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Ding Q, Funk M, Spatz ES, Lin H, Batten J, Wu E, Whittemore R. Sex-specific impact of diabetes on all-cause mortality among adults with acute myocardial infarction: An updated systematic review and meta-analysis, 1988-2021. Front Endocrinol (Lausanne) 2022; 13:918095. [PMID: 36060979 PMCID: PMC9428712 DOI: 10.3389/fendo.2022.918095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of diabetes and its impact on mortality after acute myocardial infarction (AMI) are well-established. Sex-specific analyses of the impact of diabetes on all-cause mortality after AMI have not been updated and comprehensively investigated. OBJECTIVE To conduct a systematic review and meta-analysis that examined sex-specific short-term, mid-term and long-term all-cause mortality associated with diabetes among AMI survivors (diabetes versus non-diabetes patients in men and women separately), using up-to-date data. METHODS We systematically searched Embase and MEDLINE for studies that were published from inception to November 14, 2021. Studies were included if (1) they studied post-AMI all-cause-mortality in patients with and without diabetes, (2) sex-specific all-cause mortality at short-term (in-hospital or within 90 days after discharge), mid-term (>90 days and within 5 years), and/or long-term (>5 years) were reported. From eligible studies, we used random effects meta-analyses models to estimate pooled unadjusted and adjusted sex-specific risk ratio (RR) of all-cause mortality at short-, mid-, and long-term follow-up for adults with diabetes compared with those without diabetes. RESULTS Of the 3647 unique studies identified, 20 studies met inclusion criteria. In the unadjusted analysis (Total N=673,985; women=34.2%; diabetes patients=19.6%), patients with diabetes were at a higher risk for all-cause mortality at short-term (men: RR, 2.06; women: RR, 1.83); and mid-term follow-up (men: RR, 1.69; women: RR, 1.52) compared with those without diabetes in both men and women. However, when adjusted RRs were used (Total N=7,144,921; women=40.0%; diabetes patients=28.4%), the associations between diabetes and all-cause mortality in both men and women were attenuated, but still significantly elevated for short-term (men: RR, 1.16; 95% CI, 1.12-1.20; women: RR, 1.29; 95% CI, 1.15-1.46), mid-term (men: RR, 1.39; 95% CI, 1.31-1.46; women: RR, 1.38; 95% CI, 1.20-1.58), and long-term mortality (men: RR, 1.58; 95% CI, 1.22-2.05; women: RR, 1.76; 95% CI, 1.25-2.47). In men, all-cause mortality risk associated with diabetes tended to increase with the duration of follow-up (p<0.0001). CONCLUSIONS Diabetes has substantial and sustained effects on post-AMI all-cause mortality at short-term, mid-term and long-term follow-up, regardless of sex. Tailoring AMI treatment based on patients' diabetes status, duration of follow-up and sex may help narrow the gap in all-cause mortality between patients with diabetes and those without diabetes.
