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26.  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
27.  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
28.  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
29.  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
30.  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
31.  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
32.  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
33.  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
34.  Pulmonary hypertension due to a pulmonary artery leiomyosarcoma: A case report 
ARYA Atherosclerosis  2014;10(2):133-136.
BACKGROUND
Primary pulmonary artery sarcomas are very rare and their histologic type called leiomyosarcoma is even rarer. These tumors are frequently misdiagnosed as pulmonary thromboembolism in clinical settings. Many patients receive anticoagulant therapy without response, and many are diagnosed postmortem only. Most of the tumors reported in the literature have involved the right ventricular outflow tract and the main pulmonary trunk, often extending into the main pulmonary artery (MPA) branches.
CASE REPORT
A 64-year-old woman presented with weakness, fatigue, malaise, dyspnea, and marked elevation of pulmonary artery pressure was admitted to our hospital. She was initially diagnosed with chronic pulmonary thromboembolism, and chest computed tomography (CT) scan revealed lobulated heterogeneous left hilar mass extended to precarinal and subcarinal space. Magnetic resonance imaging (MRI) demonstrated a polypoid lesion at the trunk with extension to left MPA and its first branch. The patient was operated, and a yellowish-shiny solid mass in pulmonary trunk was seen intra-operation and pulmonary endarterectomy was performed. Her tumor was pathologically diagnosed as pulmonary artery leiomyosarcoma.
CONCLUSION
Clinicians must consider pulmonary artery sarcoma when making the differential diagnosis for patients with pulmonary artery masses. The clinical prediction scores and the CT and MRI findings can help identifying patients with pulmonary artery sarcoma.
PMCID: PMC4144375  PMID: 25161682
Hypertension; Leiomyosarcoma; Pulmonary Artery; Pulmonary Embolism
35.  Acute effects of smoking on QT dispersion in healthy males 
ARYA Atherosclerosis  2014;10(2):89-93.
BACKGROUND
Cigarette smoking increases the risk of ventricular fibrillation and sudden cardiac death (SCD). QT dispersion (QTD) is an important predictor of cardiac arrhythmia. The aim of this study was to assess the acute effect of smoking a single standard cigarette containing 1.7 mg nicotine on QT interval and QTD in healthy smokers and nonsmokers.
METHODS
The study sample population consisted of 40 healthy male hospital staff, including 20 smokers and 20 nonsmokers. They were asked to refrain from smoking at least 6 h before attending the study. A 12-lead surface electrocardiogram (ECG), recorded at paper speed of 50 mm/s, was obtained from all participants before and 10 min after smoking of a single complete cigarette. QT interval, corrected QT interval, QTD, and corrected QT dispersion (QTcD) were measured before and after smoking.
RESULTS
Smokers and nonsmokers did not have any significant differences in heart rate (HR) (before smoking = 67.35 ± 5.14 vs. 67.70 ± 5.07, after smoking = 76.70 ± 6.50 vs. 76.85 ± 6.50, respectively), QTD (before smoking = 37.75 ± 7.16 vs. 39.15 ± 6.55, after smoking = 44.75 ± 11.97 vs. 45.50 ± 9.58, respectively), and QTcD (before smoking = 39.85 ± 7.40 vs. 41.55 ± 6.57, after smoking = 50.70 ± 14.31 vs. 51.50 ± 11.71, respectively). However, after smoking a single cigarette, HR, mean QTD, and QTcD significantly increased (all had P value <0.001) in comparison to the measures before smoking.
CONCLUSION
Smoking of a single complete cigarette in both smokers and nonsmokers results in significant QTD increase, which can cause arrhythmia and SCD.
PMCID: PMC4144371  PMID: 25161676
Cardiac; Death; Electrocardiography; Smoking; Sudden
36.  Stent underexpansion in angiographic guided percutaneous coronary intervention, despite adjunctive balloon post-dilatation, in drug eluting stent era 
ARYA Atherosclerosis  2014;10(1):13-17.
BACKGROUND
Stent underexpansion is the most powerful predictor of long-term stent patency and clinical outcome. The purpose of this study was to evaluate the incidence and predictors of stent underexpansion despite adjunctive post-dilatation with non-compliant balloon.
METHODS
After elective coronary stent implantation and adjunctive post-dilatation with non-compliant balloon and optimal angiographic result confirmed by the operator, intravascular ultrasound (IVUS) was performed for all the treated lesions. If the treated lesions fulfilled the IVUS criteria, they are considered as the optimal stent group; if not, they are considered as the suboptimal group.
