Arya Atherosclerosis
Volume:10 Issue: 3, May 2014

The evaluation of the ability for return to work among patients after myocardial infarction (MI) is subject to controversy. Understanding various factors, which may affect return to work process, will help in promoting effective communication between physicians and patients. Return to work is dependent on such factors as patients’ functional capacity, MI expansion, cardiac muscle function, some psychiatric variables, job satisfaction, economic status, and age. In this study, we aimed to assess the frequency of return to work after first MI attack, and factors affecting it. This was a follow-up study performed in Yazd, Iran from September 2007 until September 2010 on 200 patients suffering from their first MI attack. Patients were assessed 6 months and 1-year after MI regarding their cardiac function. Job satisfaction was evaluated by Direct Support Professional job satisfaction questionnaire. Seventy-seven percent of MI patients returned to work after 1-year. Mean time for return to work was 46.00 ± 4.12 days. Sixty percent of patients returned to work during the first 50 days after MI and 50% of them during 40 days after MI. The most common reason for not returning to work was patient’s decision. This study showed that a considerable numbers of patients returned to work after 1-year. The only factors which affected the rate of return to work were left ventricular function after MI and job satisfaction.

Diabetes mellitus (DM) is a very well-known risk factor for development of atherosclerosis, and it has been hypothesized that poor glycemic control and hyperglycemia plays a major role in this process. In the current study, we aimed to evaluate the associates of poor glycemic control in Iranian patients who have already undergone coronary artery bypass grafting (CABG), with especial focus on the inhabitation of infectious agents within the coronary arterial wall. In January 2010, 52 consecutive patients with type 2 DM who undergone CABG at the Department of Cardiovascular Surgery of Baqiyatallah University of Medical Sciences (Tehran, Iran) were included into this cross-sectional study and biopsy specimens from their coronary plaques were taken and analyzed by polymerase chain reaction (PCR) methods for detecting Helicobacter species, cytomegalovirus (CMV) and Chlamydia pneumoniae, and their potential relation to the glycemic control status in these patients. Compared to that in diabetic patients with mean fasting blood sugar (FBS) levels FBS <126, atherosclerotic lesions in type 2 diabetic patients with poor glycemic control (FBS > 126) were significantly more likely to be positive for CMV PCR test (41% vs. 9%, respectively; P = 0.05). In laboratorial test results, mean triglyceride level was significantly higher among patients of poor glycemic control (168 ± 89 vs. 222 ± 125 mg/dl, respectively; P = 0.033). Hypertension was also significantly more prevalent in this population (73% vs. 36%, respectively; P = 0.034). Type 2 diabetic patients with poor glycemic control can be at higher risk for developing CMV infection in their coronary arterial wall, which can promote atherosclerosis formation process in this patient population. According to the findings of this study, we recommend better control of serum glucose levels in type 2 diabetic patients to prevent formation/progression of atherosclerosis.

Postprandial lipid clearance failure and lipoprotein disorders, which are independent risk factors for cardiovascular diseases are well-recognized in type II diabetes. Reduction of fats through exercise has been proved, though the mechanism is not well-defined, and the effects of different intensity exercise on postprandial lipidemia in diabetes type II is unknown. This study aims to find these effects using a cycle ergometer. On three different days, 15 type II diabetics (10 women and 5 men, with a mean age 42.07 ± 6.05 years, weight 94.64 ± 4.37 kg, height 159.78 ± 9.09 cm, and body mass index 29.83 ± 3.93 kg/m2), consumed a full fat breakfast (750-800 kcal, 85% fat), and 150 min later, blood samples were taken from them to measure their lipid profile. The 1st day was the control day, without any exercises. Seven days later, 90 min after enriched breakfast, they did 30 min of exercise on the cycle ergometer with intensity of 55-70% of maximum heart rate (HRmax), and 14 days later, 90 min after enriched breakfast, they did 30 min of exercise with intensity of 70-85% of HRmax. According to Friedman non-parametric test, high-density lipoprotein (HDL) cholesterol serum level significantly increased after 30 min of moderate intensity exercise (P > 0.05, from 39.4 ± 5.2 to 48.6 ± 9.3), while this increase was insignificant after a higher intensity exercise. Neither intensity levels had any significant effects on triglyceride or on low-density lipoprotein cholesterol. Results showed that moderate intensity exercise was more effective in increasing HDL cholesterol level in type II diabetics.

