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1.  Cheese consumption in relation to cardiovascular risk factors among Iranian adults- IHHP Study 
Nutrition Research and Practice  2014;8(3):336-341.
It is expected that dairy products such as cheeses, which are the main source of cholesterol and saturated fat, may lead to the development or increase the risk of cardiovascular and metabolic diseases; however, the results of different studies are inconsistent. This study was conducted to assess the association between cheese consumption and cardiovascular risk factors in an Iranian adult population.
Information from the Isfahan Healthy Heart Program (IHHP) was used for this cross-sectional study with a total of 1,752 participants (782 men and 970 women). Weight, height, waist and hip circumference measurement, as well as fasting blood samples were gathered and biochemical assessments were done. To evaluate the dietary intakes of participants a validated food frequency questionnaire, consists of 49 items, was completed by expert technicians. Consumption of cheese was classified as less than 7 times per week and 7-14 times per week.
Higher consumption of cheese was associated with higher C-Reactive Protein (CRP), apolipoprotein A and high density lipoprotein cholesterol (HDL-C) level but not with fasting blood sugar (FBS), total cholesterol, low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and apolipoprotein B. Higher consumption of cheese was positively associated with consumption of liquid and solid oil, grain, pulses, fruit, vegetable, meat and dairy, and negatively associated with Global Dietary Index. After control for other potential confounders the association between cheese intake and metabolic syndrome (OR: 0.81; 96%CI: 0.71-0.94), low HDL-C level (OR: 0.87; 96%CI: 0.79-0.96) and dyslipidemia (OR: 0.88; 96%CI: 0.79-0.98) became negatively significant.
This study found an inverse association between the frequency of cheese intake and cardiovascular risk factors; however, further prospective studies are required to confirm the present results and to illustrate its mechanisms.
PMCID: PMC4058569  PMID: 24944780
Cheese consumption; cardiovascular risk factors; food frequency questionnaire
2.  The Cut-Off Values of Anthropometric Indices for Identifying Subjects at Risk for Metabolic Syndrome in Iranian Elderly Men 
Journal of Obesity  2014;2014:907149.
Aim. This study aimed to investigate which anthropometric indices could be a better predictor of metabolic syndrome (MetS) and the cut-off points for these surrogates to appropriately differentiate MetS in the Iranian elderly. Method. The present cross-sectional study was conducted on a sample of Isfahan Healthy Heart Program (IHHP). MetS was defined according to Third Adult Treatment Panel (ATPIII). In total, 206 elderly subjects with MetS criteria were selected. Anthropometric indices were measured and plotted using receiver operating characteristic (ROC) curves. Results. WC followed by WHtR yielded the highest area under the curve (AUC) (0.683; 95% CI 0.606–0.761 and 0.680; 95% CI 0.602–0.758, resp.) for MetS. WC at a cut of 94.5 cm resulted in the highest Youden index with sensitivity 64% and 68% specificity to predict the presence of ≥2 metabolic risk factors. BMI had the lowest sensitivity and specificity for MetS and MetS components. WC has the best ability to detect MetS which followed by WHtR and BMI had a lower discriminating value comparatively. Conclusion. WC is the best predictor for predicting the presence of ≥2 metabolic risk factors among Iranian elderly population and the best value of WC is 94.5 cm. This cut-off values of WC should be advocated and used in Iranian men until larger cross-sectional studies show different results.
PMCID: PMC3981184  PMID: 24782923
3.  Comparing clinical efficacy of Symbicort versus Pulmicort in reducing asthma symptom and improving its control 
Recently, higher efficacy of the combination of long-acting beta2-adrenoceptor agonist and inhaled corticosteroids on controlling asthma symptoms has been hypothesized. This study aimed to examine the clinical effects of the combination of Budesonide with formoterol (Symbicort) and Budesonide (Pulmicort) alone in persistent asthma.
Materials and Methods:
In a randomized double-blinded clinical trial, 76 patients with definite diagnosis of moderate-to-severe asthma were randomized to receive Pulmicort 180 mcg/inhalation two puffs twice daily, or receive Symbicort 80/4.5 mg/inhalation two puffs twice daily, or receive Symbicort 160/4.5 mg/inhalation two puffs twice daily for 3 months. All participants were initially evaluated by spirometry for assessing respiratory parameters and also the level of asthma control was assessed by Asthma Control Test (ACT).
More significant improvement in spirometry parameters, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, as well as in peak expiratory flow (PEF) in both groups of Symbicort with the regimens 80/4.5 mg/inhalation or 160/4.5 mg/inhalation 2 puffs twice daily compared with Pulmicort group, ACT score was significantly improved in Symbicort group with the regimens 160/4.5 mg/inhalation compared with both Symbicort groups with lower dosage and Pulmicort group. Response to treatment in PEF parameter and also in ACT level was significantly more in those who received Symbicort with the regimens 160/4.5 mg/inhalation compared with other two interventional groups adjusted for gender and age.
Symbicort with the regimens 160/4.5 mg/inhalation has higher efficacy in reducing asthma symptom and improving its control compared with low doses of this drug and with Pulmicort.