RESULTS
From 50 patients enrolled in this study 39 (78%) had optimal stent deployment and 11 (22%) had suboptimal stent deployment. In the suboptimal group 7 (14%) had underexpansion, 2 (4%) malposition, and 2 (4%) had asymmetry. There were no stent edge dissections detected by IVUS. We did not find any correlation between lesion calcification, ostial lesions, stent length, and stent underexpansion. Stent diameter ≤ 2.75 mm had a strong correlation with stent underexpansion.
CONCLUSION
Despite adjunctive post-dilatation with noncompliant balloon, using a relatively small stent diameter was a strong predictor for underexpansion. IVUS guided percutaneous coronary intervention (PCI) may be considered for drug eluting stent (DES) implantation in relatively small vessels.
PMCID: PMC4063511  PMID: 24963308
Stent; Percutaneous Coronary Intervention; Ultrasound; Post-dilatation
37.  The concept of Maslow's pyramid for cardiovascular health and its impact on “change cycle” 
ARYA Atherosclerosis  2014;10(1):65-69.
Since the leading cause of morbidity and mortality is cardiovascular diseases, every individual should think regularly about possessing and maintaining cardiovascular health. In reality, this self-processing is delayed until the occurrence of complications related to cardiovascular inefficiency manifested as chest pain and/or dyspnea. However, people should be trained to think about their cardiovascular health issues as a vital need from early childhood. This goal is achievable by understanding it as a "true human derive" and its consecutive "behaviors". Most people are unaware of their real needs, and even if they know all of their cardiovascular needs, this knowledge is not projected in their behaviors. In the present paper, I try to outline the Herzberg two-factor hypothesis and Maslow's hierarchy of needs.
PMCID: PMC4063512  PMID: 24963317
Maslow's;  Pyramid; Change Cycle; Cardiovascular Health
38.  Seasonal pattern in admissions and mortality from acute myocardial infarction in elderly patients in Isfahan, Iran 
ARYA Atherosclerosis  2014;10(1):46-54.
BACKGROUND
Seasonal variation in admissions and mortality due to acute myocardial infarction has been observed in different countries. Since there are scarce reports about this variation in Iran, this study was carried out to determine the existence of seasonal rhythms in hospital admissions for acute myocardial infarction, and in mortality due to acute myocardial infarction (AMI) in elderly patients in Isfahan city.
METHODS
This prospective hospital-based study included a total of 3990 consecutive patients with acute myocardial infarction admitted to 13 hospitals from January 2002 to December 2007. Seasonal variations were analyzed with the Kaplan-Meier table, log rank test, and Cox regression model.
RESULTS
There was a statistically significant relationship between the occurrence of heart disease based on season and type of acute myocardial infarction anatomical (P < 0.001). The relationship between the occurrence of death and season and type of AMI according to International Classification of Diseases code 10 (ICD) was also observed and it was statistically significant (P = 0.026). Hazard ratio for death from acute myocardial infarction were 0.96 [Confidence interval of 95% (95% CI) = 0.78-1.18], 0.9 (95%CI = 0.73-1.11), and 1.04 (95%CI = 0.85-1.26) during spring, summer, and winter, respectively.
CONCLUSION
There is seasonal variation in hospital admission and mortality due to AMI; however, after adjusting in the model only gender and age were significant predictor factors.
PMCID: PMC4063513  PMID: 24963314
Acute Myocardial Infarction; Season; Admission in Hospital; Mortality; Isfahan
39.  Determinants of uncontrolled hypertension in an Iranian population 
ARYA Atherosclerosis  2014;10(1):25-31.
BACKGROUND
Uncontrolled hypertension, a major concern among hypertensive patients, may be caused by various factors such as inadequate knowledge and inappropriate attitude, unhealthy lifestyle, and ineffective treatment. The present study tried to cast light on factors leading to uncontrolled hypertension.
METHODS
In this cross-sectional study, all hypertensive participants of the third phase of the Isfahan Healthy Heart Program were contacted and invited to take part in the study. A questionnaire including knowledge of and attitude toward hypertension and its control and treatment methods, and practice about lifestyle and pharmacological treatment was completed for all patients who consented to participate. The participants’ anthropometric indices and blood pressure were then measured. Chi-square and Student’s t-tests were used to compare the groups with controlled and uncontrolled blood pressure. The effect of each factor on uncontrolled blood pressure was assessed by employing stepwise logistic regression.
