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1.  Surgical outcomes of heart valves replacement: A study of tertiary specialied cardiac center 
ARYA Atherosclerosis  2014;10(5):233-237.
BACKGROUND
Heart valve disease is a significant and increasing global problem in the developing world. The aim of this study is to evaluate the incidence of postoperative complications and mortality in patients who underwent heart valve replacement.
METHODS
In this prospective study, 320 adult cases (186 females and 134 males, mean age of: 45.7 ± 15.0) with valvular heart diseases who underwent heart valve replacement at our center, from June 2011 to January 2012 were enrolled. All the required demographic, echocardiographic, and electrocardiogram data were studied. The incidence of intraoperative and early postoperative complications and mortality were evaluated.
RESULTS
Among total, 96.3% of the cases underwent elective surgery. Mitral valve replacement surgery was occurred the most in 58.8% of the cases. In 11.3% of the cases, bioprosthetic valves and in 88.8% of the patients prosthetic valves were required. Early postoperative complications were occurred in 85 patients (26.6%), including: valve-related events: 7 cases, postoperative arrhythmia: 24 patients, worsening function of the repaired valve: 16 cases and general complications: 38 patients. Mortality was occurred in 25 patients (7.8%), 10 cases due to cardiac problems versus 15 patients due to non-cardiac problems. There were significant correlations between age, simultaneous valve repair and replacement, the anatomic site of the valve and the incidence of postoperative complications. Age, history of diabetes mellitus (DM), hypertension (HTN), and high grade of functional capacity were reported the significant causes of postoperative mortality.
CONCLUSION
Age, DM, HTN, functional capacity and multivalve disease are significant predictors of post-valvular surgery morbidity and mortality.
PMCID: PMC4251476  PMID: 25477979
Heart Valve Diseases; Cardiac Surgery; Heart Valves
2.  Effects of oat and wheat bread consumption on lipid profile, blood sugar, and endothelial function in hypercholesterolemic patients: A randomized controlled clinical trial 
ARYA Atherosclerosis  2014;10(5):259-265.
BACKGROUND
Increased lipid profile after each meal can disturb the endothelial function. The present study assessed the effects of bread supplemented with oat bran on serum lipids and endothelial dysfunction in patients with hypercholesterolemia.
METHODS
This clinical trial was conducted on 60 isolated hypercholesterolemic patients. The subjects were randomly allocated to either intervention (consuming at least five daily servings of oat bread with 6 g beta-glucan) or control (receiving at least five servings of wheat bread). Anthropometric indicators, fasting blood sugar and lipid profiles ere measured at baseline and after 6 weeks (in the end of the intervention). Endothelial function was assessed using flow-mediated dilation (FMD). Within the group and between group differences were investigated using paired t-test and Student’s t-test, respectively.
RESULTS
Oat bread consumption could significantly reduce total cholesterol (P = 0.029). A significant increase in baseline and after ischemia brachial artery diameters at the end of the study was seen. However, it did not have a significant effect on FMD (P = 0.825). In the control group, none of the measured indices had changed significantly at the end of the study. Finally, only the mean change of brachial artery diameter after ischemia and baseline brachial artery diameter were significantly higher in the intervention group than in the control group (P = 0.036 and P = 0.012 respectively).
CONCLUSION
Oat bread with beta-glucan could successfully reduce cholesterol levels. Furthermore, in this study oat bread did not reduce FMD more than wheat bread. Since hypercholesterolemia is a proven risk factor for endothelial dysfunction, hypercholesterolemic patients can hence be advised to eat oat bread.
PMCID: PMC4251477  PMID: 25477983
Bread; Diet; Flow-Mediated Dilation; Hypercholesterolemia
3.  Coronary artery disease and plasma apolipoprotein E4 in mild cognitive impairment 
ARYA Atherosclerosis  2014;10(5):244-251.
BACKGROUND
Atherosclerosis and apolipoprotein E4 (APOE4) are known risks for Dementia. We sought to evaluate the relationship between coronary atherosclerosis and APOE4 with mild cognitive impairment (MCI).
METHODS
In a case-control study, subjects with age more than 60 years and recent coronary angiography were evaluated by mini-mental state examination and neuropsychiatry unit cognitive assessment tool (NUCOG) to find the patients with MCI (n = 40) and the controls with normal cognition (n = 40). Coronary angiography records were re-assessed to find the severity of coronary artery disease by the Gensini scores. Plasma levels of APOE4 were measured.
RESULTS
There were no-significant difference between the 2 groups regarding the plasma APOE4 levels (P = 0.706) and the Gensini scores (P = 0.236). Associations between the Gensini scores and the NUCOG scores in the MCI group (r = −0.196, P = 0.225) and the control group (r = 0.189, P = 0.243) were not significant. However, the interaction effect between the Gensini and the NUCOG scores based on allocation to the control or the patient groups showed statistically significant difference (F(1,67) = 4.84, P = 0.031).
CONCLUSION
Although atherosclerosis has been considered as known risk factor for dementia and MCI, this study could not reveal that coronary atherosclerosis-related to declining in cognitive functioning. There was no significant association between plasma APOE4 levels and MCI.
