The effects of low-volume high-intensity interval versus moderate intensity continuous training on heart rate variability, and hemodynamic and echocardiography indices in men after coronary artery bypass grafting: A randomized clinical trial study.

BACKGROUND: Heart rate variability (HRV) declines after coronary artery bypass grafting (CABG). The purpose of this study was to evaluate the effect of low-volume high-intensity interval training (LV-HIIT) and moderate-intensity continuous training (MICT) on HRV as well as, hemodynamic and echocardiography indices. METHODS: Forty-two men after CABG (55.12 ± 3.97 years) were randomly assigned into LV-HIIT, MICT, and control (CTL) groups. The exercise training in LV-HIIT consisted of 2-minute interval at 85-95 percent of maximal heart rate (HRmax), 2-minute interval at 50% of HRmax and 40-minute interval at 70% of HRmax in MICT for three sessions in a week, for 6-weeks. HRV parameters were evaluated by 24-hour Holter electrocardiography (ECG) recording, and echocardiography parameters at baseline and end of intervention were measured in all 3 groups. RESULTS: At the end of the intervention, left ventricular ejection fraction (LVEF) significantly increased in LV-HIIT group (58.53 ± 7.26 percent) compared with MICT (52.26 ± 7.91 percent) and CTL (49.68 ± 7.27 percent) groups (P < 0.001). Furthermore, mean R-R interval, root mean square successive difference (RMSSD) of R-R interval, and standard deviation of R-R interval (SDRR) in LV-HIIT group considerably increased compared with MICT group (P < 0.001). High-frequency power (HF) significantly increased in LV-HIIT and MICT groups compared with CTL group (P < 0.001). On the other hand, low frequency (LF) and LF/HF ratio significantly decreased in LV-HIIT group in comparison with MICT group (P < 0.010). CONCLUSION: These results suggest that LV-HIIT has a greater effect on improvement of cardiac autonomic activities by increasing R-R interval, SDRR, RMSSD, and HF, and decreasing LF and LF/HF ratio in patients after CABG.

Glycosylated haemoglobin and coronary atherosclerosis in non-diabetic patients: is it a prognostic factor?

BACKGROUND: Some studies aimed to evaluate the relationship between HbA1c and coronary artery disease (CAD). However, it is well known that long-term glycometabolic disorders put the heart at risk for CAD. Considering the inconsistencies between previous studies, this study aimed to investigate the relationship between HbA1c and coronary artery atherosclerosis. METHODS: A cross-sectional study was conducted on 411 non-diabetic patients who underwent their first coronary angiography between November 2013 and December 2014 in Baqiyatallah Hospital. Blood samples were taken before angiography. Coronary angiograms were reported and reviewed by two cardiologists according to the Gensini score. They were not aware about the patients' HbA1c level. Severity of CAD was determined through ascertaining the prevalence of multi-vessel disease, extent of CAD (single-, two- or three-vessel disease or left main stem stenosis (>50%)). Data analysis was performed by using SPSS software. RESULTS: A total of 411 patients (252 men and 159 women) were evaluated. Angiography was normal in 67 patients (16.3%), 30.7% had single-vessel disease (SVD), and 29.1%, 20.7% and 3.2% had two-, three- and multivessel disease, respectively. Based on the ROC curve, the HbA1c was able to differentiate between patients with and without coronary atherosclerosis (p < .001, cut-off point = 5.45). The cut-off points for differentiation of severe CAD and patients with 75-100% stenosis of coronary artery were 5.55 (p < .001) and 5.65 (p < .001), respectively. CONCLUSIONS: The present study demonstrated that HbA1c might be an independent diagnostic factor in non-diabetic patients with severe coronary atherosclerosis.

Antioxidant Activity of Heracleum persicum Fruit Extract: Evidence from a Randomized Controlled Trial.

