Arya Atherosclerosis
Volume:10 Issue: 6, Nov 2014

Regarding the relationship between blood pressure (BP) and shift work (SW), previous studies have reported contradictory results. In the present study, we used Bayesian multilevel modeling to evaluate the association of SW and BP after controlling some confounding factors. Data of this multicenter historical study were extracted from annual observations of the male workers of Isfahan’s Mobarakeh Steel Company (IMSC) and Polyacryl Iran Corporation (PIC) in Isfahan, Iran, between 2003 and 2011. In this research, we assessed the effect of SW on systolic BP (SBP) and diastolic BP (DPB) with controlling body mass index, age, work experience, marriage, and education status. A total of 8613 (IMSC, n = 5314 and PIC, n = 3299) workers participated in this study with a mean [standard deviation (SD)] age of 41.60 (8.30) and mean (SD) work experience of 16.17 (7.89) years. In this study, after controlling confounding factors, we found no significant relationship between SW and SBP and DBP. In general, the results of this multicenter cohort study did not support a relationship between SW and BP. We suggest prospective studies with controlling more confounding factors in this area.

Venous thromboembolism (VTE) and deep vein thrombophlebitis (DVT) is a serious problem with high mortality and morbidity rates. This study was conducted to compare efficacy and safety results of the two types of VTE preventing in patients underwent total knee arthroplasty (TKA). Having considered exclusion criteria, 90 patients of 136 ones were registered in the study. Our patients of TKA were split randomly in two groups. Totally, 45 patients received enoxaparin, 40 mg 12 h before surgery and treated by 40 mg daily up to 15 days. The second group (45 patients) were treated by dabigatran 150 mg 4 h after surgery and 225 mg daily up to 15 days. Efficacy was evaluated by Doppler sonography after 15 days for the presence of DVT and safety was determined by 3 months follow-up for all-cause mortality and any major or minor bleedings. Two groups were similar in baseline characteristics. The efficacy outcome events occurred in 2.2% (2 of 90) of the patients (1 symptomatic VTE in dabigatran and 1 in the enoxaparin group) without significant statistical difference between groups (P = 0.64). In terms of safety, 3 patients (6.6%) in dabigatran and 2 patients (4.4%) in enoxaparin group had major bleeding (P = 0.66) and 8 patients (17.7%) in dabigatran and 7 patients (15.7%) in enoxaparin group had non-major bleeding event (P = 0.81). There were no death, pulmonary emboli, and cardiac events during follow-up. Three months follow-up did not show statistical difference in efficacy and safety between dabigatran and enoxaparin. Future studies with mentioning to later outcomes for checking safety are warranted.

Despite established effects of atorvastatin on level of serum lipid profile in patients with different underlying clinical conditions, the effects of this drug on other serum biomarkers remain uncertain. We examined the effects of atorvastatin therapy on lipid profile, glycemic control, and liver enzymes in patients with ischemic cerebrovascular accident without any history or clinical evidences of diabetes, heart failure, renal failure, or hepatic disease. In a randomized double-blinded controlled trial, 140 hospitalized patients with an ischemic cerebrovascular accident were included and randomly assigned to receive either atorvastatin 40 mg (n = 70) or atorvastatin 20 mg daily (n = 70) for 3 months. The levels of biomarkers were measured at the time of administrating drugs as well as at the time of completing the treatment. A significant reduction was revealed in serum triglyceride, total cholesterol, low-density lipoprotein, non-high-density lipoprotein (HDL) cholesterol, and also aspartate aminotransferase levels as well as a significant increase in serum HDL level following administration of atorvastatin in both case and control groups who received the atorvastatin 40 mg/day and 20 mg/day, respectively (all P < 0.050). Although a significant increase in fasting blood sugar and hemoglobin A1c was observed in the case group received atorvastatin 40 mg/day (both P < 0.001), but this elevation was not occurred in another group treated with lower dose of the drug (both P > 0.050). Daily administration of 20 mg and 40 mg doses of atorvastatin for 3 months provides improvement in serum lipid profiles; however, because of interfering effect of high-dose atorvastatin on glycemic control status, the use of the former dose may be preferred. This is very important in these patients because the positive effects of high-dose atorvastatin in stroke patients are not confirmed.

Immunopathological and inflammatory processes play important roles in the initiation and development of ischemic heart disease. Hence, this study aimed to evaluate the relationship between serum levels rheumatoid factor (RF) and anti-nuclear antibodies (ANA) and severity of coronary stenotic lesions. Totally 140 patients with acute coronary syndrome (ACS) (n = 70) and chronic stable angina (CSA) (n = 70) that undergoing coronary angiography were enrolled in this study. ANA by the enzyme-linked immunosorbent assay (ELISA) and serum level of RF was measured by latex method. The severity of coronary stenotic lesions calculated by Gensini score. To analyze the correlations of ANA and RF to Gensini score Pearson correlation test was used. To adjust the effect of age and other confounder factors such hypertension, diabetes, hyperlipidemia and smoking multiple linear regression was used. The mean serum levels of RF and ANA in CSA group were significantly higher than ACS group after adjusting for the confounder factors (P < 0.050 for ANA). Serum levels of ANA significantly correlated with severity of coronary stenotic lesions calculated by Gensini score (r = 0.40 and P < 0.050). After adjusting confounders, multiple linear regression analysis showed ANA remained independently associated with Gensini scores in ACS group (B = 0.505, P < 0.001). Higher serum levels of ANA may be considered as independent risk factors for ACS.

