Exposure to occupational air pollution and vascular endothelial dysfunction in workers of the steel industry in Iran.

Air pollution is recognized as a risk factor for cardiovascular diseases; however, the precise underlying mechanisms remain unclear. This study investigated the impact of occupational air pollution exposure on endothelial function in workers within the steel industry. Specifically, we examined male employees in the coke-making division of the Isfahan Steel Company in Iran, as well as those in administrative roles with no known history of cardiovascular risk. Data on age, body mass index, duration of employment, blood pressure, fasting blood sugar, and lipid profile were collected. To assess endothelial function, flow-mediated dilation (FMD) was measured. The baseline brachial artery diameter was greater (mean difference [95% CI] = 0.068 mm [0.008 to 0.128]), while the FMD was lower (mean difference [95% CI] = -0.908 % [-1.740 to -0.075]) in the coke-making group than in the control group. After controlling for potential confounding variables, it was observed that working in the coke-making sector of the industry was associated with lower FMD (F = 3.954, p = .049). These findings indicated that occupational air pollution exposure among workers in the steel industry is linked to impaired endothelium-dependent vasodilation.

Medication Adherence With Polypill in Cardiovascular Disease and High-Risk Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Involving 7364 Participants.

Considering the worldwide mortality and morbidity of cardiovascular diseases (CVDs), the necessity of using multiple pills due to the chronicity of this condition, and the importance of medication adherence in these patients, we conducted this systematic review and meta-analysis to assess the polypill effect on adherence in patients with established CVD and at high risk. To accomplish this review, we searched various databases to access grey literature and several electronic databases to find randomized controlled trials (RCTs) assessing polypills compared to individual pills from January 2000 to October 2022. The outcomes were primarily medication adherence, secondarily systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C) serum level, and serious adverse events (SAEs). Ultimately, 2820 studies were detected and narrowed to 8 RCTs based on the eligibility criteria. In this study, involving 7364 patients, there was a significant improvement in medication adherence in the polypill group compared to the individual pills group (Risk Ratio [RR] = 1.29; [95%CI: 1.10; 1.50]). Out of secondary outcomes, SBP was significantly decreased (Mean Difference [MD] = -1.72 mmHg; [95%CI: -2.40; 1.03]), but LDL-C serum level (MD = -0.65 mg/dl; [95%CI: -4.47; 3.16]) and SAE (RR = 1.08; [95%CI: f0.98; 1.20]) did not have a notable difference in polypill compared to individual pills.

Does tranexamic acid diminish hemorrhage and pain in open elbow arthrolysis? a systematic review and meta-analysis.

BACKGROUND/OBJECTIVE: Effective hemostasis has the potential to reduce inflammation and pain, leading to potential benefits in the early rehabilitation of patients who undergo elbow arthrolysis. In the present study, we aim to assesse the effects of tranexamic acid (TXA) on elbow arthrolysis postoperative blood loss, patients' pain perception according to the visual analog scale (VAS), elbow range of motion (ROM), and complications. METHODS: We systematically searched PubMed, Web of Science, SCOPUS, and Cochrane Library. We included controlled trials, either randomized (RCT) or non-randomized studies of intervention (NRSI) comparing the effects of intravenous tranexamic acid (TXA) treatment with placebo/no treatment on postoperative blood loss, pain VAS score, elbow ROM, and complications, in patients who underwent open or closed elbow arthrolysis surgery. RESULTS: One RCT, and three NRSIs met eligibility criteria. The meta-analysis determined that tranexamic acid application reduced drain output 34 mm on average (WMD: -34.00; 95% CI: -49.45, -18.55). There was a discrepancy among included articles in terms of intra-operative blood loss; although the study with the largest sample size (291 and 296 patients in the case and control groups, respectively) reported reduced intra-operative blood loss in patients who received TXA. The pooled estimation for the pain VAS score on the first day post-operatively indicates a reduction in pain among patients in the TXA group (WMD: -0.82; 95% CI: -1.36, -0.28). Results for ROM, and complications' rate such as hematoma and ulnar nerve palsy were not different between the two groups. CONCLUSION: TXA may be beneficial to reduce elbow arthrolysis bleeding volume. However, it dose not seem to affect final elbow ROM and patients' pain score. Further high-quality clinical trials are needed to draw a robust conclusion on this topic.

