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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.  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
7.  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
8.  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
9.  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
10.  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
11.  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
12.  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
13.  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
14.  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
15.  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
16.  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
17.  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
18.  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
19.  Lipid profile in antipsychotic drug users: A comparative study 
ARYA Atherosclerosis  2013;9(3):198-202.
BACKGROUND
Schizophrenic patients who receive antipsychotic drugs may be highly prone to metabolic disorders such as weight gain, dyslipidemia, and insulin resistance. The objective of the present study was to compare the effect of atypical and conventional antipsychotics on lipid profile.
METHODS
128 schizophrenic patients were enrolled into the study. Patients were divided into two groups. One group had received one type of atypical antipsychotic drug, and, the other, one type of conventional antipsychotic drug. They were considered as atypical and conventional groups. Moreover, both groups had not used any other antipsychotic drugs during the past year. Demographic data and food frequency questionnaire were completed by the participants. Serum triglyceride, total cholesterol (TC), high-density lipoprotein and low-density lipoprotein (LDL) cholesterols, and apolipoprotein A and B (Apo B) were tested by blood sample drawing after 12 hours of fasting through the antecubital vein. Student’s t-test was used to compare atypical and conventional groups.
RESULTS
There was no significant difference in age, gender, duration of illness, period of drug consumption, and age at onset of illness in the two groups. Patients in the atypical group used clozapine and risperidone (46.9%) more than olanzapine. In the conventional group 81.3% of patients used phenothiazines. Comparison between lipid profile in the conventional and atypical groups showed a significantly higher mean in TC (P = 0.01), LDL (P = 0.03), and Apo B (P = 0.01) in conventional group than the atypical group.
CONCLUSION
In schizophrenic patients, the level of lipid profile had been increased in both atypical and conventional antipsychotic users, especially conventional users, so the effect of antipsychotic drugs should be investigated periodically.
PMCID: PMC3681276  PMID: 23766777
Atypical Antipsychotic; Conventional Antipsychotic; Lipid Profile
20.  Effect of continuous care model on lifestyle of patients with myocardial infarction 
ARYA Atherosclerosis  2013;9(3):186-191.
BACKGROUND
Myocardial infarction (MI) is a life threatening disease that influences the physical, psychological and social dimensions of the individual. Improper lifestyle is one of the causes of this disease. The use of nursing models could be one of the important and fundamental steps in changing the risk factors associated with MI. This study was carried out to evaluate the effect of continuous care model on the lifestyle of patients with MI.
METHODS
This randomized clinical trial was carried out on 70 patients with MI in coronary care units of hospitals affiliated to Shiraz University of Medical Sciences. Enrolled patients were randomly assigned to intervention or control groups using a randomization list (random permutated blocks with length 4). The continuous care model was used for 35 patients in the intervention group for a period of 3 months and in the control group, the usual cares were applied for 35 patients. Data were collected through lifestyle questionnaire before the intervention and 3 months after. The data were analyzed using chi-square, independent t-test and paired t-test.
RESULTS
Patients in the intervention group showed significant improvements in lifestyle (125.6 ± 15.4 vs. 180.1 ± 19.9). Moreover, the lifestyle score of intervention group was significantly better than that of the control group (117.9 ± 22.0 vs. 180.1 ± 19.9; P < 0.001) after three months.
CONCLUSION
Applying a continuous care model had positive effects on the lifestyle of patients with Myocardial Infarction. In order to reduce the risk factors and improve the lifestyle of patients with MI, nurses could use this model to create an effective change.
PMCID: PMC3681277  PMID: 23766775
Myocardial Infarction; Lifestyle; Continuous Care Model
21.  Preconditioning by isoflurane as a volatile anesthetic in elective coronary artery bypass surgery 
ARYA Atherosclerosis  2013;9(3):192-197.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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
22.  Effects of a comprehensive cardiac rehabilitation program on quality of life in patients with coronary artery disease 
ARYA Atherosclerosis  2013;9(3):179-185.
BACKGROUND
Health-related quality of life is an important factor to evaluate effects of different interventions in cardiovascular diseases. Improvement in quality of life (QOL) is an important goal for individuals participating in cardiac rehabilitation (CR) programs. The purpose of this study was to assess the impact of comprehensive CR on QOL in patients with cardiovascular disease (CAD).
METHODS
In this quasi-experimental before-after study, the files of 100 patients with CAD who were referred to rehabilitation department of Isfahan Cardiovascular Research Institute were studied using a consecutive sampling method. Data collection was performed from the patient's files including their demographics, ejection fraction, functional capacity, and resting heart rate. All patients participated in a comprehensive CR program and completed the validated questionnaire Short-Form 36 Health Status Survey (SF-36), before and after CR program. Data was analyzed based on sex and age groups (≥ 65 and < 65 years) using independent t-test and paired t-test (to compare variables between groups and before and after CR, respectively).
