Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: a cross-sectional study in Iran / 한국역학회지

OBJECTIVES: Hypertension (HTN) is an important risk factor for cardiovascular disease. Considering the importance of this disease for public health, this study was designed in order to determine the prevalence, awareness, treatment, control, and risk factors of HTN in the Iranian adult population. METHODS: This cross-sectional study was conducted among 2,107 residents of Isfahan, Iran. Samples were selected through multi-stage random cluster sampling in 2015-2016. The outcome variable was HTN, determined by measuring blood pressure in the right arm via a digital arm blood pressure monitor. Awareness, treatment, and control of HTN were assessed by a validated and reliable researcher-developed questionnaire. Other demographic and clinical variables were assessed via a demographic questionnaire. RESULTS: The overall prevalence of HTN was 17.3% (18.9 and 15.5% in men and women, respectively). The prevalence of HTN increased in both genders with age. The prevalence of awareness of HTN among people with HTN was 69.2%, of whom 92.4 and 59.9% were taking medication for HTN and had controlled HTN, respectively. Logistic regression identified age, body mass index, having diabetes and hyperlipidemia, and a positive family history of HTN as determinants of awareness of HTN. CONCLUSIONS: The results showed that HTN was highly prevalent in the community, especially in men and in middle-aged and older adults. Approximately 30.8% of patients were unaware of their disease, and there was less awareness among younger adults. Despite the high frequency of taking medication to treat HTN, it was uncontrolled in more than 40.1% of patients. Health policy-makers should therefore consider appropriate preventive and therapeutic strategies for these high-risk groups.

Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: a cross-sectional study in Iran / 한국역학회지

OBJECTIVES@#Hypertension (HTN) is an important risk factor for cardiovascular disease. Considering the importance of this disease for public health, this study was designed in order to determine the prevalence, awareness, treatment, control, and risk factors of HTN in the Iranian adult population.@*METHODS@#This cross-sectional study was conducted among 2,107 residents of Isfahan, Iran. Samples were selected through multi-stage random cluster sampling in 2015-2016. The outcome variable was HTN, determined by measuring blood pressure in the right arm via a digital arm blood pressure monitor. Awareness, treatment, and control of HTN were assessed by a validated and reliable researcher-developed questionnaire. Other demographic and clinical variables were assessed via a demographic questionnaire.@*RESULTS@#The overall prevalence of HTN was 17.3% (18.9 and 15.5% in men and women, respectively). The prevalence of HTN increased in both genders with age. The prevalence of awareness of HTN among people with HTN was 69.2%, of whom 92.4 and 59.9% were taking medication for HTN and had controlled HTN, respectively. Logistic regression identified age, body mass index, having diabetes and hyperlipidemia, and a positive family history of HTN as determinants of awareness of HTN.@*CONCLUSIONS@#The results showed that HTN was highly prevalent in the community, especially in men and in middle-aged and older adults. Approximately 30.8% of patients were unaware of their disease, and there was less awareness among younger adults. Despite the high frequency of taking medication to treat HTN, it was uncontrolled in more than 40.1% of patients. Health policy-makers should therefore consider appropriate preventive and therapeutic strategies for these high-risk groups.

Prevalence, awareness, treatment, control, and risk factors of hypertension among adults: a cross-sectional study in Iran / 한국역학회지

OBJECTIVES: Hypertension (HTN) is an important risk factor for cardiovascular disease. Considering the importance of this disease for public health, this study was designed in order to determine the prevalence, awareness, treatment, control, and risk factors of HTN in the Iranian adult population.METHODS: This cross-sectional study was conducted among 2,107 residents of Isfahan, Iran. Samples were selected through multi-stage random cluster sampling in 2015-2016. The outcome variable was HTN, determined by measuring blood pressure in the right arm via a digital arm blood pressure monitor. Awareness, treatment, and control of HTN were assessed by a validated and reliable researcher-developed questionnaire. Other demographic and clinical variables were assessed via a demographic questionnaire.RESULTS: The overall prevalence of HTN was 17.3% (18.9 and 15.5% in men and women, respectively). The prevalence of HTN increased in both genders with age. The prevalence of awareness of HTN among people with HTN was 69.2%, of whom 92.4 and 59.9% were taking medication for HTN and had controlled HTN, respectively. Logistic regression identified age, body mass index, having diabetes and hyperlipidemia, and a positive family history of HTN as determinants of awareness of HTN.CONCLUSIONS: The results showed that HTN was highly prevalent in the community, especially in men and in middle-aged and older adults. Approximately 30.8% of patients were unaware of their disease, and there was less awareness among younger adults. Despite the high frequency of taking medication to treat HTN, it was uncontrolled in more than 40.1% of patients. Health policy-makers should therefore consider appropriate preventive and therapeutic strategies for these high-risk groups.