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Affiliation(s)
- Qinglan Ding
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
- School of Nursing, Yale University, West Haven, CT, United States
- *Correspondence: Qinglan Ding,
| | - Marjorie Funk
- School of Nursing, Yale University, West Haven, CT, United States
| | - Erica S. Spatz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Haiqun Lin
- Rutgers University School of Nursing, Newark, NJ, United States
| | - Janene Batten
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, United States
| | - Emily Wu
- Krannert School of Management, Purdue University, West Lafayette, IN, United States
| | - Robin Whittemore
- School of Nursing, Yale University, West Haven, CT, United States
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Effect of aromatherapy with Melissa essential oil on stress and hemodynamic parameters in acute coronary syndrome patients: A clinical trial in the emergency department. Complement Ther Clin Pract 2021; 44:101436. [PMID: 34247027 DOI: 10.1016/j.ctcp.2021.101436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 06/17/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022]
Abstract
Stress and hemodynamic changes are among the most significant symptoms and signs that could be observed in patients with acute coronary syndrome (ACS) upon admission to the emergency department. The present study was conducted to determine the effect of the fragrance of lemon balm (Melissa Officinalis) essential oil on stress level and hemodynamic parameters in patients with ACS in the emergency department. METHODS In this double-blind clinical trial, 72 patients were allocated to two groups of Melissa and placebo based on stratified block random sampling. The Melissa group inhaled two drops of Melissa essential oil, whereas the placebo group inhaled two drops of sunflower oil in two aromatherapy phases for 10 min with 90-min intervals. Stress level was measured using the depression, anxiety and stress scale (DASS-21), and hemodynamic parameters were measured and recorded in six time points by a cardiac monitoring system. Data analysis was carried out using descriptive statistics and ANOVA statistical tests, Chi-square test, independent t-test, and post-hoc Tukey's test. RESULTS Interaction between the time and group indicated the significant decrease in the mean score of stress and heart rate in the time points 2 and 5 (5 min after every occasion of aromatherapy) (p < 0.001) and also the remarkable decrease in the mean arterial pressure (MAP) in the time point 2 in the Melissa group in comparison with the placebo group (p < 0.001). There were no significant differences between the mean changes in stress, heart rate and MAP in the two group (P > 0.05). CONCLUSION Aromatherapy via the inhalation of Melissa essential oil with temporary impacts on certain time points could relieve stress and regulate hemodynamic changes in patients with ACS in emergent and acute conditions.
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Samaniyan Bavarsad P, Kheiri S, Ahmadi A. Estimation of the 10-Year Risk of Cardiovascular Diseases: Using the SCORE, WHO/ISH, and Framingham Models in the Shahrekord Cohort Study in Southwestern Iran. J Tehran Heart Cent 2020; 15:105-112. [PMID: 33552205 PMCID: PMC7827119 DOI: 10.18502/jthc.v15i3.4219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Predicting the risk of cardiovascular diseases (CVDs) helps the management of high-risk individuals by the health system. We sought to determine the 10-year risk of CVDs in the Shahrekord Cohort Study (SCS). Methods: In this cross-sectional study based on the SCS in the southwest of Iran, the demographic, anthropometric, clinical, and laboratory data of 5152 persons recruited in the SCS by census method from 2016 to 2017 were used. R software was utilized to calculate the 10-year risk of CVDs according to the World Health Organization/International Society of Hypertension (WHO/ISH) chart, the Framingham Risk Score (FRS) model, and the Systematic Coronary Risk Evaluation (SCORE) model. Results: The mean age of the participants was 49.49±9.40 years, and 50.3% of them were female. According to the WHO/ISH chart, 94.1% of the participants were in the low-risk class, 4.1% in the moderate-risk class, and 0.4% in the high-risk class. Based on the FRS model, 72.2% of the participants were in the low-risk class, 18% in the middle-risk class, and 9.8% in the high-risk class. On the basis of the SCORE model for low-risk areas, 55.3% of the participants were in the low-risk class, 39.6% in the moderate-risk class, and 5.1% in the high-risk class. The agreement concerning risk estimation between the models was approximately 70%. Conclusion: The risk estimated in this study was higher than that in other similar studies. For monitoring risk trends over time, it is essential to nativize a valid risk function, including ethnicity and geographical characteristics, for the Iranian population.
