mohammad garakyaraghi

Garlic may have anti-oxidanmayti-hypertensive and anti-hyperlipidemic properties. However, the effects of its administration on cardiac function in heart failure (HF) patients impact require further investigation. We aimed to evaluate garlic prescription effects on cardiac outcomes and quality of life scores in Iranian HF patients.

From August to December 2020, a randomized, double-blind clinical trial was conducted. Individuals with heart failure (New York heart association (NYHA) functional class of II and III) referred to private clinics in Isfahan, Iran, were randomly assigned to intervention (n=80) and control (n=80) groups. They have received 500 mg of odorless garlic tablets or the same shape and dosage of placebo twice daily for three months. Laboratory data, cardiac outcomes (end-diastolic diameter, ventricular septal thickness, NYHA functional class, left ventricular ejection fraction), quality of life score (Minnesota living with HF questionnaire), and the Modified Borg Scale (MBS) were all evaluated at the baseline and the end of the trial.

The population’s mean age was 58.1±13.5 years (55% males). Patients who consumed garlic had remarkably improved functional class compared to placebo takers and their baseline (NYHA practical class of II, 79.4% vs. 50.6%, P<0.001 and 79.4% vs. 54%, P=0.006, respectively). MBS levels were significantly lower among garlic consumers (baseline: 2.52±0.5, after three months: 2.2±1.06, P= 0.040).

Garlic administration may improve cardiac function and breathe in HF patients. Complementary research is necessary to confirm our findings.

Numerous clinical trials have reported conflicting results regarding the benefit of digoxin in treating heart failure (HF) patients. This study was conducted with the aim to demonstrate the impact of added digoxin to beta-blocker and beta-blocker alone on all-cause mortality and rehospitalization among these patients.

We investigated the data of 1998 patients admitted with a primary diagnosis of decompensated HF in the prospective Persian Heart Failure Patients Registry in Iran. The outcomes of interest were time until death and time until first rehospitalization. Multivariate cox regression was used to compare the impact of beta-blocker plus digoxin and beta-blocker alone on 2.5-year survival and 90-day rehospitalization.

The mean age of the participants was 69.18 ± 13.26 years, and 38.1% of patients were women. The incidence rate of all-cause mortality in the total sample was 0.18 and 0.22 in patients on beta-blocker plus digoxin and beta-blocker alone, respectively [incidence rate ratio (IRR) = 1.25; 95% CI: 0.92-1.7]. The adjusted risk of all-cause mortality was significantly higher in women discharged with beta-blocker plus digoxin than beta-blocker groups [hazard ratio (HR) = 2.31; 95% CI: 1.27-4.19]. Rates of 90-day first rehospitalization were 0.10 and 0.12 in the beta-blocker plus digoxin and beta-blocker alone groups, respectively (IRR = 0.85; 95% CI: 0.53-1.35). After adjustment for covariates, beta-blocker plus digoxin therapy had no significant effect on increasing the risk of 90-day first rehospitalization in the total cohort (HR = 0.77; 95% CI: 0.48-1.23), in men (HR = 0.73; 95% CI: 0.40-1.35), and women (HR = 0.76; 95% CI: 0.36-1.65).

In patients hospitalized with decompensated HF, digoxin administration at discharge was associated with increased 30-month mortality risk in women.

Low vitamin D status may contribute to the pathogenesis of heart failure (HF), but therapeutic roles of vitamin D on cardiac performance are not well known. We evaluated vitamin D effects on left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) functional class in patients with HF for the first time.

This study was a double-blind, randomized, placebo-controlled trial. 110 patients with HF admitted to Shahid Chamran and Khorshid Hospitals, Isfahan, Iran, randomly received 500 mg calcium daily plus either 50000 IU vitamin D3 per week (case group) or placebo (control group) for 6 months. Biochemical variables, LVEF, and NYHA functional class were assessed at baseline and after 6 months.

