 0.18 according to Fisher’s exact test). Continuous atrial pacing in the postoperative setting is safe and tolerated well. In this study we found that temporary atrial pacing increased the frequency of postoperative AF. Since the difference between the two groups was not significant, larger studies are required to determine the exact correlation between pacing method and AF.

The aim of this study was to examine the association between left ventricular ejection fraction (LVEF) and incidence of depression following the myocardial infarction (MI). In a prospective study, 176 patients aged 32-84 years with the mean age of 56 years (SD = 10.05) with a definitive diagnosis of myocardial infarction and admitted to one of the coronary care units (CCU) of Isfahan during April to August 2006 were selected through consecutive sampling method. The demographic and medical characteristics were collected by their medical record and also the results of the LVEF assessment of the patients were obtained through echocardiography or angiography following the myocardial infarction. Thereafter, the patients were given Beck Depression Inventory for the primary care (BDI-PC) in three months after myocardial infarction. The collected data were analyzed during the hospitalization and follow-up periods using logistic regression method. The findings indicated that left ventricular dysfunction identified by the Left ventricular ejection fraction index was significantly correlated with depression three months after the myocardial infarction (P < 0.01). In addition, the exploratory model (which only includes LVEF variable) had the predictive validity of 64.8% with 55.7% sensitivity and 72.1% specificity. Left ventricular dysfunction is associated with increased risk of depression following the myocardial infarction.

Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST elevation myocardial infarction (STEMI). However, the required equipments are not available in all hospitals. Thus, due to shortage of time, some patients receive thrombolysis therapy first. Patients with chest pain and/or persistent ST segment elevation will then undergo rescue percutaneous coronary intervention (PCI). The present study evaluated and compared the frequency of no-reflow phenomenon and 24-hour complications after PCI among patients who underwent PPCI or rescue PCI. This cross-sectional study assessed no-reflow phenomenon, 24-hour complications, and thrombolysis in myocardial infarction (TIMI) flow in patients admitted to Chamran Hospital (Isfahan, Iran) with a diagnosis of STEMI during March-September, 2011. Subjects underwent PPCI if they had received eptifibatide. Rescue PCI was performed if patients had chest pain and/or persistent ST segment elevation despite receiving streptokinase (SK). Demographic characteristics, history of diseases, medicine, angiography findings, PCI type, and complications during the first 24 hours following PCI were collected. Data was then analyzed by Student’s t-test, chi-square test, and logistic regression analysis. A total number of 143 individuals, including 67 PPCI cases (46.9%) and 76 cases of rescue PCI (53.1%), were evaluated. The mean age of the participants was 58.92 ± 11.16 years old. Females constituted 18.2% (n = 26) of the whole population. No-reflow phenomenon was observed in 51 subjects (37.1%). Although 9 patients (6.3%) died during the first 24 hours after PCI, neither the crude nor the model adjusted for age and gender revealed significant relations between rescue PCI and death or no-reflow phenomenon. Rescue PCI and no-reflow phenomenon were not significantly correlated even after adjustments for age, gender, history of diabetes, hypertension, hyperlipidemia, coronary artery disease, smoking, platelets number, myocardial infarction level, the extent of stenosis, and the involved artery. According to the present study, although SK is more effective than eptifibatide in resolution of thrombosis and clots, rescue PCI did not differ from PPCI in terms of the incidence of no-reflow phenomenon or short-term complications.

This study aimed to determine the effects of the interventions of Isfahan Healthy Heart Program (IHHP) on the type of oil consumed at population level. It also tried to assess how this strategy has been translated into a health policy. The IHHP, a six-year community intervention program (2001-07), aimed at health promotion through the modification of cardiovascular disease risk factors. It was performed in Isfahan and Najafabad counties (intervention area) and Arak county (reference area), all in central Iran. This study targeted the whole population of over 2,000,000 in the intervention area. The findings of annual independent sample surveys were compared with the reference area. Dietary interventions were performed as educational, environmental, and/or legislative strategies. The interventions were successful in decreasing the consumption of hydrogenated oil and substituting it with liquid oil. The interventions could become as a health policy circulated by the Iranian Commerce Office causing the same changes in the type of fat distributed and consumed at population level. In turn, by increasing demand from consumers, the production of healthier types of oils increased significantly. The proposal was later implemented at the national level and resulted in a recent legislation mandating the production of oils with trans fatty acid content less than 15%. The effects of the simple, comprehensive, and integrated action-oriented interventions of our program are evidence on how research can influence policy decisions at community level. Such simple and integrated interventions can be adopted by other developing countries.