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Affiliation(s)
- Pooneh Samaniyan Bavarsad
- Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Solieman Kheiri
- Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.,Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Ali Ahmadi
- Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran.,Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Kazemi MK, Alimohammadzadeh K, Maher A. Short-and Long–Term Follow–up in the Elderly Patients With ST–Elevation Myocardial Infarction Receiving Primary Angioplasty or Thrombolytic Therapy. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2019. [DOI: 10.21859/ijcp-403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ahmadi A, Salehi F, Ahmadimirghaed Z. Cancer trends in a province of Southwest of Iran, 2003-2016. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018; 23:80. [PMID: 30294348 PMCID: PMC6161484 DOI: 10.4103/jrms.jrms_68_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/09/2018] [Accepted: 06/19/2018] [Indexed: 12/16/2022]
Abstract
Background: Awareness of the trends of cancer incidence in each geographic region is an important. The aim of present study was to determine the incidence trends of cancer in Chaharmahal and Bakhtiari (Ch and B) province in Southwest of Iran. Materials and Methods: In this secondary data analysis, retrospective existing data were used from cancer registry reports in Ch and B in Southwest of Iran in 2003–2016. Data on epidemiologic trend were analyzed using Joinpoint software package and annual percentage change (APC) with 95% confidence interval (95% CI) was computed. Results: Age-standardized incidence rate per 100,000 persons in the province in 2003 was 31.74 that increased to 147.14 in 2016. APC during 2003–2016 was 12.58% (CI: 9.3–16) and significant, which was 10.22% (7.4–13.1) and 14.47% (10.2–18.9) in men and women, respectively. Incidence of the stomach, breast, colorectal, thyroid, lymph node, and ovarian cancers is increasing and the highest incidence was observed in two age groups of 25–34 and 55–64 years. Conclusion: In general, cancers are of increasing trend. Surveillance and monitoring the incidence of cancer and studying the causes of environmental or genetic in the cancer changes can help for cancer prevention and control.
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Affiliation(s)
- Ali Ahmadi
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Fatemeh Salehi
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Zenab Ahmadimirghaed
- Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Shahrbaf MA, Mahjoob MP, Khaheshi I, Akbarzadeh MA, Barkhordari E, Naderian M, Tajrishi FZ. The role of air pollution on ST-elevation myocardial infarction: a narrative mini review. Future Cardiol 2018; 14:301-306. [PMID: 29932738 DOI: 10.2217/fca-2017-0078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
ST-elevation myocardial infarction (STEMI) is one of the potential causes of death worldwide. In spite of substantial advances in its diagnosis and treatment, STEMI is still considered as a major public health dilemma in developed and particularly developing countries. One of the triggering factors of STEMI is supposed to be air pollutants like gaseous pollutants including, sulfur dioxide, nitric dioxide, carbon monoxide, ozone and particulate matters (PM) including, PM under 2.5 µm (PM2.5) and PM under 10 µm (PM10). Air pollution can trigger STEMI with various mechanisms such as increasing inflammatory factors and changing the heart rate or blood viscosity. In this article, we aimed to explore research in the field and discuss the relationship between air pollution and STEMI.
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Affiliation(s)
- Mohammad Amin Shahrbaf
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Parsa Mahjoob
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran, Iran, 1998734383
| | - Mohammad Ali Akbarzadeh
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Barkhordari
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Naderian
- Non-Communicable Diseases Research Center, Endocrinology & Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
PURPOSE OF REVIEW Type 2 diabetes mellitus (T2DM) is associated with increased coronary heart disease (CHD) morbidity and mortality. These patients are also more prone to heart failure, arrhythmias and sudden cardiac death. Furthermore, coronary interventions performed in such high-risk patients have worse outcomes. In this narrative review, we discuss the role of diabetic dyslipidaemia on the risk of CHD in patients with T2DM. The effects of hypolipidaemic, antihypertensive and antidiabetic drugs on lipid and glucose metabolism in T2DM are also considered. RECENT FINDINGS Among CHD risk factors, diabetic dyslipidaemia characterized by moderately elevated low-density lipoprotein (LDL) cholesterol, increased triglycerides and small, dense LDL particles as well as decreased high-density lipoprotein cholesterol levels may contribute to the increased CHD risk associated with T2DM. Hypolipidaemic, antihypertensive and antidiabetic drugs can affect lipid and glucose parameters thus potentially influencing CHD risk. Such drugs may improve not only the quantity, but also the quality of LDL as well as postprandial lipaemia. SUMMARY Current data highlight the importance of treating diabetic dyslipidaemia in order to minimize CHD risk. Both fasting and postprandial lipids are influenced by drugs in patients with T2DM; physicians should take this into consideration in clinical decision making.
