Ambient carbon monoxide and cardiovascular-related hospital admissions: A time-series analysis.

Background and aims: Although several studies have investigated the association between air pollutants and cardiovascular diseases (CVDs) in recent years, a lack of evidence exists regarding carbon monoxide (CO) exposure, especially in the Eastern Mediterranean's polluted regions. In this study, we aimed to evaluate the short-term effect of CO exposure on daily CVD hospital admissions in Isfahan, a major city in Iran. Methods: Data were extracted from the CAPACITY study on daily CVD hospital admissions in Isfahan from March 2010 to March 2012. The 24-h mean CO concentrations were obtained from four local monitoring stations. In a time-series framework, the association between CO and daily hospitalizations for total and cause-specific CVDs in adults (ischemic heart disease (IHD), heart failure (HF), and cerebrovascular disease) was conducted using Poisson's (or negative binomial) regression, after adjusting for holidays, temperature, dew point, and wind speed, considering different lags and mean lags of CO. The robustness of the results was examined via two- and multiple-pollutant models. Stratified analysis was also conducted for age groups (18-64 and ≥65 years), sex, and seasons (cold and warm). Results: The current study incorporated a total of 24,335 hospitalized patients, (51.6%) male with a mean age of 61.9 ± 16.4 years. The mean CO concentration was 4.5 ± 2.3 mg/m³. For a 1 mg/m3 increase in CO, we found a significant association with the number of CVD hospitalizations. The largest adjusted percent change in HF cases was seen in lag0, 4.61% (2.23, 7.05), while that for total CVDs, IHD, and cerebrovascular diseases occurred in mean lag2-5, 2.31% (1.42, 3.22), 2.23% (1.04, 3.43), and 5.70% (3.59, 7.85), respectively. Results were found to be robust in two- and multiple-pollutant models. Although the associations changed for sex, age groups, and seasons, they remained significant for IHD and total CVD, except for the warm season, and for HF, except for the younger age group and cold seasons. Additionally, the exposure-response relationship curve of the CO concentrations with total and cause-specific CVD admissions showed non-linear relationships for IHD and total CVDs. Conclusions: Our results showed that exposure to CO contributed to an increase in the number of CVD hospitalizations. The associations were not independent of age groups, season, and sex.

Apolipoprotein B gene mutation related to familial hypercholesterolemia in an Iranian population: With or without hypothyroidism.

BACKGROUND: Familial hypercholesterolemia (FH) leads to elevated low-density lipoprotein cholesterol (LDL-C) levels in plasma. Mutations of its related gene; apolipoprotein B (APOB) is seen in about two percent of the patient with FH. Thyroid disease is usually part of the exclusion criteria for the detection of FH which alters the lipid profile. We evaluated mutations in the APOB gene in patients with high LDL-C levels. MATERIALS AND METHODS: Patients aged between 2 and 80 years with at least one LDL-C level of more than 190 mg/dl were selected (120 patients) from Isfahan Laboratories. Blood samples were obtained from all patients. Genomic DNA was extracted. Primer sequences were designed by Oligo 7.60 to amplify the desired 844 bp region of exon 26 of the APOB gene containing R3500Q and R3500W variants associated with FH. RESULTS: Overall, two patients showed a heterozygous form of a common pathogenic variant in exon 26 named c. 10579 C > T (R3500W, cDNA.10707), and one patient was hypothyroidism. We also recognized another nonpathognomonic variant c. 10913G > A (rs1801701, cDNA.11041) in 13 patients, two of them were hypothyroidism. CONCLUSION: This study for the first time shows the coexistence of APOB mutation in hypothyroidism, which emphasis screening of patients with hypothyroid for FH detection.

Familial Hypercholesterolemia (FH) in Iran: Findings from the Four-Year FH Registry.

