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Year of Publication
1.  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
2.  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
3.  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
4.  Modulation of coronary artery disease risk factors by menopausal status: A population based study among Iranian women (KERCADRStudy) 
ARYA Atherosclerosis  2013;9(6):332-336.
BACKGROUND
Menopause is now viewed as a risk factor for coronary heart diseases (CHD). There is a scarcity of evidence concerning the effects of menopause on coronary artery disease (CAD) risk factors. The present study aimed to evaluate the effects of menopausal status on CAD risk factors.
METHODS
The present study was designed as part of the Kerman coronary artery disease risk study (KERCADRS) that was a population-based study among a cohort of 6000 individuals aged 15 to 75 years in Kerman, Iran. Only women aged 35 to 60 years were enrolled. Participants were categorized according to reproductive age into the three groups of premenopausal, perimenopausal, and postmenopausal states.
RESULTS
The premenopausal status was accompanied with lower levels of triglyceride (TG), cholesterol, fasting plasma glucose (FPG), and blood pressure compared with the other two groups (P < 0.001). In addition, women in the postmenopausal group had higher levels of low-density lipoprotein (LDL) in comparison with the other two groups (P < 0.001). After adjusting for age, total cholesterol and LDL levels were significantly higher in the postmenopausal group compared with the other two groups (P < 0.05). In addition, total cholesterol and LDL levels, and systolic blood pressure were statistically different according to menopausal status after adjustment for both age and body mass index (P < 0.05).
CONCLUSION
The increased risk of cardiovascular disease in postmenopausal period can be explained by elevated levels of lipid profile and increased systolic blood pressure, regardless of effects of advanced age or other anthropometric parameters.
PMCID: PMC3933056  PMID: 24575135
CAD Risk Factors; Women; Premenopause; Perimenopause; Postmenopause
5.  Effect of conjugated linoleic acid and omega-3 fatty acid supplementation on inflammatory and oxidative stress markers in atherosclerotic patients 
ARYA Atherosclerosis  2013;9(6):311-318.
BACKGROUND
Cardiovascular disease is the major cause of morbidity, mortality, and disability in Iranian people. Inflammation and oxidative processes are key components of cardiovascular disease. The aim of this study was to evaluate the effect of conjugated linoleic acids (CLA) and omega-3 fatty acid (ω-3 fatty acids) supplementation on inflammation markers and oxidative stress in atherosclerotic patients.
METHODS
This study was a two-month clinical, randomized trial. 90 volunteers who referred to Emam Reza Heart Clinic of Shiraz University of Medical Sciences (Shiraz, Iran) from February to March 2011 and had the inclusion criteria of this study were selected. Participants were classified into 3 groups receiving 3 g/d CLA, 1920 mg/d ω-3, or placebo for 2 months. C-reactive protein (CRP), interleukin-6 (IL-6), malondialdehyde (MDA), and glutathione peroxidase (GPx) were measured before and after supplementation.
RESULTS
The hs-CRP level decreased significantly in both the omega-3 and CLA group (P < 0.05). IL-6 reduced significantly in the ω-3 group, but the reduction of IL-6 levels in the CLA group was not significant. GPx increased in the CLA and omega-3 groups (P < 0.05). MDA level decreased significantly in both omega-3 and CLA groups (P < 0.05). Comparison between the groups indicates a significant change in CRP levels in the ω-3 group relative to the control group. However, other indices did not cause any significant change in the ω-3 and CLA groups in comparison to the control group.
CONCLUSION
Diet supplementation with CLA and ω-3 can have a beneficial effect on some indices of inflammatory and oxidative stress.
PMCID: PMC3933057  PMID: 24575132
Atherosclerosis; Inflammation; Oxidative Stress; Conjugated Linoleic Acids
6.  Pivotal role of microRNA-33 in metabolic syndrome: A systematic review 
ARYA Atherosclerosis  2013;9(6):372-376.