PMCID: PMC3988601  PMID: 24761394
Asthma symptom; symbicort; pulmicort
4.  Effects of Ferulago angulata Extract on Serum Lipids and Lipid Peroxidation 
Background. Nowadays, herbs they are considered to be the main source of effective drugs for lowering serum lipids and lipid peroxidation. The present experimental animal study aimed to assess the impact of Ferulago angulata on serum lipid profiles, and on levels of lipid peroxidation. Methods. Fifty male Wistar rats, weighing 250–300 g, were randomly divided into five equal groups (ten rats in each). The rat groups received different diets as follows: Group I: fat-rich diet; Group II: fat-rich diet plus hydroalcoholic extracts of Ferulago angulata at a dose of 400 mg/kg; Group III: fat-rich diet plus hydroalcoholic extracts of Ferulago angulata at a dose of 600 mg/kg; Group IV: fat-rich diet plus atorvastatin; Group V: common stock diet. The levels of serum glucose and lipids and the atherogenic index were measured. In addition, malondialdehyde (MDA), thiol oxidation, carbonyl concentrations, C-reactive proteins, and antioxidant capacity were evaluated in each group of rats. Results. Interestingly, by adding a hydroalcoholic extract of Ferulago angulata to the high-fat diet, the levels of total cholesterol and low-density lipoproteins (LDL) in the high-fat diet rats were both significantly reduced. This result was considerably greater compared to when atorvastatin was added as an antilipid drug. The beneficial effects of the Ferulago angulata extract on lowering the level of triglycerides was observed only when a high dosage of this plant extraction was added to a high fat diet. Furthermore, the level of malondialdehyde, was significantly affected by the use of the plant extract in a high-fat diet, compared with a normal regimen or high-fat diet alone. Conclusion. Administration of a hydroalcoholic extract of Ferulago angulata can reduce serum levels of total cholesterol, triglycerides, and LDL. It can also inhibit lipid peroxidation.
PMCID: PMC3953577  PMID: 24707310
5.  Contrast-induced nephropathy; A literature review 
Journal of Nephropathology  2014;3(2):51-56.
Context: Contrast-induced nephropathy (CIN) is a common cause of acute kidney dysfunction.
Evidence Acquisitions: Directory of Open Access Journals, Google Scholar, PubMed, EBSCO and Web of Science have been searched.
Results: It is necessary to identify at risk patients at early stages to implement preventive strategies to decrease the incidence of this nephropathy. However, mechanisms of CIN have not fully explained yet. It seems that mechanisms which mediated by nitric oxide and prostaglandin-induced vasodilatation have been played a crucial role in the CIN. Hemodynamic changes of renal blood flow, which causes hypoxia in the renal medulla and direct toxic effects of contrast media on renal cells, are thought to contribute to the pathogenesis of CIN. Contrast media is normally divided into iso-osmolar, low-osmolar, and high-osmolar. N-acetylcysteine is considered as one of the best choices to prevent CIN in high-risk groups.
Conclusions: The first aim to prevent CIN is identifying high-risk subjects and controlling associate risk factors. As significant differences existed between contrasts agents due to their physicochemical properties, low-osmolar or iso-osmolar contrast media should be used to prevent CIN in at-risk patients. The volume of contrast media should be as low as possible.
PMCID: PMC3999584  PMID: 24772397
Contrast-induced nephropathy; Contrast media; Percutaneous coronary intervention
6.  A Cost-Benefit and Accurate Method for Assessing Microalbuminuria: Single versus Frequent Urine Analysis 
Background. The purpose of this study was to answer the question whether a single testing for microalbuminuria results in a reliable conclusion leading costs saving. Methods. This current cross-sectional study included a total of 126 consecutive persons. Microalbuminuria was assessed by collection of two fasting random urine specimens on arrival to the clinic as well as one week later in the morning. Results. In overall, 17 out of 126 participants suffered from microalbuminuria that, among them, 12 subjects were also diagnosed as microalbuminuria once assessing this factor with a sensitivity of 70.6%, a specificity of 100%, a PPV of 100%, a NPV of 95.6%, and an accuracy of 96.0%. The measured sensitivity, specificity, PVV, NPV, and accuracy in hypertensive patients were 73.3%, 100%, 100%, 94.8%, and 95.5%, respectively. Also, these rates in nonhypertensive groups were 50.0%, 100%, 100%, 97.3%, and 97.4%, respectively. According to the ROC curve analysis, a single measurement of UACR had a high value for discriminating defected from normal renal function state (c = 0.989). Urinary albumin concentration in a single measurement had also high discriminative value for diagnosis of damaged kidney (c = 0.995). Conclusion. The single testing of both UACR and urine albumin level rather frequent testing leads to high diagnostic sensitivity, specificity, and accuracy as well as high predictive values in total population and also in hypertensive subgroups.