BACKGROUND: Familial hypercholesterolemia (FH) is a common autosomal dominant disease. Its diagnosis in Iran was uncommon. Iran registry of FH (IRFH) has been started from 2017 from Isfahan. In this study, we report the four-year FH registry. METHODS: The Iran FH registry is an ongoing study which is followed by a dynamic cohort. It has been started from 2017. The patients are selected from laboratories due to high cholesterol level and who have history of premature cardiovascular disease. The Dutch Lipid Clinic Network (DLCN) criteria are used for the detection of FH. Cascade screening is performed for detection of first-degree relative of patients. RESULTS: Among the 997 individuals included in this registry, they were 522 (mean age 51.41 ± 12.91 year), 141 (mean age 51.66 ± 8.3 year), and 129 (mean age 41 ± 16.5 year) patients from laboratories, premature cardiovascular disease, and relatives, respectively. In total, 263 patients were diagnosed with probable or definite FH, and others were in the possible group. Low-density lipoprotein cholesterol (LDL) level was 141.42 ± 45.27 mg/dl in the laboratory group and 54.9% of patients were on LLT treatment. In patients with premature cardiovascular disease and FH, the LDL level was 91.93 ± 32.58 and was on LLT treatment. The LDL concentration in the first relative of FH patients was 152.88 ± 70.77 and 45.7% of them are on LLT therapy. CONCLUSIONS: Most of FH patients were underdiagnosed and undertreated before their inclusion in the IRFH. Cascade screening helps in the improvement of diagnosis.

Resistin and prooxidant-antioxidant balance: Markers to discriminate acute coronary syndrome from stable angina.

BACKGROUND: Resistin and oxidative stress may play a role in the pathogenesis of coronary heart disease (CHD) including acute coronary syndrome (ACS). The aim of this study was to investigate the role of serum resistin and prooxidant-antioxidant balance (PAB) in ACS occurrence in order to differentiate it from stable angina. Moreover, we aimed to determine the correlation between resistin and PAB in patients with ACS and its difference from patients with stable CHD. METHODS: This cross-sectional, descriptive study was conducted on 50 patients with ACS and 50 patients with stable CHD who underwent coronary angiography (CAG). Serum resistin level was measured using enzyme-linked immunosorbent assay (ELISA). PAB and other variables were analyzed using standard methods. RESULTS: A significant increase in serum resistin and PAB was observed in patients with ACS (2.55 ± 0.13 ng/ml and 123.5 ± 5.58 HK unit, respectively) compared to patients with stable CHD (1.53 ± 0.12 ng/ml and 95.9 ± 2.7 HK unit, respectively) (P < 0.001). In addition, a significant positive correlation was seen between serum resistin and PAB in patients with ACS (r = 0.39; P = 0.005), but this correlation was not found in patients with stable CHD (r = 0.21; P = 0.140). Resistin (r = 0.52; P < 0.001) and PAB (r = 0.55; P < 0.001) were significantly associated with high-sensitivity C-reactive protein (hs-CRP) in patients with ACS, but this association was not found in patients with stable CHD (resistin: r = 0.24; P = 0.090; PAB: r = -0.02: P = 0.910). CONCLUSION: High serum resistin or PAB levels, and their association with the occurrence of ACS, can be used as a robust discriminating factor to differentiate ACS from stable CHD.

Correlation between air pollution and hospitalization due to myocardial infarction.

BACKGROUND: Air pollution is associated with increased risk of cardiovascular disease (CVD). This study aims to evaluate the correlation between air pollutants and hospitalization due to myocardial infarction (MI) as part of "correlation of air pollution with hospitalization and mortality of CVDs and respiratory diseases (CAPACITY) study". METHODS: This case-crossover study analyzed the data of 319 patients who were admitted with diagnosis of ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) in three main hospitals of Isfahan, Iran. The data of airborne pollutants including particulate matter < 10 µm (PM10), particulate matter < 2.5 µm (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) as well as climatic indices (temperature, wind speed, and humidity) at 24 hours, 48 hours, and one week before admission were extracted from CAPACITY study. The conditional logistic regression method was used to evaluate the correlation between air pollutants and MI hospitalization. RESULTS: 319 patients with mean age of 63.15 ± 28.14 years, including 238 men (74.6%), and 207 patients with STEMI (64.8%) were recruited. The risk of hospitalization significantly increased in patients with STEMI and 10-unit increment in PM2.5 at 48 hours before admission [odds ratio (OR) = 3.70, 95% confidence interval (CI): 1.69-7.69]. Although, majority of air pollutants had positive association with hospitalization in patients with NSTEMI, they were not statistically significant. CONCLUSION: This study showed significant association between elevated PM2.5 at 48 hours before admission and hospitalization of patients with STEMI. This finding can warn policymakers to design better care services for patients at risk of acute MI during the times of increased air pollution.

