Atherogenic index of plasma as a predictor of coronary artery disease: a cohort study in south of Iran.

BACKGROUND: Coronary artery disease (CAD) is an atherosclerotic disease of an inflammatory nature. Previous studies examining the relationship between triglycerides and high-density lipoprotein cholesterol have highlighted the importance of plasma atherogenic index (AIP) as an important predictor of coronary heart disease. However, due to the lack of adequate information on this topic, this study aimed to investigate the relationship between AIP and coronary heart disease risk. RESULTS: This study included 2,226 women and 1,690 men aged 35-70 years who participated in the Bandar Kong Cohort study and met the eligibility criteria. The data was collected using a checklist and questionnaires, which were designed by experienced individuals. After participants completed a registration form and gave informed consent, face-to-face interviews were conducted by trained experts. The validity and reliability of the questionnaire had been verified by the national cohort team prior to its use. The Ethics Committee of Hormozgan University of Medical Sciences (IR.HUMS.REC.1400.171) approved the study. Data from the initial cohort survey using SPSS software version 25, were analyzed to include several factors, including age, sex, smoking status, body mass index (BMI), physical activity level, socioeconomic status, AIP, systolic blood pressure, and diastolic blood pressure. The prevalence of coronary heart disease was found to be 7.5% higher in people with a BMI of 25 or higher. Also, Individuals with low physical activity had a higher prevalence. Individuals with CAD had significantly higher mean values for the AIP, age, systolic blood pressure, and diastolic blood pressure (0.46, 57.50, 128.43, and 81.10, respectively) compared to those without CAD. Furthermore, patients with CAD had lower years of education (2649.45 and 3.59) than individuals without CAD (P < 0.05). Importantly, our findings showed that AIP increased the odds ratio of coronary heart disease by 1.86 as an independent risk factor. CONCLUSIONS: Based on our investigation, the AIP is a valuable and independent predictive risk factor for coronary artery disease. This index can be utilized effectively due to its accessibility and affordability, making it a promising tool for risk assessment in clinical settings.

Explaining the personal cognitive factors affecting physical activity and nutritional behaviors in the middle-aged at risk of coronary artery disease: A directed qualitative content analysis.

Background and Aims: Coronary artery disease (CAD) is the most common cardiovascular disease worldwide. Nutrition and physical activity are recognized as the major lifestyle-related behaviors to reduce the risk of noncommunicable diseases. It is essential to explain personal cognitive factors to identify potential ways to increase physical activity and improve nutritional behavior. Therefore, the present study aimed to explain the personal cognitive factors affecting physical activity and nutritional behavior in the middle-aged population at risk of a CAD. Methods: The present qualitative study was conducted with a directed content analysis approach. A purposive sampling was used with maximum variety of sex, age, education, marital status, job, and risk factors of CAD. The data were collected through semistructured interviews with 20 middle-aged participants at the risk of CAD visiting comprehensive health centers in Bandar Abbas city. The interviews continued until data saturation. Results: The present findings led to the identification of 4 main categories (i.e., self-efficacy, collective efficacy, outcome expectations, knowledge) and 10 subcategories. Conclusion: It seems that to increase the self-efficacy, attention should be paid to individuals' past experiences, self-efficacy of action and maintenance and successful middle-aged peers. Measures should be taken to improve and strengthen it. Peer support, networking, forming online groups (in social networks), and a comprehensive use of social media can help increase collective efficacy. Expectations of positive and negative outcomes and the public knowledge can also be modified through accurate and appropriate information provided in different campaigns for awareness-raising.

Impact of vitamin D receptor gene polymorphisms (TaqI and BsmI) on the incidence and severity of coronary artery disease: a report from southern Iran.

