Systolic and diastolic blood pressure among three groups of occupation

It is believed that occupation influences cardiovascular risk factors. To assess blood pressure [BP] and other cardiovascular risk factors in three occupation groups-teachers, military personnel and female housekeepers residing in Shiraz, southern Iran. We studied 2783 teachers, 366 military personnel, and 1896 female housekeepers who attended various medical education centers in Shiraz. BP, anthropometric parameters as well as fasted lipid profile and blood glucose level were measured determined for each participant. The mean values of all analyzed cardiovascular risk factors were higher among female housekeepers compared to female teachers. The mean systolic and diastolic BP was significantly [<0.001, and P=0.047, respectively] higher in female housekeepers than female teachers. Neither systolic nor diastolic BP had association with the type of occupation in men [military personnel vs. male teachers]. Housekeeping compared to teaching, may increase both systolic and diastolic BP in women

Correlation between fasting blood sugar and resting blood pressure in teachers residing in Shiraz, Iran 2009

Coronary Artery Disease [CAD] is the major cause of morbidity and mortality. The knowledge about correlation between the different risk factors of CAD provides valuable information for prediction and prevention of the disease in a specific population.The aim of this study was to evaluate the correlation between fasting blood sugar [FBS] and resting blood pressure in teachers residing in Shiraz, Iran. A total of 3115 teachers from different educational centers of Shiraz, Iran were interviewed in this cross sectional study. The data obtained comprised demographic information including age, sex, and history of hypertension [HTN], diabetes mellitus [DM], and current use of medications. Other parameters measured were height, weight, fasting blood sugar [FBS] and resting blood pressure [BP] as well as calculating the body mass index [BMI]. Out of all the cases studied, undiagnosed and/or untreated cases of diabetes and hypertension were 1.5% and 15.2% respectively. FBS was higher in the elderly and in cases with higher BMI, but without any significant difference in relation to sex. The prevalence of HTN was higher in males, in older cases and in those with higher BMI. A significant relationship was observed between FBS and resting BP in hypertensive and prehypertensive groups [P < 0.001] as compared to normotensive subjects. There was a significant correlation between FBS and resting BP in hypertensive and prehypertensive teachers residing in Shiraz,Iran. But this correlation was not present in the vast majority of the population with normal resting blood pressure. The prevalence of neglected DM and HTN in this population was high enough to warrant regular screening

Correlation between HDL-C and smoking in teachers residing in Shiraz, Iran

It has been established that serum HDL-C is a main predictor for cardiovascular diseases. The aim of this study was to assess the relationship of HDL-C to smoking in teachers residing in Shiraz in order to improve the health status of the group under study and community as a whole. The present study comprised a total of 3115 teachers working in Shiraz recruited in a prospective cohort study. Of these, two groups of 235 smokers and 235 non-smokers were randomly selected for evaluation of cardiovascular risk factors, and to determine any association between serum HDL-C, LDL, triglyceride [TG], systolic and diastolic blood pressure with smoking, gender and BMI. One way ANOVA, Pearson correlation and independent sample t tests by SPSS version 16 were used for statistical analysis and all means were followed by SD. Mean age of subjects was 45.5+/-6.7 years. Of smokers 4.7% were females. Among smokers males had a significantly higher mean of HDL [P=0.002] compared to females [42 vs. 32.4 mg/dl]. HDL level was significantly lower [P<0.001] in heavy smokers compared to non-smokers and light smokers [36.5 vs 41.7 and 43.5]. However, light smokers had a higher mean of HDL than non-smokers, although the difference was not statistically significant [43.5 vs. 41.7 mg/dl, P=0.131]. Serum HDL was not affected by other factors. Smoking was associated with a low serum HDL in the subjects under study who were intellectual class of the population. It is thus warranted to take preventive measures to combat cardiovascular diseases in this sector of community

Assessment of hypercoagulation state in patients with embolic cerebrovascular or transient ischemic attack and patent foramen ovale