Metabolic syndrome (MetS) is a major public health concerns and increase in the incidence of MetS caused a rise in the rates of global morbidity, and mortality due to cardiovascular disease and diabetes. Lifestyle modification, a healthy diet, and pharmacological treatment and bariatric surgery are recommended in order to control this syndrome. Molecular mechanisms of metabolic disorders are essential in order to develop novel, valid therapeutic strategies. MicroRNA-33 plays imperative regulatory roles in a variety of biological processes including collaboration with sterol regulatory element-binding protein (SREBP) to maintain cholesterol homeostasis, high-density lipoprotein formation, fatty acid oxidation, and insulin signaling. Investigation of these molecules and their genetic targets may potentially identify new pathways involved in complex metabolic disease processes, improve our understanding of metabolic disorders, and influence future approaches to the treatment of obesity. This article reviews the role of miRNA-33 in metabolic syndrome, and highlights the potential of using miRNA-33 as a novel biomarker and therapeutic target for this syndrome.
PMCID: PMC3933058  PMID: 24575141
MicroRNA-33; Insulin Resistance Syndrome X; Regulatory Role
7.  Clinical investigation of the acute effects of pomegranate juice on blood pressure and endothelial function in hypertensive individuals 
ARYA Atherosclerosis  2013;9(6):326-331.
BACKGROUND
Pomegranate juice (PJ) is rich in bioactive phytochemicals with antioxidant, and anti-inflammatory and cardioprotective functions. The present trial investigated the acute effects of PJ consumption on blood pressure and markers of endothelial function.
METHODS
In this single-arm study, thirteen hypertensive men aged 39-68 years were recruited. Included subjects were assigned to natural PJ (150 ml/day) following a 12 hour fast. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and flow-mediated dilation (FMD), along with serum concentrations of C-reactive protein (CRP), intracellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), E-selectin and interleukin-6 (IL-6) were measured at baseline and 4-6 hours after PJ consumption.
RESULTS
Comparison of pre- vs. post-trial values revealed a significant reduction in both SBP (7%; P = 0.013) and DBP (6%; P < 0.010). However, changes in FMD (20%) as well as circulating levels of CRP, ICAM-1, VCAM-1, E-selectin, and IL-6 did not reach statistical significance (P = 0.172).
CONCLUSION
PJ has promising acute hypotensive properties. Consumption of PJ could be considered in the context of both dietary and pharmacological interventions for hypertension.
PMCID: PMC3933059  PMID: 24575134
Punica Granatum L.; Cardiovascular Disease; Hypertension; Inflammation; Endothelium-Dependent Dilation
8.  Designing and standardizing a questionnaire for evaluating knowledge, attitude, and practice of Iranian adults with cardiovascular diseases about oral health 
ARYA Atherosclerosis  2013;9(6):350-356.
BACKGROUND
Cardiovascular diseases are the most common cause of death in Iran. Moreover, periodontal diseases are very common in our country. In this study, we have designed a standardized questionnaire for evaluating knowledge, attitude, and practice (KAP) of Iranian adult patients with cardiovascular diseases about oral health.
METHODS
For designing and standardizing a self-administered questionnaire, we performed a cross-sectional pilot study on 51 cases with periodontal complaints. A dentist carried out the physical examination to determine oral health indicators. Twelve experts and ten lay people of the target population answered questions about validity. Cronbach’s alpha, factor analysis, and Pearson correlation coefficients were used in the analysis.
RESULTS
The cases of this pilot study were middle aged, with moderate financial and health status, but low oral health and educational level. Debris score was correlated with all other physical exam findings except decay, missing, and filled (DMF). Reliability was 0.826 according to Cronbach’s alpha score. Face validity was higher than 80%. Content validities of the whole of the questionnaire were 85.98% for clarity, 78.05% for relevancy, 85.16% for simplicity, and 82.32% for consistency of each question with the question set. Factor analysis showed that 15 components explain 74% of the total variance.
CONCLUSION
This questionnaire is culturally adjusted and appropriate for our community, valid and reliable, and sufficiently estimates the variance of the oral health status. It can be used as a standard tool in further studies in adult population of the Iranian middle aged patients with low level of education and moderate socioeconomic status.
PMCID: PMC3933060  PMID: 24575138
Questionnaires; Reproducibility of Results; Validation Studies; Validity; Reliability; Oral Health; Periodontal Diseases
9.  Impacts of fresh lime juice and peel on atherosclerosis progression in an animal model 
ARYA Atherosclerosis  2013;9(6):357-362.
BACKGROUND
The main protective role of antioxidants in the progression of atherosclerosis has been shown in some studies. Therefore, this project evaluated the effects of Citrus aurantifolia (Christm) juice and peel on antioxidant activity and atherosclerosis progression in rabbits receiving a hypercholesterolemic diet.