RESULTS
Of 114 participants, 43 (37.12%) and 71 (62.28%) individuals had controlled and uncontrolled blood pressure, respectively. Stepwise logistic regression revealed body mass index > 25 kg/m2 to have the greatest effects on uncontrolled blood pressure [Odds ratio (OR) = 13.091, Confidence interval of 95% (95% CI): 1.437-116.352, P = 0.021). In addition, male gender increased the risk for uncontrolled blood pressure (OR = 8.475, CI95%: 1.276-56.313, P = 0.027), while inappropriate attitude decreased the mentioned risk (OR = 0.047, CI95%: 0.007-0.318, P = 0.002).
CONCLUSION
According to our findings, obesity is the most important cause of uncontrolled blood pressure. Therefore, weight has to be closely monitored and controlled in hypertensive patients.
PMCID: PMC4063514  PMID: 24963310
Uncontrolled Hypertension; Obesity; Attitude
40.  Relationship between legumes consumption and metabolic syndrome: Findings of the Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2014;10(1):18-24.
BACKGROUND
Epidemiologic studies have shown an inverse association between dietary fiber and metabolic syndrome (MetS). Therefore, the purpose of this study was to investigate the association between MetS and consumption of legumes in adults in Isfahan, Iran.
METHODS
This cross-sectional study was carried out on 2027 individuals who were a subsample of the 3rd phase of the Isfahan Healthy Heart Program (IHHP). Basic characteristics information such as age, sex, smoking status, and physical activity were collected using a questionnaire. A validated 48-item food frequency questionnaire was used to assess dietary behaviors. Blood pressure, waist circumference (WC), glucose, triacylglycerols, and high-density lipoprotein cholesterol were measured, and MetS was defined based on Adult Treatment Panel III guidelines. Multiple logistic regression models examined associations of frequency consumption of legumes with MetS occurrence and its components.
RESULTS
All MetS components were less prevalent among subjects with regular legume intake (P < 0.01). Legume intake was inversely associated with the risk of MetS, after adjustment for confounding factors in women. Life style adjusted odds ratio of Mets between highest and lowest tertile and no consumption (as reference category) of legume intake were 0.31 (0.13, 0.70), 0.38 (0.17, 0.87), respectively, in women (P = 0.01).
CONCLUSION
This study showed that age has a crucial role in MetS incidence; therefore, after further age adjustment to lifestyle adjusted model there was no significant difference in lower and higher tertile of legume intake and MetS.
PMCID: PMC4063515  PMID: 24963309
Legumes; Metabolic Syndrome; Iran
41.  Comparison of competing risks models based on cumulative incidence function in analyzing time to cardiovascular diseases 
ARYA Atherosclerosis  2014;10(1):6-12.
BACKGROUND
Competing risks arise when the subject is exposed to more than one cause of failure. Data consists of the time that the subject failed and an indicator of which risk caused the subject to fail.
METHODS
With three approaches consisting of Fine and Gray, binomial, and pseudo-value, all of which are directly based on cumulative incidence function, cardiovascular disease data of the Isfahan Cohort Study were analyzed. Validity of proportionality assumption for these approaches is the basis for selecting appropriate models. Such as for the Fine and Gray model, establishing proportionality assumption is necessary. In the binomial approach, a parametric, non-parametric, or semi-parametric model was offered according to validity of assumption. However, pseudo-value approaches do not need to establish proportionality.
RESULTS
Following fitting the models to data, slight differences in parameters and variances estimates were seen among models. This showed that semi-parametric multiplicative model and the two models based on pseudo-value approach could be used for fitting this kind of data.
CONCLUSION
We would recommend considering the use of competing risk models instead of normal survival methods when subjects are exposed to more than one cause of failure.
PMCID: PMC4063516  PMID: 24963307
Competing Risks; Cumulative Incidence Function; Fine and Gray Model; Binomial Approach; Pseudo-value Approach; Cardiovascular Diseases
42.  Atrioventricular block as the initial presentation of calcified bicuspid aortic valve 
ARYA Atherosclerosis  2014;10(1):59-64.
BACKGROUND
Bicuspid aortic valve (BAV) is one of the most common and important congenital heart disorders in adults. If a patient with congenital disorders is not diagnosed early, the patient’s disease may progress to a severe condition and thus diagnosis of the main disorder will be rendered difficult.
