Clusters of the Risk Markers and the Pattern of Premature Coronary Heart Disease: An Application of the Latent Class Analysis.

Background: Coronary heart disease (CHD) is the major cause of mortality in the world with a significant impact on the younger population. The aim of this study was to identify prematurity among patients with coronary artery bypass graft surgery (CABG) based on the clustering of CHD risk factors. Methods: Patients were recruited from an existing cohort of candidates for CABG surgery named Tehran Heart Center Coronary Outcome Measurement (THC-COM). A latent class analysis (LCA) model was formed using 11 potential risk factors as binary variables: cigarette smoking, obesity, diabetes, family history of CHD, alcohol use, opium addiction, hypertension, history of stroke, history of myocardial infarction (MI), peripheral vascular disease (PVD), and hyperlipidemia (HLP). We analyzed our data to figure out how the patients are going to be clustered based on their risk factors. Results: For 566 patients who were studied, the mean age (SD) and BMI of patients were 59.1 (8.9) and 27.3 (4.1), respectively. The LCA model fit with two latent classes was statistically significant (G2 = 824.87, df = 21, p < 0.0001). The mean (SD) age of patients for Class I and Class II was 55.66 (8.55) and 60.87 (8.66), respectively. Class I (premature) was characterized by a high probability of smoking, alcohol consumption, opium addiction, and a history of MI (P < 0.05), and class II by a high probability of obesity, diabetes, and hypertension. Conclusion: Latent class analysis calculated two groups of severe CHD with distinct risk markers. The younger group, which is characterized by smoking, addiction, and the history of MI, can be regarded as representative of premature CHD.

The 2019-2020 Khalili (Iran) Earthquake Sequence-Anthropogenic Seismicity in the Zagros Simply Folded Belt?

We investigate the origin of a long-lived earthquake cluster in the Fars arc of the Zagros Simply Folded Belt that is colocated with the major Shanul natural gas field. The cluster emerged in January 2019 and initially comprised small events of M n ∼ 3-4. It culminated on 9 June 2020 with a pair of M w 5.4 and 5.7 earthquakes, which was followed by >100 aftershocks. We assess the spatiotemporal evolution of the earthquake sequence using multiple event hypocenter relocations, waveform inversions, and Sentinel-1 Interferometric Synthetic Aperture Radar (InSAR) measurements and models. We find that the early part of the sequence is spatially distinct from the 9 June 2020 earthquakes and their aftershocks. Moment tensors, centroid depths, and source parameter uncertainties of 15 of the largest (M n ≥ 4.0) events show that the sequence is dominated by reverse faulting at shallow depths (mostly ≤4 km) within the sedimentary cover. InSAR modeling shows that the M w 5.7 mainshock occurred at depths of 2-8 km with a rupture length and maximum slip of ∼20 km and ∼0.5 m, respectively. Our results suggest that the 2019-2020 Khalili earthquake sequence was likely influenced by operation of the Shanul field, though elevated natural seismicity in the Zagros makes the association difficult to prove. Understanding how to distinguish man-made from natural seismicity is helpful for hazard and risk assessment, notably in the Zagros, which is both seismically active and rich in oil and gas reserves.

The predictive role of circulating telomerase and vitamin D for long-term survival in patients undergoing coronary artery bypass grafting surgery (CABG).

BACKGROUNDS: Cardiovascular disease (CVD) is the leading cause of mortality all over the globe. Inflammation is believed to play a pivotal role in the pathophysiology of CVD. While there are studies on the interrelationship of telomerase and vitamin D and their involvement in CVD, their independent contributions to long-term outcomes in patients with CVD are not well-defined. This study aimed to investigate the association of both telomerase and vitamin D concentrations with 10-year survival among candidates of coronary artery bypass grafting (CABG) surgery. METHODS: Participants were 404 patients from Tehran Heart Center-Coronary Outcome Measurement (THC-COM) cohort who were recruited from CABG surgery candidates in 2006. In addition to demographic and clinical data including risk factors for coronary artery disease, laboratory parameters such as markers of inflammation as well as baseline serum 25-hydroxy vitamin D [25(OH)D] and telomerase concentrations were measured. Cardiac function indexes alongside outcome measures such as mortality and survival days were recorded for every patient up to 10 years after CABG. Cox-proportional hazard model was used to study the association between all-cause mortality and research parameters. RESULTS: The mean serum telomerase enzyme level was 24.92 ±21.4 nmol/L and the mean serum 25(OH)D was 27.27±10.3 ng/mL. 10-year mortality was reported in 64 (15.8%) patients. 25(OH)D was categorized into three groups (<20, 20-30, and >30) and the cut-point for telomerase was set at 25.0 nmol/L. In Cox regression analysis, higher levels of telomerase (>25 nmol/L) were significantly associated with longer survival (p = 0.041), whereas 25(OH)D concentrations were not associated with survival time. Further analysis showed that telomerase concentrations significantly predicted survival only in the presence of insufficient levels of 25(OH)D (20-30 ng/mL) (p = 0.037). CONCLUSIONS: Telomerase can be regarded as a potential predictor of long-term outcomes in patients who underwent CABG. However, the association of telomerase with the mortality may be modified by vitamin D concentrations.