PMCID: PMC4251478  PMID: 25477981
Mild Cognitive Impairment; Coronary Artery; Angiography; Apolipoprotein E4
4.  Short term high dose atorvastatin for the prevention of contrast-induced nephropathy in patients undergoing computed tomography angiography 
ARYA Atherosclerosis  2014;10(5):252-258.
BACKGROUND
Statins are shown effective by some studies in preventing contrast-induced nephropathy (CIN). We evaluated the effectiveness of atorvastatin in the prevention of CIN in computed tomography angiography (CTA) candidates.
METHODS
This study was conducted on patients referring for elective CTA with normal renal function. Patients received atorvastatin (80 mg/day) or placebo from 24 h before to 48 h after administration of the contrast material. Serum creatinine was measured before and 48 h after contrast material injection. CIN was defined as an increase in serum creatinine level of ≥ 0.5 mg/dl or ≥ 25% of the baseline creatinine.
RESULTS
A total of 236 patients completed the study; 115 atorvastatin, 121 placebo, mean age = 58.40 ± 9.80 year, 68.6% male. Serum creatinine increased after contrast material injection in both the atorvastatin (1.00 ± 0.16-1.02 ± 0.15 mg/dl, P = 0.017) and placebo groups (1.03 ± 0.17-1.08 ± 0.18 mg/dl, P < 0.001). Controlling for age, gender, comorbidities, drug history, and baseline serum creatinine level, patients who received atorvastatin experienced less increase in serum creatinine after contrast material injection (beta = 0.127, P = 0.034). However, there was no difference between the atorvastatin and placebo groups in the incidence of CIN (4.3 vs. 5.0%, P = 0.535).
CONCLUSION
In patients undergoing CTA, a short-term treatment with high dose atorvastatin is effective in preventing contrast-induced renal dysfunction, in terms of less increase in serum creatinine level after contrast material injection. Further trials including larger sample of patients and longer follow-ups are warranted.
PMCID: PMC4251479  PMID: 25477982
Kidney Diseases; Multidetector Computed Tomography; Contrast Media; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Atorvastatin
5.  Investigation of the effect of short-term supplementation with curcuminoids on circulating small dense low-density lipoprotein concentrations in obese dyslipidemic subjects: A randomized double-blind placebo-controlled cross-over trial 
ARYA Atherosclerosis  2014;10(5):280-286.
BACKGROUND
Small dense low-density lipoprotein (sdLDL) is a sub-fraction of LDL considered to have the most atherogenic properties. The present trial aimed to assess changes in circulating sdLDL concentrations following supplementation with curcuminoids, polyphenolic compounds with diverse potential cardio-protective functions.
METHODS
This study was designed as a randomized double-blind placebo-controlled cross-over trial. A total of 30 obese dyslipidemic subjects were assigned to curcuminoids (1 g/day) or placebo for 4 weeks, followed by a 2-week washout and then treatment with the alternate for another 4 weeks. Serum sdLDL was measured at baseline and weeks 4, 6, and 10 of the trial.
RESULTS
Supplementation with curcuminoids (1 g/day) did not cause any significant alteration in serum sdLDL (P > 0.05).
CONCLUSION
Four-week supplementation with curcuminoids was not associated with any significant alteration in circulating sdLDL concentrations.
PMCID: PMC4251480  PMID: 25477987
Diferuloylmethane; Curcuma longa L.; Turmeric; Cardiovascular Disease; Hypercholesterolemia; Atherosclerosis
6.  Dietary intakes and leptin concentrations 
ARYA Atherosclerosis  2014;10(5):266-272.
BACKGROUND
Leptin, a peptide contained 146 amino-acids, is mostly secreted from adipose tissue and it has a critical role on regulation of body weight, body fat mass, appetite, and food intakes. We tried to review the previous evidence regarding the effects of dietary intakes, including consumption of carbohydrates, fats and protein on concentrations of leptin concentration.
METHODS
We searched in PubMed search engine to January 2013 by using the following key words: dietary intake, diet, dietary fat, high-fat diet, dietary carbohydrate, high carbohydrate diet, dietary protein, high protein diet in combination with leptin, adipokine. Then, we recruited 35 articles to review in the present study.
RESULTS
It seems that beside the amount of fats, type of fatty acids have the key roles on circulating leptin concentration. Energy intake also significantly associated with the hormone. Studies regarding the association between carbohydrate intake and concentration of lepton have been reached to contradictory results. It seems that protein intake can increase the lepton activity.
CONCLUSION
Findings from several studies suggest that a diet display an important role on change the concentration of lepton.
PMCID: PMC4251481  PMID: 25477984
Diet; Carbohydrate; Protein; Fat; Leptin
7.  A rare presentation of patent ductus arteriosus in an adult patient with normal pulmonary hypertension and limb edema 
ARYA Atherosclerosis  2014;10(5):273-275.
BACKGROUND
Patent ductus arteriosus (PDA) at childhood is one of the five major and frequent congenital abnormalities, but it can be rarely seen in adults. Pulmonary hypertension (PHTN) and other presentations such as heart failure and edema are the identified complications of longstanding PDA, but adult case with no permanent heart symptoms and PHTN was rare. We reported a rare case of with an obvious PDA and normal pulmonary pressure.