Comparing efficacy of receiving different dosages of eptifibatide in bleeding after percutaneous coronary intervention in patients with myocardial infarction.

BACKGROUND: Acute coronary syndrome (ACS) is a common condition that needs appropriate treatment like percutaneous coronary intervention (PCI). Glycoprotein IIb/IIIa inhibitors (GPI) like eptifibatide prevent procedural ischemic complications after PCI. Eptifibatide has increased the risk of bleeding complications, although it is effective in reducing mortality and morbidity. Eptifibatide is routinely used in bolus and infusion forms and the aim of this study is to evaluate the efficacy of bolus-only dose and bolus + infusion strategy for administrating eptifibatide in bleeding complications and consequences after PCI. METHODS: This randomized clinical trial was conducted on subjects who experienced PCI after incidence of myocardial infarction (MI). Patients were randomly divided into two groups who received bolus-only dose (n = 51) or bolus + infusion form of eptifibatide (n = 50). Then, PCI blood pressure, mean time duration of hemostasis after arterial sheath removal, laboratory data, need for blood transfusion, and presence of bleeding complications were evaluated. After 6 months, patients were followed for needs for additional coronary interventions. RESULTS: The mean age of participants was 61.68 ± 1.50 years. The prevalence of men was 70.29%. There was no significant difference in mean of systolic blood pressure (SBP) and diastolic blood pressure (DBP) during hospitalization (P > 0.050). The mean time duration of hemostasis was 8.13 ± 0.45 minutes in the bolus-only group and 16.46 ± 0.71 minutes in the bolus + infusion group (P < 0.001). There was no significant difference in the hemoglobin (Hb) level, platelet count, white blood cell (WBC), blood urea nitrogen (BUN), and creatinine level (P > 0.050). CONCLUSION: The results of this study suggested that bolus-only dose of eptifibatide before PCI could be able to decrease significantly bleeding complication and other clinical and cardiovascular outcomes.

Association between ambient air pollution and hospitalization caused by atrial fibrillation.

BACKGROUND: Many studies have shown the worst effects of air pollution on cardiovascular diseases (CVDs). Present study focused on the relationship between atrial fibrillation (AF), as one of the common arrhythmias, and air pollutants in Isfahan, Iran, an industrial city in the Middle East. METHODS: A case-crossover design was used to explore the associations between air pollution and AF hospitalized patients with ventricular response (VR) > 90 beats per minute (bpm) (fast response) and those with VR ≤ 90 bpm. All patients' records were extracted from their hospital files. Air pollutants data including particulate matter less than 10 µ (PM10), PM2.5, carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) were obtained from the Correlation of Air Pollution with Hospitalization and Mortality of Cardiovascular and Respiratory Diseases (CAPACITY) study. Conditional logistic regression test was used to measure the relationship between pollutants and hospitalization due to AF. RESULTS: Records of 369 patients, including 173 men (46.9%) who were hospitalized for AF during the study period and had complete data were extracted. Although a positive but not statistically significant relationship was shown between 10-unit increases in all pollutants (except PM10) and the hospitalization due to AF in patients with rapid VR (RVR), the only significant relationship was observed in case of NO2 [odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.0-2.1, P = 0.031]. CONCLUSION: This study showed positive significant relationships between NO2 and the hospitalization due to AF in patients with RVR. NO2 is a greenhouse gas whose levels are expected to increase due to global environmental changes. Therefore, relevant strategies should be adopted to decrease its levels, especially in industrial cities like Isfahan.

