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26.  Complete heart block in a patient with POEMS syndrome: A case report 
ARYA Atherosclerosis  2014;10(5):276-279.
BACKGROUND
Polyneuropathy, organomegaly, endocrinopathy, monoclonal syndrome (POEMS) is a rare paraneoplastic syndrome associated with plasma cell dyscrasia.
CASE REPORT
A 48-year-old man presented with a 1-year history of paresthesia and progressive weakness of extremities. Diagnosis of POEMS syndrome was made for him on the basis of clinical presentation, additional physical findings, typical sclerotic bone lesion, and bone marrow findings. In last admission, he explained episodes of dyspnea and chest pain that associated with frequent premature ventricular contraction in his electrocardiograph. Patient heart monitoring showed some episodes of complete heart block. Infra-His atrioventricular block in electro-physiologic study was detected. He had no history of ischemic heart disease. His cardiopulmonary findings on examination were normal. All results of cardiac biomarkers and serum electrolytes and repeated echocardiography were within normal range. Cong red staining of rectal fat pad biopsy was negative. After pacemaker insertion radiation of sclerotic bone, lesion started for him, but radiotherapy was ineffective, and he expired with respiratory failure. Complete heart block in POEMS syndrome has not been reported previously, and it is the first POEMS case with complete heart block.
CONCLUSION
Complete heart block is a cardiac manifestation of POEMS syndrome.
PMCID: PMC4251484  PMID: 25477986
Complete Heart Block; POEM Syndrome; Multiple Meloma
27.  In-hospital outcomes after primary percutaneous coronary intervention according to left ventricular ejection fraction 
ARYA Atherosclerosis  2014;10(4):211-217.
BACKGROUND
The primary objective of primary percutaneous coronary intervention (pPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) is not only to restore the blood flow in the infarct-related artery, but also to save the patients’ quality and duration of their life. Since left ventricular ejection fraction (LVEF) is a known predictor of clinical outcomes in STEMI patients, the possible association between characteristics of a large group of patients who undergo pPCI with LVEF and death was evaluated.
METHODS
This prospective cohort study included 304 patients who had undergone pPCI between 2009 and 2011. The association between LVEF and in-hospital outcomes of patients was assessed.
RESULTS
LVEF ≤ 25%, 25% < LVEF < 50%, and LVEF ≥ 50% were presented in 23 (7.6%), 150 (49.3%), and 128 (42.1%) of the patients, respectively. Three patients (0.01%) died before echocardiography. There was no significant difference among aforementioned three groups regarding baseline characteristics, except age (P = 0.012) and sex (P = 0.016). Cumulative number of cardiogenic shock and death were 7 (2.3%) and 22 (7.2%), respectively; with significant differences between three LVEF groups. Age more than 70 years old, pulmonary edema, systolic blood pressure < 100 mm Hg, shock, post-PCI thrombolysis in myocardial infarction (MI) flow grade, corrected thrombolysis in MI frame count, angiographic success and ST-segment resolution showed significant association with death (P < 0.050).
CONCLUSION
This study not only demonstrates that LVEF ≤ 50% is associated with a higher incidence of in-hospital adverse events, but also identifies characteristics that are strongly correlated with the risk of LVEF ≤ 50% and death after pPCI.
PMCID: PMC4173312  PMID: 25258637
Myocardial Infarction; Percutaneous Coronary Intervention; Ejection Fraction; Corrected Trombolysis in Myocardial Infarction
28.  Relationship between blood peroxidases activity and visfatin levels in metabolic syndrome patients 
ARYA Atherosclerosis  2014;10(4):218-226.
BACKGROUND
The observed relationships between visfatin, peroxidases activity, and metabolic syndrome (MetS) are inconsistent; therefore, this study was undertaken to understand these relationships.
METHODS
This cross-sectional study was conducted as a part of the Isfahan Healthy Heart Program, Iran. A blood sample of 90 MetS and non-MetS patients were used to estimate total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), triglycerides (TGs), fasting blood glucose (FBG), waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP), visfatin and peroxidases activity. Data analysis for MetS group was carried out in two ways. (1) MetS with three components and with > 3 components. (2) MetS with hyperglycemia and without hyperglycemia.
