cross-sectional study of the prevalence of coronary artery disease traditional risk factors in Yazd urban population, Yazd healthy heart project

Coronary artery disease [CAD] risk factors are increasing in developing countries. Previous studies have shown a high prevalence of CAD risk factors in Iran but Geographical prevalence is not uniform. The present study was performed to determine the prevalence of CAD risk factors among Yazd urban population. This cross- sectional study performed in 2004, comprised a total 2000 Yazd citizens [1000 males], and the corresponding data were recorded in questionnaires carrying 500 items. About 85% of Yazd citizens had at least one and 61.1% had at least two coronary artery risk factors. The following data in brackets refer to the males and females respectively. The present study showed obesity in 16.38% of Yazd citizens [9.2 and 24.2%]. The prevalence of hypercholesterolemia 12.1% [10.6 and 13.8%], dyslipidemia 58.5% [59% and 57.6%], high blood pressure 25.6% [27.5% and 23.5%], diabetes mellitus 11% [10.48% and 11.5%], impaired glucose tolerance test 8.5% [7.9% and 9.1%] and cigarette smoking 13.12% [24.45% and 0.5%]. Also 43.3% of men and 62.05% of women had excess weight. The prevalence of hypercholesterolemia, dyslipidemia, diabetes mellitus [DM], hypertention [HTN], and abdominal obesity increased significantly with age [P< 0.005]. The prevalence of obesity, abdominal obesity, hypercholesterolemia and DM were significantly higher in women. Yazd did not carry the highest levels of risk factors in Iran, but the present study showed excess weight, dyslipidemia and HTN were the most prevalent risk factors found in this region. Thus it is recommended to consider the preventive and therapeutic measures as the major health priorities in this area

Association of the co-stimulatory molecules polymorphisms with CMV infection in liver transplant recipients

Co-stimulatory molecules play a critical role in regulating T-cell function during CMV infection after liver transplantation. To investigate the relationship between the polymorphisms of the co-stimulatory genes and the susceptibility to CMV infection after liver transplantation. Single nucleotide polymorphisms [SNPs] in PD-1 gene [PD1.1 A/G, PD1.3 A/G, PD1.9 C/T] ICOS [-693 A/G, 1720 C/T], CTLA-4 gene [-318 C/T, 1722 T/C, 1661 A/G, 49 A/G] and CD28 [+17 C/T] were analyzed by PCR-RFLP in 70 liver transplant patients. CMV infection was determined in these patients by antigenemia test. CTLA-4 49G showed significant association with CMV infection [p=0.03, OR=3.82, 95% CI: 0-3.5; p=0.01, OR=004, 95% CI: 0-1.3]. G and T alleles in CTLA-4 gene [-318 C/T and 1661 A/G] [p=0.03, OR=0, 95% CI: 0-3.5; p=0.01, OR=0.04, 95% CI: 0-1.3] were significantly higher in CMV-infected rejector group. CTLA-4 have significant role in CMV pathogenesis and rejection among CMV-positive liver transplant patients

Prevalence of traditional coronary artery disease risk factors in Yazd urban population: Yazd healthy heart project

Coronary artery disease [CAD] risk factors are increasing in developing countries. Previous studies have shown a high prevalence of CAD risk factors in Iran but geographical prevalence is not uniform. We performed this study to determine the prevalence of these risk factors in Yazd province, central Iran. In this cross-sectional study, a total of 2000 participants, 1000 men and 1000 women among Yazd citizens, were surveyed and data was recorded in a 500- item questionnaire. About 85% of Yazd citizens had at least one and 61.1% had at least two coronary artery disease risk factors. The present study showed that 16.38% of Yazd citizens were obese [9.2% in men and 24.2% in women], and 43.3% of men an d62.05% of women had excess weight. Prevalence of hypercholesterolemia was 12.1% [10.6 in men and 13.8% in women, respectively], dyslipidemia 58.5% [59% and 57.6%, respectively], high blood pressure [HTN] 25.6% [27.5% and 23.5%, respectively], diabetes mellitus [DM] 11% [10.48% and 11.5%, respectively], impaired glucose tolerance 8.5% [7.9 and 9.1%, respectively] and cigarette smoking 13.12% [24.45% and 0.55, respectively]. The prevalence of hypercholesterolemia, dyslipidemia, DM, HTN, and abdominal obesity increased significantly with age [p<0.005]. The prevalence of obesity, abdominal obesity, hypercholesterolemia and DM was significantly higher in women. Excess weight, dyslipidemia and HTN were the most prevalent risk factors in Yazd. Although Yazd did not have the highest levels of risk factors in Iran, but the findings showed that Yazd is one of the "at risk" cities with regard to prevalence of risk factors. Preventive and therapeutic programs should thus be considered as a major health priority in Yazd