CASE REPORT
A 34 year-old male patient referred to a referral medical care unit for cardiac electrophysiological study with cardiac shock due to complete heart block 3 months ago and he underwent Dual-Chamber permanent pacemaker (PPM) implantation. Thick and calcified bicuspid AV with invasion to interventricular septum, moderate to severe valve insufficiency (AI), severe aortic valve stenosis (AS), and dilated ascending aorta were observed at his echocardiography. Aortic valve replacement (AVR), aneurysm of ascending aorta, root replacement with tube graft (Bentall Procedure), and also a 3 chambers intracardiac defibrillator (ICD) were used. After 2 weeks of operation, he was discharged and at the first post-hospitalization visit (1 week later), his cardiovascular condition was acceptable.
CONCLUSION
Thick calcified aortic root is a less studied and potential contributing risk factor for AV block after AVR. Therefore, in candidates of aortic valve replacement, considering conductive disorders, especially in patients with calcified valve, is mandatory. Irreversible AV block requiring PPM implantation is a rare condition following AVR.
PMCID: PMC4063517  PMID: 24963316
Atrioventricular Block; Bicuspid Aortic Valve; Calcified Valve
43.  Comparison of cost-effectiveness and postoperative outcome of device closure and open surgery closure techniques for treatment of patent ductus arteriosus 
ARYA Atherosclerosis  2014;10(1):37-40.
BACKGROUND
Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA). Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery.
METHODS
In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure) was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars.
RESULTS
There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090). The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P < 0.001). This difference remained significant after adjustment for age and gender (Standardized Beta = 0.160, P = 0.031). PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$) or with Nit-Occlud coils (PFM) (912.73 ± 565.94 US$, P < 0.001) was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650) had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths occurred, two patients experienced pneumonia and seizure, and one suffered electrolyte abnormalities including hyponatremia and hypocalcemia.
CONCLUSION
Although open surgery seems to be less expensive than device closure technique, because of lower mortality and morbidity, the latter group is more preferable.
PMCID: PMC4063518  PMID: 24963312
Cost-effectiveness; Outcome; Device Closure; Open Surgery Closure; Patent Ductus Arteriosus
44.  The relation between body iron store and ferritin, and coronary artery disease 
ARYA Atherosclerosis  2014;10(1):32-36.
BACKGROUND
Iron is essential for many physiological processes; whereas, iron overload has been known as a risk factor in progression of atherosclerosis. The aim of this study was to investigate the importance of serum ferritin levels, which are known as an indicator of body iron stored in the incidence of coronary artery disease (CAD).
METHODS
In a case-control study, we evaluated 432 eligible men who underwent coronary angiography at Chamran Cardiology Hospital, Isfahan, Iran. They were separated into two groups of case (with CAD) and control (without CAD). All subjects had given written informed consents. Then, the blood samples were taken after 12-14 hours of fast by a biologist for measuring cardiovascular risk factors and body iron stores, including serum ferritin, serum iron, and total iron binding capacity (TIBC). For statistical analyses, chi-square test, Student’s t-test, one-way ANOVA, and the logistic regression were used.
RESULTS
In the present study, 212 participants with CAD in the case group and 220 participants free of CAD in the control group were included in the analysis. At baseline, there were significant differences in serum ferritin (P < 0.001) and other cardiovascular risk factors between the two groups. Moreover, when other risk factors of CVD were included in the model, serum ferritin [Odd Ratio (OR) = 1.006, 95% confidence interval of 95% (95% CI) 1.00-1.01, P = 0.045] and serum ferritin ≥ 200 (OR = 4.49, 95% CI 1.72-11.70, P < 0.001) were associated with CAD.
CONCLUSION
High iron store, as assessed by serum ferritin, was associated with the increased risk of CAD. Furthermore, it was a strong and independent risk factor in the incident of atherosclerosis in the Iranian male population.
PMCID: PMC4063519  PMID: 24963311
Iron; Ferritin; Coronary Artery Disease; Coronary Angiography
45.  Combination of atorvastatin/coenzyme Q10 as adjunctive treatment in congestive heart failure: A double-blind randomized placebo-controlled clinical trial 
ARYA Atherosclerosis  2014;10(1):1-5.
BACKGROUND
Heart failure is one of the leading causes of mortality, is a final common pathway of several cardiovascular diseases, and its treatment is a major concern in the science of cardiology. The aim of the present study was to compare the effect of addition of the coenzyme Q10 (CoQ10)/atorvastatin combination to standard congestive heart failure (CHF) treatment versus addition of atorvastatin alone on CHF outcomes.