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Kargarian-Marvasti S, Rimaz S, Abolghasemi J, Heydari I. Comparing of Cox model and parametric models in analysis of effective factors on event time of neuropathy in patients with type 2 diabetes. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:115. [PMID: 29184573 PMCID: PMC5680655 DOI: 10.4103/jrms.jrms_6_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/28/2017] [Accepted: 07/18/2017] [Indexed: 12/24/2022]
Abstract
Background: Cox proportional hazard model is the most common method for analyzing the effects of several variables on survival time. However, under certain circumstances, parametric models give more precise estimates to analyze survival data than Cox. The purpose of this study was to investigate the comparative performance of Cox and parametric models in a survival analysis of factors affecting the event time of neuropathy in patients with type 2 diabetes. Materials and Methods: This study included 371 patients with type 2 diabetes without neuropathy who were registered at Fereydunshahr diabetes clinic. Subjects were followed up for the development of neuropathy between 2006 to March 2016. To investigate the factors influencing the event time of neuropathy, significant variables in univariate model (P < 0.20) were entered into the multivariate Cox and parametric models (P < 0.05). In addition, Akaike information criterion (AIC) and area under ROC curves were used to evaluate the relative goodness of fitted model and the efficiency of each procedure, respectively. Statistical computing was performed using R software version 3.2.3 (UNIX platforms, Windows and MacOS). Results: Using Kaplan–Meier, survival time of neuropathy was computed 76.6 ± 5 months after initial diagnosis of diabetes. After multivariate analysis of Cox and parametric models, ethnicity, high-density lipoprotein and family history of diabetes were identified as predictors of event time of neuropathy (P < 0.05). Conclusion: According to AIC, “log-normal” model with the lowest Akaike's was the best-fitted model among Cox and parametric models. According to the results of comparison of survival receiver operating characteristics curves, log-normal model was considered as the most efficient and fitted model.
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Affiliation(s)
| | - Shahnaz Rimaz
- Radiation Biology Research Center, Department of Epidemiology, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Jamileh Abolghasemi
- Department of Biostatistics, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Iraj Heydari
- Endocrine Research Center, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran.,Department of Endocrinology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Ahmadi A, Khaledifar A, Etemad K. Modeling of in hospital mortality determinants in myocardial infarction patients, with and without stroke: A national study in Iran. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:74. [PMID: 27904619 PMCID: PMC5122241 DOI: 10.4103/1735-1995.189687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/16/2016] [Accepted: 05/25/2016] [Indexed: 01/13/2023]
Abstract
Background: The data and determinants of mortality due to stroke in myocardial infarction (MI) patients are unknown. This study was conducted to evaluate the differences in risk factors for hospital mortality among MI patients with and without stroke history. Materials and Methods: This study was a retrospective, cohort study; 20,750 new patients with MI from April, 2012 to March, 2013 were followed up and their data were analyzed according to having or not having the stroke history. Stroke and MI were defined based on the World Health Organization's definition. The data were analyzed by logistic regression in STATA software. Results: Of the 20,750 studied patients, 4293 had stroke history. The prevalence of stroke in the studied population was derived 20.96% (confidence interval [CI] 95%: 20.13–21.24). Of the patients, 2537 (59.1%) had ST-elevation MI (STEMI). Mortality ratio in patients with and without stroke was obtained 18.8% and 10.3%, respectively. The prevalence of risk factors in MI patients with and without a stroke is various. The adjusted odds ratio of mortality in patients with stroke history was derived 7.02 (95% CI: 5.42–9) for chest pain resistant to treatment, 2.39 (95% CI: 1.97–2.9) for STEMI, 3.02 (95% CI: 2.5–3.64) for lack of thrombolytic therapy, 2.2 (95% CI: 1.66–2.91) for heart failure, and 2.17 (95% CI: 1.6–2.9) for ventricular tachycardia. Conclusion: With regards to the factors associated with mortality in this study, it is particularly necessary to control the mortality in MI patients with stroke history. More emphasis should be placed on the MI patients with the previous stroke over those without in the interventions developed for prevention and treatment, and for the prevention of avoidable mortalities.