81 patients completed the study. Vitamin D supplementation increased mean serum 25-hydroxyvitamin D [25(OH)D] concentration in the case group by 33.9 ng/ml (P < 0.001). After 6 months of treatment, both groups showed improvement in LVEF, but the extent of improvement was significant only in the case group (5.48% versus 0.44%, P < 0.001). The NYHA functional class improved in the case group but remained constant in the control group (P < 0.001).

Vitamin D3 improved LVEF and NYHA functional class in patients with HF and might serve as a new agent for the future treatment of this disease.

Hemoconcentration (HC) has been suggested to be a useful biomarker for determination of optimum diuretic therapy in acute heart failure (HF), but role of this factor in rehospitalization and death was still controversial. In this study, we aimed to define relation between HC and readmission and mortality rate among Iranian patients with acute HF.

This was a prospective cohort study done from March 2017 to March 2018 using data of a HF section of Persian Registry Of cardioVascular diseasE. From a total number of 390 registered HF individuals aged 18 years or older, 69 ones showed alterations in hemoglobin (Hb) levels. Hb levels were measured at admission and discharge time. HC was defined as any increased level in Hb during hospitalization. The relation of HC with readmission and death rate was done using multiple logistic regression and Cox proportional hazard model, respectively.

The mean age of study population was 70.5 ± 11.9 years with the dominant percentage of male participants (66.9%). Patients showing HC during admission did not reveal any significant decreased likelihood of rehospitalization compared to negative ones. In comparison to HC negative patients, those showing increments in Hb levels had a borderline significant lower likelihood of mortality (hazard ratio: 0.82, 95% confidence interval, CI = 0.07–1.18, P = 0.08).

Our data suggested that HC was associated marginally with reduced mortality rate 6 months post HF attack and could be utilized as a useful biomarker for risk stratification of HF patients. Several prospective longitudinal population‑based studies are necessary proving these associations.

 Proper blood pressure (BP) measurement frequency method is less evaluated to optimize hypertension (HTN) status among different nations due to cultural patience variations. The aim of this study was to compare the first (BP1), second (BP2), and the mean of first and second (BP1,2) and all the three (BP1,2,3) with the second and third BP measurements in Iranian individuals.

This cross‑sectional study was done on 2264 individuals aged 18 years or more living in Isfahan city, Iran. Their BPs were assessed from right arms by the standard tools and methods after 5 min of rest in a quiet room by a trained staff. The mean second and third readings were considered as reference, and the other aforementioned variables were compared with it.

The mean age of total population was 40.9 ± 16.1 years (males: 52%). Men had significant higher means of systolic BP (SBP) and diastolic BP (DBP) with any measurement frequency methods than women (P < 0.001 and P = 0.009). Considerable clinical significant (≥5 mmHg) ranges were mostly observed in BP1 compared with BP2,3. SBP2 and DBP2 indices showed insignificant differences compared with reference mean. Moreover, abnormal BP levels (≥140/90 mmHg) were mostly observed in terms of BP1 measurement with no remarkable variability in BP2 reading in comparison to the reference.

Our considerable data suggested that BP2 could appropriately categorize BP status similar to BP2,3 and it may be rational for physicians considering this mean and excluding the first BP measurement as a sole criterion for HTN assessment in Iranian adults. Multiple researches are necessary quantifying appropriate frequencies of BP reading.

Considering the high concentrations of pollutants in large cities of Iran and the high prevalence of heart failure (HF) among Iranians, especially with increasing life expectancy, this study investigated the relationship between airborne contaminants with a diameter < 2.5 µm or particulate matter 2.5 (PM2.5) and hospitalization and mortality in patients with HF in Isfahan, Iran, during 2011.

This ecological study was carried out on a part of data from the CAPACITY study. A total of 275 patients with HF were randomly selected from 840 subjects with International Statistical Classification of Diseases, 10th Revision (ICD-10) diagnosis code I50 in the CAPACITY study. Patients’ records were evaluated and their clinical characteristics, disease history, and laboratory and echocardiographic findings were extracted. Air pollution and climatic data were extracted from the CAPACITY study. Poisson regression was used in crude and adjusted models to evaluate the association between PM2.5 and study outcomes. All analyses were performed using crude models and models adjusted for temperature, dew point, and wind speed.