CASE REPORT
A 61-year-old woman presented with dyspnea (New York Heart Association class 2), chest pain, and lower limb edema. Echocardiogram showed; normal left ventricular chamber size and function, normal size of both atria. Furthermore, an obvious PDA (diameter = 6-7 mm) connecting the aortic arch to the pulmonary artery was reported in echocardiography. No lung congestion and evidence for PHTN was reported by computed tomographic angiography [Pulmonary capillary wedge pressure (PCWP) = 30 mmHg]. The patient was treated with antihypertensive drugs and after 1 and 3 months follow-up, edema and other symptoms were resolved.
CONCLUSION
Finally, we conclude that PDA in adulthood can present with nonspecific cardiovascular symptoms, and it seems that PHTN is not a fixed echocardiographic finding in these patients.
PMCID: PMC4251482  PMID: 25477985
Adults; Edema; Patent Ductus Arteriosus eri; Pulmonary Hypertension
8.  Carotid intima-media thickness and plasma fibrinogen among subjects with metabolic syndrome: Isfahan cohort study, Iran 
ARYA Atherosclerosis  2014;10(5):238-243.
BACKGROUND
The role of plasma fibrinogen, a key regulator of inflammation processes and increased carotid intima-media thickness (cIMT) to predict metabolic syndrome (MetS) is currently under investigation. We assessed differences in the indicators of cIMT and also plasma fibrinogen level between MetS and non-MetS subjects. We also assessed the role of these two parameters for independently relationship with MetS state.
METHODS
The subjects in this cross-sectional survey were population-based samples of 93 men and women aged ≥ 35 years and over who were selected from the Isfahan cohort study, Isfahan, Iran. Fibrinogen was measured by the clotting assay of Clauss. Ultrasound studies of the carotid artery were performed to measure cIMT. MetS defined based on the National Cholesterol Education Program’s Adult Treatment Panel III.
RESULTS
The mean level of plasma fibrinogen was not different in the two groups with and without MetS (240.10 ± 27.80 vs. 242.56 ± 35.82, P = 0.714), but the mean of cIMT was considerably higher in MetS group than in non-MetS group (0.85 ± 0.06 mm vs. 0.66 ± 0.09 mm, P < 0.001). Using a multivariable logistic regression model, high cIMT could effectively predict MetS state with the presence of different components of MetS (odds ratio = 17.544, 95% confidence interval = 2.151-142.860, P = 0.008). The optimal cutoff point of cIMT for discriminating these two clinical states was 0.6 mm yielding a sensitivity of 61.5% and a specificity of 59.6%.
CONCLUSION
Individuals with MetS demonstrated increased cIMT values compared with those without MetS. However, high plasma fibrinogen level may not be associated with MetS state.
PMCID: PMC4251483  PMID: 25477980
Metabolic Syndrome; Carotid Intima-Media Thickness; Fibrinogen; Prediction
9.  Complete heart block in a patient with POEMS syndrome: A case report 
ARYA Atherosclerosis  2014;10(5):276-279.
BACKGROUND
Polyneuropathy, organomegaly, endocrinopathy, monoclonal syndrome (POEMS) is a rare paraneoplastic syndrome associated with plasma cell dyscrasia.
CASE REPORT
A 48-year-old man presented with a 1-year history of paresthesia and progressive weakness of extremities. Diagnosis of POEMS syndrome was made for him on the basis of clinical presentation, additional physical findings, typical sclerotic bone lesion, and bone marrow findings. In last admission, he explained episodes of dyspnea and chest pain that associated with frequent premature ventricular contraction in his electrocardiograph. Patient heart monitoring showed some episodes of complete heart block. Infra-His atrioventricular block in electro-physiologic study was detected. He had no history of ischemic heart disease. His cardiopulmonary findings on examination were normal. All results of cardiac biomarkers and serum electrolytes and repeated echocardiography were within normal range. Cong red staining of rectal fat pad biopsy was negative. After pacemaker insertion radiation of sclerotic bone, lesion started for him, but radiotherapy was ineffective, and he expired with respiratory failure. Complete heart block in POEMS syndrome has not been reported previously, and it is the first POEMS case with complete heart block.
CONCLUSION
Complete heart block is a cardiac manifestation of POEMS syndrome.
PMCID: PMC4251484  PMID: 25477986
Complete Heart Block; POEM Syndrome; Multiple Meloma
10.  In-hospital outcomes after primary percutaneous coronary intervention according to left ventricular ejection fraction 
ARYA Atherosclerosis  2014;10(4):211-217.
BACKGROUND
The primary objective of primary percutaneous coronary intervention (pPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) is not only to restore the blood flow in the infarct-related artery, but also to save the patients’ quality and duration of their life. Since left ventricular ejection fraction (LVEF) is a known predictor of clinical outcomes in STEMI patients, the possible association between characteristics of a large group of patients who undergo pPCI with LVEF and death was evaluated.
METHODS
This prospective cohort study included 304 patients who had undergone pPCI between 2009 and 2011. The association between LVEF and in-hospital outcomes of patients was assessed.