RESULTS
SBP, DBP, WC, FBG, TC, TG, LDL-C, and were higher and HDL-C levels was lower in MetS patients. There was a significant correlation between visfatin levels and peroxidases activity in MetS patients with three components. Levels of visfatin were significantly higher in male as compared to female subjects in the MetS with three components group. There was a significant decrease in peroxidases activity in > 45 years old subjects in the MetS with > 3 components group. A significant correlation was observed between serum visfatin levels and FBG in the MetS without hyperglycemia group.
CONCLUSION
Peroxidases activities in MetS patients can be related to visfatin levels. Gender influences on peroxidases activity probably and was lower in female patients with MetS. Hyperglycemia does not influence peroxidases activities and visfatin levels.
PMCID: PMC4173313  PMID: 25258638
Peroxidase; Metabolic Syndrome; Visfatin
29.  Normal range of bleeding time in urban and rural areas of Borujerd, west of Iran 
ARYA Atherosclerosis  2014;10(4):199-202.
BACKGROUND
Bleeding time (BT) is the oldest and simplest test for assessing the platelets (Plts) function. BT can affect by several factors such as race and diet, which has a wide reference range. The aim of this project is to determine the normal range of BT in Borujerd, Iran. Determining the normal range of BT can help us to modify the definition of bleeding disorder and aspirin resistance.
METHODS
This was cross-sectional study carried out in 2011-2012. Subjects with a history of coagulation disorders or a positive family history of coagulation disorders, consumption of anti-Plts, anti-histamines, and phenothiazine in the previous month and subject with Plt less than 150,000 were excluded. The samples were 505 volunteers who were referred from 16 urban and 9 rural clusters to research center. BT of the samples was determined according to Ivy simplate method considering national standard protocol in the selected persons. Normal range was calculated as mean ± 2 standard deviation.
RESULTS
Of 505 volunteers, 50.4% were female. The range of BT was 2.8-2.95 min with mean of 2.79 ± 0.78 min. Range and mean of BT in women was 2.83-3.06 min and 2.88 ± 0.87 min, and range and mean of BT in men was 2.7-2.9 min and 2.69 ± 0.67 min; this difference was significant (P = 0.012). BT in urban and rural participants was 2.78 ± 0.79 and 2.77 ± 0.73 min. There was no significant difference between BT in urban and rural participants.
CONCLUSION
The normal range of BT in Boroujerd was in the lower limit of the normal universal range. In this study, BT was significantly different in both genders, but its correlation with age, blood group, and place of residency was not significant.
PMCID: PMC4173314  PMID: 25258635
Bleeding Time; Blood Platelet; Iran
30.  Undiagnosed interrupted aortic arch in a 59-year-old male patient with severe aortic valve stenosis: A case report and literature review 
ARYA Atherosclerosis  2014;10(4):230-232.
BACKGROUND
Interrupted aortic arch (IAA) is defined by a lack of the luminal continuity between the ascending and descending thoracic aorta. It is a rare, severe congenital heart defect which without surgery is associated with high mortality in the neonatal period. The aims of this study were to present a case with IAA who was alive until the age of 59 years without any surgical intervention and to review the literatures that have presented IAA cases.
CASE REPORT
The patient was admitted with respiratory distress and pulmonary edema. Echocardiography showed the sever stenosis in aortic valve and sever left ventricular dysfunction. Cardiac catheterization and angiography confirmed interrupted aorta (type A). The descending thoracic aorta was supplied by extensive collateral vessels from the vertebrobasilar system down to the posterior chest wall and the spine. Surgical correction including coronary artery bypass graft and aortic valve replacement and repair of interruption of the aorta was performed. Three weeks later the patient was died due to uncontrollable gastrointestinal bleeding and hospital acquired pneumonia. We described diagnosis and management of our case.
CONCLUSION
This case was very interesting for us, because the patient had not been diagnosed until the recent presentation. Similar cases with this diagnosis do not reach adulthood, but our patient was alive up to 59 years of age.
PMCID: PMC4173315  PMID: 25258640
Interrupted; Aorta; Aortic Valve Stenosis; Thoracic Aorta; Aortic Arch
31.  Study of antioxidant activity of sheep visceral protein hydrolysate: Optimization using response surface methodology 
ARYA Atherosclerosis  2014;10(4):179-184.
BACKGROUND
The main objective of this experiment was optimal use of none edible protein source to increase nutritional value of production with high biological function, including antioxidant activity.