54.9% (n = 151) were men with mean age of 70.4 ± 13.7 years. While most patients (85.8%) were discharged after recovery, 14.2% of the patients died in the hospital. Blood glucose, heart rate, and ejection fraction (EF) were significantly higher on unhealthy days than normal days. Regression analysis revealed no significant relationships between hospitalization and mortality rates and PM2.5 concentrations on healthy days, unhealthy days for sensitive people, and unhealthy days.

The model used in our study revealed no significant relationships between PM2.5 concentrations and hospital admission on healthy days, unhealthy days for sensitive people, and unhealthy days.

Heart failure (HF) resulted from ultimate pathway of many cardiovascular diseases (CVDs) or as a separate entity poses a considerable increasing prevalence and economic burden, but its registry for better management is less frequently done. In this study, we aimed to design and implement HF registry.

Persian Registry Of cardioVascular diseasE (PROVE) was initiated from March 2015 and continuously collected information of patients suffering from HF, ST-elevation myocardial infarction (STEMI), atrial fibrillation (AF), percutaneous coronary intervention (PCI), stroke, familial hypercholesterolemia (FH), congenital heart disease (CHD), chronic ischemic cardiovascular disease (CICD), and acute coronary syndrome (ACS) from 18 different cardiac centers. Data of patients with HF were collected from their medical forms and recorded in a registry system of PROVE/HF plus telephone follow-up survey of 1, 6, and 12 months after the date of HF attack.

Assessment of all related questions led to definition of a final questionnaire including 27 items regarding demographic information, underlying disorders and their complications, patients’ symptoms and signs, and laboratory and relevant para-clinic data at admission time, during hospitalization, and post discharge. Follow-up information was mostly based on patients’ general status and medication usage.

PROVE execution was a successful and hopeful project providing data of major CVDs in order to design appropriate preventive actions and better management and treatment strategies plus a valuable data center being utilized in multiple future comprehensive projects.

Some past studies have shown the association of air pollution with heart failure (HF). The present study was conducted to investigate the relationship between suspended particulate matters less than 10 microns (PM10) and hospitalization due to HF.

In a cross-sectional study, the data from 359 patients’ records, admitted to Shahid Chamran hospital in Isfahan City, Iran, due to HF during the years 2017-18, were collected. The inclusion criteria were the echocardiography findings such as the cardiac ejection fraction of less than 50%, and/or additional clinical evidences that confirmed HF exacerbation. The data about hourly concentration of PM10 were collected from the CAPACITY software in the Department of Environment at Isfahan Province that displayed the PM10 data from 6 fixed stations in Isfahan City. To evaluate any relationship between PM10 and hospitalization due to HF, we considered the PM10 concentrations at last 24 hours before hospitalization.

The mean age of 359 patients who diagnosed with heart failure was 63.8 ± 14.6 years, and 82 of them (22.8%) died at the time of hospitalization. There was a significant correlation between hospitalization due to HF and air pollution quartiles.

 According to the results of present study, there was a positive correlation between the concentration of particulate matters in the air and hospitalization due to heart failure.