RESULTS
After CR, scores of all physical domains of the SF-36 including physical function (PF), physical limitation (PL), body pain (BP) and vitality (V) in addition to general health (GH) were significantly improved in all patients (P < 0.05) compared to the baseline. Patients with age < 65 years had greater improvements in mental health (MH) and social function (SF) than patients with age ≥ 65 years (P < 0.05). Women had greater improvement in PF, V and MH compared to men (P < 0.05).
CONCLUSION
These results indicated that CR can improve QOL in cardiac patients especially in women. Elderly patients get benefit the same as other patients in physical domains.
PMCID: PMC3681279  PMID: 23766774
Quality of Life; Cardiac Rehabilitation; Cardiovascular Diseases
23.  Clinical associations between renal dysfunction and vascular events: A literature review 
ARYA Atherosclerosis  2013;9(3):203-209.
Chronic kidney disease affects several other organs of the human body, and causes high levels of morbidity and mortality due to these effects. The cardiovascular system is probably the most vulnerable organ to a decrease in kidney function, and responds very fast to this effect. To the extent that, more kidney disease patients die of cardiovascular events than that of the original renal disease. Moreover, cerebrovascular events have been confirmed to increase, and to have inferior outcomes on the general population. In this review article, we aim to review studies investigating effects of renal disease on vascular events.
PMCID: PMC3681280  PMID: 23766778
Renal Disease; Cardiovascular Disorders; Dialysis; Myocardial Infarction; Risk Factor
24.  Association between markers of systemic inflammation, oxidative stress, lipid profiles, and insulin resistance in pregnant women 
ARYA Atherosclerosis  2013;9(3):172-178.
BACKGROUND
Increased levels of pro-inflammatory factors, markers of oxidative stress and lipid profiles are known to be associated with several complications. The aim of this study was to determine the association of markers of systemic inflammation, oxidative stress and lipid profiles with insulin resistance in pregnant women in Kashan, Iran.
METHODS
In a cross-sectional study, serum high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), fasting plasma glucose (FPG), serum insulin, 8-oxo-7, 8-dihydroguanine (8-oxo-G), total cholesterol, triglyceride, High density lipoprotein-cholesterol (HDL-cholesterol), and plasma total antioxidant capacity (TAC) were measured among 89 primigravida singleton pregnant women aged 18-30 years at 24-28 weeks of gestation. Pearson’s correlation and multiple linear regressions were used to assess their relationships with homeostatic model assessment of insulin resistance (HOMA-IR).
RESULTS
We found that among biochemical indicators of pregnant women, serum hs-CRP and total cholesterol levels were positively correlated with HOMA-IR (β = 0.05, P = 0.006 for hs-CRP and β = 0.006, P = 0.006 for total cholesterol). These associations remained significant even after mutual effect of other biochemical indicators were controlled (β = 0.04, P = 0.01 for hs-CRP and β = 0.007, P = 0.02 for total cholesterol). Further adjustment for body mass index made the association of hs-CRP and HOMA-IR disappeared; however, the relationship for total cholesterol remained statistically significant.
CONCLUSION
Our findings showed that serum total cholesterol is independently correlated with HOMA-IR score. Further studies are needed to confirm our findings.
PMCID: PMC3681281  PMID: 23766773
Inflammation; Oxidative Stress; Insulin Resistance; Pregnancy
25.  Heart rate recovery in exercise test in diabetic patients with and without microalbuminuria 
ARYA Atherosclerosis  2013;9(3):167-171.
BACKGROUND
Diabetes mellitus (DM) has a lot of complications such as macrovessel and microvessel disease. Another complication of DM is cardiac autonomic neuropathy (CAN), which have effect on automatic nervous system of heart. Failure in heart rate slowing after exercise is a presentation of this abnormality.
METHODS
We selected diabetic patients and divided them to case and control group based on microalbuminuria. Case group comprised of diabetic patients with microalbuminuria and control group included those without microalbuminuria. Patients in both groups exercised on treadmill using Bruce protocol and heart rate was measured in first and second minutes in the recovery period.
RESULTS
We selected 35 patients with microalbuminuria (case group) and 35 without microalbuminuria (control group) among diabetic patients. No statistically significant difference was seen in sex and age between case and control groups. Heart rate recovery in the first minute of recovery in the case and control groups did not show significant difference; but in the second minute of recovery, it was significantly higher in control group (97 ± 19.4 vs. 101.9 ± 12.4 beat per minute, P = 0.04).
CONCLUSION
In this study we evaluated the heart rate recovery or deceleration in diabetic patients with albuminuria and without microalbuminuria in recovery phase after exercise test. We found out that heart rate recovery at the second minute in the case and control groups has statistically significant difference but at the first minute, it did not.
PMCID: PMC3681282  PMID: 23766772
Diabetes Mellitus; Exercise Test; Heart Rate Recovery

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