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Affiliation(s)
- Ali Ahmadi
- Department of Epidemiology and Biostatistics, School of Health, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Arsalan Khaledifar
- Department of Cardiology, School of Medicine, Modeling in Health Research Center, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Koorosh Etemad
- Department of Epidemiology, School of Public Health, Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ahmadi A, Etemad K, Khaledifar A. Risk factors for heart failure in a cohort of patients with newly diagnosed myocardial infarction: a matched, case-control study in Iran. Epidemiol Health 2016; 38:e2016019. [PMID: 27188309 PMCID: PMC4967908 DOI: 10.4178/epih.e2016019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/17/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES: Risk factors for heart failure (HF) have not yet been studied in myocardial infarction (MI) patients in Iran. This study was conducted to determine these risk factors. METHODS: In this nationwide, hospital-based, case-control study, the participants were all new MI patients hospitalized from April 2012 to March 2013 in Iran. The data on 1,691 new cases with HF (enrolled by census sampling) were compared with the data of 6,764 patients without HF as controls. We randomly selected four controls per one case, matched on the date at MI and HF diagnosis, according to incidence density sampling. Using conditional logistic regression models, odds ratios (ORs) with a 95% confidence interval (CI) were calculated to identify potential risk factors. RESULTS: The one-year in-hospital mortality rate was 18.2% in the cases and higher than in the controls (12.1%) (p<0.05). Significant risk factors for HF were: right bundle branch block (RBBB) (OR, 2.86; 95% CI, 1.95 to 4.19), stroke (OR, 2.00; 95% CI, 1.39 to 2.89), and coronary artery bypass grafting (CABG) (OR, 2.03; 95% CI, 1.34 to 3.09). Diabetes, hypertension, percutaneous coronary intervention (PCI), atrial fibrillation, ventricular tachycardia, and age were determined to be the factors significantly associated with HF incidence (p<0.05). The most important factor in women was diabetes (OR, 1.41; 95% CI, 1.05 to 1.88). Age, hypertension, PCI, CABG, and RBBB were the most important factors in men. CONCLUSIONS: Our findings may help to better identify and monitor the predictive risk factors for HF in MI patients. The pattern of risk factors was different in men and women.
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Affiliation(s)
- Ali Ahmadi
- Department of Epidemiology and Biostatistics, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Koorosh Etemad
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arsalan Khaledifar
- Department of Cardiology, School of Medicine, Hajar Hospital, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Glutamine protects cardiomyocytes from hypoxia/reoxygenation injury under high glucose conditions through inhibition of the transforming growth factor-β1-Smad3 pathway. Arch Biochem Biophys 2016; 596:43-50. [DOI: 10.1016/j.abb.2016.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/02/2016] [Indexed: 12/25/2022]
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Sadeghi M, Ahmadi A, Baradaran A, Masoudipoor N, Frouzandeh S. Modeling of the relationship between the environmental air pollution, clinical risk factors, and hospital mortality due to myocardial infarction in Isfahan, Iran. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:757-62. [PMID: 26664423 PMCID: PMC4652309 DOI: 10.4103/1735-1995.168382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: This study aimed to determine the relationship between the environmental factor, clinical risk factors, and individual variables with mortality due to acute myocardial infarction (MI) in Isfahan. Materials and Methods: This cross-sectional study was performed between April 2012 and March 2013. The data on the patients’ mortality due to MI in Isfahan were obtained from the MI National Registry. The international classification system (ICD10: I21-I22) was used to diagnose MI. The air quality indicators and environmental variables were used to measure the air pollution. Multilevel logistic regression in the Stata software was used to determine the factors associated with mortality in patients and odds ratios (ORs) were calculated. Results: Six hundred eleven patients with MI were studied during 1-year. 444 (72.2%) patients were male and the rest were female. 4.7% of the patients died due to MI. The mean age at MI incidence was 62.2 ± 13 years. Of the air pollution parameters, PM10 had the maximum mean concentration (49.113 ppm), followed by NOX, NO, NO2, CO, SO2, and O3. The adjusted OR of mortality was derived 2.07 (95% CI: 1.5-2.85) for right bundle branch block, 1.5 (95% CI: 1.3-1.7) for ST-segment elevation MI, 1.84 (95% CI: 1.13-3) for age, 1.06 (95% CI: 1.01-1.20) for CO, 1.1 (95% CI: 1.03-1.30) for O3, and 1.04 (95% CI: 1.01-1.4) for SO2, all of which were considered as the risk factors of mortality. However, OR of mortality was 0.79 for precipitation (95% CI: 0.74-0.84) and 0.52 for angioplasty (95% CI: 0.4-0.68) were considered as protective factors of mortality. The individual characteristics including age, history of MI in the immediate family, hypertension, and diabetes were significantly associated with mortality from MI. The indices of air pollution including SO2, CO, O3, and environmental factors such as the precipitation and temperature were the determinants of mortality in patients with MI. Conclusion: With regards to the factors associated with mortality from MI reported in this study, air pollution and environmental factors, in addition to the risk factors and predictive factors, should be particularly addressed to control the mortality from MI.