The association between dietary quality indices and serum telomerase activity in patient candidates for CABG.

BACKGROUND: Diet and dietary habits are major determinants of human telomere length. Telomerase activity is affected mostly by oxidative stress and inflammation. However, the association of telomerase activity with dietary quality indices has not been evaluated before. In the current work, we aimed to test the association of telomerase activity with dietary antioxidant quality score (DAQ), dietary inflammatory index and dietary patterns in patients who were candidate for coronary artery bypass grafting surgery (CABG). METHODS AND MATERIALS: In the current cross-sectional study, 454 candidates for the CABG were enrolled from Tehran Heart Center-Coronary Outcome Measurement (THC-COM) cohort. Laboratory measurements included Hb-A1C, serum lipid profile, creatinine, blood urea nitrogen, hematocrit, lipoprotein (LP)-a, telomerase activity, serum vitamin D and C-reactive protein. Dietary status was measured by semiquantitative food frequency questionnaire, and dietary indices were calculated. Dietary patterns were extracted by factor analysis method. RESULTS: High telomerase activity was associated with lower prevalence of myocardial infarction (MI) (P = 0.04), high dietary vitamin E and high total dietary antioxidant quality scores. Telomerase activity in top quartile of neo-traditional dietary pattern was higher than other quartiles (P = 0.021). No significant association between telomerase activity and other dietary patterns was obtained. Higher telomerase activity was also associated with higher serum creatinine and lower LP-(a) concentrations (P < 0.05). CONCLUSION: To our findings, higher telomerase activity was associated with higher DAQ and lower MI prevalence. It seems that adherence to healthy diet increases serum telomerase activity and reduced telomerase concentration is associated with increased cardio-metabolic risk factors. Moreover, adherence to neo-traditional pattern with higher intake of low-fat dairy products was associated with higher telomerase activity. LEVEL OF EVIDENCE: Level V: A well-designed observational cross-sectional study.

Dietary acid load significantly predicts 10-years survival in patients underwent coronary artery bypass grafting (CABG) surgery.

BACKGROUNDS: Numerous studies have revealed the role of dietary acid load as a potential risk factor for cardiovascular events and blood pressure. However, its role in predicting the mortality rate in patients underwent coronary artery bypass grafting surgery (CABG) has not been reported. In the current study we aimed to evaluate the relationship of dietary acid load and cardio-metabolic risk factors with ten year survival among patients underwent CABG. METHODS: The current prospective cohort study comprises 454 patients underwent CABG. Anthropometric, clinical and biochemical measurements were performed. Dietary acid load was calculated as either potential renal acid load (PRAL) or net endogenous acid production (NEPA) using the data obtained from a semi-quantitative food frequency questionnaire (FFQ). Survival analysis was performed using Kaplan-Meier method followed by log-rank test. The association between all-cause mortality and study parameters was performed with Cox-proportional hazard model. RESULTS: Patients in the higher PRAL and NEAP quartiles had lower BMI and lower ejection fraction rate (P <0.05). Moreover, lower hematocrit values were observed in patients of higher PRAL quartiles. Higher PRAL scores were associated with higher mortality rate and reduced survival days (adjusted hazard ratio: 1.023 (1.00-1.04; P-value = 0.01). However, there was no relationship between NEAP and survival. CONCLUSIONS: We revealed that high PRAL scores are positive predictors of 10-year mortality in patients underwent CABG. The results of our study suggest that maintaining an adequate acid-base balance can contribute to longevity by reducing the risk of mortality.