Prognostic value of CD44 expression in oral squamous cell carcinoma: A meta-analysis.

CD44 as a marker of cancer stem cells (CSCs) may be correlated with tumor growth, cell migration, metastasis and chemo-radiotherapy resistance of cancers. However, the prognostic value of CD44 in oral squamous cell carcinoma(OSCC) remains controversial. Therefore, the purpose of the current study was to evaluate the correlation of CD44 expression with the prognosis of OSCC through a meta-analysis. We systematically searched PubMed, Scopus, ISI Web of Science, Embase and Cochrane Central databases for relevant studies up to November 2022. We included 11 articles with immunohistochemistry (IHC) method involving 1084 OSCC patients. Hazard ratios (HRs) with 95 % confidence intervals (95 % CIs) were calculated to assess the association between CD44 expression and overall survival (OS) and disease-free survival (DFS). Results showed that high expression of CD44 was a poor prognostic marker for OS in OSCC patients (HR: 1.71, 95 % CI: 1.18-2.47). Also results for DFS demonstrated that in patients with high CD44 expression who received treatment, the probability of tumor recurrence or death was 1.66 times and in the worst case this ratio can reach 2.39 (HR: 1.66, 95 % CI: 1.15-2.39). High CD44 expression associated with metastasis to lymph nodes and distant metastasis, poorer survival of the patients, tumor recurrence, higher tumor stage and grade and aggressive clinicopathological features. Therefore CD44 can be used as a valuable independent marker in predicting the prognosis of OSCC patients.

A healthy diet, physical activity, or either in relation to cardiovascular and all-cause mortality: A prospective cohort study.

OBJECTIVES: The aim of our study was to compare four lifestyles-healthy diet and low activity, unhealthy diet and high activity, unhealthy diet and low activity, and healthy diet and high activity-in relation to the risk of cardiovascular disease (CVD) and all-cause mortality. METHODS: A total of 6504 adults ages ≥35 y were recruited to participate in the Isfahan Cohort Study and followed for 13 y. Diet was assessed using a validated 48-item food frequency questionnaire, and the quality of diet was assessed using the Dietary Quality Index. Physical activity (PA) was evaluated using the International Physical Activity Questionnaire. The primary outcomes were CVD and all-cause mortality. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and the 95% CIs. RESULTS: During 771 440 person-years of follow-up, 390 and 147 deaths occurred due to all causes and CVD, respectively. High PA, either with a healthy or unhealthy diet, was associated with a lower risk of death from CVD (HR = 0.43; 95% CI, 0.26-0.69, and HR = 0.32; 95% CI, 0.18-0.56, respectively) and also all-cause mortality(HR = 0.53, 95% CI, 0.39-0.71, and HR = 0.5, 95% CI, 0.36-0.68). Moreover, type of PA was important, such that when leisure time PA was considered, none of the lifestyles was associated with a lower risk of CVD and all-cause mortality. However, for occupational PA, the result was the same as the total PA. CONCLUSIONS: Having high PA (total or occupational), with or without adhering to a healthy diet, is associated with a lower risk of death from any cause and CVD; although leisure time PA, irrespective of adhering to a healthy diet, was not associated with a lower risk of all-cause and CVD mortality.

Prognostic role of osteoprotegerin and risk of coronary artery calcification: a systematic review and meta-analysis.

Aim: Coronary artery calcification (CAC) is a predictor of atherosclerosis. However, the association of osteoprotegerin (OPG) with CAC is still controversial. Methods: Prospective cohort studies that provided odds ratios with 95% CIs were included from PubMed, Embase, Web of Science and Scopus through July 2022. Results: Out of 14 studies included in the systematic review, three studies with 7642 participants were included in the meta-analysis. The pooled odds ratio indicated a significant association between higher OPG levels and accelerated risk of CAC (1.15; 95% CI: 1.03-1.30; p < 0.001) with relatively no heterogeneity between studies (I2 = 0%; p = 0.43). Conclusion: The results indicated that increased concentrations of OPG are positively associated with a 15% elevated odds of CAC after adjustment of major covariates.