PMCID: PMC3886273  PMID: 24455207
7.  Pivotal Role of Mediterranean Dietary Regimen in the Increase of Serum Magnesium Concentration in Patients with Coronary Artery Disease 
Background. Recent studies confirmed cardioprotective role of intravenous magnesium for the prevention of cardiac events, but effect of dietary intake of this mineral via recommended dietary regimens on control and inhibition of coronary artery disease (CAD) risk factors has been questioned. The aim of the present study was to determine effect of Mediterranean dietary approach on serum magnesium concentration among Iranian patients with CAD. Method. Baseline characteristics and clinical data of 102 consecutive patients with the diagnosis of CAD and candidates for isolated coronary artery bypass surgery were entered into the study. Laboratory parameters especially serum magnesium concentration were measured after 12–14 h of overnight fasting and before operation. Nutritional status was assessed by food frequency questionnaire and the diet score was calculated on the basis of Mediterranean diet quality index (Med-DQI). Results. No significant differences were found in the concentrations of albumin, last fasting blood sugar, last creatinine, and lipid profiles between the groups with Mediterranean dietary score < 5 and the group with higher dietary score; however, serum magnesium concentration in the first group was higher than that in the group with higher dietary score. Linear multivariate regression analysis showed that the lower Mediterranean dietary score was a predictor for serum magnesium concentration after adjusting for confounders. Conclusion. Taking Mediterranean dietary regimen can be associated with increased level of serum magnesium concentration, and thus this regimen can be cardioprotective because of its effects on serum magnesium.
PMCID: PMC3838832  PMID: 24307942
8.  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
9.  Sex based levels of C-reactive protein and white blood cell count in subjects with metabolic syndrome: Isfahan Healthy Heart Program 
C-reactive protein (CRP) and white blood cell (WBC) are proinflammatory markers. They are major pathophysiological for the development of metabolic syndrome (MetS). This study aimed to address the independent associations between MetS and WBC counts and serum CRP levels and evaluation of their magnitude in relation to the MetS, based on the sex in the Iranian adults.
Materials and Methods:
In this cross-sectional study, subjects who met the MetS criteria, based on the Adult Treatment Panel III were selected from the Isfahan Healthy Heart Program database. A questionnaire containing the demographic data, weight, height, waist, and hip circumference of the respondents was completed for each person. Blood pressure was measured and the anthropometric measurements were done, and fasting blood samples were taken for 2 h postload plasma glucose (2 hpp). Serum [total, high-density lipoprotein (HDL), and low-density lipoprotein] levels of cholesterol, triglyceride, and CRP as well as WBC counts were determined. The univariate analyses were carried out to assess the relation between the CRP levels, WBC counts with the MetS in both sexes the.
In men with the abdominal obesity, the higher levels of WBC count, high serum triglyceride and blood glucose levels, a low serum HDL level, and raised systolic and diastolic blood pressure were observed. However, the higher serum CRP levels were only observed in those with the low serum HDL-cholesterol levels. The mean values of the WBC counts were statistically different between the men with and without MetS, but the mean values of the CRP levels were similar between the two groups. In women, the mean values of WBC count and CRP levels were statistically different in the subjects with and without a MetS components (except for the low serum HDL levels and high diastolic blood pressure for the WBC measures and abdominal obesity for the CRP measures) and for those with and without MetS. The age and smoking adjusted changes in the CRP levels and WBC counts correlated with the number of Mets components in the women.
The findings of this study suggest substantial implications for the prevention and management of the MetS and atherosclerotic diseases, as these involve the suppression of inflammatory conditions rather than the incitement of anti-inflammatory conditions.
PMCID: PMC3818614  PMID: 24250693
C-reactive protein level; metabolic syndrome; white blood cell count
10.  Metabolic Syndrome in Iranian Youths: A Population-Based Study on Junior and High Schools Students in Rural and Urban Areas 
Journal of Diabetes Research  2013;2013:738485.
Aim. The present population-based study aimed to assess prevalence of metabolic syndrome and itsrelated components in Iranian youth in the different sex, age, and residential subgroups. Method. Overall, 1039 junior high school and 953 high school students were selected using multistage random sampling. Fasting blood sugar, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were determined. Trained individuals measured waist circumference and blood pressure. Subjects with MetS were selected according to two definitions provided by the IDF and de Ferranti. Results. Among girls in intervention area, hypertriglyceridemia was more prevalent in rural than in urban areas using IDF definition. Significant differences were observed between boys in rural and urban areas regarding some components of metabolic syndrome including hypertriglyceridemia and high waist circumference. Besides, boys who are residents in urban areas had higher blood pressure, as well as higher waist circumference, than boys in rural areas. Conclusion. Our youth population is at significant risk of developing metabolic syndrome, and the pattern of this phenomenon seems to be discrepant in boys as well as in rural and urban areas probably due to the different lifestyle aspects, genetic factors, and racial differences.
PMCID: PMC3683475  PMID: 23819128
11.  Cardiac Fibroelastoma: A Rare Cause of Stroke in Young Adults 
Case Reports in Cardiology  2013;2013:250808.
A 26-year-old man presenting with a transient episode of dysarthria and dizziness, 3 weeks prior to admission, was referred to our center to be evaluated for transient ischemic attack (TIA). The patient had been previously admitted to a different hospital and echocardiography was reported normal at that center, but upon presenting to our institution strand-like masses in the left ventricle (LV) were detected. Transesophageal echocardiography (TEE) revealed two distinct mobile LV masses suggesting a diagnosis of papillary fibroelastoma. CT angiography and histopathological studies confirmed this diagnosis.