Oxidative stress is a unifying feature of several cardiometabolic risk factors, and has been suggested to be implicated in atherogenesis. This study aimed to investigate the efficacy of supplementation with Heracleum persicum fruit-a common dietary spice-in modulating systemic biomarkers of oxidative stress in subjects undergoing coronary angiography. Twenty-seven subjects with minimal coronary artery disease (CAD; defined as < 50% obstruction in the coronary arteries) were selected for this trial and were randomly allocated to Heracleum persicum hydroalcoholic fruit extract (n = 15; 300 mg/day) or placebo (n = 12) for a period of six months. Patients were visited monthly and asked to report the adverse events during the treatment period. Serum levels of malondialdehyde (MDA), reduced glutathione (GSH) and total antioxidant capacity (TAC), and enzymatic activities of glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT) were determined at baseline and at the end of trial. Comparison of changes in the evaluated biomarkers of oxidative stress indicated a significantly greater effect of H. persicum extract versus placebo in reducing serum MDA (p = .001), and elevating GSH (p = .001), and TAC (p = .001) concentrations, as well as activities of GPx (p = .001) and CAT (p = .001). The groups were comparable with respect to changes in serum SOD activities during the course of trial (p = .255). The findings of the present randomized double-blind placebo-controlled trial clearly support the efficacy of H. persicum fruit extract as a safe antioxidant supplement in subjects with minimal CAD.

Effect of Music Therapy on Patients' Anxiety and Hemodynamic Parameters During Coronary Angioplasty: A Randomized Controlled Trial.

BACKGROUND: A cardiac catheterization laboratory can be a frightening environment and music can be a supportive source of environmental sound that stimulates and maintains relaxation. However, the results of studies are conflicting in this regard. OBJECTIVES: The aim of this study was to investigate the effect of music therapy on patients' anxiety and hemodynamic parameters during percutaneous transluminal coronary angioplasty. PATIENTS AND METHODS: This was a randomized controlled trial, conducted in the Catheterization Laboratory Unit of Baqiyatallah Hospital, in Tehran, Iran. A sample of 64 patients, who were planned to undergo coronary angioplasty, was recruited. Patients were randomly allocated to either the control or the experimental groups. In the experimental group, patients received a 20 to 40-minute music therapy intervention, consisting of light instrumental music albums by Johann Sebastian Bach and Mariko Makino. Patients in the control group received the routine care of the study setting, which consisted of no music therapy intervention. Study data were collected by a demographic questionnaire, the Spielberger's State Anxiety Inventory, and a data sheet for documenting hemodynamic parameters. Chi-square, independent-samples t tests, paired-samples t-test and repeated measures analysis of variance were used to analyze the data. RESULTS: Before the intervention, the study groups did not differ significantly in terms of anxiety level and hemodynamic parameters. Moreover, the differences between the two groups, regarding hemodynamic parameters, were not significant after the intervention (P > 0.05). However, the level of post-intervention anxiety in the experimental group was significantly lower than the control group (32.06 ± 8.57 and 38.97 ± 12.77, respectively; P = 0.014). Compared with the baseline readings, the level of anxiety in the control group did not change significantly after the study (41.91 ± 9.88 vs. 38.97 ± 12.77; P = 0.101); however, in the experimental group, the level of post-intervention anxiety was significantly lower than the pretest readings (32.06 ± 8.57 vs. 41.16 ± 10.6; P = 0.001). CONCLUSIONS: Music therapy is a safe, simple, inexpensive, and non-invasive nursing intervention, which can significantly alleviate patients' anxiety during coronary angioplasty.

Selection of DNA aptamers against Human Cardiac Troponin I for colorimetric sensor based dot blot application.

Troponin T and I are ideal markers which are highly sensitive and specific for myocardial injury and have shown better efficacy than earlier markers. Since aptamers are ssDNA or RNA that bind to a wide variety of target molecules, the purpose of this research was to select an aptamer from a 79bp single-stranded DNA (ssDNA) random library that was used to bind the Human Cardiac Troponin I from a synthetic nucleic acids library by systematic evolution of ligands exponential enrichment (Selex) based on several selection and amplification steps. Human Cardiac Troponin I protein was coated onto the surface of streptavidin magnetic beads to extract specific aptamer from a large and diverse random ssDNA initial oligonucleotide library. As a result, several aptamers were selected and further examined for binding affinity and specificity. Finally TnIApt 23 showed beast affinity in nanomolar range (2.69nM) toward the target protein. A simple and rapid colorimetric detection assay for Human Cardiac Troponin I using the novel and specific aptamer-AuNPs conjugates based on dot blot assay was developed. The detection limit for this protein using aptamer-AuNPs-based assay was found to be 5ng/ml.

Angiographic Findings after Supplementation with Heracleum persicum Extract: Results of a Randomized Controlled Trial.