METHODS
Forty white New Zealand male rabbits were randomly allocated to four groups. All groups were on hypercholesterolemic diet for two months. While the first group was considered as the hypercholesterolemic control, groups 2 and 3 (intervention groups) received 5 ml/day lime juice and 1 g/day dried lime peel powder, respectively. Group 4 was fed a normal diet (normal control). Before and after the study, weight was measured and a fasting blood specimen was taken from the rabbits. Serum lipids analyses and antioxidant activity evaluations were then performed. The rabbits’ aorta and coronary arteries were separated and the presence of fatty streaks was studied.
RESULTS
Comparing to the hypercholesterolemic control group (-25.2 ± 7.0), only the plasma total antioxidant capacity change was significantly more in rabbits supplemented with lime juice (16.3 ± 14.7) and peel (8.6 ± 7.1) (P = 0.008). The presence of fatty streaks in coronary arteries and aorta of the intervention groups [juice (0.2 ± 0.01); peel (0.0 ± 0.00)] was significantly decreased compared to the hypercholesterolemic control group (1.2 ± 0.4) (P < 0.001).
CONCLUSION
Based on our findings, Citrus aurantifolia peel and juice increase plasma antioxidant capacity in rabbits, and can thus prevent or decelerate the process of atherogenesis. However, lime peel is more effective than lime juice.
PMCID: PMC3933061  PMID: 24575139
Animal; Atherosclerosis; Atherogenic Diet; Fatty Streak; Intervention; Lime
10.  Impact of the components of Mediterranean nutrition regimen on long-term prognosis of diabetic patients with coronary artery disease 
ARYA Atherosclerosis  2013;9(6):337-342.
BACKGROUND
The impact of different nutritional regimens on long-term prognosis and outcome in diabetic patients with coronary artery disease (CAD) has been questioned. Therefore, the objective of the present study was to determine the effects of different nutritional components of Mediterranean regimen on long-term cardiovascular events in diabetic patients with CAD in the Iranian population.
METHODS
In a prospective cohort study, we recruited 233 consecutive patients with the diagnosis of type 2 diabetes mellitus and with at least 6 months of documented CAD. Nutritional assessment was obtained by a validated semi-quantitative food frequency questionnaire (FFQ) and the diet score was calculated on the basis of the Mediterranean diet quality index (Med-DQI). For Assessing long-term CAD prognosis, the patients were followed by telephone for one year. The study endpoint was long-term major adverse cardiac and cerebrovascular event (MACCE).
RESULTS
Death was observed in 19 patients (8.2%) during the one-year follow-up. Two patients (0.9%) suffered non-fatal myocardial infarction and 14 (6.0%) needed revascularization within 1 year after discharge from hospital. Overall MACCE within one year in the study population was 12.4%. There were significant differences between number of deaths and dietary scores of saturated fatty acid, cholesterol, meats, fish, and fruit and vegetables (P < 0.05). Moreover, significant differences were found between MACCE rate and dietary scores of saturated fatty acid, cholesterol, and fruit and vegetables (P < 0.05). Using multivariate logistic regression models, Mediterranean dietary regimen could effectively predict long-term death as well as MACCE adjusted for gender and age variables.
CONCLUSION
Mediterranean dietary regimens, including low level of cholesterol and saturated fatty acid, can effectively improve long-term outcome including death and MACCE in diabetic patients with CAD.
PMCID: PMC3933062  PMID: 24575136
Diabetes Mellitus; Coronary Artery Disease; Nutrition
11.  Selection of best door-to-cardiac regeneration (D2CR) time 
ARYA Atherosclerosis  2013;9(6):377-379.
In spite of great progress in the treatment of acute coronary syndrome (ACS) events in reperfusion era, patients are still at risk for development of heart failure due to negative remodeling. Thus, the importance of regenerative therapies in parallel with reperfusion strategies is fundamental. A key feature in this case is obtaining the most appropriate door-to-cardiac regeneration (D2CR) time. This golden time in which fresh stem cells can invade scare-prone tissue could be defined as door-to-cardiac stem cell (D2CSC) plus door-to-cardiac regeneration (D2CR) time. Application of stem cells in this golden time allows comprehensive regeneration and reconstruction. Therefore, the aim of this study was to plan the outlines of simultaneous application of cellular and vascular reconstruction strategies.