Obesity is a major risk factor for many diseases including cardiovascular diseases (CVDs). Recently, it has been shown that upper body obesity can predict CVDs per se. In this study, we aimed to determine the association between indicators of upper body obesity and echocardiographic indices. In this cross-sectional study conducted in Hajar Hospital in Shahrekord, Iran, from March to August 2014, 80 healthy adults were included. Participants’ neck circumference (NC), waist circumference (WC), body mass index (BMI), and blood pressure were measured. Echocardiography was performed for all participants, and echocardiographic indices such as early (E’) and late (A') diastolic tissue velocity, early (E) and late (A) transmitral flow velocity, E/E’ ratio, pulmonary arterial pressure (PAP), and left atrial volume (LAV) were recorded. The association between these indices were investigated using bivariate Pearson correlation coefficient. For men, NC had a significant correlation with LAV, systolic blood pressure (SBP), diastolic blood pressure (DBP), PAP, and A', and a negative correlation with E′. WC had a significant correlation with LAV, SBP, and PAP, and a negative correlation with E′, while BMI had a significant correlation with LAV, PAP, SBP, A, and A’. For women, NC had a significant positive correlation with LAV, A, ejection fraction (EF), SBP, PAP, and A’, and a negative correlation with E′ and E/E′. WC had a significant positive correlation with LAV, DBP, PAP, A, A’, and a negative correlation with E′, while BMI had a significant correlation with LAV, EF, SBP, PAP, E’, A, and A’. The positive correlation of NC with SBP, A, and A', as well as NC, WC, and BMI with LAV and PAP in both sexes, and the negative correlation of NC with E′ show the importance of these measures in estimation of metabolic and cardiovascular risk factors.

This study attempted to evaluate functional and structural cardiac states using echocardiography in patients with white-coat hypertension in comparison with true hypertension and normotensive conditions.
The study population consisted of 72 individuals, aged 25 to 75 years. The subjects were assigned to 4 groups: white-coat hypertensives (n=20), controlled true hypertensives (n=20), uncontrolled true hypertensives (n=12), and a normotensive group (n=20). Whilst the 4 sub- groups in the study exhibited a similar gender distribution, the normotensive subjects were significantly younger; however, there was no discrepancy in the mean age between the white- coat hypertensive group and the other hypertensive subgroups. Univariate comparisons between the functional and structural cardiac parameters of the white-coat hypertensives and the other study groups revealed low deceleration time and E’-wave velocity and high E-wave velocity and left ventricular internal dimension indices compared with the other 2 hypertensive groups.
After adjustment for sex and age, the white-coat hypertensive group revealed differing results in 2 indices of E’ wave velocity and interventricular septal thickness (IVST) when compared with the other three. A number of features were identified as the hallmarks of white-coat hypertensives: specific functional and structural cardiac changes such as low IVST in comparison with the uncontrolled hypertensives; presence of diastolic dysfunction, which was not found in the normotensives; and greater cardiac mass than that in the normotensives, less than that in the uncontrolled hypertensives, but closer to that in the controlled hypertensives.
Although the prognosis for patients with white-coat hypertension is not as grave as that for those with true hypertension, it is considerably worse than the prognosis among the normal population.

Prehypertension is one of the cardiovascular disease predicators. Management of prehypertension is an appropriate objective for clinicians in a wide range of medical centers. Massage therapy is primarily nonpharmacological treatment that is used to control blood pressure (BP). This study intends to investigate the long‑term effect of massage therapy on BP in prehypertensive women.

This was a single‑blind clinical trial study conducted on 50 prehypertensive women who referred to Sedigheh Tahereh Cardiovascular Center, during 6 months in 2009. Participants were selected by simple random sampling and were divided into control and intervention groups. The test group (25 patients) received massage for 10–15 min, three times a week for 10 sessions, and the control group (25 patients) was relaxed in the same environment but with no massage. Their BP was measured before and after each session and 72 h and 2 weeks after finishing the massage therapy. Analyzing the data was done using descriptive and inferential statistical methods (Chi‑square, Mann–Whitney, paired t‑test, and Student’s t‑test) through SPSS software version 18 and a significant level was considered as P < 0.05.

The results indicated that the mean systolic BP (SBP) and diastolic BP (DBP) in the massage group were significantly lower in comparison with the control group (P < 0.001). Evaluation of durability of the massage effects on BP also indicated that 72 h after finishing the study, still there was a significant difference between the test and control groups in SBP and DBP (P < 0.001), but after 2 weeks, there was not a significant difference in SBP and DBP (P > 0.05) between the two groups.

Although massage therapy seems to be a safe, effective, applicable, and cost‑effective intervention to control BP of prehypertensive women, its effects do not persist for a long time.