METHODS
Sheep visceral (stomach and intestine) was used as substrate. Response surface methodology (RSM) was used to optimize hydrolysis conditions for preparing protein hydrolysate from the sheep visceral, using alcalase 2.4 l enzyme. The investigated factors were temperature (43-52 °C), time (90-180 min), and enzyme/substrate ratio [60-90 Anson-unit (AU)/kg protein] to achieve maximum antioxidant activity. Experiments were designed according to the central composite design.
RESULTS
Each of the studied variables had a significant effect on responses (P < 0.05). Optimal conditions to achieve antioxidant activity were, temperature (48.27 °C), time (158.78), min and enzyme/substrate ratio (83.35) Anson-unit/kg protein. Under these conditions, antioxidant activity was 68.21%, R2 for model was 0.983. The values indicated the high accuracy of the model to predict the reaction conditions considering different variables. The chemical analysis of protein hydrolysate showed high protein content (83.78%) and low fat content (0.34%).
CONCLUSION
Our results showed that protein hydrolysate of sheep visceral, can be used as a natural antioxidant with high nutritional value.
PMCID: PMC4173316  PMID: 25258632
Antioxidant Peptides; Protein Hydrolysate; Enzyme Hydrolysis; Optimization
32.  Dietary phytochemical index and subsequent changes of lipid profile: A 3-year follow-up in Tehran Lipid and Glucose Study in Iran 
ARYA Atherosclerosis  2014;10(4):203-210.
BACKGROUND
High intakes of phytochemical-rich foods have beneficial effects on lipid profiles and cardiovascular disease (CVD). In this study, we assessed the association between the dietary phytochemical index (PI) and changes in lipid profile after 3-year follow-up among Iranian adults.
METHODS
This longitudinal study was conducted in 1983 subjects, aged 19-70 years, selected among participants of the Tehran Lipid and Glucose Study in Iran. Dietary data were collected by using a validated semi-quantitative food frequency questionnaire with 168 food items at baseline. PI was calculated based on daily energy derived from [(phytochemical-rich foods kcal/total daily energy intake kcal) × 100]. Lipid profile was measured at baseline and after 3 years and changes in serum lipid profiles were assessed during 3-year follow-up.
RESULTS
The mean age of participants was 40.4 ± 13.0 years; participants in the highest PI quartile category were more likely to be older. After 3 years of follow-up, total cholesterol was significantly lower in the highest quartile compared with lower quartile of PI in men (181 ± 3 vs. 189 ± 3, P for trend < 0.05). There were significant inverse association between dietary PI and 3 years changes of total cholesterol [β = −5.6, 95% confidence interval (CI) = −9.3, −1.8], triglycerides (β = −13.7, 95% CI = −24.6, −2.8), and non-high-density lipoprotein cholesterol (HDL-C) (β = −6.2, 95% CI = −10.8, −1.5), in highest quartile of PI in men. Lipid profiles showed no significant changes over the study period in women.
CONCLUSION
Higher dietary PI is associated with 3 years improvement of total cholesterol, triglycerides, and non-HDL-C. Higher consumption of phytochemical-rich foods is recommended to prevent CVD.
PMCID: PMC4173317  PMID: 25258636
Phytochemical; Triglyceride; Cholesterol; Fruit and vegetables; Whole Grains
33.  Antiatherogenic, hepatoprotective, and hypolipidemic effects of coenzyme Q10 in alloxan-induced type 1 diabetic rats 
ARYA Atherosclerosis  2014;10(4):192-198.
BACKGROUND
Diabetes mellitus, one of the leading metabolic syndromes, accounts for highest morbidity and mortality worldwide. In this study, we examined possible protective effect of coenzyme Q10 on lipid profile, atherogenic index, and liver enzyme markers in alloxan-induced type 1 diabetic rats.
METHODS
A total of 30 male rats were randomly divided into three groups; group 1 as control, group 2 diabetic untreatment, and group 3 treatments with coenzyme Q10 by 15 mg/kg i.p. daily, respectively .Diabetes was induced in the second and third groups by alloxan injection subcutaneously. After 8 weeks, the levels of fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), very low-density lipoprotein (VLDL), high density lipoprotein (HDL), atherogenic index, atherogenic coefficient, cardiac risk ratio, and the activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) of all groups were analyzed. Data were analyzed using non-parametric Mann-Whitney test (using SPSS) and P < 0.05 was considered as significant.