Primary Percutaneous Coronary Intervention (PPCI) was considered as a choice of treatment in ST-Elevation Myocardial Infarction (STEMI), and has been performed since several years ago in the Isfahan Province. This study was performed to describe the situation and determine in-hospital and early (30 days) clinical outcomes of the patients in order to provide sufficient evidence to evaluate and modify this treatment modality if necessary. All patients, who underwent PPCI for STEMI from July to December 2011 at Chamran and Saadi Hospitals (PPCI centers in the Isfahan Province), were included in this case series study. Premedication, angioplasty procedure, and post-procedural treatment were performed using standard protocols or techniques. All discharged patients were followed for 30 days by phone. Endpoints consisted of clinical success rate, and in-hospital and 30 day major adverse cardiac events (MACEs) (death, reinfarction, stroke, and target vessel revascularization). 93 patients (83 (89.2%) at Chamran Hospital and 10 (10.8%) patients at Saadi Hospital) had PPCI. Mean Age of the patients was 59.60 ± 11.10 and M/F ratio was 3.89. From the 181 involved vessels (involved vessels/patient ratio = 1.97 ± 0.70), the treatment of 105 lesions (lesions/patient ratio = 1.13 ± 0.368) was attempted. The clinical success rate was 72%. Pain-to-door and door-to-balloon times were, respectively, 255.1 ± 221.4 and 148.9 ± 168.5 min. The reason for failure was impaired flow (n = 17 (18.3%)), failure to cross with a guidewire (n = 2 (2.2%)), suboptimal angiographic results (n = 2 (2.2%)), and death in one patient. The in-hospital and 30 days MACE rates were, respectively, 8.6% and 3.2%. Low success rate in our series could be due to prolonged pain-to-door and door-to-balloon times and lack of an established, definite protocol to regularly perform PPCI in a timely fashion. We should resolve these problems and improve our techniques in order to prevent and treat slow/no-reflow phenomenon.

First experiences of tobacco use usually occur in adolescence. The recognition of social norms leading to youth smoking is hence necessary. We tried to assess the social norms among Iranian young cigarette and hookah smokers. This cross-sectional study was conducted on 451 girls and 361 boys aging 20-25 years old who entered Isfahan and Kashan Universities (Iran) in 2007. Demographic factors (age, gender, and age at smoking onset) cigarette and hookah smoking status, having a smoking father or smoking friends, and four related social norms were recorded. Binary logistic regression analysis was used to separately determine associations between hookah and cigarette smoking and the four social norm variables. Cigarette and hookah smokers had significant differences with nonsmokers in two social norms: “Perceived smoking by important characters” [odds ratio (OR) = 1.35 in cigarette smokers and 1.58 in hookah smokers; P < 0.001] and “smoking makes gatherings friendly” (OR = 3.62 in cigarette smokers and 6.16 in hookah smokers; P < 0.001). Furthermore, cigarette and hookah smoking were significantly associated with having smoking friends. Highlighting the social norms leading to cigarette and hookah smoking may help policy makers develop comprehensive interventions to prevent smoking among adolescents.

The purpose of the present study was to investigate physical activity by socioeconomic status (SES) and sex in an Iranian adult population. In a cross-sectional study, 6622 adults, who participated in the Isfahan Healthy Heart program (IHHP) surveys in 2004 and 2005 and were living in urban areas, were studied. Daily leisure time, household, occupational, and transportation physical activity, and total physical activity were calculated and compared in 3 socioeconomic status groups classified by the two-step cluster analysis procedure. Statistically significant variations were found in all physical activity levels, except transportation, by sex. Men were more active than women in all fields, except household physical activity. Leisure time physical activity of men and women were significantly higher in higher SES levels. There was an opposite correlation between SES and total physical activity in men. Considering the importance of physical activity as a component of a healthy lifestyle, differences among varying socioeconomic status and sex must be considered while planning for healthy lifestyle programs. Women with low SES, in particular, may need more attention.

