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1.  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
2.  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
3.  Socioeconomic characteristics and controlled hypertension: Evidence from Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2013;9(1):77-81.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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
4.  Social norms of cigarette and hookah smokers in Iranian universities 
ARYA Atherosclerosis  2013;9(1):45-50.
BACKGROUND
First experiences of tobacco use usually occur in adolescence. The recognition of social norms leading to youth smoking is hence necessary. We tried to assess the social norms among Iranian young cigarette and hookah smokers.
METHODS
This cross-sectional study was conducted on 451 girls and 361 boys aging 20-25 years old who entered Isfahan and Kashan Universities (Iran) in 2007. Demographic factors (age, gender, and age at smoking onset) cigarette and hookah smoking status, having a smoking father or smoking friends and four related social norms were recorded. Binary logistic regression analysis was used to separately determine associations between hookah and cigarette smoking and the four social norm variables.
RESULTS
Cigarette and hookah smokers had significant differences with nonsmokers in two social norms: “Perceived smoking by important characters” [odds ratio (OR) = 1.35 in cigarette smokers and 1.58 in hookah smokers; P < 0.001] and “smoking makes gatherings friendly” (OR = 3.62 in cigarette smokers and 6.16 in hookah smokers; P < 0.001). Furthermore, cigarette and hookah smoking were significantly associated with having smoking friends.
CONCLUSION
Highlighting the social norms leading to cigarette and hookah smoking may help policy makers develop comprehensive interventions to prevent smoking among adolescents.
PMCID: PMC3653255  PMID: 23696759
Cigarette; Hookah; Smoking; Social Norm
5.  Parental perceptions of weight status of their children 
ARYA Atherosclerosis  2013;9(1):61-69.
BACKGROUND
Understanding the knowledge, attitudes, and beliefs of parents is important for planning appropriately to control their children’s weight. We aimed to study these variables in parents of normal, underweight, overweight, and obese children.
METHODS
This cross-sectional study targeted the parents of normal, underweight, overweight, and obese children, who were selected using multistage random sampling method. The parents’ knowledge, attitudes, beliefs, and behaviors about the weight status of their children, weight management, obesity, diet, lifestyle, and related psychosocial factors were evaluated using a validated questionnaire. The questionnaire, which had been validated, consisted of 12 demographic, 8 knowledge, 19 attitude and beliefs, and 25 behavior questions. Mean knowledge, attitude and beliefs, and behavior scores were compared across three subgroups of parents. Student’s independent t-test, ANOVA, and Kruskal-Wallis test were used to study the correlation between different demographic and socioeconomic factors, and the studied variables.
RESULTS
90% of parents were aware that obesity is a disease, and 92% knew that eating too much fast food would lead to obesity in children. Only 5% assumed that obese children are healthier than non-obese children. The mean scores of the three subgroups showed no significant difference in knowledge, attitude and beliefs, and behavior. Families with fathers, whose education level was higher than high school diploma, rated their children’s weight status as overweight or obese significantly less than families with fathers, whose education level was high school diploma or lower (8.5% vs. 16.5%, respectively, P = 0.014). Only 12% of parents tried to help their children lose weight at least once, and only 6% arranged sport activities for the family members. In 57% and 41% of families, the child, respectively, decided how much time was enough to watch TV, and how much chocolates and sweets to eat. 46% of children watched TV for more than 2 hours/day, and 49% of children watched TV while eating meals. The mean total score of boys’ parents was significantly lower than that of girls’ parents (P < 0.05). Families with low income, with no medical insurance, or not owning a house thought that the cost of registration in sport activities for children was too high (P < 0.03).
CONCLUSION
Some parents unreasonably rated the weight status of their children as overweight/obese. It is suggested that further studies be carried out to evaluate and improve parents’ knowledge, attitudes, and behaviors regarding their children’s weight.
PMCID: PMC3653261  PMID: 23696761
Children; Obesity; Overweight; Knowledge; Attitude; Belief; Behavior
6.  The effectiveness of stress management intervention in a community-based program: Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2012;7(4):176-183.
BACKGROUND:
This study was designed to assess the effectiveness of stress management training in improving the ability of coping with stress in a large population.
METHODS:
Five cross-sectional studies using multistage cluster random sampling were performed on adults aged ≥ 19 years between 2000 to 2005 in Isfahan and Najafabad (Iran) as intervention cities and Arak, Iran as the control city within the context of Isfahan Healthy Heart Program. Stress management training was adapted according to age and education levels of the target groups. In a 45-minute home interview, demographic data, General Health Questionnaire (GHQ) and stress management questionnaires were collected. Data was analyzed by t-test, linear regression and general linear model.
RESULTS:
Trends of both adaptive and maladaptive coping skills and GHQ scores from baseline to the last survey were statistically significant in both intervention and reference areas (P < 0.001). While adaptive coping skills increased significantly, maladaptive coping skills decreased significantly in the intervention areas. Furthermore, stress levels decreased significantly in the intervention compared to the reference area.