This meta-analysis included published data on the relationship between levels of osteoprotegerin, an important molecule in the bone production process, and the risk of accumulation of calcium deposits in the vessels supplying blood to the heart. Since these calcium deposits are an early sign of heart disease and subsequently heart attacks, understanding the mechanisms and finding ways to treat patients earlier can be of great importance. This study found that the higher the osteoprotegerin level a patient has, the higher the patient's chance of having calcium deposits in his or her heart vessels.

Does Opioid Addiction Influence Clinical and Angiographic Outcomes in STEMI Patients Undergoing Emergency PCI?

Background: Despite recognizing the traditional coronary artery disease (CAD) risk factors, some secondary factors, such as opioid substance abuse, have to be considered. We aimed to assess the relationship between opioid consumption and emergency percutaneous coronary intervention (PCI) revascularization results, according to Thrombolysis in Myocardial Infarction (TIMI) flow and in-hospital survival outcomes in ST-elevation myocardial infarction (STEMI) patients. Materials and Methods: This case-control study was conducted on 186 patients (93 patients in each group) with acute STEMI, who were referred to Chamran Heart Center, Isfahan, Iran. Opioid addiction was diagnosed by patients' records and confirmed by conducting an interview based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria. Patients in both groups were evaluated and compared for angioplasty results based on the TIMI flow grade and in-hospital cardiovascular events and complications. Results: Ninety-one patients (97.84%) of each group were male, and opioid-addicted patients were younger than the non-opioid users (52.95 9.91 vs. 57.90 12.17, P = 0.003). Among the CAD risk factors, prevalence of dyslipidemia was significantly higher in non-opioid users, whereas cigarette smoking was higher in opioid-addicted patients (P < 0.050). There was no significant difference between the two groups regarding pre- and post-procedural myocardial infarction complications as well as mortality rate (P > 0.050). Also, there were no significant differences between the opioid and non-opioid users regarding TIMI flow grading, and successful PCI rate based on achieving TIMI III was 60.21% versus 59.1% in opiate-dependent and non-opioid users, respectively (P = 0.621). Conclusion: Opioid addiction has no effects on post-PCI angiographic results and in-hospital survival outcomes in STEMI patients which undergoing emergency PCI.

Correlation between osteoprotegerin and coronary artery calcification in diabetic subjects: a systematic review of observational studies.

Coronary artery calcification (CAC) is one of the critical cardiovascular complications that lead to elevated morbidity and mortality among patients with type 2 diabetes (T2M). The association between osteoprotegerin (OPG) and CAC could potentially provide a reasonable chance for preventive therapy in type 2 diabetic patients and benefit the rate of mortality. Since measurement of CAC score is relatively expensive and requires radiation exposure, the current systematic review aims to provide clinical evidence for evaluating the prognostic role of OPG in determining CAC risk among subjects with T2M. Web of Science, PubMed, Embase, and Scopus, were investigated until July 2022. We assessed human studies investigating the association of OPG with CAC in type 2 diabetic patients. Quality assessment was performed by Newcastle-Ottawa quality assessment scales (NOS). Out of 459 records, 7 studies remained eligible to be included. Observational studies that provided odds ratio (OR) estimates with 95% confidence intervals (CIs) for the association between OPG and the risk of CAC were analyzed by random-effects model. In order to provide a visual summary of our findings, the estimation of pooled OR from cross-sectional studies was reported as 2.86 [95% CI 1.49-5.49], which is consistent with the findings of the cohort study. Results revealed that the association between OPG and CAC was significant among diabetic patients. OPG is hypothesized to be a potential marker in predicting the presence of high coronary calcium score among subjects with T2M that could be recognized as a novel target for further pharmacological investigations.

Using Music for the Prevention of Delirium in Patients After Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial.