METHODS
This study was a double-blind, randomized placebo-controlled trial. In the present study, 62 eligible patients were enrolled and randomized into 2 groups. In the intervention group patients received 10 mg atorvastatin daily plus 100 mg CoQ10 pearl supplement twice daily, and in the placebo group patients received 10 mg atorvastatin daily and the placebo of CoQ10 pearl for 4 months. For all patients echocardiography was performed and blood sample was obtained for determination of N-terminal B-type natriuretic peptide, total cholesterol, low density lipoprotein, erythrocyte sedimentation rate, and C-reactive protein levels. Echocardiography and laboratory test were repeated after 4 months. The New York Heart Association Function Class (NYHA FC) was also determined for each patient before and after the study period.
RESULTS
Data analyses showed that ejection fraction (EF) and NYHA FC changes differ significantly between intervention and placebo group (P = 0.006 and P = 0.002, respectively). Changes in other parameters did not differ significantly between study groups.
CONCLUSION
We deduce that combination of atorvastatin and CoQ10, as an adjunctive treatment of CHF, increase EF and improve NYHA FC in comparison with use of atorvastatin alone.
PMCID: PMC4063520  PMID: 24963306
Coenzyme Q10; Atorvastatin; Clinical Trial; Congestive Heart Failure
46.  Does percutaneous nephrolithotomy cause elevated cardiac troponins? 
ARYA Atherosclerosis  2014;10(1):41-45.
BACKGROUND
Percutaneous nephrolithotomy is the treatment of choice in large and staghorn renal stones, and myocardial infarction is one the possible complications during and after the surgery. We investigated if renal and skeletal muscle injury, caused by percutaneous nephrolithotomy, can cause elevation in cardiac troponins (cTn).
METHODS
This study was conducted on otherwise healthy patients with renal stone undergoing percutaneous nephrolithotomy. A baseline 12-lead electrocardiogram, echocardiography, and cTn assessment confirmed no cardiac pathology in any patients. Cardiac troponins T (cTnT) and I (cTnI), and also creatine kinase (CK) were assessed before and after surgery.
RESULTS
A total of 55 patients (69.1% males, mean age: 40.5 ± 13.8 year) were included. Serum creatinine level ranged from 0.7 to 1.3 mg/dl (mean = 1.03 ± 0.17). The level of CK was significantly increased by 469.5 ± 201.4 U/l (P < 0.001), and no positive cTnT or cTnI was observed after surgery.
CONCLUSION
The results of the present study showed that renal cell injury, caused by percutaneous nephrolithotomy, is not associated with elevated cardiac troponins. These findings show that increasing troponins in patients undergoing percutaneous nephrolithotomy indicate a cardiovascular pathology.
PMCID: PMC4063521  PMID: 24963313
Percutaneous Nephrolithotomy; Coronary Artery Disease; Acute Coronary Syndrome; Cardiac Markers; Troponin
47.  Safety of herbal medicine in treatment of weight loss 
ARYA Atherosclerosis  2014;10(1):55-58.
BACKGROUND
Obesity is a common health problem in both developed and developing countries. There are many unconventional therapies, including herbal medicine, to treat this condition. Some people believe that herbal medicines are safe. This case and review is about adverse complication of treating obesity with some herbal medicine.
CASE REPORT
A 19 year old male with sever obesity (120 kg) used green tea (15 cups of green tea per day) and an intensive dietary regimen to lose weight. He lost 30 kg after 2 months. At that time, one day after usual exercise he suddenly lost consciousness due to left ventricular fibrillation.
CONCLUSION
Use of herbal medicine for weight reduction is not always safe. Moreover, for some herbal medicine the risk is sufficient to shift the risk-benefit balance against the use that medicine.
PMCID: PMC4063522  PMID: 24963315
Herbal Medicine; Sudden Death; Complication; Obesity
48.  Relationship between dietary approaches to stop hypertension score and presence or absence of coronary heart diseases in patients referring to Imam Hossein Hospital, Tehran, Iran 
ARYA Atherosclerosis  2013;9(6):319-325.
BACKGROUND
The dietary approaches to stop hypertension (DASH) dietary pattern reduces blood pressure. However, there is little information about the relationship between DASH and coronary heart diseases. This study aimed to assess the relationship between a DASH-style diet adherence score and coronary heart diseases (CHD) in patients referring for coronary angiography.