Myocardial phosphodiesterase 5 (PDE5) inhibitors are documented for use in various disease states. The efficacy of PDE5 inhibitors is less determined in heart failure patients without pulmonary hypertension. The aim of the present study was to evaluate the efficacy of PDE5 inhibitors in heart failure patients without pulmonary hypertension. Seventy-six cases with heart failure were participated in this study. The ion criteria were systolic heart failure according to the New York Heart Association (NYHA) functional classifications I and IV, echocardiographically determined left ventricular ejection fraction less than 50%, and stability for at least 3 months. The participants were randomly divided into case and control groups. Both case and control groups received 50 mg of sildenafil and a placebo for 3 months, respectively. Transthoracic echocardiography (TTE) was performed using the Vingmed 800 CSF. All the ejection fraction measurements were done using the Simpson method. Before the initiation of the trial and then 3 months afterward, TTE was obtained the participants. Changes in the functional class and the left ventricular ejection fraction before and after the trial were assessed and the data were analyzed using SPSS, version 16. In the case group, the ejection fraction after the trial with an average of 41.53 ± 7.53 was considerably more significant than that before the trial with an average of 37.92 ± 6.92 (P

The Persian Registry of Cardiovascular disease/Heart Failure (PROVE/HF) aimed to studied the demographic, clinical, and diagnostic characteristics and treatment of patients hospitalized for heart failure (HF) and to follow them for short- and long-term outcomes. Its pilot phase started in 2015 in Isfahan aiming to evaluate its feasibility to be scaled up at the national level in later stages. This article describes the method and preliminary results of the first year registry. Information of hospitalized patients with preserved and low ejection fraction, were gathered. Patients were followed for 1, 6, and 12 months. During follow-up, information of the patients’ current status, medications used during hospitalization, and in case of death, the cause and place were assessed. PROVE/HF enrolled 787 patients in the first year. The mean age of patients was 70.74 ±12.01 years, and 60.7% of them were men. The most frequent risk factors for the development of HF in the recruited patients was ischemic heart disease (77.9%), and hypertension (63.7%), respectively. The re-admission rate for patients with HF was at least once in 16% and continued until the fifth to ninth re-admission over a one-year period. Among 787 registered patients, 30.9% died in the first year of follow-up, and the in-hospital mortality was 6.2%. The mean hospitalization period was 4.88 days, and 64.2% were hospitalized for >3 days. The annual rate of re-admission and mortality was high, and the use of medication was less than the recommended one inaccordance with the guidelines for the treatment of heart failure.

Our aim was to create and establish a database called “Persian Registry of Cardiovascular Disease (PROVE)” in order to be used for future research and in addition, as a tool to develop national guidelines for diagnosis, treatment, and prevention of cardiovascular disease (CVD). In this paper, the design and methodology of the PROVE pilot study will be discussed, launched in Isfahan, Iran, in 2015-2016.
Through establishing PROVE, patient's data were collected from hospitals and outpatient clinics prospectively or retrospectively and followed up for a maximum of three years based on the type of CVDs. The inclusion criteria were as patients with acute coronary syndrome (ACS), ST elevation myocardial infarction (STEMI), stroke, atrial fibrillation (AF), heart failure (HF), congenital heart disease (CHD), percutaneous coronary intervention (PCI), and chronic ischemic cardiovascular disease (CICD). Specific protocols, questionnaires, and glossaries were developed for each registry. In order to ensure the validation of the protocols, questionnaires, data collection, management, and analysis, a well-established quality control (QC) protocol was developed and implemented. Data confidentiality was considered.
In order to register patients with ACS, STEMI, stroke, HF, PCI, and CICD, the hospital recorded data were used, whereas, in case of AF and CHD registries, the data were collected from hospitals and outpatient clinics. During the pilot phase of the study in Isfahan, from March 2015 to September 2016, 9427 patients were registered as ACS including 809 as STEMI, 1195 patients with HF, 363 with AF, 761 with stroke, 1136 with CHD, 1200 with PCI, and 9 with CICD. Data collection and management were performed under the supervision of the QC group.
PROVE was developed and implemented in Isfahan as a pilot study, in order to be implemented at national level in future. It provides a valuable source of valid data that could be used for future research, re-evaluation of current CVD management and more specifically, gap analysis and as a tool for assessment of the type of CVDs, prevention, treatment, and control by health care decision makers.