OBJECTIVE: The aim was to evaluate the effect of music on preventing delirium after coronary artery bypass grafting, to analyze vital signs and blood gas parameters, and to determine risk factors affecting delirium. DESIGN: A randomized clinical trial. SETTING: A single-center, tertiary hospital. PARTICIPANTS: In total, 200 patients who underwent coronary artery bypass grafting surgery from April 2020 to April 2021. INTERVENTIONS: A one-hour session of new-age music was administered twice a day postoperatively for 7 days using a headphone. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit before and after each session. Vital signs and blood gas parameters were compared to evaluate the effect of music. All assessments were conducted blindly by a different researcher. MEASUREMENTS AND MAIN RESULTS: Twelve participants who were delirium-positive were in the control group, and there were 3 in the case group, which suggested a statistically significant effect of music in preventing delirium (p = 0.016). The mean age of patients was 64.7 ± 7.9 years old in the control group and 62.2 ± 7.5 years old in the case group. There was a significant difference among the control and case groups in terms of the surgery time; surgery time in the control group was significantly lower than in the case group (242.4 ± 42.3 v 261.6 ± 48.9, respectively; p = 0.03 < 0.05). Blood pressure and heart rate in the case group were lower, similar to the respiratory rate and venous blood gas parameters; Blood pressure differences were not statistically significant (p > 0.05); CONCLUSION: Relaxation music, including bird, water, and wind, significantly prevents delirium after coronary artery bypass grafting.

lncRNA-miRNA-mRNA ceRNA Network Involved in Sheep Prolificacy: An Integrated Approach.

Understanding the molecular pattern of fertility is considered as an important step in breeding of different species, and despite the high importance of the fertility, little success has been achieved in dissecting the interactome basis of sheep fertility. However, the complex mechanisms associated with prolificacy in sheep have not been fully understood. Therefore, this study aimed to use competitive endogenous RNA (ceRNA) networks to evaluate this trait to better understand the molecular mechanisms responsible for fertility. A competitive endogenous RNA (ceRNA) network of the corpus luteum was constructed between Romanov and Baluchi sheep breeds with either good or poor genetic merit for prolificacy using whole-transcriptome analysis. First, the main list of lncRNAs, miRNAs, and mRNA related to the corpus luteum that alter with the breed were extracted, then miRNA−mRNA and lncRNA−mRNA interactions were predicted, and the ceRNA network was constructed by integrating these interactions with the other gene regulatory networks and the protein−protein interaction (PPI). A total of 264 mRNAs, 14 lncRNAs, and 34 miRNAs were identified by combining the GO and KEGG enrichment analyses. In total, 44, 7, 7, and 6 mRNAs, lncRNAs, miRNAs, and crucial modules, respectively, were disclosed through clustering for the corpus luteum ceRNA network. All these RNAs involved in biological processes, namely proteolysis, actin cytoskeleton organization, immune system process, cell adhesion, cell differentiation, and lipid metabolic process, have an overexpression pattern (Padj < 0.01). This study increases our understanding of the contribution of different breed transcriptomes to phenotypic fertility differences and constructed a ceRNA network in sheep (Ovis aries) to provide insights into further research on the molecular mechanism and identify new biomarkers for genetic improvement.

Assessment of Metabolic Risk Factors and Heart-Healthy Lifestyle in Atherosclerotic Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention after a 6-Month Follow-Up.

Background: Mortality due to acute coronary syndrome (ACS) has dramatically diminished because of performing life-saving interventions. This study aims to assess the metabolic risk factors and heart healthy lifestyle following the first episode of ACS under percutaneous coronary intervention (PCI) treatment after the 6-month follow-up. Materials and Methods: This is a longitudinal study conducted on 40 patients who underwent PCI because of the first episode of ACS. The patients' information including age, weight, abdominal circumference, smoking, functional capacity, patients' metabolic equivalent of task (METS), and laboratory tests including triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine, fasting blood sugar (FBS), and hemoglobin A1C were recorded before discharge and reassessed after 6-month follow-up. Results: The patients were dominantly male (92.5%) with an average age of 56.8 ± 7.11 years. Physical activity and functional capacity (METS) significantly improved within 6 months (P = 0.019). BMI significantly improved; however, although the abdominal circumference decreased, it was not significant (P = 0.28). The number of smokers (P = 0.12) and the daily number of smoked cigarettes (P = 0.37) nonsignificantly decreased within 6 months. However, HDL-C (P = 0.013) and LDL-C (P = 0.027) changes were not desirable. TG, FBS, and blood pressure did not statistically significant change (P > 0.05). Conclusion: Although BMI, physical activity, and METS remarkably improved, waist circumference decreased nonsignificantly and lipid profile got worse paradoxically. Although this population is limited for generalization, this study shows that we require further schedules to improve ACS secondary prevention practice in our community.