Patent foramen ovale [PFO] causes a right-to-left shunt in about a quarter of normal population. Hypercoagulation may be a risk factor for embolic cerebrovascular accidents [CVA] in these patients by paradoxical emboli. In this study, we checked hypercoagulation states in the embolic CVA patients with PFO. In a cross- sectional study, 40 patients with CVA or transient ischemic attack [TIA] and PFO participated in the study. Serum level of Homocystein, lupus anticoagulant screening test, Factor V leiden, Anti Cardiolipin Antibody [ACLA] [IgG, IgM], Anti- thrombin III, protein C, protein S,Anti B2 glycoprotein1 and platelet count were checked in all patients. The data were analyzed using the statistical package for social science series [SPSS 15.0] and descriptive statistical method. The mean age was 42.4 +/- 12.1. Seventeen [42.5%] patients were females. Twenty- two [55%] cases were diagnosed as having CVA and the others as TIA. Three [7.5%] of the patients were diabetic and 8 [20%] had a history of different stages of hypertension. Hyperlipidemia was detected in 6 [15%] patients and according to the laboratory data none had any signs of hypercoagulation. According to the present study, hypercoagulation as a cofactor in CVA patients with PFO did not seem to be a direct risk factor for embolic CVA at least any higher than for normal population

Prevalence of coronary artery disease risk factors in teachers residing in Shiraz-Iran 2009

Coronary artery diseases [CAD] are the leading cause of mortality, morbidity and disability with high health care cost in any countries including Iran. The prevalence of all CAD risk factors including hypertension, diabetes, lipid profile abnormalities and obesity is rising in the population of Iran. Knowing the population at risk would lead to proper education to decrease these risk factors and ultimately would reduce CAD. This descriptive cross- sectional study was conducted in February to December 2009 and comprised a total of 3115 Shiraz educational staff, aged 21- 73 years. Questionnaires were applied to collect information including; demographic data, physical activity, history of CAD, hypertension, dyslipidemia, and smoking. In addition, waist circumference, height, weight, body mass index [BMI], and hip circumference [HC] were measured and serum biochemistry profiles were determined on venous blood samples. Such data helped identify the prevalence of diabetes, hypercholesterolemia, hypertriglyceridemia, hypertension, overweight and obesity, central obesity, and smoking. The mean age of 3115 participant was 42.7 and 41.5 years for men and women respectively. The prevalence of pre-diabetes, diabetes hypertension, hypercholesterolemia and hypertriglyceridemia were%10.2,%4,%18.2,%38.30 and%33.2 respectively. Diabetes, hypertension and dyslipidemia were more prevalent among males and older subjects. The prevalence of central obesity was%75.05 [IDF criteria] and%40.64 [ATP- III criteria]. The frequency of obesity, current smoking, ex-smoking and passive smoking were%12.1,%5.85,%1.52 ,%7.9 respectively which were below the reported prevalence in Iran in previous studies, but physical inactivity was%73.3 which is very high in this study group. Although CAD risk factors seem to be very common in the study population, clinical and paraclinical data indicated that teachers residing in Shiraz have a lower rate of CAD risk factors in comparison with previous studies done in general population of Iran. This may be related to high level of education, awareness and better lifestyle in the study group. But still further educating in regard to lifestyle modifications as well as dietary surveillance is needed in general population including those dealing with educating children and on a larger scale, the community as a whole

relationship between body mass index and pre-diabetes in teachers residing in Shiraz-Iran 2009

Diabetes and cardiovascular diseases often go hand in hand and conversely, many patients with established coronary heart disease suffer from diabetes or its pre-states. Thus, it is high time that diabetologists and cardiologists join their forces to improve the quality management in diagnosis and care for the millions of patients who have both cardiovascular and metabolic diseases in common. The cardio-diabetological approach not only is of utmost importance for the sake of those patients, but also instrumental for further progress in the fields of cardiology and diabetology and prevention. This descriptive cross- sectional study was conducted February to December 2009. A total of 3115 teachers residing in Shiraz aged 21- 73 years, were enrolled. Questionnaires were applied to collect information including demographic data, physical activity, history of CAD, hypertension, dyslipidemia,and smoking. In addition, waist circumference, height, weight, body mass index [BMI], and hip circumference [HC] were measured and serum biochemistry profiles were determined on venous blood samples. The prevalence of diabetes, hypercholesterolemia,hypertriglyceridemia, hypertension, overweight, obesity, central obesity, and smoking were identified based on the above mentioned data. Total prevalence of impaired fasting glucose and diabetes were 47.2% and 6.2% and the prevalence of impaired fasting glucose and diabetes were 44.3% and 5.3% among men and 49.2% and 6.6% among women respectively. Thus the association of sex with prevalent impaired fasting glucose and diabetes was signi?cant and greater among women. Diabetes and prediabetes are more prevalent in men and women who are considered as obese in regard to waist circumference and waist/hip ratio scales. This study showed a relationship between higher range of BMI and prevalence of diabetes and prediabetes. Obesity is a preventable risk factor for diabetes mellitus and preventive measures taken to control obesity are effective means of reducing the risk of diabetes mellitus and also cardiovascular disease