Evidence suggests that the serum myeloperoxidase level has a diagnostic and predictive role in patients with chronic heart failure (CHF). We evaluated the association between the serum myeloperoxidase level and the severity and prognosis of CHF. Materials: In a prospective observational study, patients with CHF were evaluated. The myeloperoxidase serum level was measured at baseline by enzyme-linked immunosorbent assay. Transthoracic echocardiography was done at baseline and then after 6 months. History and duration of admission and also mortality were recorded during follow-up. Fifty patients at a mean age of 64.7±1.8 years (70% male) were evaluated. The mean ser into two groups of A and B with a serum myeloperoxidase level of less and more than 51 Heart Association functional class (NYHA III 20.5% vs. 27.3%; p value=0.456), left ventricular ejection fraction (30.3±10.0 vs. 29.8±10.1%; p value=0.873), systolic dysfunction (48.7% vs. 54.5%; p value=0.500), or diastolic dysfunction (38.5% vs. 63.6%; -up. The serum myeloperoxidase level was not associated with admission history or mortality. We found no significant association between the serum myeloperoxidase level and echocardiography parameters, admission history, or mortality in patients with CHF. Further studies with larger samples of patients are required in this regard.

Heart failure (HF) is currently a major concern for the middle-aged and elderly. Some studies have suggested the beneficial effects of coenzyme Q10 (CoQ10) on clinical symptoms and echocardiographic indices in patients with HF. Reduced selenium, a cofactor in the activation of CoQ10 levels, has also been found in HF. The present study evaluated the effects of the combination of CoQ10 and selenium on patients with HF. This randomized, double-blind, clinical trial was conducted on New York Heart Association (NYHA) class II and III patients. The subjects were randomly allocated to intervention and control groups (n = 32 each). A questionnaire containing demographic characteristics, history of diseases, consumed medications, and NYHA class was filled out prior to the intervention. Echocardiography (the Simpson method) was also performed to determine the left ventricular ejection fraction (LVEF) and the myocardial performance index (MPI). The intervention group then received 90 mg of CoQ10 and 200 μg of selenium per day for 3 months. The control group consumed placebos with an identical appearance during the same period. The NYHA class, LVEF, and MPI were reevaluated after the intervention. Two subjects from the intervention group and one from the control group were excluded during the course of the study. The two groups had no significant differences in terms of age, gender, history of diseases, consumed medications, and baseline NYHA class, LVEF, and MPI. However, intervention significantly improved the NYHA class, LVEF, and MPI. According to the analysis of covariance (ANCOVA) adjusted for age, gender, and baseline characteristics, the intervention improved the LV function indices in patients with HF. Based on our findings, combination therapy with selenium and CoQ10 led to clinical improvement and enhanced LV function indices in patients with HF. Further clinical trials with larger sample sizes and longer follow-up periods can clarify the appropriateness of adding these supplements to the treatment protocols for HF.

Due to the relationship between air pollution and occurrence of de-novo heart failure (HF) or decompensation of symptoms of HF, we aimed to evaluate such relationship in HF admissions in Isfahan hospitals. This case-crossover study is performed on 120 patients with mean age of 65. 9±10. 4 (45-86 years old) from cases referred to hospitals, which resulted in hospitalization with diagnosis of HF. After filling the patient information sheet, concentration of air pollutants including suspended particles (PM10) and gases (CO, NO2, SO2) within two days before hospitalization were searched from climatologic sites. Data were analyzed via SPSS software through t-test and Pearson's correlation test. HF was diagnosed in 54. 2% of cases. The mean value of PM10، CO, NO2 and SO2 indexes showed significant difference between HF and control cases (p<0. 001). There was a significant difference between ESR and mean value of PM10 and NO2 (p<0. 05). ESR had no significant relationship with other air pollution parameters (p>0. 05). CRP showed a significant relationship with mean values of PM10، and CO, but CRP and ICAM showed no significant relationship with NO2 and SO2. There is a strong link between concentration of air pollutants and decompensation of HF symptoms.