PMCID: PMC3933063  PMID: 24575142
Cardiac Regeneration; Stem Cell; Golden Time
12.  Suggested indications of clinical practice guideline for stem cell-therapy in cardiovascular diseases: A stepwise appropriate use criteria for regeneration therapy 
ARYA Atherosclerosis  2013;9(5):306-310.
Despite astonishing progress concerning cardiovascular diseases, patients are still suffering from complications of acute insults. Due to reverse remodeling and improper myocyte rebuilding, heart failure has become a common problem these days which needs more powerful myocardial reconstructing strategies. Indeed, no option cases afflicted with non-healing peripheral vascular diseases; refractory stable and unstable angina is the other field with paucity of proper treatments. For these cases, stem cell-based therapies became optimistic treatment, but lack of guideline-based indications regarding stem-cell is still a major problem which limits application of these cells for such end-stage cases. Here, an outline of appropriateness criteria for stem cell-based therapy is suggested.
PMCID: PMC3845691  PMID: 24302941
Appropriate Use Criteria; Clinical Practice Guideline; Cardiovascular Diseases; Stem Cells
13.  A rare anomalous origin of left subclavian artery from the circle of Willis in combination with right sided aortic arch: A case report 
ARYA Atherosclerosis  2013;9(5):303-305.
BACKGROUND
One of the rare aortic congenital abnormalities is right sided aortic arch which is occurred in approximately 0.1% of the population. The anomalous origin of the subclavian arteries has also been reported.
CASE REPORT
In this study, a case of a right-sided aortic arch with anomalous left subclavian artery origin from the cerebral arteries is presented which was diagnosed in Computed tomography angiogram (CT angiogram) and angiography of a 10-year-old boy referred due to recurrent chest pains during two weeks before admission and pulselessness of his left upper limb and left carotid artery.
CONCLUSION
Many of the congenital vascular anomalies may have no obvious signs or symptoms and therefore the exact history and physical examination could help us in better diagnosis. Besides, some of these anomalies are associated with other abnormalities of other body organs particularly the cardiac system.
PMCID: PMC3845692  PMID: 24302940
Congenital Anomaly; Great Arteries; Pediatric
14.  Preventive effect of cinnamon essential oil on lipid oxidation of vegetable oil 
ARYA Atherosclerosis  2013;9(5):280-286.
BACKGROUND
Lipid oxidation is the main deterioration process that occurs in vegetable oils. This process was effectively prevented by natural antioxidants. Cinnamomum zeylanicum (Cinnamon) is rich with antioxidants. The present study was conducted to evaluate the effect of cinnamon on malondialdehyde (MDA) rate production in two high consumption oils in Iranian market.
METHODS
Chemical composition of cinnamon essential oil was analyzed by gas chromatography-mass spectroscopy (GC-MS). 200 µl each oil, 50 µl tween 20, and 2 ml of 40 Mm AAPH solutions were mixed and the prepared solution was divided into four glass vials. Respectively, 50 µl of 500, 1000 and 2000 ppm of cinnamon essential oil were added to three glass vials separately and one of the glass vials was used as the control. All of the glass vials were incubated at 37° C water bath. Rate of MDA production was measured by thiobarbituric acid (TBA) test at the baseline and after the 0.5, 1, 2, 3 and 5 hours.
RESULTS
Compounds of cinnamon essential oil by GC-MS analysis such as cinnamaldehyde (96.8%), alpha-capaene (0.2%), alpha-murolene (0.11%), para-methoxycinnamaldehyde (0.6%) and delta-cadinen (0.4%) were found to be the major compounds. For both oils, maximum rate of MDA production was achieved in 5th hours of heating. Every three concentrations of cinnamon essential oil significantly decreased MDA production (P < 0.05) in comparison with the control.
CONCLUSION
Essential oil of cinnamon considerably inhibited MDA production in studied oils and can be used with fresh and heated oils for reduction of lipid peroxidation and adverse free radicals effects on body.
PMCID: PMC3845693  PMID: 24302936
Cinnamon; Essential Oil; Lipid Peroxidation; Vegetable Oils
15.  Risk of sudden cardiac death 
ARYA Atherosclerosis  2013;9(5):274-279.
