Presentation, Management and Early Mortality of Patients with Acute Coronary Syndrome in a Large Sample Study of a Middle East Country.

Background: Due to lack of contemporary data on the presentation, management, and mortality of acute coronary syndrome (ACS) admissions in Iran, in this prospective registry study, we aimed to evaluate the presentation, management, and mortality as the outcome of patients with ACS in Isfahan, Iran, 2001-2016 to address treatment and healthcare depletions. Methods: Data of 62,276 patients admitted with the diagnosis of ACS from 2001 to 2016 prospectively were obtained by Surveillance Unit of Isfahan Cardiovascular Research Center, Isfahan, Iran, in 13 hospitals of Isfahan province. We evaluated data on presentation, management, and in-hospital and 28-day mortality. Results: Nearly half of the patients ranged in age from 51 to 70 years (32050, 51.5%), which did not differ among ACS types (ST-segment myocardial infarction (STEMI): 53.9%; non-STEMI: 53.4%; unstable angina: 51.9%). In-hospital, anti-platelets use was high (84.9%). Thrombolytic were used in 48.1% of STEMI, 3.8% of non-STEMI, and 1.1% of unstable angina. Discharge medication rates were suboptimal. In-hospital and 28-day mortality were highest for STEMI (6.5 and 12.6%, respectively). Conclusions: These data represent the large ACS registry in Iran. Data revealed the various presentations of ACS and demonstrated opportunities for improving ACS management by focusing on increasing use of recommended drugs especially after discharge due to suboptimal medical treatment in these patients. The high mortality rate needs to be taken into consideration in ACS patients.

Thrombotic Events and Anticoagulants in Beta-thalassemia Patients with Focus on Anticoagulants for Atrial Fibrillation: A Brief Review.

Despite many advances in the diagnosis and treatment of beta-thalassemia patients in recent years and their longevity and quality of life which has been greatly increased, many of these patients have other life-threatening risks. The prevalence of atrial fibrillation in beta-thalassemia patients and its related thromboembolism, stroke, and mortality have been increased in the last few years. Appropriate anticoagulant therapy may help to prevent the incidence or recurrence of thromboembolism. So far warfarin is the most widely used drug. Aspirin should use with caution in these patients because of its resistance to aspirin over time, which can increase the risk of thromboembolism. Direct oral anticoagulants (DOACs) are widely used to prevent embolism in coronary artery disease and venous thromboembolism, but their use in thalassemia patients is still very limited. More high-quality researches and clinical trials are needed to prove their effectiveness and safety for atrial fibrillation in beta-thalassemia patients.

The Association between Occupational Categories and Incidence of Cardiovascular Events: A Cohort Study in Iranian Male Population.

BACKGROUND: Besides the traditional cardiovascular risk factor, some novel risk factors like occupation and career can play an important role in cardiovascular disease (CVDs) incidence. OBJECTIVE: To assess the association between occupational categories and their positions with cardiovascular events (CVEs) in an Iranian male population. METHODS: We followed 2134 men aged 35-65 years for 14 years during the Isfahan Cohort Study (2001-2015) for CVEs including ischemic heart disease and stroke. Firstly, Occupations were classified into 10 categories of International Standard Classification of Occupation (ISCO). Each category was then classified into one of the 4 pre-specified categories, namely high/low skilled white collars and high/low skilled blue collars. White-collar workers referred to managerial and professional workers in contrast with blue collar workers, whose job requires manual labor. RESULTS: The mean age of studied participants was 46.9 (SD 8.3) years. 286 CVE incidents were recorded; unstable angina had the highest rate (46%); fatal stroke, the lowest (3%). There were no significant difference was observed between white and blue collars in terms of CVE incidence, as well as their high and low skilled subgroups. Hazard ratio analysis indicated a significantly higher risk of CVEs only for low-skilled white-collar workers (crude HR 1.47, 95% CI 1.01 to 2.13); this was not significant after adjustment for confounding variables. CONCLUSION: There is no association between occupational categories and incidence of cardiovascular events among Iranian male population.

Evaluation the effect of testosterone on the number of endothelial progenitor cells and amount of SDF-1α, PDGF, bFGF, and NO.

BACKGROUND: Recent therapeutic advances in cardiovascular disease, thanks to the discovery of endothelial progenitor cells (EPCs). Stromal cell-derived factor-1α (SDF-1α), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF), and nitric oxide (NO) play a role in migration, homing, and differentiation of EPCs into mature endothelial cells. The incidence of cardiovascular disease is higher in men than in women. This fact suggests the influence of sex hormones on incidence of cardiovascular disease. METHODS: Twenty-four female wistar rats weighing 160-180 g were randomly divided into four groups (N = 6): 1. sham-treated by sesame oil, 2. ovariectomized (OVX)-treated by sesame oil, 3. OVX-treated by 10 µg/kg/day testosterone, and 4. OVX-treated by 100 µg/kg/day testosterone. After 21 days, the animals were euthanized and blood samples were saved for determination of EPC count and serum levels of SDF-1α, PDGF, bFGF, and NO production. RESULTS: High-dose testosterone induced significant increase in EPC count in OVX rats (P < 0.05). Also 100 µg/kg/day testosterone increased serum level of SDF-1α more than OVX-treated by 10 µg/kg/day testosterone (P < 0.05). But 10 µg/kg/day testosterone increased significantly the serum level of PDGF >100 µg/kg/day testosterone-treated group (P < 0.05). The serum level of bFGF in sham-treated by sesame oil was equal with its concentration in OVX-treated by 100 µg/kg/day testosterone. And the serum concentration of NO production in testosterone-treated groups were significantly less than other groups (P < 0.05). CONCLUSIONS: This study suggests that testosterone might be effective on cardiovascular disease in females by increasing EPC count through SDF-1α and PDGF mechanisms which are some of the vascular healing factors.

Evaluation the effect of low-dose aspirin on endothelial dysfunction in preeclamptic patients.

BACKGROUND: Preeclampsia complicates up to 3% of pregnancies in developing countries. Endothelial dysfunction plays an important role in pathogenesis of preeclampsia. In this study, we aim to evaluate the effect of low-dose aspirin on endothelial dysfunction in preeclamptic patients. MATERIALS AND METHODS: in this triple-blind randomized clinical trial, enrolled patients were divided randomly into two groups. Acetylsalicylic acid (ASA) 80 mg or placebo will be taken daily by oral administration from the initiation of diagnosis until 2 months after delivery. Every patient's flow-mediated dilation (FMD) were evaluated at the beginning of study and 2 months after delivery with the same experienced operator at a same period of the time (3-5 pm) by high-resolution B-mode ultrasonographic. T-test or Mann-Whitney test was used in the comparison of means between the intervention and placebo groups. To compare FMD in each group, before and after the intervention, paired t-test was used. RESULTS: Mean value of FMD in intervention (9.61 ± 5.58) and control group (9.40 ± 4.33) have no significant differences before drug consumption (P = 0.089). FMD in intervention group significantly increased after ASA consumption ([9.61 ± 5.58 vs. 13.65 ± 7.91] [P = 0.044]). CONCLUSION: Increase mean of FMD in intervention group shows that this supplement can improve endothelial function.