PMCID: PMC4007804  PMID: 24826279
12.  Preconditioning by isoflurane as a volatile anesthetic in elective coronary artery bypass surgery 
ARYA Atherosclerosis  2013;9(3):192-197.
Some pharmacological preconditioning approaches are utilized as an effective adjunct to myocardial protection, particularly following cardiac procedures. The current study addressed the potential clinical implications and protective effects of isoflurane as an anesthetic most applicable on postoperative myocardial function measured by cardiac biomarkers.
46 patients were included in the study. In 23 of them, preconditioning was elicited after the onset of cardiopulmonary bypass via a 5-minute exposure to isoflurane (2.5 minimum alveolar concentration), followed by a 10-minute washout before aortic cross clamping and cardioplegic arrest. 23 case-matched control patients underwent an equivalent period (15 minutes) of pre-arrest isoflurane-free bypass. Outcome measurements included creatine phosphokinase (CPK) and creatine kinase-MB (CK-MB) levels until 24 hours after the surgery.
None of the differences in enzyme levels at baseline and 24 hours after surgery between the two groups reached the threshold of statistical significance. The level of CPK was significantly reduced 24 hours after surgery compared with the baseline in the two groups. However, the postoperative release of CPK was consistently smaller in the isoflurane-preconditioned group than in the control group. The release of CK-MB displayed a statistically similar pattern. Multivariate linear regression analysis showed the effect of isoflurane regimen on reducing CPK level within the 24 hours after surgery compared with placebo.
Our study supports the cardio protective effect of isoflurane and the role of pharmacological preconditioning of the human heart by this volatile anesthetic during elective coronary artery bypass surgery.
PMCID: PMC3681278  PMID: 23766776
Preconditioning; Isoflurane; Volatile Anesthetic; Coronary Artery Bypass Surgery
13.  Predictors of Metabolic Syndrome in the Iranian Population: Waist Circumference, Body Mass Index, or Waist to Hip Ratio? 
Cholesterol  2013;2013:198384.
This study aimed to investigate whether body mass index (BMI), waist circumference (WC), or waist to hip ratio (WHR) could be a better predictor of metabolic syndrome and, if so, what would be the cutoff points for these surrogates to appropriately differentiate metabolic syndrome in different age and sex subgroups. Methods. The present cross-sectional study was conducted on a sample of Isfahan Cohort Study (ICS). In total, 468 individuals (194 with and 274 subjects without metabolic syndrome) according to the National Cholesterol Education Program's Adult Treatment Panel III (ATP-III) criteria were selected. Anthropometric indices were measured and plotted using receiver-operating characteristic (ROC) curves. Results. According to ROC curve analysis, WC and WHR parameters were better indicators of metabolic syndrome compared to BMI in women, whereas in men WHR had a lower discriminating value compared to the other two parameters. Among these three anthropometric parameters, BMI had a lower sensitivity and WC and WHR both had a higher sensitivity for predicting metabolic syndrome in women compared with in men. The cut points for WC were nearly equal in men and women, 90.3 versus 90.0, respectively. Women had higher cut points for BMI (28.5 kg/m2) compared to men (26.0 kg/m2). Our results showed the highest sensitivity and specificity for WC cut points specially in women. To predict metabolic syndrome, we looked into optimal age-specific cut points for BMI, WC, and WHR. The results indicated that WC had the highest discriminating value compared to other indicators in the different age subgroups. The optimal cut points for all three parameters gradually increased with age. Conclusion. Our results demonstrated that regardless of gender and age variables, WC could be a preferred parameter for predicting metabolic syndrome compared to BMI and WHR in Iranian population.
PMCID: PMC3619538  PMID: 23634297
14.  Differences in the prevalence of metabolic syndrome in boys and girls based on various definitions 
ARYA Atherosclerosis  2013;9(1):70-76.
The prevalence of metabolic syndrome (MetS) is increasing among children and adolescents. However, the prevalence of this disorder varies based on its different definitions. This study aimed to determine the prevalence of MetS in Iranian adolescents in junior high and high schools according to the definitions provided by the International Diabetes Federation (IDF) and De Ferranti.
Overall, 1039 junior high school and 953 high school students were selected using multistage random sampling. Demographic data was collected using validated questionnaires. Fasting blood sugar, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were determined. Waist circumference and blood pressure were measured by trained individuals. Subjects with MetS were selected according to two definitions provided by the IDF and De Ferranti. Chi-square and Fisher’s exact tests were used to compare the prevalence of MetS and its components based on sex, school level, and the two definitions.
The mean age of junior high and high school students was 13.11 ± 1.21ad 15.93 ± 1.07 years old, respectively. The prevalence of MetS among all participants was 4.8% and 12.7% according to the definitions by the IDF and De Ferranti, respectively. It was significantly higher among boys compared to girls. According to the IDF definition, low HDL-C and hypertension were the most frequent components. Based on the De Ferranti, abdominal obesity and hypertriglyceridemia were the most frequent components.