BACKGROUND: The association of vitamin D level and vitamin D receptor (VDR) gene polymorphisms with the prevalence of coronary artery disease (CAD) has been evaluated in various studies; however, the reported results were inconsistent. Hence, we aimed to investigate the impact of two VDR gene polymorphisms, TaqI (rs731236) and BsmI (rs1544410), on the incidence and severity of CAD in Iranian population. METHODS: Blood samples were collected from 118 CAD patients underwent elective percutaneous coronary intervention (PCI) and 52 control subjects. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed for genotyping. SYTNAX score (SS) was calculated as a grading tool for complexity of CAD by an interventional cardiologist. RESULTS: TaqI polymorphism of VDR was not associated with the incidence of CAD. A significant difference was observed between CAD patients and controls regarding BsmI polymorphism of VDR (p < 0.001). GA and AA genotypes was significantly associated with a decreased risk of CAD (p = 0.01, p-adjusted = 0.01 and p < 0.001, p-adjusted = 0.001 respectively). A allele of BsmI polymorphism was shown to have a protective effect against CAD (p < 0.001, p-adjusted = 0.002). No association was found between TaqI and BsmI polymorphisms of VDR and SS as a measure of CAD severity. CONCLUSION: Association of BsmI genotypes with the incidence of CAD revealed that the genetic variation of VDR might play a role in the pathogenesis of CAD.

Design, implementation and evaluation of an intervention based on a social cognitive theory of physical activity and nutritional behaviors in middle-aged people at the risk of coronary artery disease in Bandar Abbas: A study protocol.

BACKGROUND: Coronary artery disease (CAD) is the most common cardiovascular disease (CVD) and the main cause of mortality in developed and developing countries. Physical activity and nutritional behaviors are modifiable factors in people at the risk of CAD and its risk factors; thus, the present study aimed to design, implement, and evaluate an intervention based on the social cognitive theory for physical activity and nutritional behaviors in the middle-aged population at the risk of CAD residing in Bandar Abbas city. MATERIALS AND METHODS: The present study will be conducted in three phases: qualitative, cross-sectional, and community-based intervention. The middle-aged population with less than 150 minutes of physical activity a week with at least one other risk factor of CAD (hyperlipidemia, hypertension, diabetes, overweight and obesity, smoking) will be included in the study. In the qualitative phase of study, the participants will be selected with maximum diversity and with the aim of obtaining comprehensive information to clarify the nature and dimensions of the phenomenon in question. The cross-sectional phase aimed to determine the intensity of physical activity and nutritional behaviors. By analyzing the data obtained from the cross-sectional phase, the most important constructs of the social-cognitive theory in physical activity and nutritional behaviors will be determined, and accordingly, an effective intervention will be designed. The third phase of the pre-test-post-test intervention study will include a randomized control group. The interventions will be a combination of face-to-face meetings and the use of educational technologies. Individuals in the control group will not undergo the educational intervention. Those in the intervention group will be evaluated in two phases (before the implementation of the intervention, and 3 months after the intervention). CONCLUSION: The findings of the present study can be used as a strategic plan to help policy makers to strengthen CVD prevention and management alternatives to include physical activity and nutritional behavior as part of their preventive measures.

Dyslipidemia and its associated factors in southern Iranian women, Bandare-Kong Cohort study, a cross-sectional survey.

Dyslipidemia, a major risk factor for cardiovascular diseases, has become a global issue. Due to the variations in the prevalence of dyslipidemia, this study aimed to evaluate dyslipidemia and its associated factors in women of the Bandare-Kong Cohort Study (BKNCD). This study was conducted on women from the population-based BKNCD, as part of the Prospective Epidemiological Research Studies in IrAN (PERSIAN). Sociodemographic data, medical history, and anthropometric indices were collected. Dyslipidemia was defined as any lipid abnormality including low-density lipoprotein (LDL) ≥ 160, total cholesterol (TC) ≥ 240, high-density lipoprotein (HDL) < 40, or triglyceride > 200 mg/dl. From the 2223 women in this study (mean age: 48.28 ± 9.26 years), dyslipidemia was observed in 851 (38.3%). High TC was the most common lipid abnormality (18.5%) followed by high LDL (17.7%). Dyslipidemia was most prevalent among women aged 55-70 years, the married, those with < 6 years of education, the unemployed, the overweight or obese, with low socioeconomic status, diabetes, hypertension, and high waist circumference, those using the hookah and living in urban areas. Logistic regression revealed that women with high waist-to-hip ratio (WHR) (OR = 2.22, 95% CI 1.60-3.08), those aged 45-54 years (OR = 1.34, 95% CI 1.07-1.68) and 55-70 years (OR = 1.33, 95% CI 1.03-1.72), and those living in urban areas (OR = 1.35, 95% CI 1.05-1.73) were at significantly increased risk of dyslipidemia. In addition, the results were confirmed using deep neural network models. Dyslipidemia was highly prevalent in Iranian women in the southern coastal region. Central obesity, age over 45 years, and living in urban areas appear to be relatively significant risk factors for dyslipidemia among women.