Understanding the knowledge, attitudes, and beliefs of parents is important for planning appropriately to control their children’s weight. We aimed to study these variables in parents of normal, underweight, overweight, and obese children. This cross-sectional study targeted the parents of normal, underweight, overweight, and obese children, who were selected using multistage random sampling method. The parents’ knowledge, attitudes, beliefs, and behaviors about the weight status of their children, weight management, obesity, diet, lifestyle, and related psychosocial factors were evaluated using a validated questionnaire. The questionnaire, which had been validated, consisted of 12 demographic, 8 knowledge, 19 attitude and beliefs, and 25 behavior questions. Mean knowledge, attitude and beliefs, and behavior scores were compared across three subgroups of parents. Student’s independent t-test, ANOVA, and Kruskal-Wallis test were used to study the correlation between different demographic and socioeconomic factors, and the studied variables. 90% of parents were aware that obesity is a disease, and 92% knew that eating too much fast food would lead to obesity in children. Only 5% assumed that obese children are healthier than non-obese children. The mean scores of the three subgroups showed no significant difference in knowledge, attitude and beliefs, and behavior. Families with fathers, whose education level was higher than high school diploma, rated their children’s weight status as overweight or obese significantly less than families with fathers, whose education level was high school diploma or higher (8.5% vs. 16.5%, respectively, P = 0.014). Only 12% of parents tried to help their children lose weight at least once, and only 6% arranged sport activities for the family members. In 57% and 41% of families, the child, respectively, decided how much time was enough to watch TV, and how much chocolates and sweets to eat. 46% of children watched TV for more than 2 hours/day, and 49% of children watched TV while eating meals. The mean total score of boys’ parents was significantly lower than that of girls’ parents (P < 0.05). Families with low income, with no medical insurance, or not owning a house thought that the cost of registration in sport activities for children was too high (P < 0.03). Some parents unreasonably rated the weight status of their overweight/obese children. It is suggested that further studies be carried out to evaluate and improve parents’ knowledge, attitudes, and behaviors regarding their children’s weight.

The prevalence of metabolic syndrome (MetS) is increasing among children and adolescents. However, the prevalence of this disorder varies based on its different definitions. This study aimed to determine the prevalence of MetS in Iranian adolescents in junior high and high schools according to the definitions provided by the International Diabetes Federation (IDF) and De Ferranti. Overall, 1039 junior high school and 953 high school students were selected using multistage random sampling. Demographic data was collected using validated questionnaires. Fasting blood sugar, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were determined. Waist circumference and blood pressure were measured by trained individuals. Subjects with MetS were selected according to two definitions provided by the IDF and De Ferranti. Chi-square and Fisher’s exact tests were used to compare the prevalence of MetS and its components based on sex, school level, and the two definitions. The mean age of junior high and high school students was 13.11 ± 1.21ad 15.93 ± 1.07 years old, respectively. The prevalence of MetS among all participants was 4.8% and 12.7% according to the definitions by the IDF and De Ferranti, respectively. It was significantly higher among boys compared to girls. According to the IDF definition, low HDL-C and hypertension were the most frequent components. Based on the De Ferranti, abdominal obesity and hypertriglyceridemia were the most frequent components. The prevalence of MetS was higher in both groups of students based on De Ferranti definition compared to the IDF definition. The prevalence was not significantly different in boys and girls. Further studies to investigate the most suitable definition of MetS for Iranian adolescents are necessary.