RESULTS
LVEF ≤ 25%, 25% < LVEF < 50%, and LVEF ≥ 50% were presented in 23 (7.6%), 150 (49.3%), and 128 (42.1%) of the patients, respectively. Three patients (0.01%) died before echocardiography. There was no significant difference among aforementioned three groups regarding baseline characteristics, except age (P = 0.012) and sex (P = 0.016). Cumulative number of cardiogenic shock and death were 7 (2.3%) and 22 (7.2%), respectively; with significant differences between three LVEF groups. Age more than 70 years old, pulmonary edema, systolic blood pressure < 100 mm Hg, shock, post-PCI thrombolysis in myocardial infarction (MI) flow grade, corrected thrombolysis in MI frame count, angiographic success and ST-segment resolution showed significant association with death (P < 0.050).
CONCLUSION
This study not only demonstrates that LVEF ≤ 50% is associated with a higher incidence of in-hospital adverse events, but also identifies characteristics that are strongly correlated with the risk of LVEF ≤ 50% and death after pPCI.
PMCID: PMC4173312  PMID: 25258637
Myocardial Infarction; Percutaneous Coronary Intervention; Ejection Fraction; Corrected Trombolysis in Myocardial Infarction
11.  Relationship between blood peroxidases activity and visfatin levels in metabolic syndrome patients 
ARYA Atherosclerosis  2014;10(4):218-226.
BACKGROUND
The observed relationships between visfatin, peroxidases activity, and metabolic syndrome (MetS) are inconsistent; therefore, this study was undertaken to understand these relationships.
METHODS
This cross-sectional study was conducted as a part of the Isfahan Healthy Heart Program, Iran. A blood sample of 90 MetS and non-MetS patients were used to estimate total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), triglycerides (TGs), fasting blood glucose (FBG), waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP), visfatin and peroxidases activity. Data analysis for MetS group was carried out in two ways. (1) MetS with three components and with > 3 components. (2) MetS with hyperglycemia and without hyperglycemia.
RESULTS
SBP, DBP, WC, FBG, TC, TG, LDL-C, and were higher and HDL-C levels was lower in MetS patients. There was a significant correlation between visfatin levels and peroxidases activity in MetS patients with three components. Levels of visfatin were significantly higher in male as compared to female subjects in the MetS with three components group. There was a significant decrease in peroxidases activity in > 45 years old subjects in the MetS with > 3 components group. A significant correlation was observed between serum visfatin levels and FBG in the MetS without hyperglycemia group.
CONCLUSION
Peroxidases activities in MetS patients can be related to visfatin levels. Gender influences on peroxidases activity probably and was lower in female patients with MetS. Hyperglycemia does not influence peroxidases activities and visfatin levels.
PMCID: PMC4173313  PMID: 25258638
Peroxidase; Metabolic Syndrome; Visfatin
12.  Normal range of bleeding time in urban and rural areas of Borujerd, west of Iran 
ARYA Atherosclerosis  2014;10(4):199-202.
BACKGROUND
Bleeding time (BT) is the oldest and simplest test for assessing the platelets (Plts) function. BT can affect by several factors such as race and diet, which has a wide reference range. The aim of this project is to determine the normal range of BT in Borujerd, Iran. Determining the normal range of BT can help us to modify the definition of bleeding disorder and aspirin resistance.
METHODS
This was cross-sectional study carried out in 2011-2012. Subjects with a history of coagulation disorders or a positive family history of coagulation disorders, consumption of anti-Plts, anti-histamines, and phenothiazine in the previous month and subject with Plt less than 150,000 were excluded. The samples were 505 volunteers who were referred from 16 urban and 9 rural clusters to research center. BT of the samples was determined according to Ivy simplate method considering national standard protocol in the selected persons. Normal range was calculated as mean ± 2 standard deviation.
RESULTS
Of 505 volunteers, 50.4% were female. The range of BT was 2.8-2.95 min with mean of 2.79 ± 0.78 min. Range and mean of BT in women was 2.83-3.06 min and 2.88 ± 0.87 min, and range and mean of BT in men was 2.7-2.9 min and 2.69 ± 0.67 min; this difference was significant (P = 0.012). BT in urban and rural participants was 2.78 ± 0.79 and 2.77 ± 0.73 min. There was no significant difference between BT in urban and rural participants.
CONCLUSION
The normal range of BT in Boroujerd was in the lower limit of the normal universal range. In this study, BT was significantly different in both genders, but its correlation with age, blood group, and place of residency was not significant.
PMCID: PMC4173314  PMID: 25258635
Bleeding Time; Blood Platelet; Iran
13.  Undiagnosed interrupted aortic arch in a 59-year-old male patient with severe aortic valve stenosis: A case report and literature review 
ARYA Atherosclerosis  2014;10(4):230-232.
BACKGROUND
Interrupted aortic arch (IAA) is defined by a lack of the luminal continuity between the ascending and descending thoracic aorta. It is a rare, severe congenital heart defect which without surgery is associated with high mortality in the neonatal period. The aims of this study were to present a case with IAA who was alive until the age of 59 years without any surgical intervention and to review the literatures that have presented IAA cases.
