Sex differences in conventional and some behavioral cardiovascular risk factors, Analysis of the prevention clinic database

Background: An increase in Cardiovascular Disease (CVD) frequency was observed over the past three decades in low- and middle income countries, especially in Iran. The purpose of the present study was to review and compare the frequencies of conventional and some non-conventional CVD risk factors between men and women in a tertiary level referral cardiovascular teaching hospital in a six month period in the North of Iran.  Methods: A descriptive cross-sectional study was conducted using medical databases including conventional risk factors: opium consumption, physical inactivity, high salt diet, and serum vitamin D level. The chi-square and independent t tests were used to assess the differences between groups.  Results: A total of 740 (55% women) who had available full medical history data were recruited in the study. Approximately 62% of the participants were older than 45 years with the mean age of 54 (14.2) years old. Percentages of hypertension, diabetes, dyslipidemia, and obesity in women were significantly higher than those of men (P<0.05). A total of 50% of all the participants were physically inactive. Men had higher frequency of opium and saltshaker use than women (P<0.05).  Conclusion: The current study indicated that despite the importance of conventional CVD risk factors like diabetes, hypertension, dyslipidemia, and obesity, educational programs should be considered to improve physical activity and reducing salt consumption and awareness about opium use complications

Is there any association between contrast-induced nephropathy and serum uric acid levels?

Introduction: During the recent years, several studies have investigated that hyperuricemia is associated with greater incidence of contrast induced nephropathy (CIN). Most of them are in acute conditions like primary percutaneous coronary interventions. This study aimed to assess the relationship between high serum uric acid and incidence of acute kidney injury in patients undergoing elective angiography and angioplasty. Methods: This prospective study was conducted on 211 patients who were admitted to hospital for elective coronary angiography or angioplasty. The researchers measured serum creatinine and uric acid on admission and repeated creatinine measurement in 48 hours and seven days after the procedure. According to serum uric acid, the patients were divided into two groups; group 1 with normal uric acid and group 2 with hyperuricemia which was defined as uric acid more than 6 mg/dL in women and 7 mg/dL in men. CIN is defined as an increased creatinine level of more than 0.5 mg/dL or 25% from the baseline in 48 hours after the intervention. Results: In total, 211 patients with mean age of 60.58 years were enrolled in the study. Of these, 87 (41.2%) patients were in the high uric acid group and 124 (58.8%) were in the normal uric acid group. CIN was occurred in 16 patients (7.5%). Seven out of 16 (8.04%) were in the high uric acid and nine (7.2%) were in the normal uric acid group. There were no significant differences between the two groups (P =0.831). Conclusion: The frequency of CIN development was not different in the patients with hyperuricemia

Effect of Exercise-Based Cardiac Rehabilitation on Ejection Fraction in Coronary Artery Disease Patients: A Randomized Controlled Trial

Background: Exercise training as a part of cardiac rehabilitation aims to restore patient with heart disease to health. However, left ventricular ejection fraction (LVEF) is clinically used as a predictor of long-term prognosis in coronary artery disease (CAD) patients, there is a scarcity of data on the effectiveness of exercise-based cardiac rehabilitation on LVEF. Objective: To investigate the effectiveness of exercise-based cardiac rehabilitation on LVEF in early post-event CAD patients. Patients and Methods: In a single blinded, randomized controlled trial, post-coronary event CAD patients from the age group of 35-75 years, surgically (Coronary artery bypass graft or percutaneous coronary angioplasty) or conservatively treated, were recruited from Golsar Hospital, Iran. Exclusion criteria were high-risk group (AACVPR-99) patients and contraindications to exercise testing and training. Forty-two patients were randomized either into Study or Control. The study group underwent a 12-week structured individually tailored exercise program either in the form of Center-based (CExs) or Home-based (HExs) according to the ACSM-2005 guidelines. The control group only received the usual cardiac care without any exercise training. LVEF was measured before and after 12 weeks of exercise training for all three groups. Differences between and within groups were analyzed using the general linear model, two-way repeated measures at alfa=0.05. Results: Mean age of the subjects was 60.5 ± 8.9 years. There was a significant increase in LVEF in the study (46.9 ± 5.9 to 61.5 ± 5.3) group compared with the control (47.9 ± 7.0 to 47.6 ± 6.9) group (P=0.001). There was no significant difference in changes in LVEF between the HExs and CExs groups (P=1.0). Conclusion: A 12-week early (within 1 month post-discharge) structured individually tailored exercise training could significantly improve LVEF in post-event CAD patients