Risk and Age of Cardiovascular Event in Women with Metabolic Syndrome: Menopause Age in Focus.

BACKGROUND: There is still a controversy about the causal relationship between menopause status and cardiovascular disease (CVD). The present study aimed to evaluate whether premature menopause would predict higher risk and lower the age of CVD occurrence and how this differs in women with metabolic syndrome (MetS). METHODS: Using a population-based Isfahan Cohort Study (ICS), 1154 postmenopause women were followed up from 2001 to 2013 for any CVD occurrence. Cox proportional hazards regression analyses were used to estimate the association between menopause age of (≤45, 46-50, 51-55, ≥56 years) and CVD incidence. The menopause age group of 46-50 years was considered as reference group. RESULTS: During 12 years follow-up, 235 CV events were recorded. The mean age of menopause (±standard deviation) was 48.06 ± 5.48 years. The age at menopause was not predictive of total CV events, in women with and without MetS. In women without MetS, a trend with increasing incidence of stroke was observed at menopause age of ≤45 years (age adjusted hazard ratio: 4.84, 95% confidence interval: 0.99-23.5, P = 0.05). Women with menopause age of ≤45 years suffered from CV events, 5.7 years earlier than women with menopause age of ≥56 years (P = 0.11); this difference was 5.3 years in women with MetS (P = 0.4). CONCLUSION: This study showed that younger age at menopause is not predictive of the occurrence of CV events. It also revealed that age at menopause is not associated with earlier CV events in postmenopause women, with and without MetS.

The prevalence of obesity among school-aged children and youth aged 6-18 years in Iran: A systematic review and meta-analysis study.

BACKGROUND: Obesity is considered as a major health problem of children and adolescents. The present meta-analysis was conducted by extensive search of studies on the prevalence of obesity among school-aged children and youth aged 6-18 years in Iran. METHODS: All conducted cross-sectional studies on the prevalence of obesity in Iranian students in all grades were extracted, without applying any restriction on time in national and international databases including Magiran, Iranmedex, SID, Scopus, Google Scholar, and PubMed. Statistical software Stata 12 was used to analyze the data and to obtain the prevalence of obesity among Iranian students. The heterogeneity between the results was determined using statistical test I2. RESULTS: In this meta-analysis, 51 papers met our inclusion criteria and were therefore considered for the analysis. The prevalence of obesity was equal to 5.82% [95% confidence interval (CI): 5-6.66] in Iranian students. The prevalence of obesity was higher in boys than in girls (6.85% compared to 5.13%) (P = 0.300). The highest prevalence of obesity was related to students living in the North and Northwest areas with 7.07% (95% CI: 4.35-9.78). CONCLUSION: The prevalence of obesity among Iranian students is not high when compared to Western countries. However, due to lifestyle changes in recent years, it is necessary to plan intervention programs within families and schools to improve dietary patterns and physical activity of this age group.

Association of glycaemic index and glycaemic load with metabolic syndrome in an Iranian adult population: Isfahan Healthy Heart Program.