RESULTS
Coenzyme Q10 inhibited significantly the activities of ALT (11.17%), AST (19.35%) and ALP (36.67%) and decreased FBG (21.19%), TG (37.24%), TC (17.15%), LDL (30.44%), VLDL (37.24%), atherogenic index (44.24%), atherogenic coefficient (49.69%), and cardiac risk ratio (37.97%), HDL level was significantly (33.38%) increased when treated with coenzyme Q10.
CONCLUSION
The findings of this study suggest that coenzyme Q10 exert beneficial effects on the lipid profile, atherogenic index, and liver enzymes activity in alloxan-induced type 1 diabetic rats.
PMCID: PMC4173318  PMID: 25258634
Diabetes; Lipid Profile; Atherogenic Index; Rats; Liver Enzymes; Coenzyme Q10
34.  P-wave dispersion and its relationship to aortic stiffness in patients with acute myocardial infarction after cardiac rehabilitation 
ARYA Atherosclerosis  2014;10(4):185-191.
BACKGROUND
The aim of our study was to investigate the P-wave dispersion from standard electrocardiograms (ECGs) in patients with acute myocardial infarction (AMI) after cardiac rehabilitation (CR) and determine its relation to arterial stiffness.
METHODS
This is a prospective study included 33 patients with AMI and successfully re-vascularized by percutaneous coronary intervention (PCI) underwent CR. Left ventricular ejection fraction (LVEF) was measured by biplane Simpson’s method. Left atrium (LA) volume was calculated. The maximum and minimum durations of P-waves (Pmax and Pmin, respectively) were detected, and the difference between Pmax and Pmin was defined as P-wave dispersion (Pd = Pmax-Pmin). Aortic elasticity parameters were measured.
RESULTS
LVEF was better after CR. The systolic and diastolic blood pressures decreased after CR, these differences were statistically significant. With exercise training, LA volume decreased significantly. Pmax and Pd values were significantly shorter after the CR program. The maximum and minimum P-waves and P-wave dispersion after CR were 97 ± 6 ms, 53 ± 5 ms, and 44 ± 5 ms, respectively. Aortic strain and distensibility increased and aortic stiffness index was decreased significantly. Aortic stiffness index was 0.4 ± 0.2 versus 0.3 ± 0.2, P = 0.001. Aortic stiffness and left atrial volume showed a moderate positive correlation with P-wave dispersion (r = 0.52, P = 0.005; r = 0.64, P < 0.001, respectively).
CONCLUSION
This study showed decreased arterial stiffness indexes in AMI patient’s participated CR, with a significant relationship between the electromechanical properties of the LA that may raise a question of the preventive effect of CR from atrial fibrillation and stroke in patients with acute myocardial infarction.
PMCID: PMC4173319  PMID: 25258633
Cardiac Rehabilitation; P-Wave Dispersion; Aortic Stiffness; Acute Myocardial Infarction
35.  Protection against ischemia-reperfusion injury in prolonged resuscitation: A case report and review of literature 
ARYA Atherosclerosis  2014;10(4):227-229.
BACKGROUND
The severity of ischemia/reperfusion injury determines the neurologic outcome after successful cardiopulmonary resuscitation.
CASE REPORT
We present a case of prolonged open-chest resuscitation who survived without neurologic sequel. Multiple applied strategies to limit the deleterious effects of ischemia and reperfusion injury, that is, infusion of magnesium sulfate and mannitol, protective lung ventilation and optimal postoperative pain control prevented the end organ damage in this patient. During the 40 min open-chest resuscitation, ventricular defibrillation was successfully attempted with extrathoracic paddles.
CONCLUSION
The appropriate use of pharmacologic and non-pharmacologic protective strategies could modify the inflammatory cascade and minimize the deleterious effects of reperfusion after prolonged periods of ischemia. The successful defibrillation in this patient warrants the use of standard paddles in open-chest surgeries where surgical small paddles are not available.
PMCID: PMC4173320  PMID: 25258639
Resuscitation; Ischemia; Reperfusion; Neuroprotection; Addiction; Extrathoracic Defibrillation
36.  Glycemic control in type 2 diabetes mellitus prevents coronary arterial wall infection 
ARYA Atherosclerosis  2014;10(3):141-146.
BACKGROUND
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
PMCID: PMC4144376  PMID: 25161684
Diabetes Mellitus; Hyperglycemia; Coronary Artery; Cytomegalovirus; Infection
37.  Comparison of the effect of different intensity exercise on a bicycle ergometer on postprandial lipidemia in type II diabetic patients 
ARYA Atherosclerosis  2014;10(3):147-153.