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Affiliation(s)
- Mehraban Sadeghi
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Ali Ahmadi
- Department of Epidemiology and Biostatistics, School of Health, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Azar Baradaran
- Department of Clinical Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Masoudipoor
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Soleiman Frouzandeh
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Ahmadi A, Soori H, Mehrabi Y, Etemad K, Sajjadi H, Sadeghi M. Predictive Factors of Hospital Mortality Due to Myocardial Infarction: A Multilevel Analysis of Iran's National Data. Int J Prev Med 2015; 6:112. [PMID: 26730342 PMCID: PMC4689097 DOI: 10.4103/2008-7802.170026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 07/13/2015] [Indexed: 01/10/2023] Open
Abstract
Background: Regarding failure to establish the statistical presuppositions for analysis of the data by conventional approaches, hierarchical structure of the data as well as the effect of higher-level variables, this study was conducted to determine the factors independently associated with hospital mortality due to myocardial infarction (MI) in Iran using a multilevel analysis. Methods: This study was a national, hospital-based, and cross-sectional study. In this study, the data of 20750 new MI patients between April, 2012 and March, 2013 in Iran were used. The hospital mortality due to MI was considered as the dependent variable. The demographic data, clinical and behavioral risk factors at the individual level and environmental data were gathered. Multilevel logistic regression models with Stata software were used to analyze the data. Results: Within 1-year of study, the frequency (%) of hospital mortality within 30 days of admission was derived 2511 (12.1%) patients. The adjusted odds ratio (OR) of mortality with (95% confidence interval [CI]) was derived 2.07 (95% CI: 1.5–2.8) for right bundle branch block, 1.5 (95% CI: 1.3–1.7) for ST-segment elevation MI, 1.3 (95% CI: 1.1–1.4) for female gender, and 1.2 (95% CI: 1.1–1.3) for humidity, all of which were considered as risk factors of mortality. But, OR of mortality was 0.7 for precipitation (95% CI: 0.7–0.8) and 0.5 for angioplasty (95% CI: 0.4–0.6) were considered as protective factors of mortality. Conclusions: Individual risk factors had independent effects on the hospital mortality due to MI. Variables in the province level had no significant effect on the outcome of MI. Increasing access and quality to treatment could reduce the mortality due to MI.