Smoking motivators are different among cigarette and waterpipe smokers: the results of ITUPP

The present study explores different drivers of cigarette and water pipe smoking among middle and high school students in Isfahan province. A questionnaire-based cross-sectional study was conducted. Trained staff collected questionnaires and saliva samples for response accuracy evaluation. Prevalence by demographic, parental and educational factors was calculated. Logistic regression was applied to compare behavior drivers of those who purely smoked cigarettes or a waterpipe. Waterpipe smokers were considered as the reference category. This study reported ORs along 95% confidence intervals; 5408 questionnaires were returned. The sample age was 15.37 +/- 01.70 on average. The self-reported prevalence of cigarette and waterpipe experimentation was 11.60% [n = 624] and 20.70% [n = 1,109], respectively; and 5.08% [n = 311], 11.06% [n = 619] for smokers, and 13.30% [n = 711] for the whole sample. Psychological factors were the most important driver for cigarette smoking; bad event happening with odds of 2.38 [95% CI: 1.29-4.39]; angriness 2.58 times [95% CI: 1.51-4.43]; and distress by 2.49 times [95% CI: 1.42-4.40]. Habitual situations were strong predictors of cigarette smoking, but not a predictor of waterpipe smoking, such as smoking after a meal [OR = 3.11, 95% CI: 1.67-5.77]; and smoking after waking up [OR = 2.56, 95% CI: 1.42-4.40]. Comprehensive and multifaceted preventive programs must tailor identified factors and increase family's awareness

Indicators developed to evaluate the international framework convention on tobacco control in Iran; a grounded theory study

This study aimed to develop indicators for evaluating the implementation of The Framework Convention on Tobacco Control [FCTC] in Iran. We used the "grounded theory" framework. Totally, 265 policy-makers, stakeholders, and community members were recruited by purposeful sampling in 2008. After analyzing the gathered data, 251 indicators, including 82 indicators as "applied indicators", were derived from second-level codes for three groups. A suitable evaluation questionnaire can be designed based on the extracted indicators for policy makers, stakeholders, and the community to follow the implementation of the FCTC in Iran

Cheese consumption in relation to cardiovascular risk factors among Iranian adults- IHHP Study

BACKGROUND/OBJECTIVE: It is expected that dairy products such as cheeses, which are the main source of cholesterol and saturated fat, may lead to the development or increase the risk of cardiovascular and metabolic diseases; however, the results of different studies are inconsistent. This study was conducted to assess the association between cheese consumption and cardiovascular risk factors in an Iranian adult population. SUBJECTS/METHODS: Information from the Isfahan Healthy Heart Program (IHHP) was used for this cross-sectional study with a total of 1,752 participants (782 men and 970 women). Weight, height, waist and hip circumference measurement, as well as fasting blood samples were gathered and biochemical assessments were done. To evaluate the dietary intakes of participants a validated food frequency questionnaire, consists of 49 items, was completed by expert technicians. Consumption of cheese was classified as less than 7 times per week and 7-14 times per week. RESULTS: Higher consumption of cheese was associated with higher C-Reactive Protein (CRP), apolipoprotein A and high density lipoprotein cholesterol (HDL-C) level but not with fasting blood sugar (FBS), total cholesterol, low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and apolipoprotein B. Higher consumption of cheese was positively associated with consumption of liquid and solid oil, grain, pulses, fruit, vegetable, meat and dairy, and negatively associated with Global Dietary Index. After control for other potential confounders the association between cheese intake and metabolic syndrome (OR: 0.81; 96%CI: 0.71-0.94), low HDL-C level (OR: 0.87; 96%CI: 0.79-0.96) and dyslipidemia (OR: 0.88; 96%CI: 0.79-0.98) became negatively significant. CONCLUSION: This study found an inverse association between the frequency of cheese intake and cardiovascular risk factors; however, further prospective studies are required to confirm the present results and to illustrate its mechanisms.

Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan healthy heart program

This study evaluated the outcome of a comprehensive, community-based healthy lifestyle program on cardiometabolic risk factors. The Isfahan Healthy Heart Program [IHHP] was a comprehensive action-oriented, multi-component intervention with a quasi-experimental design and reference area. IHHP targeted the population-at-large [n = 2,180,000] in three districts in central Iran. Data from independent sample surveys before [2000 - 2001] and after [2007] this program were used to compare differences in the intervention area and reference area over time after controlling for age, education level and income. The samples in 2000 - 2001 and 2007 included 6175 and 4719 participants in intervention area, and 6339 and 4853 in reference area, respectively. Multiple interventional activities were performed based on the four main strategies of healthy nutrition, increased physical activity, tobacco control and coping with stress. The prevalence of abdominal obesity, hypertension, hypercholesterolemia, hypertriglyceridemia and high LDL-C decreased significantly in the intervention area versus the reference area in both sexes. However the reduction in overweight and obesity was significant only in females [P < 0.05 for all]. There were no significant changes in the prevalence of diabetes mellitus. In the intervention area, the prevalence of hypercholesterolemia decreased from 23.5% to 12.5% among females without any changes in females in the reference area [p < 0.0001]. In males, hypercholesterolemia decreased significantly in both intervention area [18.5% to 9.6%] and reference area [14.4% to 9.8%; p = 0.005]. Mean triglyceride levels had a significant decrease in the intervention area and a non-significant decrease in the reference area [p < 0.0001]. A comprehensive healthy lifestyle program comprising preventive and promotional activities that considers both population and high risk approaches can be effective in controlling cardiometabolic risk factors in a middle-income country

Incidence of cardiovascular diseases in an Iranian population: the isfahan cohort study

Introduction: accurate estimates of the incidence of cardiovascular diseases [CVD] comprising of acute myocardial infarction [AMI], unstable angina pectoris [UAP], sudden cardiac death [SCD], and stroke are very important for public health. However, such information is scarce, especially for middle- and low-income countries

Methods: the Isfahan Cohort Study [ICS] prospectively followed up 6504 individuals, 51.8% women, aged 35 years and over, 6323 initially free of CVD, from urban and rural areas in three districts in central Iran including Isfahan, Najafabad, and Arak. A panel of specialists in cardiology and neurology decided on the diagnosis of the occurred events based on patients’ hospital records, verbal autopsy, and death certificates

Results: after 32893 person-years of follow-up, 427 new cases of CVD events [229 in men] were registered. Confirmed cases of AMI, stroke, UAP, and SCD were 57, 43, 93, and 36 in men and 32, 48, 100, and 18 in women, respectively. The corresponding crude incidence rates were 352, 265, 352, and 220 per 100000 person-years in men and 186, 279, 584, and 104 in women, respectively. No significant differences were found in age at the time of events occurrence between men and women and between different event types except for SCD and stroke in women that in average the former occurred nine years later. CVD mortality rate was 331 per 100000 person-years in men and 203 in women

Conclusion: we found substantially high incidence rates for almost all CVDs and mortality. These findings need urgent consideration by health policy makers specifically for women

association between stress levels and food consumption among Iranian population

Background: stress has been considered as a highly common disorder that has a complicated relation with dietary intake and has been linked with both increased and decreased dietary intake

Objective: this study was conducted to assess the association between food consumption and stress levels in an Iranian adult population

Methods: in this cross-sectional study, data from the third phase of Isfahan Healthy Heart Program [IHHP] that was conducted for cardiovascular diseases prevention and health promotion were used. Nine thousand five hundred forty-nine adults aged = 18 years participated in the study. Dietary habits were assessed by a 49- item Food Frequency Questionnaire [FFQ]. Stress levels were assessed by General Health Questionnaire-12 [GHQ-12]. The participants were separated on the basis of their stress levels into two groups as the low- and high- stress groups

Results: individuals in the low- stress group were significantly younger and tended to have higher physical activity and education level, lower LDL cholesterol, and were less likely to be current smokers. Dietary intake of unsaturated oils, grains, fruits, vegetables, meat, and dairy products was significantly higher in the low- stress group whereas dietary intake of saturated oils was significantly lower; moreover, Global Dietary Index [GDI] was lower in the low- stress group. We found a significant positive association between stress level, GDI [OR: 1.24; 95% CI: 1.14 – 1.35], and saturated oils [OR: 1.17; 95% CI: 1.08 – 1.28] and inverse association between stress level and intake of unsaturated oils [OR: 0.84 ; 95% CI: 0.77 – 0.91], fruits and vegetables [OR: 0.83; 95% CI: 0.76 – 0.90], meat [OR:0.88; 95% CI:0.82 – 0.97],and dairy products [OR: 0.88 ; 95% CI: 0.81 – 0.96] after adjustments based on sex, age, smoking, and physical activity