CONCLUSION:
Stress management programs could improve coping strategies at the community level and can be considered in designing behavioral interventions
PMCID: PMC3413087  PMID: 23205052
Stress Management; Community; Intervention; Coping Strategies
7.  Determination of normal range of bleeding time in rural and urban residents of Borujerd, Iran: A pilot study 
ARYA Atherosclerosis  2012;8(3):136-142.
BACKGROUND
Bleeding time test is used to assess the function of platelets in human body. The aim of this project was thus to estimate the sample size required to determine the normal range of bleeding time (BT) in Borujerd (a city in Iran). A pilot study was designed to determine the range of normal BT in a small group of normal people. The total sample size for the next study was then calculated according to the results.
METHODS
In order to determine the sample size, a total of 33 volunteers participated in this study. The normal range of BT was determined by Ivy method. Written informed consents were obtained from all participants and their clinical history was recorded. The sampling was performed once for each participant. However, the results were interpreted by two observers. The study protocol was approved by the Ethics Committee of the research center at Lorestan University of Medical Sciences (Iran).
RESULTS
In this study, 33 normal participants (20 women and 13 men) were divided into four age groups of 35-44, 45-54, 55-64 and over 64 years old. Maximum and minimum BTs in men were 209 (in the age group of 35-44 years) and 150 seconds (in the age group of over 64 years), respectively. On the other hand, the corresponding values in women were 194 (in 55-64 year-old subjects) and 145 seconds (in women over 64 years of age). Considering the aforementioned results, the total sample size for the next study was determined to be 580 normal subjects by two-sample t-test power analysis at a power of 0.91816.
CONCLUSION
There was a significant difference between the normal range of BT in participants of Borujerd and previously recorded range in other studies. Moreover, normal BT in men decreased by aging. This study did not show any special order in increasing or decreasing BT in women.
PMCID: PMC3557001  PMID: 23358456
Platelet; Bleeding Time; Ivy Method; Gender
8.  The effects of an educational program based on PRECEDE model on depression levels in patients with coronary artery bypass grafting 
ARYA Atherosclerosis  2012;8(1):36-42.
BACKGROUND
Depression is among the most important barriers to proper treatment ofcardiac patients. It causes failure in accepting their conditions, decreases their motivation infollowing the therapeutic recommendations, and thus negatively affects their functionality andquality of life. The present study aimed to investigate the effects of an educational programbased on Predisposing, Reinforcing, Enabling Constructs in Educational Diagnosis andEvaluation (PRECEDE) model on depression level in coronary artery bypass grafting (CABG)surgery patients.
METHODS
This was a quasi-experimental study in which 54 post-bypass surgery patients ofIsfahan Cardiovascular Research Center were investigated. The patients were randomly dividedinto two groups of intervention and control. The data was collected using two questionnaires.Primarily, the cardiac depression scale was used to measure the degree of depression followedby PRECEDE model-based educational questionnaire to identify the role of the educationalintervention on patients. The PRECEDE model-based intervention composed of 9 educationalsessions per week (60-90 minutes each). The patients were followed up for two months postintervention.
RESULTS
Following the educational intervention, mean scores of predisposing, enabling,and reinforcing factors, and self-helping behaviors significantly increased in the interventiongroup compared to the control group (P < 0.001). In addition, a significant difference in meanscores of depression was observed between the two groups following the educationalintervention (P < 0.001).
CONCLUSION
The findings of the current study confirmed the practicability and effectivenessof the PRECEDE model-based educational programs on preventing or decreasing depressionlevels in CABG patients.
PMCID: PMC3448400  PMID: 23056099
Educational Program; PRECEDE Model; Depression; Coronary Artery Bypass Surgery.
9.  Stress Level and Smoking Status in Central Iran: Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2011;6(4):144-148.
BACKGROUND
Individuals are faced with numerous stressful life events which can negatively influence mental health. Many individuals use smoking as a means of confronting stress. Given the relatively high prevalence of smoking in central Iran, the present study was conducted to compare stress levels in smokers, non-smokers and those who had quit smoking.
METHODS
This study was conducted as part of Isfahan Cardiovascular Research Program on 9752 individuals in the cities of Isfahan, Arak, and Najafabad in 2008. Sampling was performed using multi-stage cluster randomization method. Data on age, sex, demographic characteristics, and smoking status was collected through interviews. Stress level detected by General Health questionnaire.Logistic regression and chi- squere test was used for data analyzing.
RESULTS
In the present study, 30% of non-smokers, 32.1% ex- smoker and 36.9% of smokers had GHQ of 4 and higher (P=0.01). In regression analysis, the final model which was controlled for age, sex, socioeconomic statues (including place of residence, marital status and education level) showed that the odds ratio of stress in smokers and ex- smoker was significantly higher than in non-smokers (OR=1.66 and OR=1.12, respectively).
CONCLUSION
Since in conducted studies, mental problems and stresses have had an important role in people's smoking, it seems suitable to use the results of this study to present intervention for correct methods of coping with stress towards reducing the prevalence of smoking in the community.
PMCID: PMC3347833  PMID: 22577433
Cigarette; Stress; Community-based Program.