AIM: There is controversy around the clinical effects of the dietary glycaemic index (GI) and glycaemic load (GL) on cardiovascular diseases risk factors such as metabolic syndrome (MetS). So, the present study was performed to evaluate the relationship between GI or GL and metabolic syndrome in an Iranian adult population in 2007. METHODS: The study was based on data from a sub-sample of the Isfahan Healthy Heart Program (IHHP), collected across three cities in central Iran, in the year 2007. This was a cross-sectional survey of 1618 randomly selected adults aged ≥19 years. Nutritional assessment was conducted by a single 24-hour recall questionnaire. Fasting serum lipids, anthropometric indicators and blood pressure were measured by standard methods. Analysis of covariance was used to compare metabolic syndrome components according to energy-adjusted GI and GL levels. To expose the effect of potential confounders, hierarchical logistic regression models were utilised to determine adjusted odds ratios (OR) and 95% CI. RESULTS: After adjustment for age, gender, body mass index and energy intake, high GI was found to be significantly associated with MetS (OR 95% CI) (1.46 (1.01-2.12)). This was attenuated marginally by excluding the confounding effects of dietary fibre intake (1.29 (1.01-1.74)). All hierarchical models illustrated no significant association between energy-adjusted GL and the risk of MetS adjusted for confounders. CONCLUSIONS: There is a positive relationship between dietary GI, but not GL, and the presence of MetS after adjustment for potential confounders. However, studies with long duration of follow up and experimental studies are still required to confirm this relationship.

Do Cardiometabolic Risk Factors Relative Risks Differ for the Occurrence of Ischemic Heart Disease and Stroke?

BACKGROUND: The effects of the risk factors of ischemic heart disease (IHD) and stroke on the occurrence of these diseases differ between different populations. OBJECTIVES: To study the difference in the effects of different cardiovascular (CVD) risk factors on the incidence of IHD and stroke in an Iranian adult population. PATIENTS AND METHODS: The Isfahan Cohort Study (ICS) is a longitudinal study that followed up 6323 subjects older than 35 years with no history of CVD since 2001. Of the original sample, only 5431 participants were contacted and followed up until 2011. The end points were the occurrence of IHD (defined as fatal and non-fatal myocardial infarction, unstable angina, and sudden cardiac death) and stroke. After 10 years of follow-up, 564 new cases of IHD and 141 new cases of stroke were detected. The relative risks (RRs) of cardiometabolic risk factors such as hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, high low-density lipoprotein cholesterol (LDL-C) level, low high-density lipoprotein cholesterol (HDL-C) level, current smoking, obesity, high waist-to-hip ratio, family history of CVD, and metabolic syndrome were compared between IHD and stroke patients. The ratio of relative risks (RRR) was calculated for comparing two RRs and estimated adjusted RRR was calculated by using generalized linear regression with a log link and binomial distribution. RESULTS: The RRs of the occurrence of IHD and stroke in diabetic patients were 1.94 and 3.26, respectively, and the difference was statistically different (P = 0.016). The RR of high LDL-C was significantly higher for IHD than for stroke (P = 0.045), while all the other risk factors showed similar RRs for IHD and stroke, with no significant difference in their RRR, including hypertension. Diabetes and hypertension had the highest RRs for IHD, followed by diabetes, metabolic syndrome, and hypertension for stroke. CONCLUSIONS: The effect of diabetes mellitus on stroke was more significant than on IHD, and the effect of high LDL-C level was more significant on IHD than on stroke, other risk factors, including hypertension, have similar RRs for IHD and stroke. Health care professionals need more training regarding the RRs of these risk factors in the Iranian society, and health decision makers should consider it in their future policies.

Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2).

OBJECTIVES: To assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS). SETTING: 11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran. PARTICIPANTS: Patients aged ≥ 20 and ≤ 80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA). PRIMARY AND SECONDARY OUTCOME MEASURES: Patients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds. RESULTS: A total of 1799 patients (25.7% STEMI and 74.3% HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6%), clopidogrel (91.8%), anticoagulants (93.4%), statins (94.3%) and ß-blockers (89.3%). Reperfusion therapy was performed in 62.6% of patients with STEMI (46.3% thrombolytic therapy and 17.3% primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7% and 79.5% of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0% of all patients. CONCLUSIONS: Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications.

Effect of self-care education on lifestyle modification, medication adherence and blood pressure in hypertensive adults: Randomized controlled clinical trial.