Hypertension is a major risk factor for cardiovascular diseases. It affects approximately 18.0% of Iranian adults. This study aimed to estimate age-adjusted prevalence of hypertension and its control among Iranian persons older 19 years of age. It also tried to find and socioeconomic factors associated with hypertension control in Iranian population. In Isfahan Healthy Heart Program (IHHP) subjects were selected by multistage random sampling. The participants completed questionnaires containing demographic information, lifestyle habits, medical history, and consumption of relevant medications, especially antihypertensive agents. Income, marital status, and educational level were considered as socioeconomic factors. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or taking antihypertensive medications. Controlled hypertension was considered as systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg among hypertensive subjects. The prevalence of hypertension and controlled hypertension was 18.9% and 20.9%, respectively. We found significant relationships between hypertension and marital status, education, and income. At age ≥ 65 years old, odds ratio (OR) was 19.09 [95% confidence interval (CI): 15.01-24.28] for hypertension. Middle family income (OR: 0.71; 95% CI: 0.58-0.87) and education level of 6-12 years (OR: 0.29; 95% CI: 0.25-0.35) were significantly associated with increased risk of hypertension (P = 0.001). Among subjects aging 65 years old or higher, the OR of controlled hypertension was 2.64 (95% CI: 1.61-4.33). Married subjects had a higher OR for controlled hypertension (OR: 2.19; 95% CI: 1.36-3.52). Obesity had no significant relationships with controlled hypertension. The IHHP data showed significant relationships between some socioeconomic factors and controlled hypertension. Therefore, as current control rates for hypertension in Iran are clearly unacceptable, we recommend preventive measures to control hypertension in all social strata of the Iranian population.

Hypertension (HTN) treatment has remained insufficient. New modalities such as “Symplicity method” for the treatment of HTN are a priority, especially in patients with resistant hypertension. In this study, we describe our first experience with a novel percutaneous treatment modality, without using Symplicity catheter. 30 Patients who were resistant to at least three types of antihypertensive medical therapy were selected. Patients received percutaneous renal artery denervation, without Symplicity catheter method, and were followed up for 1 week, 1, 3, and 6 months later after treatment. Ambulatory 24-hour blood pressure (BP) Holter was performed 1 week before intervention and after 1 month. The primary outcome was change in 24-hour ambulatory BP and change in office and home-based BP measurements. The mean age of the studied patients was 52 ± 15.4 years and 43.3% (n = 13) were female. Systolic and diastolic BP at baseline was 163 ± 17.2 and 95 ± 8.2 mmHg, respectively. Patients took 3.6 ± 1.3 hypertensive medications. Systolic and diastolic BP at 1-week, 1-month, 3-month and 6-month after renal denervation significantly decreased compared to the baseline (P < 0.0001). Average BP derived from 24-hour ambulatory BP monitoring changed in parallel with office-based BP measurements. Most of patients (50%) who underwent renal denervation had reductions of 10 mmHg or greater in systolic BP and 56.7% of them had reductions of 5 mmHg or greater in diastolic BP. 33.3% of patients also achieved the target of systolic BP less than 140 mmHg and 60% achieved the target of diastolic BP less than 90 mmHg. No patients showed vascular damage at final angiography. Catheter based renal ablation was associated with a significant reduction in both systolic and diastolic BP, on top of maximal medical therapy, which persisted throughout 6 months follow-up in the first-in-man study without the Symplicity catheter.

Primary prevention of chronic diseases has been suggested to initiate health promotion activities from childhoods. The impact of Isfahan Healthy Heart Program (IHHP), a comprehensive community trial, on unhealthy snacks and fast food intake changes was evaluated in Iranian adolescents between 2001 and 2007. Healthy Heart Promotion from Childhood (HHPC) as one of the IHHP interventional projects was conducted in adolescents aged 11-18 years, selected randomly by multistage random sampling. Isfahan and Najafabad districts were intervention areas (IA) and Arak district was reference area (RA). The baseline and post-intervention surveys were conducted on 1941 and 1997 adolescents, respectively.Healthy lifestyle interventions were performed during the 2nd phase of the study targeting about 410000 students in urban and rural areas of the IA via education, environmental and legislation activities. Dietary intake was assessed annually using a fifty-item food frequency questionnaire in both communities. The interaction of year×area demonstrated that the consumption of unhealthy snacks decreased significantly in middle school boys of RA compared to IA (P for interaction=0.01). However, middle school girls (P for interaction = 0.002) and both sexes of high school students in IA showed a significant reduction in fast food consumption against RA (P for interaction < 0.001). The HHPC interventions made some improvement in fast food consumption. It did not show significant decrease regarding unhealthy snacks in adolescents. Proper and higher dose of interventions may be effective in achieving this goal.