BACKGROUND: Heracleum persicum is a common dietary spice with several traditional medicinal properties important for cardiovascular health including antioxidant, hypolipidemic, and anti-inflammatory effects. This study explored the effects of supplementation with H. persicum fruit on the angiographic findings of patients with minimal coronary artery disease (CAD). METHODS: Subjects who were diagnosed with <50% stenosis in any of their coronary arteries by angiography were selected for this trial and randomly assigned to H. persicum hydroalcoholic fruit extract (n = 15; 300 mg/day) or placebo (n = 12) for 6 months. At the end of the trial, participants underwent a second coronary angiography in order to evaluate the progression of their disease. RESULTS: Posttrial angiography did not reveal any improvement in the number of stenosed vessels after consumption of H. persicum extract versus placebo (P > 0.05). Similarly, there was no significant difference between the study groups in terms of disease progression and chest pain score (P > 0.05). CONCLUSIONS: The present results do not support any clinically significant benefit of supplementation with H. persicum extract on the angiographic findings of in patients with minimal CAD.

Effects of supplementation with Heracleum persicum fruit extract on serum lipids in patients undergoing coronary angiography: a pilot trial.

Heracleum persicum Desf. Ex Fischer (Apiaceae) is a native medicinal plant in the Iranian traditional medicine and also a safe and common dietary spice. The present pilot study aimed to investigate the impact of supplementation with H. persicum fruits on serum lipid concentrations in a group of patients with minimal coronary artery disease. Subjects who were diagnosed with <50% luminal narrowing in any of the major coronary arteries in coronary angiography were recruited for this trial and were randomized to receive either H. persicum hydroalcoholic fruit extract (n=15; 300 mg/day) or placebo (n=12) for a period of 6 months. Serum concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were measured at baseline and at the end of study. No significant difference in concentrations of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol was observed between H. persicum extract and placebo groups (p>0.05). However, serum triglycerides levels were reduced after H. persicum extract supplementation in a borderline significant manner (p=0.063). Short-term supplementation with H. persicum fruit extract might be used as an adjunctive treatment for patients with hypertriglyceridemia.

A rare presentation of patent ductus arteriosus in an adult patient with normal pulmonary hypertension and limb edema.

BACKGROUND: Patent ductus arteriosus (PDA) at childhood is one of the five major and frequent congenital abnormalities, but it can be rarely seen in adults. Pulmonary hypertension (PHTN) and other presentations such as heart failure and edema are the identified complications of longstanding PDA, but adult case with no permanent heart symptoms and PHTN was rare. We reported a rare case of with an obvious PDA and normal pulmonary pressure. CASE REPORT: A 61-year-old woman presented with dyspnea (New York Heart Association class 2), chest pain, and lower limb edema. Echocardiogram showed; normal left ventricular chamber size and function, normal size of both atria. Furthermore, an obvious PDA (diameter = 6-7 mm) connecting the aortic arch to the pulmonary artery was reported in echocardiography. No lung congestion and evidence for PHTN was reported by computed tomographic angiography [Pulmonary capillary wedge pressure (PCWP) = 30 mmHg]. The patient was treated with antihypertensive drugs and after 1 and 3 months follow-up, edema and other symptoms were resolved. CONCLUSION: Finally, we conclude that PDA in adulthood can present with nonspecific cardiovascular symptoms, and it seems that PHTN is not a fixed echocardiographic finding in these patients.

Evaluation of Aggregometery Parameters and Efficacy of Plavix versus Clopidex in Patients Suffering from Ischemic Heart Disease: A Randomized Double Blind Clinical Trial.