BACKGROUND
The aim of this study was to determine characteristics of patients with sudden cardiac arrest (SCA) and/or sudden cardiac death (SCD). We need an effective risk stratification method for SCD in patients without low left ventricular ejection fraction (LVEF).
METHODS
The study population of this cross-sectional study consisted of 241 patients with SCA or SCD who were admitted to an academic hospital, in Tehran, Iran, from 2011 through 2012. SCD was defined as unexpected death from cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of acute changes in cardiovascular status, or an unobserved death in which the patient was seen and known to be doing well within the previous 24 hours. Survivors of aborted SCD were also included in the study. Clinical and paraclinical characteristics as well as emergency department complications of patients were recorded.
RESULTS
The mean age of population was 66.0 ± 16.5 (17 to 90 years). Among the patients, 166 (68.9 %) were male, 50 (20.7%) were smoker, 77 (32.0%) had hypertension, 47 (19.5%) had diabetes mellitus, 21 (8.7%) had hyperlipidemia, and 32 (13.3%) had renal insufficiency. According to New York Health Association (NYHA) functional class, 31 (12.9%) patients were asymptomatic, 42 (17.4) and 99 (41.1%) subjects were in NYHA I and II, respectively and only 69 (28.6%) patients were in NYHA III or IV. In this study, presenting arrhythmia was pulseless electrical activity or asystole which was observed in 130 (53.9%) subjects. Ventricular tachycardia (VT) or ventricular fibrillation (VF) was seen in 53 (22%) patients. Cardiopulmonary resuscitation in emergency room was successful only in 46 (19.1%) subjects.
CONCLUSION
Low ejection fraction (EF) may be an independent predictor of sudden cardiac death in patients, but it is not enough. While implantable cardioverter defibrillators can save lives, we are lacking effective risk stratification and prevention methods for the majority of patients without low EF who will experience SCD.
PMCID: PMC3845694  PMID: 24302935
Death; Sudden Cardiac Arrest; Sudden Cardiac Death
16.  Evaluating the relative frequency and predicting factors of acute renal failure following coronary artery bypass grafting 
ARYA Atherosclerosis  2013;9(5):287-292.
BACKGROUND
Renal dysfunction or acute renal failure in patients undergoing coronary artery bypass grafting (CABG) is an important cause of morbidity and mortality. The great impact of acute renal failure (ARF) in the outcomes of cardiac surgery demands its study in our population, encouraging to the elaboration of this study, which aimed to identify the incidence and risk factors of ARF after CABG.
METHODS
Since March 2010 to 2011, 589 patients were studied who underwent CABG in Sina Hospital (Isfahan, Iran). In this cross-sectional study, patients were divided into two groups based on the occurrence of ARF after CABG and measured variables were compared between the two groups was also statistically significant. P value less than 0.05 was set as a significant level.
RESULTS
A total of 434 men and 155 women were enrolled in the study. The mean age of the study subjects was 57.6 years. ARF was seen in about 22% of patients after CABG. The mean age of ARF group was more than 3 years higher than that in the other group and the difference was significant between the two groups. Serum creatinine level after the surgery was different between the two groups. Moreover, the history of diabetes mellitus was significantly different between the two groups. Pump time comparison also showed was also statistically significant.
CONCLUSION
Our data showed older patients were more prone to affected by ARF. In addition, diabetic patients should be considered as high risk patients and are more likely to deteriorate by ARF. Despite increased prevalence of renal insufficiency in CABG patients, studies show that in most cases, this is not a serious problem and it is easily treatable. A lower proportion of patients (1.0 to 1.7% in different large series) develop ARF severe enough to require dialysis.
PMCID: PMC3845695  PMID: 24302937
Coronary Artery Bypass; Acute Kidney Injury; Creatinine
17.  A retrospective cohort study on factors associated blood pressure using multilevel modeling 
ARYA Atherosclerosis  2013;9(5):293-299.
BACKGROUND
Hypertension is a health problem in Iran. Given the importance of this subject, we reviewed the factors affecting the blood pressure in this survey.