BACKGROUND: Self-care management has recently been suggested as an effective approach for secondary prevention of hypertension. This study was conducted to examine whether self-care behaviors could modulate blood pressure levels and also comparing the different training methods of self-care on patients' adherence and controlling hypertension. MATERIALS AND METHODS: This study was a prospective randomized controlled clinical trial, conducted on 180 hypertensive patients referring to four centers in Isfahan, Iran, between July and December 2013. Block randomization method were applied to divide eligible subjects into four equal groups, including group A in which the patients and their family were educated by cardiology resident about self-care behaviors through eight sessions, group B and group C were obtained self-care education through four pamphlets or eight short message services (SMS), respectively and group D were obtained only usual care of hypertension without any training about self-care management. RESULTS: Increasing vegetable intake and frequency of subject who took antihypertensive medication regularly and the reduction in the frequency of subjects who consumed high salt were significantly more in group A than the others (P = 0.001, P < 0.001 and P < 0.001, respectively). The systolic and diastolic blood pressure had significantly more reduction in the group A than the other groups (-8.18 ± 18.3 and - 3.89 ± 4.1; P < 0.001, respectively). CONCLUSIONS: The self-care management education integration into the usual care along with using SMS and other educational materials may improve the efficient and effective adherence strategies.

The effect of pioglitazone on circulating interleukin-10 and tumor necrosis factor-alpha levels in a patient with metabolic syndrome: A randomized, double-blind controlled trial.

BACKGROUND: This study aimed to evaluate the effect of pioglitazone as an insulin sensitizer on circulating interleukin-10 (IL-10) as an anti-inflammatory factor and tumor necrosis factor-alpha (TNF-α) as main proinflammatory factor in non-diabetic metabolic syndrome (MetS) patients in Caucasians race of Middle East area in Iran. METHODS: We conducted a randomized double-blind controlled study of 68 non-diabetic patients with MetS. Patients were randomly divided into two groups including intervention group received pioglitazone 30 mg daily for 24 weeks, and the control group received placebo pills for the same duration. Circulating levels of TNF-α and IL-10 were assessed as a primary goal. Lipid profile, liver enzymes, blood pressure (BP), waist circumference, and body mass index (BMI) also were measured. RESULTS: Lipid profile and fasting blood sugar had non-significant changes after treatment by pioglitazone, but BMI was increased significantly (P = 0.002). BP and waist circumference had a significant decrease in both groups (P < 0.050). Aspartate transaminase and alanine transaminase were decreased significantly in the pioglitazone group (P = 0.002). TNF-α decreased non-significantly in both groups (P > 0.050). IL-10 increased in intervention group non-significantly (P = 0.971); whereas in placebo group decreased to a little extent (P = 0.401). C-reactive protein was also decreased insignificant after receive pioglitazone (P = 0.333). There was no significant difference in all variables between the two groups (P > 0.050) except liver enzymes (P < 0.050). CONCLUSION: This study indicates that the pioglitazone has no positive effect on improving inflammatory status in the non-diabetes patients with MetS.

A case of noncompaction at all segments of both right and left ventricles.

Background. Noncompaction/hypertrabeculation left ventricle (NCM/HVM) is most commonly reported in one or more segments of left ventricle and sometimes both ventricles. In this case, we present noncompaction of all segments of right and left ventricle, in a young man with mental retardation. Case Presentation. A 19-year-old male was referred to us with sudden dyspnea at rest and chest discomfort. He was a known case of mental retardation. He was born full term with birth weight = 1250 grams. On physical examination. A systolic murmur (II/VI) at left sternal border was heard. ECG showed increased voltage in precordial lead and deep ST segment depression. Chest X-ray (CXR) was within normal limits. Transthoracic echocardiography showed situs solitus, D loop, normal connection of great vessels, noncompaction LV at all segments (noncompaction/compaction = 2.5/0.5) with moderate systolic dysfunction (LVEF = 40%), diastolic dysfunction grade II, normal RV size with mild systolic dysfunction and hypertrabeculation, mild tricuspid regurgitation (TR), and normal pulmonary artery systolic pressure. After injection of agitated saline some bubbles were passed from right to left through patent foramen oval (PFO). Conclusions. Extensive sinusoid formation and trabeculation of RV and nearby all LV segments and its association with mental retardation suggest presence of strong genetic background.