10-year survival in coronary artery bypass grafting surgery patients in Tehran heart center, coronary outcome measurement study: Predictive power of dietary inflammatory index and dietary antioxidant quality.

OBJECTIVES: There is a higher rate of mortality from cardiovascular disease (CVD) in Iran and the mortality rate increases even after coronary artery bypass grafting (CABG). The aim of this study was to evaluate the association between mortality and survival in patients 10 y after CABG, using the dietary inflammatory index (DII) and dietary antioxidant indices. METHODS: In the current prospective cohort study, 450 patients with CVD who were referred to the Tehran Heart Center and who underwent an isolated CABG during the 6-mo period between April and September 2006 were enrolled. Anthropometric measurements and clinical assessments were performed. Biochemical assay, including hemoglobin A1c, serum lipids, creatinine, blood urea nitrogen, lipoprotein(a), albumin, and C-reactive protein, were also measured. DII, dietary antioxidant quality (DAQ) scores, and dietary Mediterranean quality index (MEDQI) were measured using the data obtained from a semi-quantitative food frequency questionnaire. Survival analysis was performed using the Kaplan-Meir method followed by log-rank test. The association between all-cause mortality and study parameters was performed with Cox proportional hazard model. RESULTS: According to the present results, older ages, male sex, lower educational attainment, opium use, previous history of diabetes and myocardial infarction, and higher hematocrit and creatinine concentrations were associated with higher mortality rates. Among nutritional indices, a high inflammatory diet was a positive predictor of mortality, whereas a higher DAQ score was a negative predictor (P < 0.05). No association was found between the MEDQI score and mortality rate among patients. CONCLUSION: According to the present findings, a diet high in inflammatory foods and low in antioxidant content is a potent predictor of mortality 10 y post-CABG. Therefore, reducing the inflammatory potential of the diet and improving its antioxidant content will be a preventive strategy for reducing mortality after CABG.

Dietary total antioxidant capacity (TAC) among candidates for coronary artery bypass grafting (CABG) surgery: Emphasis to possible beneficial role of TAC on serum vitamin D.

AIMS: Recently, the clinical importance of total antioxidant capacity (TAC) and its protective role against several chronic diseases like cardiovascular disease, osteoporosis and several types of cancers has been reported. However, its association with cardio-metabolic risk factors among patients candidate for coronary artery bypass graft surgery (CABG) has not been evaluated yet. CABG is associated with increased oxidative stress and free radicals; so, the current study was aimed to evaluate the potential association of TAC with cardiovascular risk factors among patients candidate for CABG. METHODS AND MATERIALS: In the current cross-sectional study, 454 patients aged 35-80 years as candidates of CABG and hospitalized in Tehran Heart Center were enrolled. Anthropometric and demographic characteristics were obtained from all participants. Total dietary antioxidant capacity (TAC) was calculated according to the findings of semi-quantitative food-frequency questionnaire (FFQ). Biochemical parameters including serum lipids, albumin, creatinine, HbA1C, C-reactive protein (CRP), lipoprotein (a), creatinine, blood urea nitrogen (BUN) and serum vitamin D concentrations were also assessed by commercial laboratory methods. RESULTS: Male patients in the top quintiles of TAC had significantly lower prevalence of hypertension (35.1% vs 45.9%). Moreover, male patients at fifth quintile of TAC were 2% more serum vitamin D concentrations, 3% lower serum cholesterol concentrations compared with lowest quintile. Top quintiles of TAC make patients more likely to have low hematocrit and high serum albumin concentrations compared with lowest quintiles (P < 0.05). However, in female participants, only serum creatinine concentration was in negative association with TAC. In comparison of clinical parameters, females in the fifth quintile of TAC had 9% higher EF compared with patients in the first quintile (P = 0.021). CONCLUSION: To our findings, higher dietary antioxidant capacity was associated with lower prevalence of hypertension, lower hematocrit, total cholesterol and higher albumin and vitamin D concentrations. Therefore, high dietary TAC could be considered as a potent protective tool against cardio-metabolic risk factors in patients CABG candidate for especially in male patients.

Empirically developed dietary inflammatory potential (EDIP) in patients candidate for coronary artery bypass grafting surgery (CABG): Association with metabolic parameters, dietary antioxidant quality score and dietary phytochemical index.