Do Opioid Addicts Require Higher Doses of Heparin During Percutaneous Coronary Intervention?

BACKGROUND: Patients who undergo percutaneous coronary intervention (PCI) receive anticoagulants, most commonly heparin to prevent thrombotic events during the procedure. Opioid addicts may require higher doses of heparin for PCI. We aimed to compare the effect of heparin on activated clotting time (ACT) between opioid addicts and non-addicts prior to and during PCI. METHODS: This comparative study included 107 patients scheduled for elective PCI, of whom 50 were opioid addicts and 57 non-addicts. Patients' baseline characteristics including age, gender, weight, comorbidities, drug history, and smoking were recorded. Prothrombin time (PT), ýpartial thromboplastin time (PTT), international normalized ratio (INR), and platelet count were measured in venous blood samples collected from all participants. All patients underwent PCI through femoral access. They received 100 IU/kg heparin right at the beginning of the procedure. ACT was measured at 2 and 30 minutes. FINDINGS: Age, gender, weight, and the amount of heparin used were comparable between groups. As for general characteristics, the number of patients with hyperlipidemia was significantly higher in non-addicts (P = 0.031), and cigarette smoking was higher in opioid addicts (P < 0.001). No significant difference was found between the groups regarding PT, PTT, INR, and platelet count (P > 0.050). ACT at 2 and 30 min were significantly lower in opioid addicts (P < 0.001). Taking other variables into account, ACT at 2 min was directly correlated with drug history of aspirin in opioid addicts (P = 0.031) and inversely correlated with cigarette smoking in non-addicts (P = 0.023). CONCLUSION: Opioid addicts may require higher doses of heparin in PCI for the prevention of thrombotic complications compared to non-addicts.

Delayed diagnosis of myocardial infarction in a young man with a blunt chest trauma.

A 19 year old man was admitted to emergency department (ED) because of motorcycle to motorcycle accident. In ED he was evaluated as a multiple trauma patient and after overnight observation, was discharged with stable vital signs (VS) next morning. Twenty four hours later, he developed chest pain and dyspnea, and was admitted to ED for the second time. This time he was evaluated as a chest trauma patient and chest X ray and CT scanning were performed. According to cardiology consult, an electrocardiogram was recorded and extensive anterolateral ST elevation myocardial infarction (STEMI) was confirmed. Coronary angiography revealed total thrombotic occlusion of left anterior descending artery (LAD) from ostium. Percutaneous coronary intervention (PCI) was performed and LAD stented successfully. After 10 days of ICU admission, he was discharged with an ejection fraction (EF) of 35%.

Physicians' knowledge, attitudes, and practice for hypertension management: A cross-sectional study in Hormozgan province, Iran.