Frequency of renal artery stenosis and associated factors in patients undergoing coronary angiography

Background: Coronary artery disease (CAD) is the first cause of mortality in developed and developing countries, including Iran. Identifying high-risk patients can save many from morbidity and mortality. Renal artery stenosis (RAS) seems to be equivalent to CAD in patients with cardiovascular risk. Objectives: The present study aimed to determine the prevalence, severity, and extent of RAS and its predictors in patients with confirmed CAD on coronary angiography. Patients and Methods: All patients suspected of ischemic heart disease (IHD), who underwent diagnostic coronary angiography at Heshmat heart hospital, Iran were recruited (May 2015 to June 2016). Patients with confirmed CAD underwent non-selective renal angiography, which was categorized as mild, moderate or severe based on luminal diameter narrowing more than normal >0% to 50%, between 50%-70% and more than 70%, respectively. Results: Of 233 patients, RAS was observed in 123 (53%). Around 20% were mild, 10% were moderate and 23% were severe. Additionally, RAS in 37% was unilateral and in 16% were bilateral. Besides,19%, 25% and 56% of patients had atherosclerosis in one, two and three vessels, respectively. There was no correlation between the CAD severity and severity of RAS (P=0.807). Conclusions: Higher prevalence of RAS in patients with hyperlipidemia (60% vs. 40%) was detected. Its association with variables affecting CAD indicates that RAS can be a predictor of CAD. Therefore, simultaneous assessment of RAS in coronary angiography can be a good screening method for CAD beside earlier diagnosis of kidney disease

Effect of multimorbidity on quality of life in adult with cardiovascular disease: a cross-sectional study

Abstract Background The aim of present study was to describe the effect of multimorbidity on Health-Related Quality of Life (HRQoL) in patients with coronary artery disease (CAD). Methods A cross-sectional study with a simple sampling method of 296 patients undergoing coronary artery bypass surgery in a referral hospital of the northern part of Iran was conducted between April, 2015 and September, 2016. Multimorbidity was defined as the presence of at least two chronic diseases based on self-reporting and medical records. HRQoL was measured using the 36-item short form (SF-36) health status survey. We used analysis of variance (ANOVA) to assess the effect of multimorbidity on mental and physical component of HRQoL. Results Approximately, 69% of CAD patients had at least one other disease like diabetes or hypertension. Patients without multimorbidity compared with patients with multimorbidity were significantly older (p = 0.012) and more educated (p = 0.002). Both physical and mental component score of HRQoL was better in patients without any morbidity (48.82 vs. 43.93 with 95%CI of mean difference: 3.37–6.42 and 54.85 vs. 50.44 with 95% CI of mean difference: 1.68–7.15, respectively). Both physical and mental component score was significantly lower in female and lower educated patients (physical mean score 43.07 vs. 46.54 with P = .001 and 42.53 vs. 46.82 with P < .001 and mental mean score 49.98 vs. 52.65 with P = .055 and 49.80 vs. 52.75 with P = .022 for sex and education, respectively). Also, two-way ANOVA showed that regards to morbidity, physical component score was greater in patients with lower education level than higher education level (P < .001). Conclusion The findings of this study suggest that women, lower education level and overweight patients reported lower quality of life. HRQoL is affected by multimorbidity among CAD patients specially in less educated