AIMS: It has been suggested that empirically developed dietary inflammatory potential (EDIP) is a diagnostic tool for assessment of inflammatory potential of diet in prediction of risk factors related to chronic disease. In the current work, we examined the association between EDIP with cardio-metabolic risk factors, dietary antioxidant quality score (DAQs), dietary phytochemical index (DPI) and Mediterranean dietary quality index (MEDQI) in patients candidate for CABG. MATERIALS AND METHODS: In the current cross-sectional study, the data obtained from Tehran- Heart Center-Coronary Outcome Measurement (THC-COM) study from 454 patients candidate for the CABG were used. Laboratory measurements including hemoglobin (Hb)-A1C, serum lipids, creatinine, blood urea nitrogen (BUN), hematocrit, Lp(a), telomerase activity, serum vitamin D and c-reactive protein (CRP) were measured with commercial laboratory methods. Dietary indices were measured according to the data obtained from with semi-quantitative FFQ. RESULTS: In the current work, patients in top quintile of EDIP had higher BMI and higher prevalence of hyperlipidemia compared with patients in lowest quintile (BMI: 28.08 ±3.68 vs 26.69 ± 3.67 and hyperlipidemia: 77.8 vs 65.5%; P < 0.05). Moreover, lower EDIP scores were accompanied with higher vitamin E (0.48 vs 0.4) and total dietary antioxidant scores (4.40 VS 4.28), higher dietary phytochemical scores (69.79 vs 58.29) and lower dietary Mediterranean quality scores (P < 0.05 and P < 0.01 respectively). In male patients, being at highest quintiles of EDIP make patients 2-5% more likely to have higher concentrations of serum cholesterol, BUN and Lp (a), and 6 to 8 times more likely to have higher creatinine and 66% more likely to have lower albumin concentrations compared with male patients in lowest quintiles. In female patients, lower HCT, higher creatinine, higher CRP concentrations and higher telomerase activity were also achieved by higher EDIP scores (P < 0.05). CONCLUSION: According to our finding, EDIP was associated with obesity, high prevalence of dyslipidemia and cardio-metabolic risk factors. Moreover, EDIP was in an inverse association with dietary antioxidant quality score and dietary phytochemical index. Therefore, EDIP could be assumed as a precise tool for estimating the CVD related risk factors among patients candidate for CABG.

Circulating Levels of IL-35 and Gene Expression of FoxP3 in Coronary Artery Disease: Is There Any Interplay Between Them and 25-Hydroxyvitamin D3?

BACKGROUND: We aimed to evaluate interleukin-35 (IL-35) serum levels and the forkhead box P3 (FoxP3) expression in peripheral blood mononuclear cells (PBMCs) of coronary artery disease (CAD) patients compared with the non-CAD group. Also, we examined the possible relationship between gene expression of FoxP3 and serum levels of IL-35 with several CAD-related clinical parameters. METHODS: This study was conducted on 40 men with CAD and 40 men with a normal coronary artery. The gene expression of FoxP3 was measured by real-time polymerase chain reaction (real-time PCR). The serum concentrations of IL-35 and 25-hydroxyvitamin D3 (25(OH)D3) were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: FoxP3 gene expression was significantly decreased in patients compared to controls (p = 0.01). Serum concentrations of IL-35 and 25(OH)D3 were significantly reduced in patients in comparison with the control group (both, p < 0.001), and reduction of IL-35 showed an independent association with CAD. IL-35 levels had a significant positive correlation with serum 25(OH)D3 (r = 0.266, p = 0.044) in the whole population. Moreover, there was an inverse correlation between the FoxP3 expression and CAD severity in CAD patients (r = -0.372, p = 0.01). CONCLUSIONS: It appears that reduced mRNA expression of FoxP3 and circulating level of IL-35 are of significance in the context of CAD pathogenesis. However, more studies are required to elucidate underlying mechanisms.

Niemann-Pick Disease, Type C1 Gene Expression in PBMCs is Associated with Interleukin 10 Serum Concentration: a Case-Control Study.