METHODS
This retrospective cohort study was performed on 3961 male workers employed at Isfahan Polyacryl Corporation (Iran) in health and safety executive between 1996 until 2008. In this study, systolic and diastolic blood pressure (SBP and DBP) were considered as dependent variables; body mass index (BMI), age, type of job, marital status, shift work and educational level were considered as independent variables. MLwiN programmer version 2.1 was used to analyze the data.
RESULTS
BMI, age, shift work, marital status and educational level had statistical significant association with DBP. The result for SBP was similar to DBP except shift work and educational level that had no statistically significant association.
CONCLUSION
The results can be considered in the industry to provide practical solutions to reduce blood pressure.
PMCID: PMC3845696  PMID: 24302938
Blood Pressure; Cohort Study; Retrospective Study; Risk Factor; Multilevel Anal
18.  Aortic valve streptococcus group B endocarditis post-extracorporeal shock wave lithotripsy 
ARYA Atherosclerosis  2013;9(5):300-302.
BACKGROUND
Sub-acute left-sided bacterial endocarditis is a serious condition that may present with variable clinical manifestations. Its symptoms include both sterile and infected emboli, and various immunological phenomena.
CASE REPORT
This report presents a 55 year old man with frequency and dysuria after a lithotripsy and several admissions with urosepsis. Due to the suspicion of infective endocarditis echocardiography was done which confirmed streptococcus group B endocarditis.
CONCLUSION
Streptococci group B is one of the rare causes of infective endocarditis, but it was observed after various producers such as lithotripsy.
PMCID: PMC3845697  PMID: 24302939
Group B Streptococci; Infective Endocarditis; Lithotripsy
19.  Comparison of cardiovascular risk factors and biochemical profile in patients with cardiac syndrome X and obstructive coronary artery disease: A propensity score-matched study 
ARYA Atherosclerosis  2013;9(5):269-273.
BACKGROUND
This study was designed to compare the frequency of conventional cardiovascular disease risk factors and clinical biochemistry profile in patients with cardiac syndrome X (CSX) and obstructive coronary artery disease (CAD).
METHODS
A cross-sectional study was conducted on patients with typical angina and positive exercise tolerance test undergoing coronary angiography in our center. 342 consecutive patients with CSX were enrolled into this study and were matched regarding age and sex with 342 patients with acute coronary syndrome (ACS) and also 342 patients with chronic stable angina (SA). Cardiovascular risk factors as well as biochemistry profile of the patients were recorded.
RESULTS
Mean age of the studied patients was 53.0 years and 41.5% were male. There was no significant difference between the CSX patients and CAD patients regarding body mass index (BMI). Frequency of diabetes mellitus, hyperlipidemia, smoking, family history of premature CAD and hypertension was significantly lower in patients with CSX than ACS and SA patients. Patients with CSX had significantly higher levels of high-density lipoprotein cholesterol (HDL-cholesterol) than comparators while the levels of low-density lipoprotein cholesterol (LDL-cholesterol), total cholesterol, triglyceride and fasting blood sugar (FBS) were significantly lower in patients with CSX than CAD patients.
CONCLUSION
The present study demonstrated that CSX patients had substantially lower frequency of all conventional CVD risk factors than patients with obstructive CAD. This might aid in developing novel scoring systems or appropriateness criteria for angiographic evaluation of patients with typical angina and positive exercise test in order to reduce the rate of negative results.
PMCID: PMC3845698  PMID: 24302934
Cardiac Syndrome X; Microvascular Dysfunction; Coronary Artery Disease; Risk Factors
20.  Global coronary arteries spasm in a young patient 
ARYA Atherosclerosis  2013;9(4):260-262.
BACKGROUND
Coronary artery spasm is a transient narrowing of coronary arteries that slows or stops blood flow through the artery.
CASE REPORT
We present a 42-year-smoker man without any medical problem who developed syncope. Coronary angiography revealed diffuse significant narrowing of proximal left anterior descending artery (LAD), 90% osteal stenosis of large obtuse marginal (OM), 90% diffuse narrowing of proximal right coronary artery (RCA), which was relieved by intracoronary administration of nitrate. He was discharged on calcium channel blockers and nitrates but one month later developed syncope again and died.
CONCLUSION
Multivessel coronary artery spasm should be considered in young smoker patients without any other coronary risk factors who present with syncope.