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Affiliation(s)
- Ali Ahmadi
- Department of Epidemiology and Biostatistics, Research Center for Modeling of Non Communicable Disease, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hamid Soori
- Department of Epidemiology, Safety Promotion and Injury Prevention Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, Safety Promotion and Injury Prevention Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Koorosh Etemad
- Department of Epidemiology, Safety Promotion and Injury Prevention Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homeira Sajjadi
- Department of Community Medicine, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Mehraban Sadeghi
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
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14
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Ahmadi A, Soori H, Mehrabi Y, Etemad K. Spatial analysis of myocardial infarction in Iran: National report from the Iranian myocardial infarction registry. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2015; 20:434-9. [PMID: 26487871 PMCID: PMC4590197 DOI: 10.4103/1735-1995.163955] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Myocardial infarction (MI) is a leading cause of mortality and morbidity in Iran. No spatial analysis of MI has been conducted to date. The present study was conducted to determine the pattern of MI incidence and to identify the associated factors in Iran by province. Materials and Methods: This study has two parts. One part is prospective and hospital-based, and the other part is an ecological study. In this study, the data of 20,750 new MI cases registered in Iranian Myocardial Infarction Registry in 2012 were used. For spatial analysis in global and local, spatial autocorrelation, Moran's I, Getis-Ord, and logistic regression models were used. Data were analyzed by Stata software and ArcGIS 9.3. Results: Based on autocorrelation coefficient, a specific pattern was observed in the distribution of MI incidence in different provinces (Moran's I: 0.75, P < 0.001). Spatial pattern of incidence was approximately the same in men and women. MI incidence was clustering in six provinces (North Khorasan, Yazd, Kerman, Semnan, Golestan, and Mazandaran). Out of the associated factors with clustered MI in six provinces, temperature, humidity, hypertension, smoking, and body mass index (BMI) could be mentioned. Hypertension, smoking, and BMI contributed to clustering with, respectively, 2.36, 1.31, and 1.31 odds ratio. Conclusion: Addressing the place-based pattern of incidence and clarifying their epidemiologic dimension, including spatial analysis, has not yet been implemented in Iran. Report on MI incidence rate by place and formal borders is useful and is used in the planning and prioritization in different levels of health system.
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Affiliation(s)
- Ali Ahmadi
- Department of Epidemiology and Biostatistics, School of Public Health, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hamid Soori
- Department of Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Koorosh Etemad
- Department of Epidemiology, School of Public Health, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Soleimani AR, Akbari H, Soleimani S, Beladi Mousavi SS, Tamadon MR. Effect of sour tea (Lipicom) pill versus captopril on the treatment of hypertension. J Renal Inj Prev 2015; 4:73-9. [PMID: 26468478 PMCID: PMC4594217 DOI: 10.12861/jrip.2015.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/05/2015] [Indexed: 12/17/2022] Open
Abstract
Introduction: Herbal medicines are traditionally prescribed to manage blood pressure.
Objectives: We aimed to evaluate effect of sour tea pill containing the herb’s extract versus captopril on the treatment of hypertension.
Patients and Methods: In our crossover clinical trial 20 patients were enrolled in the study and advised for life style modification then the participants were randomly divided into 2 groups. Sour tea pills was prescribed at a dose of 500 mg and captopril at a dose of 12.5 mg twice daily. In order to improve precision and final measurement, ambulatory blood pressure monitoring (ABPM) was performed both prior and after measuring the hypertension in 2 successive visits. After 6 weeks of therapy, the methods changed and 6 weeks later ABPM was performed three times (baseline, at end of the 6th and 12th week). The 2 groups were merged together before data analysis.
Results: Of the 20 patients, 13 (65%) were male and 7 (35%) were female. No significant difference of sex, age, and job was detected between 2 groups (P ≥ 0.05). Mean decreasing in systolic blood pressure was 7.75 ± 8.3 and 13.3 ± 16.1 mm Hg in the captopril and sour tea groups, respectively. Also, mean decline in diastolic blood pressure decreases was 2.15 ± 4.14 and 5.8 ± 7.8 mm Hg for captopril and sour tea groups, respectively. No side effect was observed in the sour tea pill group in the study.
Conclusion: According to the effect of sour tea pill on decreasing blood pressure, without giving priority over captopril, sour tea pill containing the herb’s extract can be prescribed as an adjuvant therapy for lowering the prescribed dosage of captopril.
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Affiliation(s)
- Ali-Reza Soleimani
- Department of Internal Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Akbari
- Department of Statistics, Kashan University of Medical Sciences, Kashan, Iran
| | - Saeid Soleimani
- Department of Internal Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Mohamad-Reza Tamadon
- Department of Internal Medicine, Semnan University of Medical Sciences, Semnan, Iran
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