Egg consumption and risk of cardiovascular events among Iranians: results from Isfahan Cohort Study (ICS).

PURPOSE: The association between egg consumption and cardiovascular events remains controversial. This study aims to evaluate this association in cardiovascular events including myocardial infarction (MI), ischemic coronary heart disease (ICHD), stroke, cardiovascular disease (CVD), and CVD mortality in an Iranian population. METHODS: This prospective cohort study included 6504 adults (age ≥ 35 years) with no history of CVD event at baseline. The frequency of egg consumption was assessed using a validated food frequency questionnaire. Participants were followed for 12 years and incidence of new CVD cases were determined through active examinations and linkages to multiple registries. Cox frailty models were conducted to calculate adjusted hazard ratios (HR)s for cardiovascular events associated with egg consumption. RESULTS: Over a median follow-up of 12 years, fully adjusted model [adjusted for age, sex, education, residency, smoking, daily physical activity, family history of CVD, metabolic syndrome, aspirin, body mass index and Global Dietary Index] revealed a null association between egg and cardiovascular events. Compared with non-consumers (&lt;1 time/week), higher egg consumption (≥3 time/week) was not associated with incident MI (HR = 1.44, 95% CI: 0.86, 2.41; P = 0.48), ICHD (HR = 1.26, 95% CI: 0.80, 1.99; P = 0.41), stroke (HR = 0.79, 95% CI: 0.46, 1.38; P = 0.71) and CVD (HR = 1.05, 95% CI: 0.79, 1.40; P = 0.93). CONCLUSION: These findings suggest that higher egg consumption is not associated with increased risk of MI, ICHD, stroke, and CVD among Iranians. Larger studies with longer duration of follow-up are warranted to explore these associations in populations with higher egg consumption.

The Effects of Comprehensive Home-Based Cardiac Rehabilitation versus Usual Care in Patients with Ischemic Heart Disease in Iran: Study Protocol for a Multicenter Randomized Controlled Trial.

Background: Cardiovascular diseases are the leading causes of mortality all around the world. Patients with Ischemic heart disease (IHD) are at an increased risk of ischemic events; therefore, secondary prevention measures should continue for these patients. Although Cardiac rehabilitation (CR) is one of the secondary prevention measures for IHD patients which has favorable clinical outcomes, only 50% of patients are referred and among them, a small percentage attends CR. Therefore, other strategies should be considered, one of which is home-based cardiac rehabilitation. Methods: A multicenter, parallel-group randomized controlled trial has been conducting in three hospitals in Isfahan and patients have been assigned into a 1:1 ratio for the evaluation of the effectiveness of home-based cardiac rehabilitation versus usual care. Psycho-educational consultation based on the Health Action Process Approach including heart-healthy diet, stress management, lifestyle changes, smoking cessation, and physical activity has been performed. Primary outcomes, including the quality of life, psychological and smoking status, body mass index, blood pressure, blood cholesterol level, and physical activity level have been measured at 6 months after the randomization and intervention. One year after the intervention, primary and secondary outcomes, including cardiovascular events, the frequency of hospital admissions, and the death rates due to cardiovascular reasons will be assessed. Conclusion: HBCR program can increase patient accessibility to CR services its implantation can be reduce burden IHD.

Fixed Dose Combination Therapy for Secondary Prevention of Major Cardiovascular Events: Review of Literature and Design for Persian Polypill, A Randomized Clinical Trial.

This is a review on clinical trials assessing polypill in secondary prevention of cardiovascular diseases (CVD), followed by design of Persian Polypill study. We identified six completed studies and three ongoing trials having at least 10% of their participants with established CVD. Evaluation of these trials showed insufficient data to support polypill as a strategy to reduce major adverse cardiovascular events (MACE) in CVD patients, and a lack of studies in low and middle income countries. Persian Polypill will be an open labeled, parallel two arm, randomized clinical trial conducting on patients hospitalized because of an acute myocardial infarction (AMI). It is planned to randomize 1200 patients to one of the two arms, either receiving polypill or usual care and follow them for 34 months. The primary outcome will be a composite clinical outcome of MACE and the secondary outcome will be cost-effectiveness of polypill treatment. Results of this study might support comprising polypill in routine management of AMI, especially in developing countries.