METHODS
In this study, 201 adults (102 males, 99 females) within the age range of 40-80 years who referred for coronary angiography were selected. Diet was evaluated using a validated food frequency questionnaire. DASH score was calculated based on 8 food components (fruits, vegetables, whole grains, nuts and legumes, low fat dairy, red/processed meats, soft drinks/sweets, and sodium). The relationship between DASH score and CHD was assessed using logistic regression analysis.
RESULTS
Mean of DASH score was 23.99 ± 4.41. Individuals in the highest quartile of DASH score were less likely to have CHD [odds ratio (OR) = 0.38, 95% confidence interval (CI): 0.16-0.86]. However, after adjustment for gender or smoking, there was little evidence that coronary heart disease was associated with DASH diet score. There was a significant negative correlation between DASH score and diastolic blood pressure (P ≤ 0.05).
CONCLUSION
In conclusion, having a diet similar to DASH plan was not independently related to CHD in this study. This might indicate that having a healthy dietary pattern, such as DASH pattern, is highly related to gender (dietary pattern is healthier in women than men) or smoking habit (non-smokers have healthier dietary pattern compared to smokers).
PMCID: PMC3933053  PMID: 24575133
Coronary Heart Disease; Dietary Approach to Stop Hypertension; Blood Pressure
49.  Comparison of effects of soft margarine, blended, ghee, and unhydrogenated oil with hydrogenated oil on serum lipids: A randomized clinical trail 
ARYA Atherosclerosis  2013;9(6):363-371.
BACKGROUND
Trans fatty acids (TFAs) are known as the most harmful type of dietary fats. Therefore, this study was done to compare the effects of some different oils including unhydrogenated, blended, ghee, and soft magazine with hydrogenated oil on serum lipid profile of healthy adults.
METHODS
This study was a randomized clinical trial conducted on 206 healthy participants of 20 to 60 years of age. Subjects were randomly divided into 5 groups and each of them was treated with a diet containing unhydrogenated oil, ghee, blended oil, soft margarine, or hydrogenated oil for 40 days. Fasting serum lipids were measured before and after the study.
RESULTS
Compared to hydrogenated oil, total cholesterol (TC) and triglyceride (TG) had a significant reduction in all groups, LDL-C declined in unhydrogenated oil and soft margarine groups, and apolipoprotein (Apo) B only in unhydrogenated oil group (all P < 0.05). However, there was a significant enhancement in ApoA of ghee oil (P < 0.001).
CONCLUSION
Consuming unhydrogenated oil, ghee, soft margarine, and blended oil had some beneficial effects on serum lipids.
PMCID: PMC3933054  PMID: 24575140
Clinical Trial; Dietary Fat; Commercial Oil; Lipid
50.  Amiodarone versus lidocaine for the prevention of reperfusion ventricular fibrillation: A randomized clinical trial 
ARYA Atherosclerosis  2013;9(6):343-349.
BACKGROUND
Reperfusion ventricular fibrillation after aortic cross clamp is one of the important complications of open cardiac surgery and its prevention could reduce myocardial injuries. This study aimed to evaluate the efficacy of single dose of amiodarone or lidocaine by the way of pump circuit three minutes before aortic cross clamp release and compare the results with normal saline as placebo in a randomized double blinded controlled trial.
METHODS
One hundred fifty patients scheduled for first time elective coronary artery bypass graft surgery were randomly assigned to receive either single dose of amiodarone (150 mg), lidocaine (100 mg), or normal saline (5 ml) three minutes before aortic cross clamp release. The incidence of ventricular fibrillation and the need for reuse of drug were compared between these groups by chi-square, Student’s t-test, Mann-Whitney test, and One-way ANOVA. SPSS software was used for statistical analysis.
RESULTS
The incidence of ventricular fibrillation is higher in the placebo group (15.9%) compare to lidocaine (11.8%) and amiodarone (8.9%) groups; however, there was no statistical difference among the three groups (P = 0.41). Moreover, the reuse of amiodarone (22.7%) was statistically higher (P < 0.05) than lidocaine (5.9%).
CONCLUSION
This study showed no difference among lidocaine, amiodarone, and placebo in preventing ventricular fibrillation after aortic cross clamp release.
PMCID: PMC3933055  PMID: 24575137
Amiodarone; Lidocaine; Ischemia Reperfusion Injury; Ventricular Fibrilation; Randomized Controlled Trial

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