Hypertension has become a major problem throughout the world, especially in developing countries like Iran. As it is a major risk factor for coronary heart disease, even small reductions in the prevalence can have potentially large public health benefits. Among the complementary methods, massage provides an effective means to lower the blood pressure. If nurses perceive the experiences of hypertensive patients receiving massage, they can use massage more effectively in their care plan. This is a descriptive phenomenological study. Deep interviews were conducted with nine prehypertensive women who received Swedish massage three times a week in a total of 10 sessions, with each session lasting 10-15 min. Then, the researcher conducted an interview using a ‘grand tour question (open ended question) and the participants were then encouraged to speak freely explaining their thoughts and feelings about the experience of massage therapy. Data analysis was done by Colaizzi’s method. Validity and reliability were obtained through measures such as real value, applicability, continuity, and authenticity. Women evaluated the massage therapy positively. The findings yielded six themes, including relaxation, sleeping better, reduction of anxiety and tension, reduction of fatigue, invigorating experience, improve connecting. This study demonstrates that a body‑centered intervention like massage can be valuable in a multidisciplinary approach to women with prehypertension. This method is easy to learn and relatively short (10-15 min) to administer as a suitable complement in nursing care for this group of patients.

Uncontrolled hypertension state is a major public health problem that may influence different quality of life aspects in hypertensive patients. The present study aimed to assess the effect of hypertension control status upon quality of life in Iranian hypertensive patients. Hypertensive patients in the present case-control designed study were identified from a district-wide, population-based register [Isfahan Healthy Heart Program (IHHP)]. Patients in two case groups had a diagnosis of controlled (n=314) or uncontrolled (n=1346) hypertension and those in the control group were healthy without symptomatic diseases or treatments (n=7718). The World Health Organization Quality of Life (WHOQOL)-BREF was used to assess general quality of life. The score of all four physical, psychological, social, and environmental components were far lower in the uncontrolled group compared to the controlled hypertensive group and healthy group, with no apparent difference between the patients with controlled hypertension and those with healthy status. The value of systolic blood pressure was adversely correlated with the physical component score. A negative association was revealed between the value of diastolic blood pressure and physical, psychological, and environmental component scores. According to the linear regression model, poorer quality of life could be predicted by uncontrolled hypertension status (Beta = -2.074, Standard Error = 0.798; P= 0.009). Uncontrolled hypertensive patients are faced with lower physical, psychological, environmental, and social domains of quality of life, as compared to normal controls or to those with controlled hypertension.

Heart failure is one of the leading causes of mortality, is a final common pathway of several cardiovascular diseases, and its treatment is a major concern in the science of cardiology. The aim of the present study was to compare the effect of addition of the coenzyme Q10 (CoQ10)/atorvastatin combination to standard congestive heart failure (CHF) treatment versus addition of atorvastatin alone on CHF outcomes. This study was a double-blind, randomized placebo-controlled trial. In the present study, 62 eligible patients were enrolled and randomized into 2 groups. In the intervention group patients received 10 mg atorvastatin daily plus 100 mg CoQ10 pearl supplement twice daily, and in the placebo group patients received 10 mg atorvastatin daily and the placebo of CoQ10 pearl for 4 months. For all patients echocardiography was performed and blood sample was obtained for determination of N-terminal B-type natriuretic peptide, total cholesterol, low density lipoprotein, erythrocyte sedimentation rate, and C-reactive protein levels. Echocardiography and laboratory test were repeated after 4 months. The New York Heart Association Function Class (NYHA FC) was also determined for each patient before and after the study period. Data analyses showed that ejection fraction (EF) and NYHA FC changes differ significantly between intervention and placebo group (P = 0.006 and P = 0.002, respectively). Changes in other parameters did not differ significantly between study groups. We deduce that combination of atorvastatin and CoQ10, as an adjunctive treatment of CHF, increase EF and improve NYHA FC in comparison with use of atorvastatin alone.