The Effect of 3-Month Growth Hormone Administration and 12-Month Follow-Up Duration among Heart Failure Patients Four Weeks after Myocardial Infarction: A Randomized Double-Blinded Clinical Trial.

BACKGROUND: The probable impact of growth hormone (GH) as a heart failure (HF) treatment strategy is still less investigated. Therefore, we aimed to evaluate the relation of 3-month GH prescription on left ventricular ejection fraction (LVEF), interventricular septum (IVS), posterior left ventricle (LV) thickness, end systolic and end diastolic diameters (ESD and EDD), and pulmonary arterial pressure (PAP) among Iranian individuals suffering from HF due to MI attack. METHODS: A total of 16 clinically stable participants with HF diagnosis and LVEF < 40% were selected for enrollment in this pilot randomized double-blinded study. They were randomly assigned equally to groups received 5 IU subcutaneous GH or placebo. Injections were done every other day for a total of 3-month duration. After termination of intervention and nine months afterwards, cardiac outcomes were assessed. RESULTS: Baseline and 12-month posttrial participants' characteristics were similar. LVEF was increased significantly by three months started from baseline in individuals receiving GH (32 ± 3.80% to 43.80 ± 4.60%, P = 0.002). During the next 9 months of follow-up concurrent with cessation of injections, LVEF was declined (43.80 ± 4.60% to 32.20 ± 6.97%, P = 0.008). LVEF and ESD were remarkably higher and lower in GH group compared with controls by the end date of injections (43.80 ± 4.60% vs. 33.14 ± 4.84%, P = 0.02 and 39.43 ± 3.45 mm vs. 33 ± 3.16 mm, P = 0.03, respectively). No other considerable association was found in terms of other predefined variables in neither GH nor placebo groups. CONCLUSIONS: GH administration in HF patients was associated with increased LVEF function. Several randomized clinical trials are necessary proving this relation. This trial is registered with IRCT201704083035N1.

A Systematic Review and Meta-analysis on the Prevalence of Smoking Cessation in Cardiovascular Patients After Participating in Cardiac Rehabilitation.

Smoking is the most important modifiable cardiovascular risk factor causes around approximately one of every 4 cardiovascular-related deaths worldwide. Cardiac rehabilitation (CR) is the standard way of management of heart diseases after myocardial infraction. This study aimed to determine the prevalence of cardiovascular patients' quit smoking after participation in CR. PubMed, EMBASE, Web of Science, Scopus, and google scholar were searched systematically. In total, 18 studies were analyzed. Results showed that the mean age of smokers' were 54.80 (52.06, 57.55), and of them 53 % (22%, 83%) quit smoking after participating in CR. Subgroup analysis showed that among type of CR the most effective one was the educational along with physical exercise (comprehensive CR) cause 99% (98%, 100%) smoking cessation (SC). Group-based methods with76% (57%, 94%) of quitters showed to be more effective than individual-based. It can be concluded that CR has been effective in terms of smoking cessation.

The transulnar approach in the patients with ipsilateral radial artery occlusion.

BACKGROUND: Transulnar approach (TUA) has been classified as an appropriate surrogate for the transradial approach (TRA), but the safety of TUA in the presence of ipsilateral radial artery occlusion (RAO) is not well studied. In this article, we aimed to assess the feasibility and occurrence of complications of this approach in Iranian individuals with ipsilateral RAO. METHODS: In this prospective double-center study, a total number of 70 participants from July 2017 to November 2018 with coexisting ipsilateral RAO due to prior RA angiography, severe arterial spasm, prominent vascular anomalies, or arterial harvesting for hemodialysis or graft procedures were enrolled and underwent TUA. Incidence of probable complications including pain, hematoma, arteriovenous fistula (AVF), pseudoaneurysm formation, any adverse events requiring immediate vascular surgery, life-threatening hand ischemia, infection, ulnar nerve palsy, major adverse cardiac events (MACE) including death, myocardial infarction (MI), or stroke plus ulnar artery (UA) obstruction and narrowing was evaluated both before discharge time and one month afterward. RESULTS: The mean age of the study population was 68.2 ± 12.8 years [men number: 41 (58.5%)]. Our success rate was 98.6% and 37.1% of subjects underwent further coronary intervention. No aforementioned adverse outcomes were reported in any individual except for pain (11.4%) and minor hematoma (grade I) (5.7%) as well as MACE (1.4%). Follow-up assessment revealed asymptomatic UA occlusion (UAO) and severe narrowing in 2.8% and 1.4% of participants, respectively. CONCLUSION: Our outcomes suggested that due to high safety and low complication rates, TUA could be tried safely in patients with concurrent ipsilateral RAO. Other appropriate cohort studies are required for assessing the incidence of TUA complications.