Women health heart project: Methodology and effect of interventional strategies on low education participants.

BACKGROUND: Cardiovascular diseases (CVD) are the most common cause of mortality and morbidity in women. Intervention programs aimed at improving the lifestyle can reduce the incidence of these diseases and their factors. The purpose of this study was to evaluate the difference of the interventions impact on CVD risk factors and the women's physical and biochemical indicators based on education levels. MATERIALS AND METHODS: As part of Isfahan Healthy Heart Program after identifying the status of women over the age of 18 and over five years, a large educational or environmental intervention was performed in different methodologies and in order to improve the lifestyle. Some organizations such as health care centers and the Literacy Campaign Organization have cooperated for low educated women. Demographic data and risk factors such as obesity, hypertension, diabetes and serum lipids were investigated and compared during the first and last phase. Data were entered in SPSS-15 software and were analyzed by using T-test in two independent samples, Chi-square test and Fisher exact test. RESULTS: Findings of this study showed that performing the five years interventions could reduce physical and biochemical indexes such as nutrition, lipid profile, waist circumference and waist-to-hip ratio in both groups (P < 0.005). In the pre-intervention phase, 6391 subjects and after the intervention 4786 women participated. After Interventions, women with higher educational levels were showed significant decrease in Body Mass Index (BMI) (P = 0.01) and dyslipidemia (P = 0.02). CONCLUSION: The present study showed that the community-based interventions even in low-literate women could cause effective changes on improving lifestyle and CVD risk factors. Due to the greater impact of interventions in literate women, effective interventions should be considered in the society to decrease the prevalence of Non-Communicable Diseases (NCDs).

Beneficial effects of testosterone therapy on functional capacity, cardiovascular parameters, and quality of life in patients with congestive heart failure.

BACKGROUND: According to the present evidences suggesting association between low testosterone level and prediction of reduced exercise capacity as well as poor clinical outcome in patients with heart failure, we sought to determine if testosterone therapy improves clinical and cardiovascular conditions as well as quality of life status in patients with stable chronic heart failure. METHODS: A total of 50 male patients who suffered from congestive heart failure were recruited in a double-blind, placebo-controlled trial and randomized to receive an intramuscular (gluteal) long-acting androgen injection (1 mL of testosterone enanthate 250 mg/mL) once every four weeks for 12 weeks or receive intramuscular injections of saline (1 mL of 0.9% wt/vol NaCl) with the same protocol. RESULTS: The changes in body weight, hemodynamic parameters, and left ventricular dimensional echocardiographic indices were all comparable between the two groups. Regarding changes in diastolic functional state and using Tei index, this parameter was significantly improved. Unlike the group received placebo, those who received testosterone had a significant increasing trend in 6-walk mean distance (6MWD) parameter within the study period (P = 0.019). The discrepancy in the trends of changes in 6MWD between study groups remained significant after adjusting baseline variables (mean square = 243.262, F index = 4.402, and P = 0.045). CONCLUSION: Our study strengthens insights into the beneficial role of testosterone in improvement of functional capacity and quality of life in heart failure patients.

Are obese adolescents more depressed?