BACKGROUND: Recent studies showed that atherosclerosis is a lysosomal storage disease (LSD) and Niemann-Pick disease type C1 (NPC1) is the most important protein of the lysosomal membrane that is involved in the removal of FC from lysosomes. Whereas several in vitro and in vivo studies have described the crosstalk between lysosomal cholesterol accumulation and increased inflammation, there is no study addressing the correlation between NPC1 gene expression and an anti-inflammatory cytokine, interleukin 10 (IL-10) serum concentration in atherosclerotic patients. METHODS: IL-10 and 25-hydroxyvitamin D serum concentrations were quantified by enzyme-linked immunosorbent assay (ELISA) in atherosclerotic patients (n = 40) and a control group (n = 40). NPC1 gene expression analysis was performed by quantitative real-time PCR, and correlation between the two parameters was assessed. RESULTS: Mean IL-10 serum concentration and peripheral blood mononuclear cells' (PBMCs) gene expression of NPC1, adjusted for drug consumption, age, and BMI, was not significantly different between the patient and control groups (p = 0.6 and 0.67 respectively). However, NPC1 gene expression showed positive significant correlation with IL-10 serum concentration (p = 0.04, r = 0.29). We also observed lower serum concentration of IL-10 in the subjects with lower 25-hydroxyvitamin D serum concentration (p = 0.034). CONCLUSIONS: Our findings supported the previous observations showing the contribution of lysosomal lipid homeostasis of PBMCs to inflammation and pathogenesis of atherosclerosis.

Dietary inflammatory index: a potent association with cardiovascular risk factors among patients candidate for coronary artery bypass grafting (CABG) surgery.

BACKGROUND: Recently, the clinical importance of dietary inflammatory index (DII) in predicting the inflammatory potential of diet and its role in pathogenesis of several chronic disease including some types of cancers, osteoporosis, cardiovascular disease and renal disease has been proposed. However, its association with the disease severity and progression and cardio-metabolic risk factors among patients candidate for coronary artery bypass graft surgery (CABG) has not been evaluated yet. In the current study, the association of DII with cardiovascular risk factors among patients candidate for CABG has been investigated. METHODS: In the current cross-sectional study, 454 patients aged 35-80 years as candidates of CABG and hospitalized in Tehran Heart Center were enrolled. Anthropometric and demographic characteristics were obtained from all of the participants. Dietary intakes were evaluated with a semi-quantitative food-frequency questionnaire (FFQ) and DII was calculated. Biochemical parameters including hemoglobin (Hb) A1C, serum lipids, albumin, creatinine and high-sensitive C-reactive protein (hs-CRP), lipoprotein (a), creatinine, blood urea nitrogen (BUN), albumin and hematocrit (HCT) were also assessed by commercial laboratory methods. Left ventricular ejection- fraction, number of diseased vessels, New York Heart Association (NYHA) functional class and the European system for cardiac operative risk evaluation (EuroSCORE) were estimated for clinical assessment. One way analysis of variance and chi square tests were used for comparison of demographic parameters between groups. Beta estimates and 95% confidence intervals (CI) for the association between DII and clinical parameters were estimated using linear regression adjusted for the confounders. RESULTS: According to our findings, high DII scores were associated with higher age, lower body mass index (BMI), higher prevalence of diabetes and myocardial infarction (MI) and lower educational attainment (P < 0.05). Male patients in 4th and 3rd quartile of DII had significantly higher total cholesterol (TC), triglyceride (TG), albumin, creatinine, BUN and hs-CRP concentrations and lower high density lipoprotein cholesterol (HDL) concentrations compared with male patients in lower quartiles (P < 0.05). While in female patients, only lipoprotein (a) concentrations and hematocrit (HCT) percentage in the 4th and 2nd quartile were significantly higher than lower quartiles. EuroSCORE was also significantly higher in top quartiles of DII (P = 0.006). CONCLUSION: As shown in our results, DII was in a positive association with several cardiovascular risk factors. The higher inflammatory potential of diet denoted higher values of serum lipids, CRP and kidney function tests and higher EuroSCORE as a predictor of post-operative mortality. Therefore, DII can be demonstrated as a target of nutritional interventions for ameliorating the CVD risk factors among patients candidate for CABG especially in male patients.

Coronary Artery Bypass Graft Surgery Outcomes Following 6.5 Years: A Nested Case-control Study.