Effect of coronary artery bypass graft on qt interval dispersion: a measure of inhomogeneity in ventricular repolarization

The QT interval dispersion [QTd] has been described as the maximum minus minimum QT intervals in simultaneously 12-lead electrocardiographic recording which reflect inhomogeneity in myocardial repolarization. Increased QTd has been illustrated in patients with a variety of cardiac diseases such as myocardial infarction and left ventricular dysfunction and was suggested as a risk factor for development of ventricular arrhythmias and sudden death. QTd may also be a prognostic factor in patients undergoing Coronary Artery Bypass Grafting [CABG]. The purpose of this study was to evaluate the influence of CABG on QTd in patients with coronary artery disease. In this retrospective study we evaluated the effect of CABG on QTd in 79 consecutive patients with coronary artery disease. Measurement of QTd was performed on ECGs taken before and 24 hours after operation. There was no significant QTd changes in post CABG patients compared with baseline QTd [0.06 +/- 0.04 vs. 0.06 +/- 0.03, P=0.18]. In subgroups analysis, decrease in QTd was observed following CABG only in those with two-vessel coronary involvement compared with baseline [0.05 +/- 0.04 SD seconds versus 0.07 +/- 0.02SD seconds, P<0.05]. The present study showed that CABG does not affect QTd except in few patients with two-vessel coronary involvement

Prevention of deep vein thrombosis associated with temporary transvenous cardiac pacemakers by enoxaparin

The purpose of this prospective study is to quantify the risk of lower limb deep venous thrombosis [DVT] in patients requiring temporary transvenous femoral pacing and to evaluate the use of different enoxaparin dosages [Prophylactic or therapeutic] for thrombus prevention. Transvenous temporary cardiac pacemaker, with catheters frequently used along the femoral vein is useful to relieve difficult bradyarrythmias and some tachyarrythmias. Up to one-third of patients receiving transfemoral pacing develop asymptomatic DVT. At present, there are no recommendations for thrombus prophylaxis in these patients. Besides, the efficacy in this specific condition has not been studied. Sixty consecutive patients who underwent transvenous femoral pacing and had no contraindication to low molecular weight herparin [LMWH] therapy were divided into 3 groups each group consisted of 20 patietns. Group I received prophylactic enoxaparin [1mg/kg/day; subcutaneously], group II received therapeutic enoxaparin [1mg/kg/day every 12 hours; subcutaneously], and group III consisting of patients who were not treated with enoxaparin was considered as control groups. Patients were evaluated daily for clinical features of DVT. Color Doppler sonography imaging was performed on both lower limbs of all patients within 24 hours after removal of the temporary pacemakers. Of the sixty patients, two who belonged to group III, had definitive evidence of right lower limb DVT by color Doppler sonography. These two cases of DVT were asymptomatic and had thrombosis of femoral vein. No evidence of thrombus was detected in contra lateral lower limb. No DVT was detected among patients who received prophylactic or therapeutic doses of enoxaparin. No heparin related complications were detected in this study. There were no significant difference in the clinical characteristics among 2 groups [I,II] and control group. Correlations of age and gender with occurrence of DVT were not significant [P= 0.512, 0.737]. This study showed that DVT is a common complication of femoral pacing, and that its incidence can be reduced with the use of prophylaxis and therapeutic intravenous enoxaparin

Boxer thrombus: a large highly mobile thrombus in a normal functioning left ventricle

A 45-year-old woman with complaint of left side weakness admitted to neurology ward. Trans-esophageal echocardiography showed a large, highly mobile mass in left ventricle with its tip looking like a fist, punching the aortic valve cusps. Emergency operation was done and the mass was confirmed to be a large thrombus and was removed completely. During the follow up, patient was free of symptoms

Modulation of blood pressure in hypertensive patients by vitamin C

Essential hypertension is characterized by endothelial dysfunction, arterial stiffness, and increased oxidative stress. We evaluated the effect of short-term treatment with the antioxidant vitamin C on blood pressure in essential hypertensive patients. A total of 50 participants with essential hypertension were evaluated before and after the study. They received 250 mg vitamin C twice daily for one month. Blood pressure, weight and height were measured before and after intervention. Body mass index was calculated and dietary pattern was assessed by using food frequency questionnaire and 24 dietary recalls. We observed a significant decline in both systolic blood pressure [138.1 +/- 12.7 vs 134.2 +/- 11.5 mmHg, p<0.005] and diastolic blood pressure [87.2 +/- 10.1 vs 85 +/- 8.8 mmHg, p<0.005] of the participants after one month of vitamin C intake. These effects were independent of patient's BMI. Our results indicates that daily intake of 500 mg supplementary vitamin C [250mg twice daily] may have beneficial effects on blood pressure and thus reducing the risk of complications