The prevalence of MetS was higher in both groups of students based on De Ferranti definition compared to the IDF definition. The prevalence was not significantly different in boys and girls. Further studies to investigate the most suitable definition of MetS for Iranian adolescents are necessary.
PMCID: PMC3653251  PMID: 23696762
Metabolic Syndrome; Adolescence; International Diabetes Federation and De Ferranti
15.  Socioeconomic characteristics and controlled hypertension: Evidence from Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2013;9(1):77-81.
Hypertension is a major risk factor for cardiovascular diseases. It affects approximately 18.0% of Iranian adults. This study aimed to estimate age-adjusted prevalence of hypertension and its control among Iranian persons older 19 years of age. It also tried to find and socioeconomic factors associated with hypertension control in Iranian population.
In Isfahan Healthy Heart Program (IHHP) subjects were selected by multistage random sampling. The participants completed questionnaires containing demographic information, lifestyle habits, medical history, and consumption of relevant medications, especially antihypertensive agents. Income, marital status, and educational level were considered as socioeconomic factors. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or taking antihypertensive medications. Controlled hypertension was considered as systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg among hypertensive subjects.
The prevalence of hypertension and controlled hypertension was 18.9% and 20.9%, respectively. We found significant relationships between hypertension and marital status, education, and income. At age ≥ 65 years old, odds ratio (OR) was 19.09 [95% confidence interval (CI): 15.01-24.28] for hypertension. Middle family income (OR: 0.71; 95% CI: 0.58-0.87) and education level of 6-12 years (OR: 0.29; 95% CI: 0.25-0.35) were significantly associated with increased risk of hypertension (P = 0.001). Among subjects aging 65 years old or higher, the OR of controlled hypertension was 2.64 (95% CI: 1.61-4.33). Married subjects had a higher OR for controlled hypertension (OR: 2.19; 95% CI: 1.36-3.52). Obesity had no significant relationships with controlled hypertension.
The IHHP data showed significant relationships between some socioeconomic factors and controlled hypertension. Therefore, as current control rates for hypertension in Iran are clearly unacceptable, we recommend preventive measures to control hypertension in all social strata of the Iranian population.
PMCID: PMC3653252  PMID: 23696763
Socioeconomic Factor; High Blood Pressure; Control
16.  The impact of a community trial on the pharmacological treatment in the individuals with the metabolic syndrome: findings from the Isfahan Healthy Heart Program, 2001-2007 
Archives of Medical Science : AMS  2012;8(6):1009-1017.
Pharmacological therapy is a crucial step in the management of individuals with the metabolic syndrome, when lifestyle modifications alone cannot achieve the therapeutic goals. The present study aimed to evaluate the efficacy of comprehensive interventions with the pharmacological treatment in individuals with the metabolic syndrome.
Material and methods
A cross-sectional population-based survey examined a sample of adults before and after conducting a community trial. Physical examination and blood sampling, data regarding the demographic characteristics, medical status and history of medication use were obtained. Pharmacologic treatment related to metabolic syndrome's components was also determined.
The most common pharmacologic agents consumed by individuals with metabolic syndrome were β-blockers (26.1% and 30.4% in 2001 and 2007, respectively), followed by lipid-lowering agents (5.4% and 14% in 2001 and 2007, respectively), with significant differences before and after intervention. The prevalence of metabolic syndrome was higher in women than in men both before (36.4% vs. 14%) and after the community trial (26.1% vs. 16%, respectively) in the intervention areas (p < 0.001).
We found a significant increase in medication use to control blood pressure and dyslipidemia among the individuals with the metabolic syndrome, notably in the intervention areas. In addition to the population approach, the high-risk approach should be considered in community trials for prevention and control of non-communicable diseases.
PMCID: PMC3542491  PMID: 23319975
metabolic syndrome; pharmacological treatment; community trial; Iran
17.  Metabolic syndrome in Iranian elderly 
ARYA Atherosclerosis  2012;7(4):157-161.
This study aimed to compare Iranian elderly with the middle-aged population in terms of the prevalence of metabolic syndrome and its components.
This cross-sectional study was conducted using the data from the third phase of the Isfahan Healthy Heart Program. Male and female residents of Isfahan over 19 years of age were selected by multistage cluster random sampling. A questionnaire including demographic characteristics, health status, medical history, medications used, as well as waist circumference, weight, height, and systolic and diastolic blood pressures was completed for all participants. Fasting blood samples were obtained from all subjects and examined for fasting blood sugar and lipid profile. T-test and Mann-Whitney test were used for quantitative data and chi-square test was performed for qualitative data.
The prevalence of metabolic syndrome in individuals aged over 60 years was significantly higher than those under 60 (49.5% vs. 17.5%, respectively; P < 0.001). Metabolic syndrome was also more prevalent among elderly females than in males (59.2% vs. 39.8%, respectively; P < 0.005). Some anthropometric measures such as height, body mass index, abdominal circumference, waist-hip ratio, and waist-to-height ratio were significantly different in men and women below 60 years in comparison with those over 60 years (P < 0.05). Moreover, there were significant differences in most studied parameters between the elderly and non-elderly women (P < 0.001).