CASE REPORT
The patient was admitted with respiratory distress and pulmonary edema. Echocardiography showed the sever stenosis in aortic valve and sever left ventricular dysfunction. Cardiac catheterization and angiography confirmed interrupted aorta (type A). The descending thoracic aorta was supplied by extensive collateral vessels from the vertebrobasilar system down to the posterior chest wall and the spine. Surgical correction including coronary artery bypass graft and aortic valve replacement and repair of interruption of the aorta was performed. Three weeks later the patient was died due to uncontrollable gastrointestinal bleeding and hospital acquired pneumonia. We described diagnosis and management of our case.
CONCLUSION
This case was very interesting for us, because the patient had not been diagnosed until the recent presentation. Similar cases with this diagnosis do not reach adulthood, but our patient was alive up to 59 years of age.
PMCID: PMC4173315  PMID: 25258640
Interrupted; Aorta; Aortic Valve Stenosis; Thoracic Aorta; Aortic Arch
14.  Study of antioxidant activity of sheep visceral protein hydrolysate: Optimization using response surface methodology 
ARYA Atherosclerosis  2014;10(4):179-184.
BACKGROUND
The main objective of this experiment was optimal use of none edible protein source to increase nutritional value of production with high biological function, including antioxidant activity.
METHODS
Sheep visceral (stomach and intestine) was used as substrate. Response surface methodology (RSM) was used to optimize hydrolysis conditions for preparing protein hydrolysate from the sheep visceral, using alcalase 2.4 l enzyme. The investigated factors were temperature (43-52 °C), time (90-180 min), and enzyme/substrate ratio [60-90 Anson-unit (AU)/kg protein] to achieve maximum antioxidant activity. Experiments were designed according to the central composite design.
RESULTS
Each of the studied variables had a significant effect on responses (P < 0.05). Optimal conditions to achieve antioxidant activity were, temperature (48.27 °C), time (158.78), min and enzyme/substrate ratio (83.35) Anson-unit/kg protein. Under these conditions, antioxidant activity was 68.21%, R2 for model was 0.983. The values indicated the high accuracy of the model to predict the reaction conditions considering different variables. The chemical analysis of protein hydrolysate showed high protein content (83.78%) and low fat content (0.34%).
CONCLUSION
Our results showed that protein hydrolysate of sheep visceral, can be used as a natural antioxidant with high nutritional value.
PMCID: PMC4173316  PMID: 25258632
Antioxidant Peptides; Protein Hydrolysate; Enzyme Hydrolysis; Optimization
15.  Dietary phytochemical index and subsequent changes of lipid profile: A 3-year follow-up in Tehran Lipid and Glucose Study in Iran 
ARYA Atherosclerosis  2014;10(4):203-210.
BACKGROUND
High intakes of phytochemical-rich foods have beneficial effects on lipid profiles and cardiovascular disease (CVD). In this study, we assessed the association between the dietary phytochemical index (PI) and changes in lipid profile after 3-year follow-up among Iranian adults.
METHODS
This longitudinal study was conducted in 1983 subjects, aged 19-70 years, selected among participants of the Tehran Lipid and Glucose Study in Iran. Dietary data were collected by using a validated semi-quantitative food frequency questionnaire with 168 food items at baseline. PI was calculated based on daily energy derived from [(phytochemical-rich foods kcal/total daily energy intake kcal) × 100]. Lipid profile was measured at baseline and after 3 years and changes in serum lipid profiles were assessed during 3-year follow-up.
RESULTS
The mean age of participants was 40.4 ± 13.0 years; participants in the highest PI quartile category were more likely to be older. After 3 years of follow-up, total cholesterol was significantly lower in the highest quartile compared with lower quartile of PI in men (181 ± 3 vs. 189 ± 3, P for trend < 0.05). There were significant inverse association between dietary PI and 3 years changes of total cholesterol [β = −5.6, 95% confidence interval (CI) = −9.3, −1.8], triglycerides (β = −13.7, 95% CI = −24.6, −2.8), and non-high-density lipoprotein cholesterol (HDL-C) (β = −6.2, 95% CI = −10.8, −1.5), in highest quartile of PI in men. Lipid profiles showed no significant changes over the study period in women.
CONCLUSION
Higher dietary PI is associated with 3 years improvement of total cholesterol, triglycerides, and non-HDL-C. Higher consumption of phytochemical-rich foods is recommended to prevent CVD.
PMCID: PMC4173317  PMID: 25258636
Phytochemical; Triglyceride; Cholesterol; Fruit and vegetables; Whole Grains
16.  Antiatherogenic, hepatoprotective, and hypolipidemic effects of coenzyme Q10 in alloxan-induced type 1 diabetic rats 
ARYA Atherosclerosis  2014;10(4):192-198.
BACKGROUND
Diabetes mellitus, one of the leading metabolic syndromes, accounts for highest morbidity and mortality worldwide. In this study, we examined possible protective effect of coenzyme Q10 on lipid profile, atherogenic index, and liver enzyme markers in alloxan-induced type 1 diabetic rats.
METHODS
A total of 30 male rats were randomly divided into three groups; group 1 as control, group 2 diabetic untreatment, and group 3 treatments with coenzyme Q10 by 15 mg/kg i.p. daily, respectively .Diabetes was induced in the second and third groups by alloxan injection subcutaneously. After 8 weeks, the levels of fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), very low-density lipoprotein (VLDL), high density lipoprotein (HDL), atherogenic index, atherogenic coefficient, cardiac risk ratio, and the activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) of all groups were analyzed. Data were analyzed using non-parametric Mann-Whitney test (using SPSS) and P < 0.05 was considered as significant.