Hypertension (HTN) considers as one of the most common risk factors, which potentially raises the risk of cardiovascular disease. Regarding high prevalence of HTN among Iranian population this study designed to examine a range of socio-demographic and clinical variables to determine the association with failure to achieve blood pressure control in a cohort of hypertensive subjects. This retrospective cohort study is a part of Isfahan cohort study which carried out on adults aged 35 years old or more. Subjects with confirmed HTN entered in this sub-study. For all subjects questionnaire included socio-demographic characteristics, clinical data and lifestyle behavior completed by trained nurses. Uncontrolled HTN was defined as systolic and diastolic blood pressure more than 140/90 in the presence or absent of pharmacological treatment. The prevalence of uncontrolled men was significantly higher than controlled in both 2001 and 2007 (P < 0.001). A significant association was found between sex and control of blood pressure: compared with women, being men [odds ratio (OR) = 2.31; 95 % confidence interval (CI) = 1.64-3.24] was significantly associated with uncontrolled HTN in 2001 and (OR = 2.38; 95% CI = 1.78-3.18). Among lifestyle behaviors, tendency for more consumption of salty foods increased the risk of uncontrolled HTN in 2001 by 1.73 times [OR = 1.73, 95% CI = 1.20-2.50, (P = 0.003)]. Patients who were naive to mono-therapy without considering the type of antihypertensive drug were found to be associated with uncontrolled blood pressure (OR = 0.14; 95 % CI =0.1-0.2). Uncontrolled HTN was sex, marital status, diabetes, tendency to salty foods and medication adherence. Assessment of them presence of these risk factors is warranted to recommend an aggressive HTN management with the goal of reducing excessive risk of cardiovascular events caused by uncontrolled HTN.

Despite exercise is recommended as an adjunct to medication therapy in patients with heart failure (HF), non-adherence to exercise is a major problem. While improving self-efficacy is an effective way to increase physical activity, the evidence concerning the relationship between strategies to enhance self-efficacy and exercise among HF has not been systematically reviewed. The objective of this systematic review is to assess the effect of interventions to change the self-efficacy on exercise in patients with HF. A systematic database search was conducted for articles reporting exercise self-efficacy interventions. Databases such as PubMed, ProQuest, CINAHL, Scopus, and PsycINFO, and the Cochrane Library were searched with restrictions to the years 2000-June 2014. A search of relevant databases identified 10 studies. Published randomized controlled intervention studies focusing strategies to change self-efficacy to exercise adherence in HF were eligible for inclusion. In addition, studies that have applied self-efficacy-based interventions to improve exercise are discussed. Limited published data exist evaluating the self-efficacy strategies to improve exercise in HF. Dominant strategies to improve patients’ self-efficacy were performance accomplishments, vicarious experience, verbal persuasion, emotional arousal. Evidence from some trials supports the view that incorporating the theory of self-efficacy into the design of an exercise intervention is beneficial. Moreover, exercise interventions aimed at integrating the four strategies of exercise self-efficacy can have positive effects on confidence and the ability to initiate exercise and recover HF symptoms. Findings of this study suggest that a positive relationship exists between self-efficacy and initiating and maintaining exercise in HF, especially in the short-term period.

Although Marfan’s syndrome is a disease with various phenotypes, but the major mechanism of death is cardiovascular complication. Aortic dissection is a major cause of death in Marfan syndrome.CASE REPORT: A 30-year-old man with severe refractory chest and left flank pain and history of previously surgically repaired Type A aortic dissection was referred to the hospital. His typical manifestations of Marfan’s syndrome were identified. Cardiovascular imaging showed an acute spiral dissection in the descending aorta extending to the left renal and femoral arteries with no evidence of thrombosis in its huge false lumen (8 cm). By the diagnosis of acute, expanded, spiral, Type B aortic dissection, he underwent the stent grafting of dissected aorta. He discharged without any complication. On follow-up cardiovascular imaging, thrombosed false lumen in stented aorta from descending aorta to the proximal abdominal aorta was seen. Endovascular treatment of Type B dissection is an effective treatment in Type B dissection, even in patients with Marfan syndrome.

Methadone is a synthetic opioid, which has been successfully used in treating heroin addiction and chronic pain syndrome in palliative care for more than 30 years. This drug is a potent blocker of the delayed rectifier potassium ion channel, which may result in corrected QT (QTc) interval prolongation and increased risk of torsades de pointes (TdP) in susceptible individuals.CASE REPORT: We describe here a case of methadone-induced TdP that deteriorated into ventricular fibrillation, which was resolved after treatment with IV magnesium, potassium, and Lidocaine. Our purpose in this case review was to highlight the risk of cardiac arrhythmias, in particular QTc interval prolongation leading to TdP in a heroin-dependent patient receiving methadone substitution therapy, and then to present a perspective on treatment and prevention strategies of methadone induced prolonged QTc. Methadone-induced TdP is a potentially fatal complication of methadone therapy. As the popularity of methadone use grows, clinicians will encounter more cases of methadone induced TdP, especially in our region, Iran. Hence, a thorough patient history and electrocardiogram monitoring are essential for patients treated with this agent, and alterations in treatment options may be necessary.