Conclusion: our results showed a significant positive association between dietary intake and stress. We must have a special attention to dietary intake in stress management program of high- stress individuals, and in dietary recommendations, psychologic aspects should be considered. However, prospective longitudinal studies are needed to assess the causal relationship between stress and dietary factors

Abdominal fat distribution and serum lipids in patients with and without coronary heart disease

Objective: to investigate the association between obesity indices, abdominal fat distribution, and lipid profile in patients with stable angina [SA]

Methods: body weight, height, waist circumference [WC], body mass index [BMI], and waist /height ratio [WHtR] of 123 patients with SA who underwent coronary angiography were measured. Fasting blood samples were taken to measure the levels of fasting blood sugar [FBS], total cholesterol [TC], low- and high-density lipoprotein cholesterol [LDL-C, HDL-C], apolipoproteins A and B [apo A and apo B], and triglycerides [TG]. According to angiography reports, the participants were divided into patients with or without coronary heart disease [CHD]. All patients underwent an abdominal computerized tomography [CT] scan to measure the visceral, superficial, and deep subcutaneous fat

Results: the mean ages of the patients with CHD [n = 73] and without CHD [n = 50] were 50.5 +/- 7.6 and 53.7 +/- 7.6 years, respectively [P = 0.03]. The patients with CHD had significantly higher levels of TC, TG, and superficial subcutaneous fat, while the patients without CHD had higher levels of apo A [P = 0.05]. Multivariate analyses showed a significant association of visceral fat with TC, LDL-C, TG, and apo B, in the patients without CHD, while significant inverse associations were found between WC and HDL-C, WHtR, and apo A as well as visceral fat and LDL-C in the patients with CHD

Conclusions: among anthropometrics and imaging indices of obesity, WC and WHtR have shown better association between central obesity with dyslipidemia in the patients with CHD, while CT-measured visceral adipose tissue area was the best correlate of dyslipidemia in the patients without CHD

Opium decreases the age at myocardial infarction and sudden cardiac death: a long-and short-term outcome evaluation

Background: opium dependence is a recognized individual and public health threat, but little is known about its association with acute myocardial infarction [AMI] or sudden cardiac death [SCD]

Methods: in a cross-sectional study followed by a one-year matched longitudinal cohort, all 569 men hospitalized with AMI in all Cardiac Care Units [CCU] of Isfahan, Iran, were recruited in a six-month period. In addition, 123 out-of-hospital deaths were included that were diagnosed as SCD at the same duration. Among those discharged alive, 126 opium dependents were matched with 126 nondependents [mostly nonusers] according to age and smoking status, and were followed for one year. Opium dependence was measured using the ICD10 criteria and Severity of Dependence Scale [SDS] questionnaire. The method was validated by morphine blood levels. Biochemical measurements, blood pressure, blood cell counts, anthropometrics, and ejection fraction were measured at baseline and repeated at the end of follow-up

Results: there were 118 [17.1%] patients with an average of 17.4 +/- 10.4 years of abuse who met the criteria for opium dependency. Opium dependence decreased the age at event by 3.6 [95% CI: 1.2 – 6.0] years and was independent of smoking [P = 0.003]. In terms of cardiovascular risk factors such as ejection fraction, in addition to post-AMI mortality and morbidity, no significant associations were noted at baseline or after one year of follow-up. The odds ratio of sustained smoking after AMI was 1.92 [95% CI: 1.04 – 3.52] in opium dependents [P = 0.033]

Conclusion: despite public opinion, opium did not improve cardiovascular risk factors, or post-AMI mortality and morbidity. Conversely, there were irrefutable findings regarding the detrimental effects of opium dependence

association between hypertriglyceridemic waist phenotype, menopause, and cardiovascular risk factors

Background: the incidence of cardiovascular disease [CVD] and its risk factors increase after menopause, thus realizing that the effect of menopause on women’s health is becoming ever more vital