PMCID: PMC3746942  PMID: 23970922
Syncope; Implantable Cardiac Defibrillators; Variant Angina
21.  Developing an appropriate model for self-care of hypertensive patients: first experience from EMRO 
ARYA Atherosclerosis  2013;9(4):232-240.
BACKGROUND
Cardiovascular diseases (CVDs) constitute 53% of deaths above the age of 30; 54% of these deaths are attributed to high blood pressure. Coronary artery disease (CAD) is the main cause of mortality in the world. Hypertension accounts for 13% of mortalities and 6% of morbidities and is one of the main risk factors that cause loss of healthy life years. Blood pressure is not optimally controlled even among those who are aware of their disease. Previous studies showed that apart from pharmacological treatment, lifestyle improvement can also play a significant role in the prevention of high blood pressure CVDs. Self-care among them has been addressed in several previous studies. There are few self-care programs in Iran, but no study has been conducted on blood pressure.
METHODS
In this study the primary model is designed and then revised, and in the pilot study the feasibility of the project was approved and the final model presented.
RESULTS
The current project proposes a model for self-care of hypertensive patients and their families, and is based on education of health care providers and patients in such a way that patients can control their illness.
CONCLUSION
The model can be implemented at a national scale.
PMCID: PMC3746943  PMID: 23970918
Self-Care; Hypertension; Model
22.  The correlation between educational levels and central obesity in the north of Iran: An epidemiologic study 
ARYA Atherosclerosis  2013;9(4):217-222.
BACKGROUND
The main aim of this study was to evaluate the association between educational levels and central obesity in northern Iran in 2010.
METHODS
This was a cross-sectional study carried out on 2428 subjects (1227 men and 1201 women) of 15-65 years of age who were chosen by cluster and stratified sampling methods. Subjects were randomly selected from 125 clusters and each cluster included 20 cases. Interviewers recorded the data using a multidimensional questionnaire comprising socio-demographic indexes.
RESULTS
Central obesity was seen in 34.8% of all subjects (15.9% male and 56.7% female) and in 15% of uneducated people. In the uneducated group, it was 20.0% and 31.1% higher than in the 1-9 years of schooling and high school or college educated groups, respectively (P = 0.001). The risk of central obesity increased in uneducated people (OR = 4.214, P = 0.001) and in people with 1-9 years of schooling (OR = 2.283, P = 0.001) compared with high school or college educated people. The risk of central obesity was higher in urban areas than in rural area (OR = 1.481, P = 0.001), in women than men (OR = 7.039, P = 0.001), in 40-65 year olds than 15-40 year olds (OR = 3.090, P = 0.001), and in the wealthy economic group than poor economic group (OR = 1.360, P = 0.013). The risk of central obesity increased in urban areas (OR = 2.266, P = 0.001) and the wealthy economic group (OR = 1.732, P = 0.001) after it was adjusted for education.
CONCLUSION
Central obesity as a health problem in northern Iran has been supported in this study, and it had an inverse correlation with educational levels. Public health programs that aim to reduce central obesity should mainly focus on the illiterate and low educated people.
PMCID: PMC3746944  PMID: 23970916
Education; Northern Iran; Adults; Central Obesity
23.  The correlation between early complications of percutaneous coronary intervention and high sensitive C-reactive protein 
ARYA Atherosclerosis  2013;9(4):263-267.
BACKGROUND
Increased incidence of cardiovascular diseases, especially coronary artery disease (CAD), during recent decades shows this disease entity to be the leading cause of death in the world. On the other hand many successes were achieved in the treatment of these diseases with new technology, which has its own side effects and threats for the patient. Among these new strategies is percutaneous coronary intervention (PCI), especially with stent implantation. Although coronary stents are effective in the treatment of dissection and prevention of restenosis, many side effects and even death have been observed, from 5-10% per year. Some studies showed that there is a relation between high sensitivity C-reactive protein (hs-CRP), as a laboratory marker for early detection of thrombosis and/or restenosis, and early complications of percutaneous coronary intervention. The aim of this study is to evaluate hs-CRP level in patients after PCI and to investigate if this can be a prognostic value for detection of early complication.
METHODS
This is a descriptive, analytical study done in Shahid Chamran Hospital (Isfahan, Iran) in 2011-2012. 87 patients who had undergone PCI were studied. Their hs-CRP level was measured before and after the study. Moreover, early stent complications were detected during the first 24 hours after insertion. The data was recorded in a researcher-constructed checklist and analyzed by SPSS for Windows 20.