Serum uric acid levels and its association with cardiovascular risk factors

Although the issue of hyperuricemia as a risk factor for cardiovascular diseases [CVD] has been disputed, several studies have shown an association between hyperuricemia and several CVD risk factors. The aim of this study was to assess distribution of uric acid level in Yazd City, center of Iran, and its association with CVD risk factors. From autumn 2004 to summer 2005, 2000 urban population of Yazd City, aging 20-74 years via clustering random sampling were enrolled in this cross sectional study. Serum uric acid level, systolic blood pressure [SBP], diastolic blood pressure [DBP] and waist/hip ratio were significantly higher in men than in women [P < 0.001],moreover, total cholesterol, HDL cholesterol and body mass index [BMI] were significantly higher in women [P < 0.001]. The prevalence of hyperuricemia and metabolic syndrome in men and women was [17.9%, 11.25% P = 0.001] and [11.87%, 19.32% P= 0.01], respectively. Hyperuricemia was more prevalent in metabolic syndrome and ischemic heart disease independent of age and sex. Significant correlations were found between serum uric acid and several components of the metabolic syndrome. Weight, waist circumstance, triglyceride level and DBP, were the major determinants of the variations in serum uric acid levels. This could be attributed to the insulin resistance status

[Ankle / brachial index in thrombotic cerebrovascular disease patients]

Previous studies showed that Ankle Brachial Index [ABI] score less than 0.9 increases probability of ischemic heart disease up to 2 times, risk of TIA/ stroke to quadruple, and asymptomatic carotid and popliteal artery stenosis to one and half fold. ABI <0.9 is related with diffuse atherosclerosis. The aim of this study was to review ABI findings in patients with cerebral artery disease. This cross-sectional descriptive study was done on 98 patients with thrombotic cerebrovascular accident in Yazd Shahid Sadughi Hospital, between February 2001 and February 2002. A questionnaire including demographic, clinical, and paraclinical data was completed and results were analyzed using descriptive statistics and frequency distribution tables. Forty four percent of the patients were men. Mean age was 73/1 +/- 1/5. ABI<0.9 was seen in 15% of the cases. In patients older than 65 years old ABI<0.9 frequency rate was 12.5% and in patients younger that 65 year old it was 3.1%. There was no significant difference between ABI<0.9 and history of diabetes mellitus, hypertension, smoking, and ischemic heart disease. ABI<0.9 was prominently seen in patients with hyperlipidemia [P<0.05]. ABI<0.9 was seen in older ages, hypertensive, smoker, and CAD patients more than the others [P>0.07]. Because of lack of samples in the present study, authors suggest a study with a larger sample group

[Role of obesity in premature MI occurrence and hospital and one year follow up mortality]

Nowadays, obesity is developing as an epidemy and it is one of major risk factors of coronary artery disease, therefore this study determinated the effect of obesity on age of occurrence of MI and It's mortality. In this prospective study we studied on 212 hospitalized patients because of MI in CCU[s] from May 2001 to October 2002 and they followed for one year, questionnaires for all patients were completed and data analyzed with SPSS ver.11.00.. 34.9% of patients were overweight and 16.5% were obese. Average BMI was 25.87 +/- 4.38. Obese patients were younger than overweight and normal weight patients significantly. [P=0.039] there was a linear relationship between BMI and age of occurrence of MI. [P=0.005]. Obesity and overweight status didn't affect on hospital and late [1 year] mortality. According to our results, obesity associated with premature occurrence of AMI because obesity accelerated coronary atherosclerosis but obesity didn't associate with increased incidence of inhopsital or one year mortality. Thus we suggest to long term follow up in later studies