Objective: the aim of this study was to investigate the menopausal effect on cardiovascular risk factors in elevated triglycerides [TG] and waist circumference [WC] phenotype, and to compare this phenotype among pre- and postmenopausal women

Method: a total of 4146 women were randomly selected for this study from three districts of Isfahan, Arak, and Najafabad in Isfahan Healthy Heart Program [IHHP]. Anthropometric, physical, and biochemical factors were assessed using standard methods. All variables were studied based on the menopause status and the levels of TG and WC

Results: twenty-five point three percent of the postmenopausal women and 9.5% of the pre-menopausal women were hyper-TG/WC phenotype; however, the highest percent [77.1%] belonged to high-WC women in the postmenopausal group. In comparison with the postmenopausal women, the premenopausal women were more physically active, with higher education level, but lower BMI, WC, waist to hip ratio, and less likely to be smoker. In postmenopausal women, biochemical factors including fasting blood sugar and lipid profiles were significantly higher than the premenopausal women. There was no significant difference for multivariate-adjusted means of cardiovascular risk factors for menopause in different phenotypes of the WC and TG groups after adjustment for age and BMI

Conclusion: hyper- TG/WC phenotype was more prevalent in postmenopausal women and menopause is not independently associated with CVD risk factors

Is the association between salt intake and blood pressure mediated by body mass index and central adiposity?

Objective: to assess the amount of salt intake among normotensive [NT] and prehypertensive [PHT] subjects and to determine whether the association between salt intake and blood pressure is correlated with body weight and waist circumference [WC] or is independent

Methods: a total of 806 NT and PHT subjects from Isfahan Healthy Heart Program [IHHP] were enrolled in the study. A standard questionnaire was used to assess sociodemographic characteristics. The amount of salt intake was measured by the 24-hour urine collection method. Blood pressure, height, weight, and WC were measured based on standard protocols

Results: the mean ages [+/- SD] of NT and PHT subjects were 35.9 [+/- 11.9] and 44.7 [+/- 12.5] years, respectively [P < 0.001]. The mean values of body mass index [BMI] and WC were greater among PHT than NT subjects [BMI: 27.9 +/- 3.8 vs. 25.1 +/- 4.3 kg/m2; P < 0.001 and WC: 90.2 +/- 8.6 vs. 81.2 +/- 11.2 cm; P < 0.001, respectively]. PHT subjects had higher amount of salt intake than NT ones [10.3 +/- 6.2 vs. 12.7 +/- 7.1 g/d, respectively; P = 0.003]. Odds ratio [OR] for being PHT increased significantly across the tertils of salt intake in crude model and sociodemographic- adjusted model. Further adjustment for BMI and WC values weakened the OR for being PHT and showed nonsignificant trend [OR [and 95% CI] for BMI across tertiles of salt intake: 1, 1.26 [0.59 – 2.69], 1.89 [0.93 – 3.81]; P = 0.063 and OR [and 95% CI] for WC across tertiles of salt intake: 1, 1.22 [0.58 – 2.57], 1.79[0.89 – 3.56]; P = 0.082]

Conclusion: the findings of this study suggest that the association between salt intake and blood pressure is related to body weight and WC

influence of gender and place of residence on cardiovascular diseases and their risk factors the Isfahan cohort study

To determine the impact of gender and place of residence on cardiovascular disease [CVD] events and related risk factors. In a prospective cohort study, 6323 participants free of CVD [3255 women], with age of more than 35 years from 3 cities [Isfahan, Najafabad, and Arak] and their rural districts in central Iran were followed-up from 2001 to 2007. This study was carried out at the Cardiovascular Research Institute of Isfahan University of Medical Sciences, Isfahan, Iran. Endpoints were defined as fatal- and nonfatal myocardial infarction, sudden cardiac death, unstable angina and stroke that constituted CVD events. Subjects in the rural area had significantly better risk factor profile in terms of most CVD risk factors in both genders, but it was reverse for low density lipoprotein [LDL]-cholesterol in both genders, and smoking in men. Except for smoking, men had an overall better risk factor profile compared to women. The age and risk factors adjusted hazard ratio of living in rural area was 0.71 [95% confidence interval [CI]: 0.51-0.99] for men, and 0.63 [95% CI: 0.44-0.91] for women. The age of CVD occurrence was similar in men and women, and in rural and urban areas. Hypertension was the strongest predictor of these events except for rural men showing that high LDL-cholesterol was the strongest risk factor. The findings in this study documented differences in CVD risk factors affecting the occurrence of CVD events according to gender and place of residence. Such differences should be taken into account in future preventive public health strategies for CVD prevention.