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). 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. 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. 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.

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. 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. 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. 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.

Diabetes mellitus (DM) has a lot of complications such as macrovessel and microvessel disease. Another complication of DM is cardiac autonomic neuropathy (CAN), which have effect on automatic nervous system of heart. Failure in heart rate slowing after exercise is a presentation of this abnormality. We selected diabetic patients and divided them to case and control group based on microalbuminuria. Case group comprised of diabetic patients with microalbuminuria and control group included those without microalbuminuria. Patients in both groups exercised on treadmill using Bruce protocol and heart rate was measured in first and second minutes in the recovery period. We selected 35 patients with microalbuminuria (case group) and 35 without microalbuminuria (control group) among diabetic patients. No statistically significant difference was seen in sex and age between case and control groups. Heart rate recovery in the first minute of recovery in the case and control groups did not show significant difference; but in the second minute of recovery, it was significantly higher in control group (97 ± 19.4 vs. 101.9 ± 12.4 beat per minute, P = 0.04). In this study we evaluated the heart rate recovery or deceleration in diabetic patients with albuminuria and without microalbuminuria in recovery phase after exercise test. We found out that heart rate recovery at the second minute in the case and control groups has statistically significant difference but at the first minute, it did not.

One of the causes of mortality in acute myocardial infarction (AMI) is ventricular tachycardia. Abnormal serum Potassium (K) level is one of the probable causes of ventricular tachycardia in patients with AMI. This study carried out to determine the relationship between serum potassium level and frequency of ventricular tachycardia in early stages of AMI. Ina cross-sectional study on 162 patients with AMI in the coronary care unit (CCU) of Nour Hospital (Isfahan, Iran), the patient's serum potassium level was classified into three groups: 1) K<3.8 mEq/l, 2) 3.8≤K<4.5 mEq/l and 3) K≥4.5 mEq/l. The incidence of ventricular tachycardia in the first 24 hours after AMI was determined in each group by chi-square statistical method. The frequency of ventricular tachycardia in the first 24 hours after AMI in K< 3.8 mEq/l, 3.8≤K<4.5 mEq/l and K≥4.5 mEq/l groups were 19.0%, 9.6% and 9.9% respectively. The high frequency of this arrhythmia in the first group as compared with the second and the third group was statistically significant. Hypokalemia increased the probability of ventricular tachycardia in patients with AMI. Thus, the follow up and treatment of hypokalemia in these patients is of special importance.

Despite conventional treatment methods of acute myocardial infarction, its complications and mortality rates are still very high. Finding new cost-effective treatments like regulation of ischemic muscle metabolism at the time of thrombolytic therapy can meet this requirement to some extent. This study investigated the efficacy of the pharmaceutical combination of glucose, insulin, potassium (GIK) and magnesium along with thrombolytic therapy. In a double-blind, controlled clinical trial, 200 patients with acute myocardial infarction who had the indication for thrombolytic treatment were selected and divided to 6 groups of almost 30 people. A specific treatment protocol was designed for each group. The patients in the first 5 groups were compared with the ones in the sixth group as the control group in terms of frequency of complications and in-hospital mortality and also mortality during 3 and 6 months after the treatment. Mean age of the patients was 58.77 ± 2.6 years. Males constituted 77% of the study population. Heart failure, in-hospital arrhythmia and ejection fraction (EF) at discharge showed favorable results in the five groups which received metabolic regulations as compared to the control group. In-hospital mortality of no groups was different from that of the control group (P > 0.05). Three months after the treatment, mortality of the group that received GIK and magnesium was lower than that of the control group (P < 0.05). After 6 months, none of the patients who received high-dose GIK and magnesium along with thrombolytic therapy died while the mortality rate of the control group was 44.4% (P < 0.05). The infusion of GIK and magnesium solution along with thrombolytic therapy can lead to a decrease in the long-term mortality and complications in patients with acute myocardial infarction.