BACKGROUND: Ischemic heart disease is the leading cause of death in most societies. In a pathophysiologic point of view, it chiefly results from the formation of thrombus in coronary arteries which could not be only prevented by aspirin. Many of clinical trials have shown the long-term benefits of antiplatelet drugs in reducing the risk of thrombotic accidents. OBJECTIVES: Clopidogrel is a thienopyridine derivative used to prevent platelets from adhering together by direct inhibition of Adenosine diphosphate (ADP), the major factor behind platelets aggregation. Sanofi-Aventis and Bristol-Myers are companies that produce Clopidogrel by the name of Clopidogrel bisulfate. Its trade name is Plavix, nonetheless in Iran it is distributed under the name of Clopidex by Exir Company. In this study we are to compare Plavix and Clopidex in terms of efficacy as well as aggregometry parameters like ADP and PRP (Platelet Rich Plasma). PATIENTS AND METHODS: This is a double blind clinical trial in which we had two groups of patients suffering from Ischemic heart disease who were selected by inclusion criteria. Group A (36 patients) took Plavix (75 mg/d) and group B (36 patients) used clopidex (75 mg/d) both for 30 days. The aggregometry parameters also consisted of PRP and ADP that were run on the patients before and after the study. Finally, a comparison of aforementioned tests, quality of life, lab parameters and compliance in both groups was provided. RESULTS: In groups A and B, the mean levels of PRP before the study were 348000 and 340000/µL respectively. The ADPs were also 73/76 and 68/07 µM that showed no significant difference (P > 0.05).The Means of ADP5 in group A before and after the study were 66.40 and 43.84 µM respectively that there was significant difference (P = 0.001). The Means of ADP5 in group B before and after the study were 58.04 and 40.16 µM respectively that there was significant difference (P < 0.001).The Means of ADP20 in group A before and after the study were 73.76 and 54.97 µM respectively which showed significant difference (P < 0.001). The Means of ADP20 in group B before and after the study were 68.07 and 52.49 µM respectively which showed significant difference (P = 0.001). Difference of ADP5 between group A and B was not significant (P = 0.495). Difference of ADP20 between group A and B was not significant (P = 0.721). The Means of PRP in group A before and after the study were 348000 and 335000/ µL respectively that there was no significant difference (P = 0.66). The Means of PRP in group B before and after the study were 340000 and 336000/ µL respectively that indicated no significant difference (P = 0.81). Difference of PRP between group A and B was not significant (P = 0.563). CONCLUSIONS: Our findings suggested that both drugs significantly lessen the ADP level; even so there was no significant difference between two groups in PRP and ADP factors.

Efficacy and Safety of Dorocontin(®) versus Sustac(®) in the Treatment of Stable Angina Pectoris: A Randomized, Double-Blind Comparative Trial.

BACKGROUND: Development of generic drugs has numerous benefits in terms of cost-efficiency and availability. Slow-release nitroglycerin is a vasodilator drug commonly prescribed for patients with angina pectoris. OBJECTIVE: The objective of this study was to compare the efficacy and safety of generic slow-release nitroglycerin (Dorocontin(®)) with that of the innovator brand (Sustac(®)) in patients with stable angina pectoris. METHODS: In this randomized, double-blind comparative trial, 110 patients were allocated to Dorocontin(®) (n=67) or Sustac(®) (n=43) at a dose of 6.4 mg TID, for a total period of two months. Maximum endurable MET (metabolic equivalent of task), MPI (myocardial perfusion imaging), along with changes in the ECG and biomarkers of renal (serum creatinine, BUN) and hepatic (AST, ALT, and ALP) function, lipid profile (total cholesterol, LDL-C, HDL-C, VLDL-C, and triglycerides), electrolytes (Na(+) and K(+)), CBC-diff (RBC, WBC, Plt, Hb, Hct, MCV, MCH, MCHC, and RDW), and FBS were assessed at the baseline and at the end of the trial. The frequency of adverse events during the course of the trial was also recorded. RESULTS: Apart from a significantly greater reduction in maximum ST depression in the Sustac(®) versus the Dorocontin(®) group (p=0.03), none of the functional (MET, MPI, and ECG) and paraclinical (renal function, hepatic function, lipid profile, electrolytes, and FBS) parameters significantly differed between the study groups. The mean Hb (p=0.035), Hct (p=0.045), and MCH (p=0.032) were decreased by the end of the trial in the Sustac(®), but not in the Dorocontin(®) group, whilst there was no change in other CBC-diff parameters. Reported adverse events were not serious and included headache, vertigo, gastrointestinal upset, and orthostatic hypotension. The frequency of these adverse events was comparable between the study groups. CONCLUSION: The findings of the present trial showed comparable efficacy and safety of the generic and innovator products of slow-release nitroglycerin in the management of stable angina pectoris.

Investigation of the effects of Chlorella vulgaris supplementation on the modulation of oxidative stress in apparently healthy smokers.