This study showed that metabolic syndrome has a relatively high prevalence in Iranian elderly people, especially in elderly women. Therefore, early diagnosis and management of the complication are recommended among this high-risk group to avoid the subsequent complications.
PMCID: PMC3413084  PMID: 23205049
Metabolic Syndrome; Elderly; Iran
18.  Initial clinical outcomes of intracoronary infusion of autologous progenitor cells in patients with acute myocardial infarction 
ARYA Atherosclerosis  2012;7(4):162-167.
Myocardial infarction (MI) is an irreversible cardiomyocytes injury which begins after 15–20 minutes of coronary artery occlusion. The extent of infarction is modulated by a number of factors including collateral blood supplies, medications, and ischemic preconditioning. Although angioplasty and thrombolytic agents can relieve the cause of the infarction, the time from the occlusion onset to reperfusion determines the degree of irreversible myocardial injury. Experimental studies suggested that stem cells and progenitor cells derived from bone marrow can be used in the repair of cardiac tissue after acute MI. This study was designed to investigate the feasibility, safety and initial clinical outcome of intracoronary infusion of autologous progenitor cells in patients with acute MI.
Patients with a history of anterior MI and a left ventricular ejection fraction (LVEF) less than 35 % who were candidates for coronary angioplasty were randomly allocated in a 1:1 ratio to either control or bone marrow cell groups (each including 16 patients). Thallium scan and 17-segment echocardiography analysis for regional wall motion abnormality were performed before and 1 and 6 months after intracoronary infusion of bone marrow cells. The same tests were also conducted for the control group at identical time intervals. Quantitative variables were compared by independent t-test and paired t-test. Statistical significance was assumed at a value of P < 0.05.
LVEF in the case and control groups increased to 39.37 ± 2.47% and 31.00 ± 1.87%, respectively (P = 0.069 and 0.1, respectively). Wall motion abnormality index (WMAI) decreased insignificantly in both groups. Perfusion defect scores (PDSs) decreased significantly in the case group.
In this study, autologous mesenchymal stem cell transplantation by intracoronary catheter during angioplasty in patients with a history of severe LV dysfunction caused mild increases in LVEF.
PMCID: PMC3413085  PMID: 23205050
Myocardial Infarction Left Ventricular Failure; Stem Cell
19.  Hypertension control in industrial employees: findings from SHIMSCO study 
ARYA Atherosclerosis  2012;7(4):191-196.
Hypertension prevention and control are among the most important public health priorities. We evaluated the impacts of a workplace intervention project “Stop Hypertension in Mobarakeh Steel Company” (SHIMSCO) on controlling hypertension in industrial workers.
The study was carried out in Mobarakeh Steel Company in Isfahan among 7286 male workers and employees. All individuals were evaluated for the presence of hypertension (HTN). According to examinations, 500 subjects with systolic blood pressure (SBP) ≥ 140 mmHg, and/or diastolic blood pressure (DBP) ≥ 90 mmHg, and/or those using antihypertensive medications were confirmed to have HTN and thus included in this study. They were questioned for sociodemographic characteristics, past medical history and medication use. They received an educational program including healthy lifestyle and self-care recommendations of HTN management and control as well as training for accurate blood pressure measurement and home monitoring for two years. SBP, DBP, weight, height and routine lab tests were measured for all hypertensive subjects before and after the interventions. Paired t-test, generalized estimation equation (GEE) and ordinary linear regression (OLR) were used for statistical analysis in SPSS.
The comparison of SBP and DBP before and after the educational program showed significant reductions in both parameters (−7.97 ± 14.72 and −2.66 ± 9.96 mmHg, respectively). However, a greater decrease was detected in case of DBP. GEE showed SBP and DBP to decrease about −0.115 and −0.054 mmHg/month. OLR also revealed reductions of 4.88 and 2.57 mmHg respectively in SBP and DBP upon adding each antihypertensive drug.
SHIMSCO, a 3-year interventional project in workplaces, was effective in reducing SBP and DBP among hypertensive employees and workers. We conclude that implementing simple educational programs in worksites can improve the management and control of hypertension and perhaps other chronic diseases.
PMCID: PMC3413089  PMID: 23205054
Hypertension; Worksite; Industrial; Blood Pressure; Control
20.  Can the infusion of isotonic fluids or vasopressors prevent hemodynamic changes in cardiac surgery patients? 
ARYA Atherosclerosis  2012;8(3):161-163.
A common problem in cardiac surgery patients is decreased central venous pressure (CVP) and systemic blood pressure during transfer from operation room to intensive care unit (ICU). Since these reductions may lead to dangerous complications, this study aimed to evaluate the effects of vasopressors and isotonic fluids on hemodynamic status of cardiac surgery patients during their transfer to ICU.
This randomized single-blind clinical trial was conducted in Chamran Hospital (Isfahan, Iran). A total number of 75 consecutive patients undergoing planned first-time coronary artery bypass grafting entered our study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), CVP, and pulse rate (PR) were recorded at 5 to 10 minutes before leaving operating room and immediately after hospitalization in the ICU. Subjects in the first group received 7 cc/kg intravenous normal saline (as an isotonic fluid) within 5-10 minutes. The second group received 10 mg ephedrine before being transferred to the ICU.