Atherosclerosis is accepted as an inflammatory disease. Evidence suggests that inflammation evoked by injury plays a pathogenic role in all stages of atherosclerosis. This study aimed to investigate whether the high-mobility group box-1 (HMGB1) a proinflammatory cytokine/nuclear protein, which is derived from both injured endothelium and activated macrophages/monocytes, could contribute to the progression of atherosclerosis and other cardiovascular diseases. This study was designed as case–control. A total of 135 patients who referred to the hospital due to angina pectoris had the diagnosis of unstable angina and were candidates of angiography were recruited in this study. Forty patients who had coronary artery disease confirmed by angiography were considered as case group and control group consists of 40 persons who had no plaque, and 55 persons were excluded according to the exclusion criteria. At first, a questionnaire was filled for each patient including demographic factors and their medical history. Then a blood sample was taken to assess the level of HMGB1. Data were analyzed using SPSS version 18, Student’s independent t-test, and chi-square tests. The mean plasma level of HMGB1 in the case group was 27.1 ± 2.9 ng/ml, while it was 19.6 ± 1.9 ng/ml in control groups (P = 0.03). The odds ratio for coronary artery plaque associated with high (>15.03 ng/ml) levels of HMGB1 was 2.50 (95% confidence interval, 1.02-6.17, P = 0.03). Increased plasma HMGB1 concentration may be associated with an increased risk of coronary atherosclerosis.

To study the relationship between cortisol, insulin, and thyroid hormone levels with 24-h urinary sodium (Na) excretion levels in essential hypertensive patients. All patients underwent history taking, physical examination, blood pressure (BP) measurement, 12 lead electocardiographic evaluation, routine urine analysis, biochemical analysis including measurement of cortisol, insulin, and thyroid hormone levels, 24-h urine collection to measure urinary Na and protein excretion and creatinine clearance. In total, 68 newly diagnosed hypertensive patients were included. Spearman correlation analysis revealed that 24-h urinary Na excretion was correlated with insulin levels (ρ = −0.473, P < 0.0001), serum cortisol levels (ρ = −0.404, P= 0.0010) and creatinine clearance (ρ: 0.407, P: 0.0010). Linear regression of independent factors has revealed that systolic BP (B: 0.004, CI: 0.001-0.008, P: 0.0170), body mass index (B = 0.014, CI = 0.005-0.023, P: 0.0030), being male (B: 0.077, CI: 0.001-0.153, P: 0.0480), creatinine clearance (B: 0.003, CI: 0.001-0.006, P: 0.0120) and insulin levels (B: −0.008, CI: −0.014 to −0.002, P: 0.0070) were independently related with logarithmically converted 24-h Na excretion. In conclusion, we found that insulin but not cortisol and thyroid hormone levels were independently related with 24-h urinary Na excretion in newly diagnosed essential hypertensive patients.

Obesity is associated with many metabolic and chronic diseases, such as diabetes and cardiovascular disease. Family history of diabetes (FHD) is also an important risk factor for type 2 diabetes. Furthermore, the presence of FHD and obesity has a synergic effect on risk of diabetes incidence. The aim of this study was to determine whether FHD influence the weight loss induced by weight loss diet. This study was an intervention between individuals with or without FHD. Seventy-eight positive FHD and 74 negative FHD individuals were participated in this study. Two groups were matched for age, gender, and body mass index (BMI). In the present study, expert interviewers collected socio-demographic data and prescribed dietary recommendations in a face-to-face method. Dietary intervention significantly reduces the body weight and BMI in both groups, but these reductions were not different between negative and positive FHD groups. This study could not find any significant association between FHD and responsiveness to weight loss diets (β = −0.058; 95% confidence interval, −1.618 to 0.832; P = 0.526). Individuals with FHD have higher risk for obesity and chronic diseases, but in the current study there was no difference in responsiveness to weight loss in individuals with a positive family history and those without a family history.

Salt sensitivity of blood pressure (BP) is an independent risk factor for cardiovascular morbidity. Up to 50% of patients with essential hypertension are salt-sensitive, as manifested by a rise in BP with salt intake. Several genetic variations have been identified as being associated with salt sensitivity. The present study aimed to review the evidence on the effect of gene polymorphisms on the salt sensitivity of BP. We searched in PubMed website from 1990 to 2011, with the use of following keywords: “hypertension, dietary salt, polymorphisms, and blood pressure”. The effect of sodium intake on BP differed by genotype at the genes of the renin-angiotensin system, aldosterone synthase, cytochrome p450 3A, epithelial sodium channel genes, genes of sympathetic nervous system, β-3 subunit of G-protein, alpha-adducin, endothelial nitric oxide synthase, Kallikrein-Kinin system. These approaches suggest that these polymorphisms may be potentially useful genetic markers of BP response to dietary salt. There is evidence that genetic predisposition modulates the BP response to diet. Therefore, diet and nutrition can mitigate or enhance the effects of genetic predisposition. Increasing our knowledge of this relationship can lead to individualized treatment and increased understanding of hypertension.

Tachycardia-induced cardiomyopathy (TIC) is a rare cause of dilated cardiomyopathy (DCMP). The diagnosis can be missed because tachycardia is a common symptom in DCMP.CASE REPORT: We reviewed a case 5-year-old with palpitation and dyspnea with symptoms and signs of heart failure that diagnosed as DCMP initially. Then, in the evaluation for cause of tachycardia, atrial tachycardia was detected. Hence, treatment with flecainide was started and after 3 months, left ventricular (LV) systolic function and symptoms of the patient was relieved. TIC should be suspected in all patients with unexplained LV dysfunctions in the setting of a persistent tachyarrhythmia.