BACKGROUND: Coronary artery disease (CAD) is the leading causes of mortality and morbidity in worldwide. This nested case-control study investigated the predictors of death in long-term follow-up after coronary artery bypass graft surgery (CABG). METHODS: Cases were defined as CABG patients who died in the period of May 2006-March 2013. Controls were CABG patients who were alive in the same period. Cases and controls were derived from an existing cohort, Tehran Heart Center-Coronary Outcome Measurement. One hundred and fifty-nine patients in control group were randomly selected from 566 available patients in follow-up database. A series of simple and multiple logistic regressions was performed in the context of univariate and multivariate analyses, respectively, for computing unadjusted and adjusted odds ratios and their confidence intervals (CI). In the univariate analyses, demographic or cardiometabolic factors were entered separately, and for multivariate analysis, we got both significant risk factors from univariate analysis and the major risk factors. RESULTS: The results of multivariate analyses showed that for age, the likelihood of mortality increases in CABG patients (95%CI: 1.1; 1.03-1.2; P < 0.005). Other significant independent risk factors were peripheral vascular disease (PVD) (95%CI: 2.7; 1.06-6.8; P = 0.036), diabetics (95%CI: 2.49; 0.9-6.3; P = 0.039), smoking (95%CI: 4.38; 1.45-13.7; P = 0.011), length of stay in hospital after CABG surgery (95%CI: 1.14; 1.0-1.24; P = 0.001), total cholesterol (95%CI: 1.12; 1-1.2; P = 0.001), and C-reactive protein (CRP) (95%CI: 1.12; 0.99-1.27; P = 0.049) (all P < 0.05). CONCLUSIONS: The study results indicated that age, diabetes, cigarette smoking, PVD, long length of stay in hospital, elevated triglycerides, total cholesterol, CRP, and high-density lipoprotein cholesterol were significant contributing to increased mortality after CABG. It seems that vulnerable older patients continue to be at high risk with poor outcomes.

Mediterranean dietary quality index and dietary phytochemical index among patients candidate for coronary artery bypass grafting (CABG) surgery.

BACKGROUND: The aim of the present research was to evaluate the relationship between Mediterranean dietary quality index (Med-DQI) and dietary phytochemical index (DPI) with metabolic risk factors of cardiovascular disease in candidates for coronary artery bypass graft (CABG) surgery. METHODS: This was a cross-sectional study on 454 patients aged 35-80 years as candidates of CABG and hospitalized in Tehran Heart Center. Anthropometric and demographic characteristics were obtained from all participants and a 138-item semi-quantitative food frequency questionnaire (FFQ) was used to evaluate Med-DQI and DPI. Biochemical parameters including HbA1C, serum lipids, albumin, creatinine and C-reactive protein (CRP) were assessed by commercial laboratory methods. RESULTS: Patients with higher scores of "saturated fatty acids" had lower serum albumin concentrations (P < 0.05). High scores of "cholesterol" subgroup was also accompanied with higher serum Hb A1C percent (P = 0.04). Significantly higher concentrations of serum creatinine were also observed in categorizes with lower "fish" scores. Patients with lower phytochemical intakes had significantly higher Med-DQI scores. CONCLUSION: According to our findings, high dietary intakes of saturated fatty acids and cholesterol were associated with low serum albumin and Hb A1C concentration. Further studies are needed to better clarify these associations and possible underlying mechanisms.

Nasogastric tube insertion in anaesthetized patients: a comprehensive review.

Nasogastric tubes (NGT) still remain the easiest and the best way for gastrointestinal tract access. There are various indications for the insertion of a nasogastric tube in anaesthetized and critically ill patients. Although many techniques have been introduced to facilitate nasogastric tube insertion using anatomic landmarks and a group of devices, there is no consensus on a standard method. Moreover, there are different methods for the assessment of the correct placement of a nasogastric tube. In addition to these challenges in insertion and assessment methods, there are varieties of major life-threatening and minor complications to be addressed. Thus, selecting the most appropriate approach requires enough knowledge in this area, considering patient condition and clinical factors, as well as the practitioners' sufficient education and experience, along with skill in performance. This is a comprehensive review of the literature evidence on different methods for nasogastric tube insertion, on the assessment of correct placement and the evaluation of complications, in addition to an approach to the effect of education on the quality of routine practice and patients' outcome.  .

Association Between Two Common Polymorphisms of Vitamin D Binding Protein and the Risk of Coronary Artery Disease: A Case-control Study.