RESULTS
Coenzyme Q10 inhibited significantly the activities of ALT (11.17%), AST (19.35%) and ALP (36.67%) and decreased FBG (21.19%), TG (37.24%), TC (17.15%), LDL (30.44%), VLDL (37.24%), atherogenic index (44.24%), atherogenic coefficient (49.69%), and cardiac risk ratio (37.97%), HDL level was significantly (33.38%) increased when treated with coenzyme Q10.
CONCLUSION
The findings of this study suggest that coenzyme Q10 exert beneficial effects on the lipid profile, atherogenic index, and liver enzymes activity in alloxan-induced type 1 diabetic rats.
PMCID: PMC4173318  PMID: 25258634
Diabetes; Lipid Profile; Atherogenic Index; Rats; Liver Enzymes; Coenzyme Q10
17.  P-wave dispersion and its relationship to aortic stiffness in patients with acute myocardial infarction after cardiac rehabilitation 
ARYA Atherosclerosis  2014;10(4):185-191.
BACKGROUND
The aim of our study was to investigate the P-wave dispersion from standard electrocardiograms (ECGs) in patients with acute myocardial infarction (AMI) after cardiac rehabilitation (CR) and determine its relation to arterial stiffness.
METHODS
This is a prospective study included 33 patients with AMI and successfully re-vascularized by percutaneous coronary intervention (PCI) underwent CR. Left ventricular ejection fraction (LVEF) was measured by biplane Simpson’s method. Left atrium (LA) volume was calculated. The maximum and minimum durations of P-waves (Pmax and Pmin, respectively) were detected, and the difference between Pmax and Pmin was defined as P-wave dispersion (Pd = Pmax-Pmin). Aortic elasticity parameters were measured.
RESULTS
LVEF was better after CR. The systolic and diastolic blood pressures decreased after CR, these differences were statistically significant. With exercise training, LA volume decreased significantly. Pmax and Pd values were significantly shorter after the CR program. The maximum and minimum P-waves and P-wave dispersion after CR were 97 ± 6 ms, 53 ± 5 ms, and 44 ± 5 ms, respectively. Aortic strain and distensibility increased and aortic stiffness index was decreased significantly. Aortic stiffness index was 0.4 ± 0.2 versus 0.3 ± 0.2, P = 0.001. Aortic stiffness and left atrial volume showed a moderate positive correlation with P-wave dispersion (r = 0.52, P = 0.005; r = 0.64, P < 0.001, respectively).
CONCLUSION
This study showed decreased arterial stiffness indexes in AMI patient’s participated CR, with a significant relationship between the electromechanical properties of the LA that may raise a question of the preventive effect of CR from atrial fibrillation and stroke in patients with acute myocardial infarction.
PMCID: PMC4173319  PMID: 25258633
Cardiac Rehabilitation; P-Wave Dispersion; Aortic Stiffness; Acute Myocardial Infarction
18.  Protection against ischemia-reperfusion injury in prolonged resuscitation: A case report and review of literature 
ARYA Atherosclerosis  2014;10(4):227-229.
BACKGROUND
The severity of ischemia/reperfusion injury determines the neurologic outcome after successful cardiopulmonary resuscitation.
CASE REPORT
We present a case of prolonged open-chest resuscitation who survived without neurologic sequel. Multiple applied strategies to limit the deleterious effects of ischemia and reperfusion injury, that is, infusion of magnesium sulfate and mannitol, protective lung ventilation and optimal postoperative pain control prevented the end organ damage in this patient. During the 40 min open-chest resuscitation, ventricular defibrillation was successfully attempted with extrathoracic paddles.
CONCLUSION
The appropriate use of pharmacologic and non-pharmacologic protective strategies could modify the inflammatory cascade and minimize the deleterious effects of reperfusion after prolonged periods of ischemia. The successful defibrillation in this patient warrants the use of standard paddles in open-chest surgeries where surgical small paddles are not available.
PMCID: PMC4173320  PMID: 25258639
Resuscitation; Ischemia; Reperfusion; Neuroprotection; Addiction; Extrathoracic Defibrillation
19.  Glycemic control in type 2 diabetes mellitus prevents coronary arterial wall infection 
ARYA Atherosclerosis  2014;10(3):141-146.
BACKGROUND
Diabetes mellitus (DM) is a very well-known risk factor for development of atherosclerosis, and it has been hypothesized that poor glycemic control and hyperglycemia plays a major role in this process. In the current study, we aimed to evaluate the associates of poor glycemic control in Iranian patients who have already undergone coronary artery bypass grafting (CABG), with especial focus on the inhabitation of infectious agents within the coronary arterial wall.
METHODS
In January 2010, 52 consecutive patients with type 2 DM who undergone CABG at the Department of Cardiovascular Surgery of Baqiyatallah University of Medical Sciences (Tehran, Iran) were included into this cross-sectional study and biopsy specimens from their coronary plaques were taken and analyzed by polymerase chain reaction (PCR) methods for detecting Helicobacter species, cytomegalovirus (CMV) and Chlamydia pneumoniae, and their potential relation to the glycemic control status in these patients.