BACKGROUND
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.
METHODS
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 index29.83 ± 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.
RESULTS
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.
CONCLUSION
Results showed that moderate intensity exercise was more effective in increasing HDL cholesterol level in type II diabetics.
PMCID: PMC4144377  PMID: 25161685
Postprandial Lipidemia; Resistance Exercise; Bicycle Ergometer; Type II Diabetes
38.  Tachycardia-induced cardiomyopathy 
ARYA Atherosclerosis  2014;10(3):175-178.
BACKGROUND
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.
CONCLUSION
TIC should be suspected in all patients with unexplained LV dysfunctions in the setting of a persistent tachyarrhythmia.
PMCID: PMC4144378  PMID: 25161690
Dilated Cardiomyopathy; Heart Failure; Tachyarrhythmia
39.  The relationships between cortisol levels, insulin levels, and thyroid hormones with 24-h urinary sodium excretion in never treated essential hypertensive patients 
ARYA Atherosclerosis  2014;10(3):159-163.
BACKGROUND
To study the relationship between cortisol, insulin, and thyroid hormone levels with 24-h urinary sodium (Na) excretion levels in essential hypertensive patients.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
PMCID: PMC4144379  PMID: 25161687
Cortisol; Hypertension Insulin; Sodium; Thyroid
40.  Prognostic value of the high-mobility group box-1 in young patients with chest pain 
ARYA Atherosclerosis  2014;10(3):154-158.
BACKGROUND
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.
METHODS
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, Student’s independent t-test, and chi-square tests.
RESULTS
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).
CONCLUSION
Increased plasma HMGB1 concentration may be associated with an increased risk of coronary atherosclerosis.
PMCID: PMC4144380  PMID: 25161686
High-Mobility Group Box-1; Coronary Artery Diseases; Inflammation; Biomarkers
41.  Evaluation of the return to work and its duration after myocardial infarction 
ARYA Atherosclerosis  2014;10(3):137-140.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
PMCID: PMC4144381  PMID: 25161683
Myocardial Infarction; Return to Work; Left Ventricular Function; Job Satisfaction
42.  The association of genetic variations with sensitivity of blood pressure to dietary salt: A narrative literature review 
ARYA Atherosclerosis  2014;10(3):169-174.
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.
PMCID: PMC4144382  PMID: 25161689
Hypertension; Genetics; Diet Therapy
43.  Is responsiveness to weight loss diets affected by family history of diabetes? 
ARYA Atherosclerosis  2014;10(3):164-168.
BACKGROUND
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
PMCID: PMC4144383  PMID: 25161688
Body Weight; Body Mass Index; Weight Loss Diet; Family History of Diabetes
44.  Pediatric patients with renal disease and cardiovascular complications: A literature review 
ARYA Atherosclerosis  2014;10(2):118-128.
The cardiovascular burden of end stage renal disease (ESRD) in children has recently received more attention, and some authors have recommended that the origins of the increase in cardiovascular morbidity and mortality be found in childhood. In this comprehensive review of the literature, we aim to review the main and most recent studies evaluating cardiovascular risk factors in pediatric kidney disease patients. The literature suggests that ESRD, even in the pediatric population, is associated with a high rate of cardiovascular morbidity and mortality, and needs serious attention. Unfortunately, there is extreme scarcity of data on the efficacy of preventive strategies on cardiovascular morbidity and mortality in pediatric patients with renal disease. Therefore, authors of the current article recommend future studies to be directed to find beneficial and/or potential harmful effects of different interventions conventionally used in this population, including lifestyle modifications and pharmaceutical therapy on cardiovascular indices. Moreover, the effects of these drugs on the renal function of children with minimal kidney disease should be evaluated.
PMCID: PMC4144367  PMID: 25161680
Cardiovascular Complication; Children; Kidney Disease; Pediatrics
45.  A rare case of stenting of spontaneous dissection of Shepherd’s Crook right coronary artery 
ARYA Atherosclerosis  2014;10(2):129-132.
BACKGROUND
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS) and sudden death. It usually occurs in young women during the peripartum period; however, it had also been reported in older aged males having risk factors for atherosclerotic coronary artery disease.
CASE REPORT
This case describes a 69-year-old male patient who presented with manifestations of ACS due to a spontaneous dissection of the Shepherd’s Crook right coronary artery (RCA), which was successfully managed with percutaneous coronary intervention (PCI) and stenting. At the 6th month follow-up, the patient remained chest pain free.