BACKGROUND: Coronary Artery Disease (CAD) is one of the most widespread non-communicable diseases. Vitamin Dbinding protein (VDBP) and its genetic poly morphisms have been highlighted as the susceptible components for CAD. The aim of the present study was to examine the association of VDBP single nucleotide poly morphisms (SNPs) - rs7041 and rs4588 - with CAD susceptibility among the Iranian population. METHODS: A total of 143 men with CAD and 145 healthy age-sex matched controls underwent genotyping for the - rs7041 and rs4588 polymorphisms using the polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method. Serum level of 25(OH)D was assayed using microplate colorimetric enzyme immunoassay. RESULTS: We found a significant association between GG genotype (rs7041) and CAD (p=0.02, OR=0.537 95% CI =0.306-0.944). Regarding rs4588 polymorphism, a significant difference was observed in which the CA genotype (p=0.00032, OR=2.578, 95% CI=1.579-4.208) and allele A (P=0.028, OR=1.491, 95% CI=1.043-2.132) were significantly higher in CAD patients compared to controls. In spite of lower serum levels of 25(OH)D in CAD patients, we found no significant association between these SNPs and Vitamin D serum concentrations. CONCLUSION: We concluded that VDBP polymorphisms affect the susceptibility to CAD in Iranian men. Therefore, further studies are required to clarify the association of VDBP phenotypes and its serum levels with CAD.

Gensini scores and well-being states among patients with coronary artery disease: A comparison study.

BACKGROUND: World Health Organization (WHO) considered Mental Health Continuum (MHC) as a good instrument for well-being studies. Moreover, gensini score (GS) is an intensity index for coronary artery disease (CAD). The aim of our study was to compare GSs among patients who had coronary artery disease with different well-being states. METHODS: This was a cross-sectional study conducted in Tehran Heart Center, Iran, in 2013. The study population consisted of 50 non-depressed patients who were candidates for coronary artery bypass graft (CABG). All of the participants were interviewed according to the Iranian version of Mental Health Continuum (IV-MHC) and were allocated to flourishing, maternal mental health (MMH) and languishing states based on the related classification criteria. GS was calculated for each participant. Data were analyzed by SPSS. RESULTS: Forty one (82%) patients were in flourishing, 9 (18%) in MMH and nobody was in languishing states. The mean (standard deviation) of GS was 90.43 (44.424) and 89.67 (33.378) for flourishing and MMH ones, respectively (P = 0.962). There was no statistically significant correlation between GSs and well-being states (all Ps > 0.050). CONCLUSION: Considering IV-MHC classification, all of our patients were only allocated to flourishing and MMH states. There was no relationship between intensity of CAD and the states (P > 0.050). We recommend further research with larger sample sizes for better evaluation of the Iranian version of the instrument.

Outcomes and long-term survival of coronary artery surgery: The controversial role of opium as risk marker.

AIM: To study survival in isolated coronary artery bypass graft (CABG) patients and to evaluate the impact of preoperative chronic opium consumption on long-term outcome. METHODS: Cohort of 566 isolated CABG patients as Tehran Heart Center cardiac output measurement was conducted. Daily evaluation until discharge as well as 4- and 12-mo and 6.5-year follow-up information for survival status were fulfilled for all patients. Long-term 6.5-year overall and opium-stratified survival, adjusted survival curves based on opium consumption as well as possible predictors of all-cause mortality using multiple cox regression were determined by statistical analysis. RESULTS: Six point five-year overall survival was 91.8%; 86.6% in opium consumers and 92.7% in non-opium consumers (P = 0.035). Patients with positive history of opium consumption significantly tended to have lower ejection fraction (EF), higher creatinine level and higher prevalence of myocardial infarction. Multiple predictors of all-cause mortality included age, body mass index, EF, diabetes mellitus and cerebrovascular accident. The hazard ratio (HR) of 2.09 for the risk of mortality in opium addicted patients with a borderline P value (P = 0.052) was calculated in this model. Further adjustment with stratification based on smoking and opium addiction reduced the HR to 1.20 (P = 0.355). CONCLUSION: Simultaneous impact of smoking as a confounding variable in most of the patients prevents from definitive judgment on the role of opium as an independent contributing factor in worse long-term survival of CABG patients in addition to advanced age, low EF, diabetes mellitus and cerebrovascular accident. Meanwhile, our findings do not confirm any cardio protective role for opium to improve outcome in coronary patients with the history of smoking. Further studies are needed to clarify pure effect of opium and warrant the aforementioned findings.