Citrus sinensis juice (CSJ) is a rich source of dietary flavonoids which reduce the risk of adverse cardiovascular events. This study aimed to examine the effects of four-week intake of natural and commercial orange (Citrus sinensis) juice on blood pressure in healthy volunteers. In this single-blind randomized crossover study, 22 healthy subjects (age: 18-59 years old) were included and randomly divided into two groups of 11. Group A consumed commercial CSJ during the first four-week period. After a two-week washout period, they consumed natural CSJ for another four weeks. The procedure was reversed in group B. The participants were asked to drink 500 ml/day of either natural or commercial CSJ twice a day with breakfast and dinner. The effects of orange juice on blood pressure were evaluated. After drinking commercial CSJ, diastolic and systolic blood pressure were significantly decreased (5.13%; P = 0.033 and -5.91%; P = 0.003, respectively). However, consumption of natural CSJ did not have significant effects on either diastolic or systolic blood pressure. Commercial CSJ significantly decreased blood pressure. Higher flavonoid, pectin, and essential oils content of concentrated products compared to natural juice might have been responsible for this finding. Nevertheless, further studies to focus on dose-response effects are recommended.

Although psychological factors play an important role in coronary heart diseases (CHD), it seems there is a need for more researches in this respect. The present study aimed to review psychological factors, including depression, anxiety and stress related to etiology and prognosis of CHD. This was a review on medical and psychological literatures, particularly in the years 1995-2012. As protective factor or risk factor, psychological factors play an important role in CHD. Given the findings of this study, it seems necessary that we pay attention to psychological factors, as independent risk factors or protective factors for CHD.

Several studies have emphasized thrombosis associated with thrombocytopenia as a potentially fatal complication of heparin. A number of agents are used for this condition. As a new oral, reversible direct thrombin inhibitor, dabigatran has been approved for short-term thromboprophylaxis after elective hip and knee replacement surgery. We present a case of dabigatran administration in a patient with femoral fracture. CASE REPORT: A 67-year-old woman referred to the orthopedic ward of Shariati Hospital (Isfahan, Iran) due to femoral fracture following an accident. Immediately after surgery, she was found to be suffering from deep vein thrombosis (DVT) in her lower extremity despite sufficient prophylaxis by enoxaparin. Laboratory data showed severe thrombocytopenia. Considering the clinical history, an initial diagnosis of heparin-induced thrombocytopenia was made. Doppler ultrasound confirmed the diagnosis. Heparin was thus replaced with dabigatran which increased platelet count to the normal range and improved DVT. Dabigatran can be a life-saving treatment in heparin-induced thrombocytopenia. However, it is contraindicated in patients with renal dysfunction since it may cause potentially catastrophic results.

Cardiovascular diseases are the major causes of mortality worldwide and acute myocardial infarction (AMI) is the leading cause of mortality among cardiovascular diseases. Thrombolytic therapies, especially during the first few hours after the disease onset, can significantly reduce AMI-related mortality. The current study aimed to determine the prevalence and causes of non-administration of thrombolytic therapy for AMI patients admitted to Hajar Hospital, Shahrekord, Iran, from May until November 2000. Non-probability convenient sampling method was used to select 106 subjects with Q-wave AMI. Data was collected by completing a questionnaire, reviewing medical records, and interviewing with patients. SPSS7.5 was for data analysis. A total number of 106 AMI patients were studied among whom 62 (59%) individuals received thrombolytic therapy. Delayed referral to the hospital was the major cause of failure to provide thrombolytic therapy. The cause of non-treatment could not be identified in 15 (19.5%) subjects eligible to receive therapy. Training general practitioners and individuals involved in this regard along with accelerating the process of patient referral to hospitals can reduce AMI-related mortality.