[Relation between admission blood glucose levels and in-hospital and one year mortality in non-diabetic acute myocardial infarction patients]

Several studies have evaluated the association of admission blood glucose levels and short and long term mortality after myocardial infarction and have had different results. The aim of this study was evaluation of association between admission blood glucose levels and in-hospital and one year mortality in non-diabetic patients with AMI. In this study, demographic, clinical and Para clinical data of 120 non-diabetic patients with AMI on admission was collected and analyzed. The patients were followed for one year. Blood glucose level >/= 140 mg/dl was defined as hyperglycemia. 78% of patients were men. The mean age and admission blood glucose level was 63 +/- 13 years and 146 +/- 76mg/dl, respectively. Death due to cardio vascular causes was seen in 20% of patients in hospital and 9.8% during the one year follow up. The mean admission blood glucose level in patients who died in hospital was significantly more than live patients and also had an influence on the in-hospital outcome. Every 100mg/dl increase in blood glucose level was associated with 11% increase in in-hospital mortality risk in non-diabetic patients. Our results demonstrate that admission blood glucose level is a good marker for diagnosing patients with worse prognosis after AMI. We suggest that later studies should focus on optimal control of hyperglycemia with insulin in patients with AMI

[ comparison of ABI findings with ultrasound duplex scanning in PAD patients]

Atherosclerosis of peripheral arteries occurs in 12% of individuals with 65 years of age or older. Peripheral arterial disease [PAD] is one of the chronic diseases that is responsible for a significant number of mortality or morbidity in the developed countries. At least 28% of these patients have coronary heart diseases and 10% of them have cerebrovascular diseases. In addition, PAD is an independent predictor of both all causes and cardiovascular mortality. of this study is to calculate agreement between the two diagnostic tests of PAD, ankle brachial index [ABI] and ultrasound duplexes scanning [UDS] and to evaluate the results of these tests against symptoms of patients we designed this study on PAD patients. Forty symptomatic PAD patients that referred to the department of Sonography to complete their work up were enrolled in this validation study. Demographic characteristics, risk factors, symptoms, ABI and UDS measurements were recorded. Based on symptoms, ABI and UDS findings, patients were divided in to four groups and were compared with each other. Finally, agreement and association of these findings were analyzed. 32 patients [80%] were men with the mean age of 62 +/- 12.8 years [26-90]. Smoking [75%] and hypertension [100%] were the most common risk factors in men and women respectively and diabetes was ranked as the second common risk factor had the second degree in both genders. Agreement between ABI and UDS in men was significant, but was not significant in women. [P=0.02] Agreement between symptoms and ABI was significant [P=0.04] and between symptoms and UDS was not significant [P=0.037]. ABI is an appropriate tool for estimating the severity of arterial stenosis and lower extremity circulation

Early outcome of acute myocardial infarction

Introduction: Previos studies indicated that generally after acute myocardial infarction women have a poorer outcome thane men. Further studies with complete adjustements for coexisting condition are needed to determin whether the older age of the women who studied or the presence of other unfavorable prognostic factors or both explains this difference

Material and Method: We studied 817 consecutive patients [556 men and 261 women] hospitalized in all CCUs in city of Yazd due to acute myocardial infarction from May 2000 to October 2001

Results: In this survey, women were older than men [67.50 +/- 11 Vs 60 +/- 13] and had higher prevalence of hypertension, diabetes, dyslipidemia and in-hospital mortalities. The unadjusted odds ratio for death among women compared to men was 2.7[95 percent confidence interval, 1.79 to 4.28]. After adjustment for age the odd ratio reduced to 2.03 [95 percent confidence interval, 1.3 to 3.1]. Adjustmen for other differences in the base line characteristics reduced the odds ratio to 1.91 [95 percent confidece interval, 1.03 to 3.5]. These differences were significat, but after adjustment for treatment the odds ratio reduced to 1.51 [95 percent confidence interval, 0.6 to 3.7], and it wasn't Statistically significant

Conclusin: Women have worse prognosis after acute myocardial infarction and on the treatment may be contributing to this, and for correct judgement the difference of mortality after acute myocardial infarction, both sexes should under go the same approach for treatment