The mean age of participants was 61.0 ± 3.6 years. No significant change in PR was detected in normal saline group (P > 0.05). No significant differences were found in two groups in SBP before and after hospitalization in the ICU (P > 0.05). DBP and CVP had statistically significant reductions in both groups after hospitalization in the ICU (P < 0.001). The mean CVP was also reduced significantly (10.7 ± 2.9 vs. 8.2 ± 3.4; P < 0.001).
Significant reductions in mean values of DBP and CVP occur during cardiac surgery and after arrival to the ICU. These reductions cannot be prevented by administration of vasopressors, such as ephedrine, or infusion of isotonic fluids, such as normal saline. Further studies are required to assess whether more fluids, other types of fluids, or other drugs can stop this phenomenon.
PMCID: PMC3557008  PMID: 23359114
Ephedrine; Cardiac Surgery; Isotonic Fluids; Intensive Care Unit
21.  Predictive value of P-wave duration and dispersion in post coronary artery bypass surgery atrial fibrillation 
ARYA Atherosclerosis  2012;8(2):59-62.
Atrial fibrillation (AF) is the most common complication of cardiac surgery. Although it is managed easily, it can cause critical hemodynamic instabilities for intensive care patients. This observational study investigated the predictive power of P-wave dispersion (PWD) for the incidence of post cardiac surgery AF.
Among patients undergoing isolated coronary artery bypass grafting surgery (CABG), 52 patients were selected randomly. Before the operation, ejection fraction, regional wall motion abnormality, and mitral regurgitation were determined by echocardiography. Angiographic data provided information about stenosed vessels. PWD was measured before and after CABG. The incidence of post-CABG AF was determined by rhythm monitoring.
There were no significant differences in age, sex, stenosed vessels, maximum P-wave duration, the prevalence of hypertension, smoking, mitral regurgitation, and regional wall motion abnormality between post-CABG AF and non-AF groups (P > 0.05). The mean prevalence of diabetes mellitus in post-CABG AF group was more than non-AF group (P = 0.036). The mean ejection fraction in post-CABG AF group was lower than non-AF group (P < 0.005). The mean PWD in AF group vs. non-AF group before CABG was 47.5 vs. 23.7 ms. The mean values of post-surgical PWD in AF and non-AF groups were 48.10 and 24.4 ms, respectively. Before CABG, the mean ejection fraction value and minimum P-wave duration in AF group were lower than non-AF group (P < 0.005). A reverse relation was present between minimum P wave duration and PWD (P < 0.001). There was a negative association between high ejection fraction values and decreased PWD (P = 0.002).
Our data suggested minimum P wave duration, PWD, and low ejection fraction are as good predictors of AF in patients undergoing isolated CABG. The absence of differences in age, sex, smoking, hypertension, mitral regurgitation, and regional wall motion abnormality in our study was in contrast with other reports. On the other hand, increased rate of post-CABG AF in our diabetic patients with lower ejection fraction supports other studies. Overall, minimum P wave duration, PWD, and low ejection fraction can be used for patient risk stratification of AF after CABG.
PMCID: PMC3463989  PMID: 23056104
Atrial Fibrillation; Coronary Artery Bypass Grafting; P-Wave Dispersion; Predictor
22.  Body Mass Index or Microalbuminuria, Which One is More Important for the Prediction and Prevention of Diastolic Dysfunction in Non-diabetic Hypertensive Patients? 
Numerous studies have now demonstrated that heart failure with a normal ejection fraction (HFnlEF) is common. Hypertension is also the most commonly associated cardiac condition in patients with HFnlEF. Despite the observed link between microalbuminuria, obesity, and cardiovascular disorders, this question has remained – ‘Which is more important for the prediction and prevention of diastolic dysfunction in non-diabetic hypertensive patients?’
The current study was a cross-section study conducted on a total of 126 non-diabetic hypertensive patients screened to identify those with hypertension. Urine creatinine was measured by the picric acid method and urine albumin content was measured by a sensitive, nephelometric technique. The urinary albumin/creatinine ratio (UACR) was determined as an indicator of microalbuminuria. Complete two-dimensional, doppler, and tissue-doppler echocardiography was performed and the recording of the diastolic function parameters was carried out.
High body mass index and high systolic blood pressure were positively correlated with the appearance of left ventricular hypertrophy, whereas, the UACR index had no significant relationship with hypertrophy. Multivariable analysis also showed that advanced age and systolic blood pressure were significantly associated with the E/E annulus parameter.
According to our investigation obesity is more important than microalbuminuria for the prediction and prevention of diastolic dysfunction in non-diabetic hypertensive patients.