CONCLUSION
Patients with SCAD in the presence of ongoing ischemia can be treated with PCI and stenting.
PMCID: PMC4144368  PMID: 25161681
Acute Coronary Syndrome; Percutaneous Coronary Intervention; Shepherd’s Crook Right Coronary Artery; Spontaneous Coronary Artery Dissection
46.  Behavioral determinants of cardiovascular diseases risk factors: A qualitative directed content analysis 
ARYA Atherosclerosis  2014;10(2):71-81.
BACKGROUND
The PRECEDE model is a useful tool for planers to assess health problems, the behavioral and environmental causes of the problems, and their determinants. This study aims to understand the experiences of patients and health care providers about the behavioral causes of cardiovascular diseases (CVDs) risk factors and their determinants.
METHODS
This qualitative study utilized content analysis approach based on the PRECEDE model. The study was conducted for over 6 months in 2012 at the diabetes units of health centers associated with Alborz University of Medical Sciences, which is located in Karaj, Iran. Data were collected using individual semi-structured interviews with 50 patients and 12 health care providers. Data analysis was performed simultaneously with data collection using the content analysis directed method.
RESULTS
Stress, unhealthy eating, and physical inactivity were the behaviors, which predict the risk factors for CVD. Most of the patients considered stress as the most important underlying cause of their illness. In this study, 110 of the primary codes were categorized into seven subcategories, including knowledge, attitude, perceived susceptibility, severity, perceived benefits, barriers, and self-efficacy, which were located in the predisposing category of the PRECEDE model. Among these determinants, perceived barriers and self-efficacy for the mentioned behaviors seemed to be of great importance.
CONCLUSION
Identifying behavioral determinants will help the planners design future programs and select the most appropriate methods and applications to address these determinants in order to reduce risky behaviors.
PMCID: PMC4144369  PMID: 25161674
Behavior; Cardiovascular Diseases; Risk Factors; Qualitative Research
47.  The effect of calcitriol on lipid profile and oxidative stress in hyperlipidemic patients with type 2 diabetes mellitus 
ARYA Atherosclerosis  2014;10(2):82-88.
BACKGROUND
Cardiovascular mortality is high among diabetic patients due to abnormalities in the plasma lipid and lipoprotein metabolism, and increased oxidative stress. This study aimed to investigate the effects of active vitamin D on serum lipids and oxidative stress markers in type 2 diabetic patients.
METHODS
A double-blind randomized placebo-controlled trial was carried out in 70 participants with type 2 diabetes, aged 30-75 years of age. The participants were randomly assigned to two groups. One group received two capsules of calcitriol (0.25 µg 1,25-dihydroxycholecalciferol per capsule) per day. The second group received placebo tablets. All participants received their oral hypoglycemic drugs as prescribed by the endocrinologist. At the beginning, after 6 weeks, and at the end of the 12-week supplementation trial, serum total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), and serum malondialdehyde (MDA) levels were measured.
RESULTS
There was a significant reduction in total cholesterol, LDL-cholesterol, TG, and MDA levels in both treatment and placebo groups (P < 0.05). Serum HDL-cholesterol level decreased significantly in the placebo group (P < 0.05), while it remained unchanged in the treatment group. However, the P values related to the between group’s comparisons were not significant for any variables.
CONCLUSION
Active vitamin D reduced lipid profile and oxidative stress markers in diabetic patients compared to the control group, but these alterations were not statistically significant
PMCID: PMC4144370  PMID: 25161675
Diabetes Mellitus; Lipoproteins; Oxidative Stress; Vitamin D
48.  The sustainability of interventions of a community-based trial on children and adolescents’ healthy lifestyle 
ARYA Atherosclerosis  2014;10(2):107-117.
BACKGROUND
Sustainability is the core of a successful health-related intervention program. This study was conducted to evaluate the sustainability of interventions of the Heart Health Promotion from Childhood (HHPC) project, one of the 10 interventional projects of the Isfahan Healthy Heart Program.
METHODS
The evaluation of HHPC included administrating surveys to 500 elementary and middle, and 500 high school students. The study participants were randomly selected from all schools in Isfahan. The questionnaires were administered by interviews to evaluate the sustainability of interventions.