RESULTS
The mean ± SD of hs-CRP level in patients with and without complication were 1.36 ± 0.97 and 3.09 ± 1.8, respectively. According to Student’s t-test, the hs-CRP level in patients with early complications was higher than patients without early complications of stent implantation; the difference was statistically significant (P < 0.001).
CONCLUSION
The hs-CRP serum concentrations of patients with, and without early stent complications were significantly different. According to the control diseases center (CDC) guideline, patients with a high level of hs-CRP need special care and attention.
PMCID: PMC3746945  PMID: 23970923
High Sensitivity C-reactive Protein (hs-CRP); Percutaneous Coronary Intervention (PCI) Complication
24.  Effects of quince leaf extract on biochemical markers and coronary histopathological changes in rabbits 
ARYA Atherosclerosis  2013;9(4):223-231.
BACKGROUND
Atherosclerosis is the main cause of cardiovascular disease which is caused by a high-fat diet. Many of these patients use boiled quince leaves for their treatment. However, the supporting scientific information is limit. The aim of this study was to evaluate the effect of quince leaf on the progression of atherosclerosis and whether it can be an appropriate alternative to statins.
METHODS
24 male rabbits were randomly divided into two groups: normal diet (6 n) and high-cholesterol diet (2% cholesterol, 18 n) for 8 weeks. At the end of the 8 weeks, both groups underwent blood sampling and their biochemical markers were measured. Then, all animals in the normal-diet group and three of the high-cholesterol diet group were killed to investigate atheromic plaque in their coronary artery. The 15 remaining rabbits of the high-cholesterol diet group were randomly divided into 3 groups (5 n) after discontinuation of the fatty diet. The first group was not given any treatment, the second received atorvastatin (0.5 mg/kg) orally, and the third received quince leaf extract (50 mg/kg) orally for 12 weeks. At the end of this period, after blood sampling, biopsy of coronary artery was performed for histological study.
RESULTS
The results showed that atorvastatin and quince leaf significantly decreased total cholesterol, triglyceride, LDL, AST, ALT, AP, BUN, and Cr levels compared with the first group of the high-cholesterol diet group (P < 0.05). No significant difference was found between atorvastatin and quince leaf extract groups in biochemical markers and atherosclerotic plaque in coronary artery.
CONCLUSION
Atorvastatin and quince leaf extract can effectively prevent the progression of atherosclerosis in coronary arteries. According to the results of this study and also lower toxic effects of herbal medication compared to synthetic medication, leaf extract can be a substitute for statins in treatment and prevention of cardiovascular disease. The anti-atherosclerotic effect of quince leaf is most likely related to its antioxidant components.
PMCID: PMC3746946  PMID: 23970917
Hyperlipidemia; Atherosclerosis; Coronary Arteries; Biochemical Markers; Atheromic Plaque; Atorvastatin; Quince Leaf Extract
25.  Factors affecting outcome of primary percutaneous coronary intervention for acute myocardial infarction 
ARYA Atherosclerosis  2013;9(4):241-246.
BACKGROUND
Primary percutaneous coronary intervention (PCI) is the main treatment for patients with ST-segment elevation myocardial infarction (STEMI). We investigated factors affecting the major complications of this procedure.
METHODS
This case-control study assessed 200 patients receiving primary PCI for STEMI. Effects of some factors including age, sex, coronary artery risk factors, left ventricular function, thrombolysis in myocardial infarction (TIMI) flow, and number of involved vessels on major adverse cardiac events (MACE) were studied.
RESULTS
Two thirds of patients were male but sex had no significant effect on MACE. Similarly, age, hypertension, and hyperlipidemia did not significantly affect the incidence of MACE. However, Killip class, left ventricular ejection fraction, diabetes, TIMI flow, and type of involved vessels had significant relations with the incidence of MACE.
CONCLUSION
According to our findings, factors such as diabetes, left ventricular function, left anterior descending artery involvement, and low TIMI flow are risk factors of MACE.
PMCID: PMC3746947  PMID: 23970919
Primary Percutaneous Coronary Intervention; ST-Segment Elevation Myocardial Infarction; Major Adverse Cardiac Events

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