10.  The Correlation Between Lipid Profile and Stress Levels in Central Iran: Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2010;6(3):102-106.
BACKGROUND
Previous studies suggest that mental status may influence serum lipid levels. This study was conducted on adult population living in rural and urban areas in Central Iran to assess the correlation between stress level and lipid profile disorders.
METHODS
Data was extracted from final evaluation of Isfahan Healthy Heart Program (IHHP) in 2008. Multistage and random cluster methods were used for sampling. The study population consisted of 9752 adults aged ≥19 years living in three districts namely Isfahan, Arak and Najaf Abad. Demographic data, age and sex were recorded. Blood samples were taken to determine the lipid levels including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), low levels of high-density lipoprotein cholesterol (HDL-C) and triglycerides. Stress levels were assessed using the General Health Questionnaire. Logistic regression and chi-square tests were used for statistical analysis.
RESULTS
The odds ratios of high stress in individuals with high levels of TC, LDL-C and low levels of HDL-C compared to normal individuals after adjustment for age and sex were as follows respectively: 1.05 (1.02,1.15), 1.06 (1.02,1.18), 1.06 (1.01,1.17).
CONCLUSION
Intervention activities towards reduction of stress levels at the community level may be useful as part of the strategy for cardiovascular disease prevention.
PMCID: PMC3347824  PMID: 22577424
Cholesterol; Triglycerides; Stress; Adult
11.  The Relationship Between Ankle-Brachial Index and Number of Involved Coronaries in Patients with Stable Angina 
ARYA Atherosclerosis  2010;6(1):6-10.
BACKGROUND
Atherosclerosis is the commonest cause of vascular disease which can involve peripheral and/or cardiac vessels. This study was conducted to evaluate the possible link between Ankle-Brachial Index (ABI) and coronary vessel involvement in patients with stable angina.
METHODS
This cross-sectional study was conducted in 2008 on 120 individuals who were hospitalized in Chamran Heart Center and underwent coronary angiography. A questionnaire was completed to obtain demographic information, history of previous heart disease and smoking. Body height and weight, as blood pressure on hand and foot were measured. The patients underwent angiography and the extent of coronary involvement (> 75%) was determined. After12-14-hour of fasting, blood sugar was obtained to measure total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The Ankle Brachial Pressure Index (ABI) was calculated as the ratio of the blood pressure in the ankles to the blood pressure in the arms. The data were analyzed by SPSS-15 using ANOVA, T-Student test, Spearman's rank correlation coefficient, and discriminant analysis.
RESULTS
Samples were 46 women (38.33%) and 74 men (61.67%) with a mean age of 55.50 ± 10.49. Mean and SD of ABI in men and women was 0.72 ± 0.20 and 0.80 ± 0.19 with no significant difference (P=0.012). The correlation between ABI and extent of coronary involvement was 0.47 (P < 0.0001). The group with lower ABI had the highest levels of coronary involvement (triple vessel, P < 0.05).
CONCLUSION
ABI had a significant relationship with the degree of coronary involvement and a significant predictive value. Therefore ABI seems to be a reliable indicator of high coronary risk.
PMCID: PMC3347808  PMID: 22577406
Ankle to brachial index; Coronary involvement; Stable angina
12.  Is there any Relationship Between C-Reactive Protein Level and Complex Coronary Plaques in Patients with Unstable Angina? 
ARYA Atherosclerosis  2010;6(1):31-34.
BACKGROUND
Coronary artery disease is a leading cause of death in developed countries. On the other hand, increased level of CRP has been seen in atherosclerosis. According to this finding, we decided to conduct this study to assess the relationship between CRP and complex lesions of coronary arteries in patients with unstable angina.
METHODS
In this analytical cross sectional study which was conducted in 2007 in Chamran hospital, samples were collected using simple sampling and included 80 patients who referred to the hospital due to angina pectoris, had the diagnosis of unstable angina and were candidates of angiography. At first, a questionnaire was filled for each patient including demographic factors and their medical history. Then a blood sample was taken to assess level of CRP, FBS, and lipid profiles. The results of angiographic studies were considered by three cardiologists and abnormal patients were classified into simple and complex groups according to Ambrose criteria. Data was analyzed using SPSS version 15, t-student and chi-square tests.
RESULTS
Mean age of samples was 58.27 ± 6.23 years old. Considering the risk factors, most simple and complex lesions happened in obese patients however the only significant difference was observed in BMI between two groups (P < 0.05). Mean level of CRP in the population under study was 6.05 ± 4 mg/dl which was 1.37 ± 2 and 8.01 ± 6 in simple and complex groups respectively (P < 0.05). CRP mean was significantly higher in the group with complex lesions, less than 1 mg/dl in simple lesion and more than 4 mg/dl in complex lesions.
CONCLUSION
According to our findings, there is a significant difference considering CRP level in unstable angina patients who have complex lesions compared with simples ones. As complex plaques are more susceptible to develop coronary events, patients with a higher probability of complicated lesions can be screened.
PMCID: PMC3347811  PMID: 22577410
CRP; Simple and complex lesion; Unstable angina; Angiography

Results 1-12 (12)