RESULTS
The results of interviews showed that interventions were sustainable in 100% of elementary school, 99% of middle school, and 87% of high school students. Training of healthy lifestyle behaviors was significantly higher in all-girls middle schools (P < 0.001). Daily morning exercise was more frequent in girls high schools (P < 0.001), while selling unhealthy food was more frequent in boys high schools (P < 0.001). The participants attributed the success of the program mostly to students’ agreement and cooperation.
CONCLUSION
Even though 5 years have passed since the end of the HHPC project, many of the interventions have been continued at the schools, often because healthy behaviors have become institutionalized in the target population. However, now all schools have the same level of sustainability, especially the middle and high schools, and all-boys schools. Therefore, it is important for future projects to place additional emphasis on these institutions for future school-based interventions.
PMCID: PMC4144372  PMID: 25161679
Behavior; Community Health Planning; Institutionalization; Schools; Sustainability
49.  Subarachnoid block with low dose of bupivacaine and sufentanil in patients with coronary artery disease 
ARYA Atherosclerosis  2014;10(2):94-99.
BACKGROUND
Subarachnoid block with local anesthetics and opioids enable efficacious spinal anesthesia because of their synergistic effect and permit the use of low-dose local anesthetics, which results in a stable hemodynamic state. The purpose of this study was to describe the cardiovascular effects of spinal anesthesia with low-dose bupivacaine and sufentanil on patients with coronary artery disease.
METHODS
This study was a double-blind randomized clinical trial. A total of 18 patients who had known coronary artery disease were enrolled. Our subjects underwent spinal block for lower limb surgery with 7.5 mg hyperbaric bupivacaine 0.5% and 5 µg sufentanil. Complications related to anesthesia such as hypotension, bradycardia, vasopressor need, and blood or volume use were recorded.
RESULTS
The average mean arterial pressure decreased 15% in the first 15 min of spinal block in our cases. No patients presented with hypotension and the subjects were without complaints during the spinal anesthesia. All patients remained alert, and no ST segment changes were observed intraoperatively and until 6 h after the operation. Baseline ejection fraction (EF) 40% or less was observed in 10 patients and these subjects were compared with other patients. Systolic and diastolic blood pressures, mean arterial pressure, and heart rate decreased during the first 15 min in response to spinal anesthesia in both groups of patients, but decreased more significantly in patients with EF > 40%.
CONCLUSION
We recommend spinal block with low-dose bupivacaine and sufentanil in patients with coronary artery disease and especially in patients with low EF.
PMCID: PMC4144373  PMID: 25161677
Bupivacaine; Coronary Artery Disease; Subarachnoid Block
50.  Prediction of short-term clinical outcome of percutaneous coronary intervention in patients with acute coronary syndrome through myeloperoxidase levels 
ARYA Atherosclerosis  2014;10(2):100-106.
BACKGROUND
The present study assessed the significance of troponin and myeloperoxidase levels in the prediction of major adverse cardiac events (MACE) during the 1st month after percutaneous coronary intervention (PCI).
METHODS
This prospective, longitudinal study included 100 patients with acute coronary syndrome who underwent PCI. The participants’ characteristics were recorded in a questionnaire. Blood samples were obtained before and 24 h after PCI, and troponin, and myeloperoxidase levels were measured. During the 1st month after PCI, death, myocardial reinfarction, and revascularization during admission were investigated through weekly phone calls. The value of troponin and myeloperoxidase levels before and after PCI in predicting MACE was evaluated using Cox regression.
RESULTS
Considering the obtained methods and the short duration of the study, 99% of the patients completed the study. Moreover, one death and four cases of myocardial infarction and revascularization were reported. Cox regression did not show significant relations between the incidence of MACE and myeloperoxidase levels before (hazard ratio = 1.12; 95% confidence interval 0.9, 1.39) and after PCI (hazard ratio = 0.86; 95% confidence interval = 0.43, 1.71), or troponin levels before (hazard ratio = 0.97; 95% confidence interval = 0.81, 1.17) and after PCI (hazard ratio = 1.03; 95% confidence interval = 0.96, 1.11).
CONCLUSION
It seems that the few cases of MACE, due to the small sample size and short duration of follow-up, had been insufficient for determining the predictive value of troponin and myeloperoxidase levels before and after PCI. Therefore, further studies with larger sample size and longer follow-up duration are recommended.
PMCID: PMC4144374  PMID: 25161678
Percutaneous Coronary Intervention; Acute Coronary Syndrome; Major Adverse Cardiac Events; Myeloperoxidase

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