C-reactive protein in angiographically documented stable coronary disease

The association between C-reactive proteins [CRP], a marker of inflammation, and major coronary risk factors has been highlighted in several investigations. CRP is associated with acute cardiac events and can predict their occurrence. The aim of this study was to evaluate the association between CRP serum level and coronary artery disease [CAD] along with it's major risk factors, in patients with stable angina pectoris. In a cross-sectional case control study, CRP and major coronary risk factors including cholesterol, diabetes mellitus [DM] smoking and hypertension were evaluated in 200 angiographically documented CAD [case group] and 120 subjects with normal coronary arteries[control group]. Of 320 subjects 50 in both case and control groups were presented with a CRP >/= 6 mg/dl, with 30 [60%] female and 20 [40%] male patients. There was a significant association between CRP >/= 6 mg/dl and those with age>60 years [P=0.002], hypertensive subjects [P<0.05], diabetic patients [P<0.05], hypercholesterolemic patients [P<0.05], Low HDL [P<0.05] and smokers [P<0.05] in both the case and control groups. Multivariate analysis showed a significant correlation with CRP and angiographically documented CAD independent of coronary risk factors. The present study showed a significant relationship between C-reactive protein levels and coronary risk factors and also demonstrated an independent relationship between angiographically documented CAD and elevated CRP serum levels in patients with chronic stable ischemic heart disease

Collateral circulation in normal coronary arteries

A 64-year-old woman referred with a 4-month history of intractable chest pain. Coronary angiography was performed and showed normal left coronary arteries. Posterior descending coronary artery was filled via distal left circumflex artery. The right coronary artery injection showed prompt filling of the distal circumflex through prominent collaterals. There was no evidence of proximal obstructive disease or spasm. We present a case in which a large collateral artery was seen in angiographically normal coronary arteries

[ impact of vitamin E on glycemic control and lipid profiles in type 2 diabetes patients]

Diabetic complications have been related to hyperlipidemia and hyperglycemia. Alpha -tochoferol has antioxidant effects and can improve lipid profiles. We evaluated the effect of vitamin E supplementation on glucose, insulin and lipid profiles in type 2 diabetic patients. In a randomized clinical trial, 31 patients included 14 men and 17 women [51.9 +/- 5.9 year] with type 2 diabetes were randomly divided into treatment with vitamin E [800 mg/day] and placebo groups for 2 months. Plasma glucose, Insulin and lipid profiles were measured at the beginning and at the end of 3 months supplementation. The paired and independent t-test was used for analyzing of data. Anthropometric indexes were stable throughout the study. Vitamin E administration lowered fasting plasma insulin concentrations [28.25 +/- 2.37 and 27.8 +/- 2.56, p<0.016] plasma triglyceride concentration [279.41 +/- 194.99 and 212.48 +/- 85.18 p <0.03]. The plasma glucose and the other lipid profiles did not change after vitamin E consumption for 2 months. We need more research to establish beneficial effect of vitamin E intake in type 2 diabetic patients

Safety of enoxaparin versus unfractioned heparin in patients undergoing percutaneous coronary intervention using drug eluting stents: a pilot study

Unfractioned heparin [UFH] is the standard antithrombotic agent in elective percutaneous coronary intervention [PCI], but has its own limitations. Several studies have suggested intravenous enoxaparin as a safe and effective alternative but most of them are uncontrolled. Our main goal was to evaluate the safety of enoxaparin over UFH in PCI patients undergoing coronary stenting by drug eluting stents [DES].We randomly assigned 195 patients undergoing PCI using DES to receive either 0.75 mg enoxaparin per kilogram of body weight or 10000 IU unfractioned heparin. The primary end point was the incidence of major or minor bleeding. The secondary end point was the incidence of acute coronary events [ST-elevation myocardial infarction, non ST-elevation myocardial infarction,and unstable angina] in the first 24 hours after PCI. The rate of major and minor bleedings was similar in the first 24 hours after procedure between enoxaparin group and UFH group [P value>0.05]. The incidence of acute coronary events and mortality was also similar between two arms.In DES based PCI, a single intravenous bolus of 0.75 mg of enoxaparin per kilogram is associated with similar rate of bleeding as compaired with UFH. Also the rates of ischemic events are not different for enoxaparin and UFH however larger trials are needed for definit conclusion