BACKGROUND: Smoking is among the established yet modifiable risk factors for cancers, cardiovascular diseases, and pulmonary disorders. Oxidative stress has been proposed as a key mechanism mediating the deleterious consequences of smoking. The present study evaluated the effect of supplementation with Chlorella vulgaris, a nutrient and bioactive green microalgae with proven antioxidant capacity, on the burden of oxidative stress in Iranian smokers. METHODS: Thirty-eight smokers (mean age: 37.11 +/- 1.69 years; females: 18.4%) were administered C. vulgaris extract (3600 mg/day) for a period of 6 weeks. Fasted serum samples collected at baseline and after the completion of study were analyzed for the concentrations of vitamin C, vitamin E, glutathione, and malonedialdehyde (MDA) as well as activities of superoxide dismutase, glutathione peroxidase, and catalase. Total antioxidant capacity of serum was also determined by the ability of serum to inhibit the formation of ferryl myoglobin radical species. RESULTS: Six-week supplementation with C. vulgaris extract in smokers was associated with marked elevation of all assessed serum antioxidant measures (p < 0.001) and significant reduction of MDA levels (p = 0.002). After gender segregation, a similar pattern of changes was observed for both male and female subjects apart from lack of significant change in serum vitamin E status in females. Although the magnitude of change in serum vitamin E was significantly greater in males compared to females (p = 0.014), there was no significant change in the magnitude of changes for other assessed parameters between the genders. CONCLUSIONS: Supplementation with C. vulgaris extract significantly improves antioxidant status and attenuates lipid peroxidation in chronic cigarette smokers. Hence, C. vulgaris might prevent the disease burden and mortality rate associated with smoking.

Atorvastatin therapy is not associated with slowing the progression of aortic stenosis: findings of a randomized controlled trial.

BACKGROUND: Aortic stenosis (AS) is the most common type of valvular cardiac disorders. AS has many risk factors in common with atherosclerosis. Hypercholesterolemia is an important pathomechanism for AS. However, the impact of statin drugs on slowing AS progression has not yet been well established. OBJECTIVE: To investigate the impact of statin therapy on slowing AS progression. METHODS: This was a randomized double-blind placebo-controlled trial in which 75 patients with mild to moderate AS were randomized to receive either simvastatin (20 mg/day) or placebo for a period of one year. Serum lipid profile, C-reactive protein (CRP), and echocardiographic parameters were evaluated at baseline as well as at the end of trial. RESULTS: Treatment with atorvastatin was associated with significant decreases in total cholesterol, triglycerides, and LDL-C and an elevation of HDL-C. None of the lipid profile parameters changed in the placebo group. Serum CRP was not significantly altered in any of the groups. Left ventricular end-systolic volume was significantly increased by the end of trial in the statin group (p = 0.012). In the placebo group, significant increases were observed for aortic valve mean (p = 0.017) and peak (p < 0.001) gradient. Other echocardiographic measures remained statistically unchanged in the statin and placebo groups. The number of patients whose disease progressed into severe stage was comparable between the groups and post-trial echocardiographic assessment did not reveal any significant change in the severity of AS between atorvastatin and placebo (p > 0.05). CONCLUSIONS: The findings of the present randomized trial did not support a beneficial effect of statin therapy (20 mg/day) against AS progression in Iranian patients with mild to moderate disease.

Chlamydia pneumoniae in the atherosclerotic plaques of coronary artery disease patients.

An association between Chlamydia pneumoniae (C. pneumoniae) and cardiovascular disease has been demonstrated. In this study, we aimed to study this potential relationship in 105 Iranian patients. Coronary artery specimens from 105 Iranian patients undergoing CABG were analyzed by PCR method for C. pneumoniae. Serological evaluation for C. pneumoniae IgG and IgM was performed using ELISA. 53 specimens from mamillary artery were also investigated. C. pneumoniae PCR test result was positive for 23 (21.9%) of patients with coronary artery atherosclerosis, but none of the specimens from the mamillary artery was positive for C. pneumoniae when it was evaluated by the PCR (P<0.001). Coronary artery disease patients with and without a history of unstable angina or myocardial infarction were comparable in C. pneumoniae PCR test positive rates (P=0.618). Relevance of IgG and IgM positivity were also studied by correlating it to the study parameters, but no difference was found. CRP was significantly higher in the IgM positive group (P<0.001). A significant proportion of coronary atherosclerotic plaques are infected with C. pneumoniae while no infection was found in the normal mamillary artery specimens. No association was found between acute coronary syndromes and serological and PCR positivity. Further prospective randomized controlled studies with large patient population are needed to confirm our findings.

A novel prediction model for all cause emergency department visits in ischemic heart disease.