Barriers and facilitators of weight management in overweight and obese people: qualitative findings of tabassom project

Since weight management is affected by various factors, including social and behavioral ones, this study aimed to explore the peoples' experience of barriers and facilitators of weight management. This qualitative content analysis was conducted as the initial step of TABASSOM Study. Participants, who tried to reduce their weight at least once, were selected by purposeful sampling method from aerobic fitness clubs, parks, and public offices in Isfahan in 2010. Data saturation was reached after indepth unstructured interviews with 11 participants. Data analysis was done by conventional content analysis method. The participants have intermittently followed weight loss program. Barriers such as physical problems, lack of motivation, lack of work and family support and lack of time have resulted in their failures and outages. The main facilitator to start or restart after stopping such programs for a while was positive psychologic effect. Findings showed that many problems could prevent weight loss. It is important to identify obstacles that hinder weight management and regimen programs and to discuss them with people before planning for their weight management.

comprehensive model to evaluate implementation of the world health organization framework convention of tobacco control

Iran is one of the countries that has ratified the World Health Organization Framework Convention of Tobacco Control [WHO-FCTC], and has implemented a series of tobacco control interventions including the Comprehensive Tobacco Control Law. Enforcement of this legislation and assessment of its outcome requires a dedicated evaluation system. This study aimed to develop a generic model to evaluate the implementation of the Comprehensive Tobacco Control Law in Iran that was provided based on WHO-FCTC articles. Using a grounded theory approach, qualitative data were collected from 265 subjects in individual interviews and focus group discussions with policymakers who designed the legislation, key stakeholders, and members of the target community. In addition, field observations data in supermarkets/shops, restaurants, teahouses and coffee shops were collected. Data were analyzed in two stages through conceptual theoretical coding. Overall, 617 open codes were extracted from the data into tables; 72 level-3 codes were retained from the level-2 code series. Using a Model Met paradigm, the relationships between the components of each paradigm were depicted graphically. The evaluation model entailed three levels, namely: short-term results, process evaluation and long-term results. Central concept of the process of evaluation is that enforcing the law influences a variety of internal and environmental factors including legislative changes. These factors will be examined during the process evaluation and context evaluation. The current model can be applicable for providing FCTC evaluation tools across other jurisdictions.

Gender differences in risk factors of obese patients after cardiac rehabilitation program

Obesity is common in patients with cardiovascular disease [CVD] and the vast majority of patients entering into cardiac rehabilitation program [CRP] are obese. Regarding the gender differences, the risk of developing coronary heart disease [CHD] is recognized to be different between obese men and women. So, the purpose of this study was to explore the effect of CRP in functional capacity [FC] and risk factors, such as obesity indexes, lipid profiles, and fasting blood sugar [FBS] in obese men and women with CHD. In an observational study between 2000 and 2011, we evaluated a total of 156 obese men and women patients with CHD who were referred to cardiac rehabilitation of Isfahan Cardiovascular Research Institute. Before and after CRP, FC and risk factors were assessed and all the participants completed this period. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes, independent t tests and paired sample t tests were used. Data revealed, after CRP, obese women had significant improvement in most evaluated risk factors except total cholesterol [P = 0.05] and FBS [P = 0.09]; and obese men had favorable changes in weight [P = 0.00] and body mass index [P = 0.00], FC [P = 0.00] and total cholesterol [P = 0.02]; in spite of no significant differences in other lipid profiles. Comparing the 2 groups did not show any significant differences unless high-density lipoprotein cholesterol [P = 0.01] and low-density lipoprotein cholesterol/ high-density lipoprotein cholesterol ratio [P = 0.02] had greater improvement in obese women. We concluded that CRP is an important step initiating the process of risk reduction and restoration of FC in obese men and obese women with CHD under attendance and supervision of physician, nurse, and exercise physiologist.

woman with typical chest pain and broken heart

Stress-induced cardiomyopathy is an increasingly recognized syndrome characterized by transient apical or midventricular dysfunction that mimics myocardial infarction in the absence of significant coronary artery disease [CAD], but with essential difference in their management; thus our report present one of these cases