RESULTS
Compared to that in diabetic patients with mean fasting blood sugar (FBS) levels FBS < 126, atherosclerotic lesions in type 2 diabetic patients with poor glycemic control (FBS > 126) were significantly more likely to be positive for CMV PCR test (41% vs. 9%, respectively; P = 0.05). In laboratorial test results, mean triglyceride level was significantly higher among patients of poor glycemic control (168 ± 89 vs. 222 ± 125 mg/dl, respectively; P = 0.033). Hypertension was also significantly more prevalent in this population (73% vs. 36%, respectively; P = 0.034).
CONCLUSION
Type 2 diabetic patients with poor glycemic control can be at higher risk for developing CMV infection in their coronary arterial wall, which can promote atherosclerosis formation process in this patient population. According to the findings of this study, we recommend better control of serum glucose levels in type 2 diabetic patients to prevent formation/progression of atherosclerosis.
PMCID: PMC4144376  PMID: 25161684
Diabetes Mellitus; Hyperglycemia; Coronary Artery; Cytomegalovirus; Infection
20.  Comparison of the effect of different intensity exercise on a bicycle ergometer on postprandial lipidemia in type II diabetic patients 
ARYA Atherosclerosis  2014;10(3):147-153.
BACKGROUND
Postprandial lipid clearance failure and lipoprotein disorders, which are independent risk factors for cardiovascular diseases are well-recognized in type II diabetes. Reduction of fats through exercise has been proved, though the mechanism is not well-defined, and the effects of different intensity exercise on postprandial lipidemia in diabetes type II is unknown. This study aims to find these effects using a cycle ergometer.
METHODS
On three different days, 15 type II diabetics (10 women and 5 men, with a mean age 42.07 ± 6.05 years, weight 94.64 ± 4.37 kg, height 159.78 ± 9.09 cm, and body mass index29.83 ± 3.93 kg/m2), consumed a full fat breakfast (750-800 kcal, 85% fat), and 150 min later, blood samples were taken from them to measure their lipid profile. The 1st day was the control day, without any exercises. Seven days later, 90 min after enriched breakfast, they did 30 min of exercise on the cycle ergometer with intensity of 55-70% of maximum heart rate (HRmax), and 14 days later, 90 min after enriched breakfast, they did 30 min of exercise with intensity of 70-85% of HRmax.
RESULTS
According to Friedman non-parametric test, high-density lipoprotein (HDL) cholesterol serum level significantly increased after 30 min of moderate intensity exercise (P > 0.05, from 39.4 ± 5.2 to 48.6 ± 9.3), while this increase was insignificant after a higher intensity exercise. Neither intensity levels had any significant effects on triglyceride or on low-density lipoprotein cholesterol.
CONCLUSION
Results showed that moderate intensity exercise was more effective in increasing HDL cholesterol level in type II diabetics.
PMCID: PMC4144377  PMID: 25161685
Postprandial Lipidemia; Resistance Exercise; Bicycle Ergometer; Type II Diabetes
21.  Tachycardia-induced cardiomyopathy 
ARYA Atherosclerosis  2014;10(3):175-178.
BACKGROUND
Tachycardia-induced cardiomyopathy (TIC) is a rare cause of dilated cardiomyopathy (DCMP). The diagnosis can be missed because tachycardia is a common symptom in DCMP.
CASE REPORT
We reviewed a case 5-year-old with palpitation and dyspnea with symptoms and signs of heart failure that diagnosed as DCMP initially. Then, in the evaluation for cause of tachycardia, atrial tachycardia was detected. Hence, treatment with flecainide was started and after 3 months, left ventricular (LV) systolic function and symptoms of the patient was relieved.
CONCLUSION
TIC should be suspected in all patients with unexplained LV dysfunctions in the setting of a persistent tachyarrhythmia.
PMCID: PMC4144378  PMID: 25161690
Dilated Cardiomyopathy; Heart Failure; Tachyarrhythmia
22.  The relationships between cortisol levels, insulin levels, and thyroid hormones with 24-h urinary sodium excretion in never treated essential hypertensive patients 
ARYA Atherosclerosis  2014;10(3):159-163.
BACKGROUND
To study the relationship between cortisol, insulin, and thyroid hormone levels with 24-h urinary sodium (Na) excretion levels in essential hypertensive patients.
METHODS
All patients underwent history taking, physical examination, blood pressure (BP) measurement, 12 lead electocardiographic evaluation, routine urine analysis, biochemical analysis including measurement of cortisol, insulin, and thyroid hormone levels, 24-h urine collection to measure urinary Na and protein excretion and creatinine clearance.
RESULTS
In total, 68 newly diagnosed hypertensive patients were included. Spearman correlation analysis revealed that 24-h urinary Na excretion was correlated with insulin levels (ρ = −0.473, P < 0.0001), serum cortisol levels (ρ = −0.404, P = 0.0010) and creatinine clearance (ρ = 0.407, P = 0.0010). Linear regression of independent factors has revealed that systolic BP (B = 0.004, CI = 0.001-0.008, P = 0.0170), body mass index (B = 0.014, CI = 0.005-0.023, P = 0.0030), being male (B = 0.077, CI = 0.001-0.153, P = 0.0480), creatinine clearance (B = 0.003, CI = 0.001-0.006, P = 0.0120) and insulin levels (B = −0.008, CI = −0.014 to −0.002, P = 0.0070) were independently related with logarithmically converted 24-h Na excretion.