BACKGROUND: Hypertension is a common risk factor for developing cardiovascular, brain, and kidney disorders; and today, it affects about one billion people worldwide. Insufficient clinical knowledge of the practitioners and family physicians and not following the guidelines has led to the improper control of hypertension. This study intended to investigate the knowledge, attitude, and practice of general practitioners (GPs) about hypertension in Hormozgan province, Iran. METHODS: This cross-sectional study used consecutive sampling method. A three-part researcher-made questionnaire was used to collect data on demographic, attitude, knowledge, and practice information from 220 GPs working in Hormozgan province. RESULTS: The mean and standard deviation (SD) of scores on knowledge, practice, and attitude of GPs about hypertension management were (5.00 ± 0.50), (10.00 ± 0.02) and (9.00 ± 0.15), respectively; which present a proper state. Attending training courses and increased work experience have statistically significant effects on the knowledge and attitude of GPs (P < 0.050). The only exception was the area of practice, where there was no significant relationship between the practitioners' work experience and their practice (P = 0.266). CONCLUSION: The results of this study can be utilized by decision-makers and general medicine curriculum designers to plan effective training courses for medical graduates to be used in clinical settings for health promotions.

Intracardiac Thrombosis in Sickle Cell Disease.

In patients with sickle cell disease, thrombotic microangiopathy is a rare complication. Also in sickle cell disease, intracardiac thrombus formation without structural heart diseases or atrial arrhythmias is a rare phenomenon. We herein describe a 22-year-old woman, who was a known case of sickle cell-ßthalassemia, had a history of recent missed abortion, and was admitted with a vaso-occlusive crisis. The patient had manifestations of microangiopathic hemolytic anemia, including laboratory evidence of hemolytic anemia, thrombocytopenia, respiratory distress, fever, jaundice, and abnormal liver function and coagulation tests, accompanied by clot formation on the Eustachian valve of the inferior vena cava in the right atrium and also a long and worm-like thrombus in the right ventricle. Therapeutic plasma exchange improved her clinical condition, and her intracardiac thrombus was completely resolved after 1 week. Echocardiography, as a simple and inexpensive imaging modality, had a significant role in the diagnosis and follow-up of this patient.

Silent Pulmonary Artery Dissection in a patient with old Pulmonary Balloon Valvuloplasty.

Percutaneous pulmonary balloon valvuloplasty (PBV) remains the treatment of choice for pulmonary stenosis (PS). This procedure is effective, safe and gives excellent results. Pulmonary artery (PA) dissection is a rare complication of PBV. This report is a case of an asymptomatic 17-year-old male with a history of PBV due to severe PS dating back to fifteen years ago. During recent echocardiography, an intimal flap was detected in the main PA and entry site was clearly seen by contrast study.

A rare case of community-acquired native quadruple-valve endocarditis.

We report the case of a male patient with community-acquired quadruple-valve endocarditis on presumed normal native valves. This patient had originally presented elsewhere with generalized edema and malaise and had been diagnosed with suspicious endocarditis and renal dysfunction, for which he unfortunately received incomplete treatment. Transthoracic and transesophageal echocardiographic examinations confirmed quadruple-valve endocarditis and ventricular septal defect.

Assessment of Inter and Intra-atrial Asynchrony in Patients with Systolic Heart Failure Using Velocity Vector Imaging.

BACKGROUND: According to previous studies on the deformation properties of the left atrium, the systolic strain and strain rates represent the atrial reservoir function and the early and late diastolic strain rates show the conduit and booster functions, respectively. OBJECTIVES: We sought to evaluate the intra and interatrial asynchrony using strain/strain rate imaging in systolic heart failure patients. PATIENTS AND METHODS: Twenty five patients with systolic heart failure (LVEF ≤ 40%) were enrolled into the study. Asynchrony quantifications were performed according to the standard deviation of time-to peak (TP-SD) of deformation of three segments manually located along the perimeter of the left atrium free wall, right atrium free wall and interatrial septum, as imaged in an apical four-chamber view. We also calculated classic echocardiography parameters such as LV end-diastolic dimension index, LA volume index, RA area, as well as deceleration time (DT) on transmitral pulsed wave Doppler and E/E' ratio on mitral annular tissue Doppler imaging. RESULTS: In heart failure patients either inter or intra-atrial asynchrony were far more common in comparison with normal subjects (P=0.008 and P=0.007 respectively). CONCLUSIONS: Left ventricular systolic heart failure, may result in inter and intra-atrial asynchrony even in clinically stable patients without significant pulmonary hypertension and diastolic dysfunction.