BACKGROUND: Ischemic heart disease (IHD) is the main cause of morbidity and mortality worldwide, and a considerable part of these patients attend to emergency departments, which increases the burden to these busy departments. The aim of this study was to develop a prediction model enabling prediction of all cause emergency department (ED) visits in patients with documented coronary stenosis in a derivation set, and then to determine its accuracy in a validation set. METHODS: In a prospective study at outpatient setting of Baqiyatallah hospital, Tehran, Iran, 502 patients with IHD were followed for 6 months for observing the outcome of ED visits for all causes. They were divided in two random groups of derivation set (n = 335) and validation set (n = 167). In the derivation set, to achieve an all cause ED visits prediction model, a prediction model was reached by entering demographic data, clinical variables, somatic comorbidity (Ifudu index), level of anxiety and depression (Hospital Anxiety Depression Scale (HADS) questionnaire), and angina grade (WHO Rose Angina) to a logistic regression. Then in the validation set, the sensitivity, specificity, and the accuracy of that model was tested. RESULTS: A novel model for prediction of all cause ED visits in IHD patients in six months was presented with gender, anxiety, WHO angina grade and somatic comorbidity as inputs. Sensitivity, specificity, and accuracy of the model were 63.0%, 68.6%, and 67.7%, respectively. CONCLUSIONS: Testing and using the achieved model is suggested to health care providers in other settings.

Results of a randomized,open-label,clinical trial investigating the effects of supplementation with Heracleumpersicum extract as an adjunctive therapy for dyslipidemia.

The present study evaluated the potential benefit of supplementation with Heracleumpersicum as an adjunctive therapy to atorvastatin in dyslipidemic subjects. In a randomized, open-label, clinical trial, 100 dyslipidemic subjects were randomly assigned to: (1) H. persicum group (n=50, completers=18), receiving H. persicum extract (500 mg/day) + atorvastatin (10 mg/day) for 8 weeks, or (2) atorvastatin group (n=50, completers=34), receiving only atorvastatin (20 mg/day) for 8 weeks. Weight, body mass index (BMI), lipid profile, and biomarkers of hepatic and renal injury were determined at baseline and at the end of the trial. There were significant reductions in serum total cholesterol and LDL-C in both the H. persicum (p=0.001) and atorvastatin (p< 0.001) groups. Serum HDL-C was elevated in the atorvastatin group (p< 0.05), while no significant change was observed in the H. persicum group (p> 0.05). Serum triglyceride levels remained statistically unchanged by the end of the trial in both groups (p> 0.05). Serum alanine (p=0.049) and aspartate aminotransferase (p=0.013) levels rose in the atorvastatin, but not the H. persicum(p> 0.05) group. In comparison with baseline values, no significant change was observed in weight and BMI, as well as serum levels of creatinine, blood urea nitrogen, and fasting blood sugar in either of the groups (p> 0.05). Apart from HDL-C, the effects of atorvastatin (20 mg/day) on other lipid profile parameters do not appear to be significantly superior to those achieved by combination therapy with H. persicum+ atorvastatin (10 mg/day).

Sexual function and psychological status among males and females with ischemic heart disease.

INTRODUCTION: Patients with coronary artery disease (CAD) may also suffer from mental and sexual problems, and we should consider the mutual influence such conditions have on each other. However, the interrelation between sexual and mental problems in the context of CAD has not been fully investigated, especially when it comes to gender. AIM: Our aim was to evaluate sexuality and psychiatric symptoms among patients with CAD and the relation between them in each gender. METHODS: In this cross-sectional study, 550 (397 men and 153 women) patients with documented CAD were surveyed for anxiety and depression using the hospital anxiety and depression scale (HADS) self-administered questionnaire as well as the relation and sexuality scale (RSS). Three subscores were calculated for sexual function, frequency, and fear, with higher scores indicative of a poorer condition. MAIN OUTCOME MEASURES: The HADS and the RSS. RESULTS: Depressive symptoms and anxiety were more severe among our female subjects than they were among the male ones. In addition, the scores for sexual frequency, sexual function, and the total RSS were significantly higher in women, while men had a significantly higher score for sexual fear. The total RSS score correlated with depressive symptoms in women (r = 0.19, P = 0.03), but not in the male subjects. Considering the subscores, a higher score for sexual frequency correlated with depressive symptoms in both genders; however, being afraid of sexual relation correlated with depressive symptoms only in men with CAD and their spouses (r = 0.18, P = 0.001). CONCLUSION: We found that women with CAD have poorer sexual relation and more severe depressive symptoms than men do. Among men with CAD and their wives, fear of sexual relationship is a more serious problem. Such gender-specific characteristics and their interrelations ought to receive due consideration in the management of CAD.