CONCLUSION
In conclusion, we found that insulin but not cortisol and thyroid hormone levels were independently related with 24-h urinary Na excretion in newly diagnosed essential hypertensive patients.
PMCID: PMC4144379  PMID: 25161687
Cortisol; Hypertension Insulin; Sodium; Thyroid
23.  Prognostic value of the high-mobility group box-1 in young patients with chest pain 
ARYA Atherosclerosis  2014;10(3):154-158.
BACKGROUND
Atherosclerosis is accepted as an inflammatory disease. Evidence suggests that inflammation evoked by injury plays a pathogenic role in all stages of atherosclerosis. This study aimed to investigate whether the high-mobility group box-1 (HMGB1) a proinflammatory cytokine/nuclear protein, which is derived from both injured endothelium and activated macrophages/monocytes, could contribute to the progression of atherosclerosis and other cardiovascular diseases.
METHODS
This study was designed as case-control. A total of 135 patients who referred to the hospital due to angina pectoris had the diagnosis of unstable angina and were candidates of angiography were recruited in this study. Forty patients who had coronary artery disease confirmed by angiography were considered as case group and control group consists of 40 persons who had no plaque, and 55 persons were excluded according to the exclusion criteria. At first, a questionnaire was filled for each patient including demographic factors and their medical history. Then a blood sample was taken to assess the level of HMGB1. Data were analyzed using SPSS, Student’s independent t-test, and chi-square tests.
RESULTS
The mean plasma level of HMGB1 in the case group was 27.1 ± 2.9 ng/ml, while it was 19.6 ± 1.9 ng/ml in control groups (P = 0.03). The odds ratio for coronary artery plaque associated with high (> 15.03 ng/ml) levels of HMGB1 was 2.50 (95% confidence interval, 1.02-6.17, P = 0.03).
CONCLUSION
Increased plasma HMGB1 concentration may be associated with an increased risk of coronary atherosclerosis.
PMCID: PMC4144380  PMID: 25161686
High-Mobility Group Box-1; Coronary Artery Diseases; Inflammation; Biomarkers
24.  Evaluation of the return to work and its duration after myocardial infarction 
ARYA Atherosclerosis  2014;10(3):137-140.
BACKGROUND
The evaluation of the ability for return to work among patients after myocardial infarction (MI) is subject to controversy. Understanding various factors, which may affect return to work process, will help in promoting effective communication between physicians and patients. Return to work is dependent on such factors as patients’ functional capacity, MI expansion, cardiac muscle function, some psychiatric variables, job satisfaction, economic status, and age. In this study, we aimed to assess the frequency of return to work after first MI attack, and factors affecting it.
METHODS
This was a follow-up study performed in Yazd, Iran from September 2007 until September 2010 on 200 patients suffering from their first MI attack. Patients were assessed 6 months and 1-year after MI regarding their cardiac function. Job satisfaction was evaluated by Direct Support Professional job satisfaction questionnaire.
RESULTS
Seventy-seven percent of MI patients returned to work after 1-year. Mean time for return to work was 46.00 ± 4.12 days. Sixty percent of patients returned to work during the first 50 days after MI and 50% of them during 40 days after MI. The most common reason for not returning to work was patient’s decision.
CONCLUSION
This study showed that a considerable numbers of patients returned to work after 1-year. The only factors which affected the rate of return to work were left ventricular function after MI and job satisfaction.
PMCID: PMC4144381  PMID: 25161683
Myocardial Infarction; Return to Work; Left Ventricular Function; Job Satisfaction
25.  The association of genetic variations with sensitivity of blood pressure to dietary salt: A narrative literature review 
ARYA Atherosclerosis  2014;10(3):169-174.
Salt sensitivity of blood pressure (BP) is an independent risk factor for cardiovascular morbidity. Up to 50% of patients with essential hypertension are salt-sensitive, as manifested by a rise in BP with salt intake. Several genetic variations have been identified as being associated with salt sensitivity. The present study aimed to review the evidence on the effect of gene polymorphisms on the salt sensitivity of BP. We searched in PubMed website from 1990 to 2011, with the use of following keywords: “hypertension, dietary salt, polymorphisms, and blood pressure”. The effect of sodium intake on BP differed by genotype at the genes of the renin-angiotensin system, aldosterone synthase, cytochrome p450 3A, epithelial sodium channel genes, genes of sympathetic nervous system, β-3 subunit of G-protein, alpha-adducin, endothelial nitric oxide synthase, Kallikrein-Kinin system. These approaches suggest that these polymorphisms may be potentially useful genetic markers of BP response to dietary salt. There is evidence that genetic predisposition modulates the BP response to diet. Therefore, diet and nutrition can mitigate or enhance the effects of genetic predisposition. Increasing our knowledge of this relationship can lead to individualized treatment and increased understanding of hypertension.
PMCID: PMC4144382  PMID: 25161689
Hypertension; Genetics; Diet Therapy

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