High Sensitivity C-Reactive Protein Predictive Value for Cardiovascular Disease: A Nested Case Control from Isfahan Cohort Study (ICS).

Background: High sensitivity C-reactive protein (hs-CRP) was proven to be an independent risk factor for cardiovascular diseases (CVDs). The aim of this study was to investigate the benefits of assessing hs-CRP among individuals with different cardiovascular risk factors. Methods: This nested case-control study was obtained from the Isfahan Cohort Study (ICS). Anyone who has been suffering from any CVDs, including myocardial infarction, unstable angina, sudden cardiac death and stroke was put in the case group. Density sampling method was utilized to choose the control group who had no aforementioned CVDs during follow-up. Four quartiles of hs-CRP (Q1: 0.1-2.3, Q2: 2.4-3, Q3: 3.1-4 and Q4: 4.1-14 mg/l) were assessed defining odds ratios (OR) of CVDs prediction in different CVDs risk factor categories. Confidence intervals of 95% are put in brackets. Results: A total of 502 cases and 538 controls were recruited. All hs-CRP quartiles showed increased CVDs likelihood compared to normal subjects in terms of diabetes mellitus (DM) and hypertension (HTN). Second quartile showed a 1.93 [1.33-2.81] and 3.34 [1.36-8.17] increased risks in patients with hypertriglyceridemia or dyslipidemia, respectively. Smokers in the third quartile group revealed increased CVDs risk. The fourth quartile showed significant increased risks in patients suffering from hypercholesterolemia (OR = 1.91 [1.33-2.74]), high LDL-C (OR = 1.88 [1.33-2.66]), and hypertriglyceridemia (OR = 2.31 [1.57-3.41]). Conclusions: Our findings suggested that assessing hs-CRP is beneficial for predicting CVDs in patients with HTN and DM. Furthermore, specific patients with lipid abnormalities or history of smoking benefits from checking hs-CRP.

Impact of secondhand smoke exposure in former smokers on their subsequent risk of coronary heart disease: evidence from the population-based cohort of the Tehran Lipid and Glucose Study.

OBJECTIVES: Cigarette smoking is an established, strong, and modifiable risk factor for coronary heart disease (CHD). However, little research has investigated CHD risk in former smokers who continue to be exposed to others' cigarette smoke (former & secondhand smokers). METHODS: In the Tehran Lipid and Glucose Study, a prospective population-based cohort (n=20,069) was followed up for a median period of 14.6 years. A subset of 8,050 participants of 30 years of age and older was analyzed, with first CHD events as the study outcome. Participants were categorized as never, former, current, secondhand, and former & secondhand smokers. Data on smoking intensity (cigarette/d) were also collected. A Cox proportional hazards regression model was applied to estimate the risk of CHD, taking into account the main potential confounders. RESULTS: The mean age of participants was 46.10 ±11.38 years, and they experienced 1,118 first CHD events (with most CHD cases in former smokers) during the follow-up period. The risk of CHD was highest in current smokers, followed in order by former & secondhand, former, and secondhand smokers (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.65 to 2.39; HR, 1.55; 95% CI, 1.15 to 2.08; HR, 1.39; 95% CI, 1.12 to 1.72; HR, 1.27; 95% CI, 1.07 to 1.51, respectively), compared to never smokers. The risk of CHD increased with smoking intensity, which has been proposed as a preferable measure of smoking, indicating a dose-response pattern. CONCLUSIONS: The elevated risk of CHD in former & secondhand smokers was a noteworthy finding, with possible implications for health policy; however, further research is needed.

Nature of Cardiac Rehabilitation Around the Globe.

BACKGROUND: Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region. METHODS: In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models. FINDINGS: 111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ±â€¯2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ±â€¯1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p = < 0.05). INTERPRETATION: This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes.