Arya Atherosclerosis
Volume:16 Issue: 1, Oct 2020

Improving knowledge towards risk factors for congenital heart disease (CHD) is important because of its high mortality and morbidity and trying for prevention of occurrence of CHD.

This case-control study was conducted on a total of 898 children with their mothers, who referred to the Clinic of Pediatric Cardiology of School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, during the years of 2014 to 2016. Cases comprised of 464 children with CHD diagnosed by echocardiography and controls were 434 sex- and agematched children without any evidence of CHD, who were admitted for a heart check-up at the same study period and in similar conditions. The children's parents completed check lists for collecting demographic characteristics, family history of CHD, history of obesity in mother, history of abortion and diseases in mother, use of medicine during pregnancy, exposure to teratogens during pregnancy, and children characteristics such as birth height and birth weight, etc.

Based on the results of data analyses with multiple logistic regression model [odds ratio (OR) with 95% confidence interval (CI)], history of obesity in mother before pregnancy, history of abortion, parental consanguinity, exposure to cigarette smoke during pregnancy, exposures to teratogens in the first trimester of the pregnancy, and use of medicine during pregnancy were associated with an increased odds of CHDs.

Results of this study emphasizes the use of policies that enhance pre-marital counseling, regular counseling during pregnancy, treatment of mothers' disease, and enhancing knowledge of women of childbearing age about exposure to certain teratogens for controlling risk factors of CHD.

Hypertension (HTN) is one of the most prevalent risk factors for arteriosclerosis and coronary artery disease (CAD). Its side effects can be decreased through the use of some methods and interventions. The present study was conducted with the aim to evaluate the effects of a lifestyle management on blood pressure, heart rate, and body mass index (BMI) of patients with HTN who have undergone angioplasty.

This clinical trial was conducted on 2 groups in 3 stages in an educational hospital in Isfahan, Iran, in 2014. The study participants consisted of 60 patients with HTN who had undergone angioplasty. The participants were randomly allocated to the study and control groups. The intervention was implemented in 6 educational sessions during 3 weeks, and then, follow-up was conducted through phone calls in the study group. The collected data were analyzed using independent t-test, chi-square, Mann-Whitney U test, and ANOVA in SPSS software.

Repeated measures ANOVA results indicated that the effect of time (P < 0.001) and group (P = 0.027) on systolic blood pressure (SBP) was significant. The effect of time (P = 0.015) and group (P = 0.040) on diastolic blood pressure (DBP) was also significant. In terms of BMI, both effects of time (P = 0.010) and group (P = 0.034) were significant. However, the effect of time (P = 0.899) and group (P = 0.900) on heart rate was not significant.

The lifestyle management program implemented in the present study was effective on decreased DBP, SBP, and BMI in patients with HTN who had undergone angioplasty. Thus, nurses could implement this program as a part of their care provision program for patients.

Some recent studies reported an inverse association between obesity and risk of cardiovascular diseases (CVD), heart failure related mortality rate, outcomes of myocardial infarction (MI), and the consequences of cardiovascular events interventions; this inverse association was named the obesity paradox. The present study was conducted with the aim to determine whether the obesity paradox will be detectable when the 10-year risk of CVD is estimated using CVD risk assessment tools.

The related data of 2910 subjects aged 40-74 years obtained in our cohort study that was carried out among 6140 subjects in Amol, in northern Iran, was included in this study. CVD risk assessment tools were used to estimate the 10-year risk of CVD. Obesity was evaluated using 4 indices, including waist circumference (WC), waist to height ratio (WHtR), waist to hip ratio (WHR), and body mass index (BMI). The receiver operating characteristic (ROC) curve analysis was utilized to evaluate the discriminatory power of obesity indices for 10-year risk of CVD.

Categorizing the participants to with and without obesity according to BMI showed that a significantly higher proportion of men with obesity had a 10-year risk of CVD ≥ 7.5% and ≥ 10% according to American College of Cardiology/American Heart Association (ACC/AHA) and the Framingham approaches, respectively. A higher proportion of women without obesity had a 10-year risk of CVD ≥ 7.5% than women with obesity based on the ACC/AHA equation (28.54% vs. 24.15%; P = 0.0707). BMI had a non-significant AUC (< 0.5) according to the the ACC/AHA equation.

BMI showed a weak and non-significant inverse association with 10-year risk of CVD estimated using pooled cohort equations of ACC/AHA in women. However, this result cannot directly provide enough evidence for the obesity paradox.

Cardioplegia is one of the main post-operative cardiac protective factors widely used in recent decades in the form of crystalloid (St. Thomas) and bloody solutions [del Nido (DN)]. The purpose of this study was to compare the effect of a crystalloid cardioplegic agent (St. Thomas) with that of a bloody cardioplegic agent (DN) in pediatric cardiac surgery among children with Tetralogy of Fallot (TOF).

This study was performed on 60 children with TOF, who were candidates for heart repair surgery. The participants were randomly divided into two groups of crystalloid cardioplegic agent and bloody cardioplegic agent. Operative outcomes such as required time for onset of heart arrest, duration of returning to normal heart rhythm, and cardiopulmonary bypass (CPB) time, and operative complications were compared between the two groups.

The duration of returning to normal heart rhythm (50.43 ± 10.93 seconds vs. 43.03 ± 16.35 seconds; P = 0.044) and duration of inotropy (80.40 ± 27.14 hours vs. 63.20 ± 26.91 hours; P = 0.017) were significantly higher in the DN group compared to the St. Thomas group. However, there were no significant differences between the two groups in terms of heart arrest time, cross-clamp time, CPB time, supplementary lasix time, duration of intubation, and intensive care unit (ICU) and hospital length of stay (LOS) (P > 0.050).

The use of St. Thomas cardioplegic solution was more effective in reducing the duration of returning to normal heart rhythm and inotropy compared with DN cardioplegic agent, and a single dose of these two cardioplegic agents can keep the mean cardiac arrest duration within the range of 50-70 minutes. It seems that the use of St. Thomas cardioplegic solution can be suggested in pediatric heart surgery.

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.

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.

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.

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.

In patients with polycystic ovarian syndrome (PCOS), this is now hypothesized that whether increased risk for cardiovascular disorders is related more to obesity than PCOS per se. This study aimed to compare cardiovascular risk factors between the lean and obese women with PCOS.

This case-control study was conducted on 86 (43 obese and 43 lean) women with PCOS. The presence of overweight and obesity was defined based on the body mass index (BMI) (> 25 kg/m2). The study objectives were first to compare mean levels of cardiovascular laboratory parameters between lean and obese patients with PCOS and then to assess the relationship between obesity indices and these laboratory parameters.

Compared to the lean group, the obese group had significantly higher mean fasting blood sugar (FBS) (89.40 ± 10.73 versus 84.09 ± 7.87 mg/dl, P = 0.011), higher mean serum triglyceride (TG) (119.09 ± 60.66 versus 96.86 ± 27.23 mg/dl, P = 0.032), higher mean total cholesterol (147.70 ± 57.38 versus 126.79 ± 35.95 mg/dl, P = 0.045), and also higher mean lowdensity lipoprotein (LDL) (92.30 ± 13.53 versus 83.77 ± 17.61 mg/dl, P = 0.014). Using the Pearson’s correlation test, positive correlations were found between BMI and waist circumference (WC) indices and study parameters including FBS, serum TG, serum total cholesterol, serum LDL, and also blood pressure (BP).

Because of higher concentrations of FBS and lipid profiles in obese patients with PCOS and considering obesity as a more important risk factor for coronary artery disease (CAD) than PCOS, it is recommended to assess and monitor cardiovascular risk factors in these population to reduce the risk for cardiovascular disorders and metabolic syndrome. Also, by reducing body weight and normalizing BMI value, the cardiovascular and metabolic risk factors can be modified and prevented.