INTRODUCTION: Obesity is a growing problem in all countries which leads to various physical, psychological, and social problems. The present study aimed to assess depression in children and adolescents aged 10-18-year old compared with the control group. MATERIALS AND METHODS: In a case-control study, from among the 10- to 18-year-old students of the five education districts of Isfahan, 100 people (50 girls and 50 boys) were selected as obese children with the Body Mass Index (BMI) of greater than 95(th) percentile for their age and gender and 100 others (50 girls and 50 boys) as the control group with the BMI of 5(th) to 85(th) percentile. The case and control groups were matched for age, gender, and socio-economic status. After calculating BMI based on weight (kg)/height(2) (meter), subjects were interviewed based on DSM IV criteria to diagnose clinical depression. The severity of children's depression was measured using standardized questionnaire. RESULTS: The mean age of the case group was 12.2 ± 1.86-years old and that of the control group 13.06 ± 2.25. They were, respectively, diagnosed with depression of 7% and 6%. The mean depression score of the case group was 11.7 ± 5.3 and that of the control group was 10.6 ± 6.03 with no statistical significance. DISCUSSION: Given our findings, the Jolly fat hypothesis applies to the case group. It seems that health policy-makers need to make intervention plans to change behavior; attitude, skill, and knowledge (BASK) of the public toward obesity and its long-term side-effects.

Prediction of short-term clinical outcome of percutaneous coronary intervention in patients with acute coronary syndrome through myeloperoxidase levels.

BACKGROUND: The present study assessed the significance of troponin and myeloperoxidase levels in the prediction of major adverse cardiac events (MACE) during the 1st month after percutaneous coronary intervention (PCI). METHODS: This prospective, longitudinal study included 100 patients with acute coronary syndrome who underwent PCI. The participants' characteristics were recorded in a questionnaire. Blood samples were obtained before and 24 h after PCI, and troponin, and myeloperoxidase levels were measured. During the 1st month after PCI, death, myocardial reinfarction, and revascularization during admission were investigated through weekly phone calls. The value of troponin and myeloperoxidase levels before and after PCI in predicting MACE was evaluated using Cox regression. RESULTS: Considering the obtained methods and the short duration of the study, 99% of the patients completed the study. Moreover, one death and four cases of myocardial infarction and revascularization were reported. Cox regression did not show significant relations between the incidence of MACE and myeloperoxidase levels before (hazard ratio = 1.12; 95% confidence interval 0.9, 1.39) and after PCI (hazard ratio = 0.86; 95% confidence interval = 0.43, 1.71), or troponin levels before (hazard ratio = 0.97; 95% confidence interval = 0.81, 1.17) and after PCI (hazard ratio = 1.03; 95% confidence interval = 0.96, 1.11). CONCLUSION: It seems that the few cases of MACE, due to the small sample size and short duration of follow-up, had been insufficient for determining the predictive value of troponin and myeloperoxidase levels before and after PCI. Therefore, further studies with larger sample size and longer follow-up duration are recommended.

The relation between body iron store and ferritin, and coronary artery disease.

BACKGROUND: Iron is essential for many physiological processes; whereas, iron overload has been known as a risk factor in progression of atherosclerosis. The aim of this study was to investigate the importance of serum ferritin levels, which are known as an indicator of body iron stored in the incidence of coronary artery disease (CAD). METHODS: In a case-control study, we evaluated 432 eligible men who underwent coronary angiography at Chamran Cardiology Hospital, Isfahan, Iran. They were separated into two groups of case (with CAD) and control (without CAD). All subjects had given written informed consents. Then, the blood samples were taken after 12-14 hours of fast by a biologist for measuring cardiovascular risk factors and body iron stores, including serum ferritin, serum iron, and total iron binding capacity (TIBC). For statistical analyses, chi-square test, Student's t-test, one-way ANOVA, and the logistic regression were used. RESULTS: In the present study, 212 participants with CAD in the case group and 220 participants free of CAD in the control group were included in the analysis. At baseline, there were significant differences in serum ferritin (P < 0.001) and other cardiovascular risk factors between the two groups. Moreover, when other risk factors of CVD were included in the model, serum ferritin [Odd Ratio (OR) = 1.006, 95% confidence interval of 95% (95% CI) 1.00-1.01, P = 0.045] and serum ferritin ≥ 200 (OR = 4.49, 95% CI 1.72-11.70, P < 0.001) were associated with CAD. CONCLUSION: High iron store, as assessed by serum ferritin, was associated with the increased risk of CAD. Furthermore, it was a strong and independent risk factor in the incident of atherosclerosis in the Iranian male population.