PMCID: PMC3309635  PMID: 22448314
Hypertension; microalbuminuria; heart failure; obesity
23.  Echocardiographic assessment of inappropriate left ventricular mass and left ventricular hypertrophy in patients with diastolic dysfunction 
Early diagnosis of left ventricular mass (LVM) inappropriateness and left ventricular hypertrophy (LVH) can result in preventing diastolic left ventricular dysfunction and its related morbidity and mortality. This study was performed to determine if diastolic dysfunction is associated with LVH and inappropriate LVM.
Materials and Methods:
One hundred and twenty five uncomplicated hypertension from Isfahan Healthy Heart Program underwent two-dimensional echocardiography. Inappropriate LVM was defined as an LVM index greater than 88 g/m2 of body-surface area in women and greater than 102 g/m2 in men. LVH-defined septal and posterior wall thickness greater than 0/9 cm in women and greater than 1 cm in men, respectively. Echocardiographic parameters, including early diastolic peak velocity (E)/late diastolic peak velocity (A), deceleration time (DT), and E/early mitral annulus velocity (E′) were measured.
The mean systolic and diastolic blood pressure at the patients’ admission day were 142.87 ± 18.12 and 88.45 ± 9.18 mmHg, respectively. Totally, 21.7% of subjects had inappropriate LV mass that moderate and severe abnormal LV mass was revealed in 5.6% and 5.6%, respectively. The mean of age and BMI was significantly higher in patients with moderate left ventricular hypertrophy (P < 0.05). Adjusted by age, gender, BMI, and systolic and diastolic blood pressures, both E/A ratio and deceleration time were higher in those with the severer ventricular hypertrophy. Subjects with severe showed significantly higher BMI 33. 7 ± 3.7 (P < 0.001). There was a slight difference between the grade of diastolic dysfunction and the severity of inappropriate LV mass (P = 0.065). But no significant difference was found between E/A, E/E′, and deceleration time and the level of inappropriate LV mass (P > 0.05). Spearman's Rank test was used to test the correlation between diastolic dysfunction and LV mass (P = 0.025).
LVH is correlated with the severity of diastolic dysfunction manifested by the E/A value and deceleration time, but inappropriate LVM can slightly predict diastolic dysfunction severity in uncomplicated hypertension.
PMCID: PMC3525029  PMID: 23264785
Echocardiographic; left ventricular mass; left ventricular hypertrophy; Diastolic dysfunction
24.  Diagnostic performance and discriminative value of the serum ferritin level for predicting preterm labor 
The measuring serum ferritin level as a sensitive inflammatory biomarker might effectively predict preterm delivery, but the power and the best cut-off point of this biomarker for predicting preterm labor in Iranian population has not been substantially identified. Our purpose was to determine what concentrations of serum ferritin could identify patients at risk for preterm delivery in Iranian population for the first time.
Materials and Methods:
This case control study involved 222 singleton pregnancies that were referred to referral university hospitals clinics in Isfahan. Women with spontaneous preterm delivery before 24–26 weeks (preterm delivery group, n = 69) and those who delivered at term (term delivery group, n = 153) were compared with respect to serum ferritin concentration. Venous blood samples were analyzed for the serum ferritin level using the ferritin quantitative test system-sensitive for the normal ferritin range.
Women who delivered before 37 weeks had a higher mean serum ferritin concentration than those who delivered after 37 weeks of gestation (26.7 ± 5.5 ng/mL versus 19.8 ± 3.6 ng/mL, P<0.001). A serum ferritin level of 22.5 ng/mL yielded the best combination with sensitivity of 78.3%, specificity of 83.0%, positive predictive value of 67.5%, and negative predictive value of 89.4% for prediction of preterm delivery.
The serum ferritin level provides an appropriate discrimination in predicting preterm delivery with an optimal cut-off value of 22.5 ng/mL in Iranian population.
PMCID: PMC3525035  PMID: 23264791
Cut off; ferritin; predict; preterm labor; serum
25.  Comparing Diagnostic Techniques of Magnetic Resonance Angiography (MRA) and Doppler Ultrasonography in Determining Severity of Renal Artery Stenosis 
ARYA Atherosclerosis  2011;7(2):58-62.
Renal artery stenosis is one of the important causes of hypertension and end stage renal failure. Magnetic resonance angiography (MRA) and Doppler ultrasonography are non-invasive and safe diagnostic techniques that have also high sensitivity and specificity. Since the accuracy and reliability of these techniques depend upon technicians and softwares, we decided to evaluate and compare the sensitivity and specificity of these techniques in Isfahan.
Our study included all the patients (37 patients) who underwent renal artery angiography during 2 years from May 2003 to May 2005 and up to six months after that had underwent MRA (21 patients) and Doppler sonography (16 patients) in Isfahan. Renal artery angiography was considered as the gold standard.
Sensitivity, specificity, positive and negative predictive values of 100%, 25%, 25%, and 100% were obtained for MRA respectively. Specificity and positive predictive values (PPV) of Doppler sonography were 67%. Its sensitivity and negative predictive values (NPV) were 57%.
Although it seems that technician dependency, technical and software problems were the reasons of low specificity of gadolinium-enhanced MRA in our study, further studies with larger sample sizes are recommended.
PMCID: PMC3347845  PMID: 22577447
MRA; Doppler Ultrasonography; Renal Artery Stenosis.

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