Investigating the inflammatory status in the patients candidate for second angiography after coronary stent implantation.

BACKGROUND: Inflammation has been shown to be an important feature of atherosclerosis. We aimed to assess a profile of inflammatory cytokines and growth factors in patients with established coronary artery disease (CAD), 12 months after stent implantation. METHODS: A total of 193 patients with CAD, who were candidates for angiography, 12 months after stent implantation (cases), were compared with 107 patients with CAD, who were candidates for their first angiography (controls). Fasting blood glucose (FBG), triglycerides (TGs), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and high-sensitive C-reactive protein (hs-CRP) were measured using routine methods. The serum concentrations of IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, IFN-γ, MCP-1, EGF and VEGF were determined using competitive chemiluminescence immunoassays. RESULTS: Serum levels of FBG (p = .002), TG (p = .029) and hs-CRP (p = .005) were significantly lower in cases than controls. The cytokines and growth factor profiles in cases were significantly different from controls. After multivariate analysis, serum levels of IL-2 (p < .001), IL-4 (p = .028) were significantly lower in cases compared with the controls while serum levels of IL-8, TNF-α, MCP-1, EGF and VEGF were significantly higher in the cases (p < .001). CONCLUSIONS: In patients with CAD and higher consumption of drug used (statins, aspirin and glucose lowering agents) to mitigate the risk of a secondary event, the level of hs-CRP one year after stent implantation decreased despite of significant higher serum levels of pro- and anti-inflammatory cytokines and growth factors.

Application of the Truncated Zero-Inflated Double Poisson for Determining of the Effecting Factors on the Number of Coronary Artery Stenosis.

BACKGROUND: Risk factors of coronary heart disease have been discussed in the literature; however, conventional statistical models are not appropriate when the outcome of interest is number of vessels with obstructive coronary artery disease. In this paper, a novel statistical model is discussed to investigate the risk factors of number of vessels with obstructive coronary artery disease. METHODS: This cross-sectional study was conducted on 633 elderly cardiovascular patients at Ghaem Hospital, Mashhad, Iran from September 2011 to May 2013. Clinical outcome is number of vessels with obstructive coronary artery disease (=0, 1, 2, 3), and predictor variables are baseline demographics and clinical features. A right-truncated zero-inflated double Poisson regression model is performed which can accommodate both underdispersion and excess zeros in the outcome. The goodness-of-fit of the proposed model is compared with conventional regression models. RESULTS: Out of 633 cardiovascular patients, 327 were male (51.7%). Mean age was ~65 ± 7 years (for individuals with zero, one ,and two coronary artery stenosis) and ~66 ± 7 years (for individuals with three coronary artery stenosis). BMI (0.04 ± 0.01, p = 0.011) and female gender (0.19 ± 0.09, p = 0.032) were significant associated with the count part of the model, and only BMI (-0.47 ± 0.2, p = 0.011) was significantly predictive of logit part of the model. The goodness-of-fit measurements indicate that the proposed model outperforms the conventional regression models. CONCLUSION: The proposal regression model shows a better fit compared to the standard regression analysis in modeling number of vessels with obstructive coronary artery disease. Hence, using truncated zero-inflated double Poisson regression model-as an alternative model-is advised to study the risk factors of number of involved vessels of coronary artery stenosis.

Psychosocial Determinants of Changes in Dietary Behaviors Among Iranian Women: An Application of the Pender's Health Promotion Model.

Data on how the complex cognitive processes, personal, and social factors influence health promoting behaviors of women are very limited and the results have been inconsistent. Here, we examine how prior behaviors, behavior-specific cognition (perceived benefits/barriers, self efficacy, and activity-related affect), situational and interpersonal factors (social support, modeling, and norms) associated with the level of dietary behaviors in Iranian women. A cross sectional survey of 356 women aged 18-60 years from health care centers in Iran was undertaken from October 2015 to September 2016. Multiple analytical models and Pender's health promotion model (HPM) were implemented to examine the effectiveness of HPM and its potential constructs on PA behaviors. The instruments used were designed using Pender's HPM as a basis. The path model fitted data and accounted for 51% of the variance in dietary behaviors; and prior behavior, perceived self-efficacy, interpersonal influences, and commitment to plan were significantly associated with dietary behavior. We found that constructs from the HPM are empirically improved dietary behavior among the women population. This result provides a suitable source for designing strategies of a nutrition education intervention for improving the frequency and nutrient intake of breakfast consumption among female students.

Predictors of physical activity among women in Bojnourd, north east of Iran: Pender's health promotion model.

BACKGROUND: This study examined how socio-demographic characteristics constructs derived from the health promotion model (HPM) influence the level of physical activity (PA) women in Bojnourd, North East of Iran. METHOD: This cross-sectional study has been carried out through multi-stage sampling design on 356 women aged 18-60 years living in Iran. Data was collected through reliable and valid questionnaire survey women who were selected from their homes. RESULTS: Most of participants (53.40%) had a low level of physical activity behaviors with minimal physical activity (PA) scores. Using regression analysis showed that 23.22% of the total variance in PA behaviors was predicted by socio-demographic variables, whilst 40.81% of the variance in PA behaviors was predicted by constructs from the HPM. The results from Path modeling indicated that prior behavior, interpersonal influences, perceived self-efficacy, perceived barriers and commitment to PA, were significant predictors for PA behaviors with 86.93% of total effects on PA, whereas, activity-related affect and situational influences had no significant effect on the PA behaviors. CONCLUSIONS: We found that constructs derived from the HPM are determinants of PA among Iranian women and may be important in developing educational intervention programs to facilitate a physically active lifestyle in this population.

Effect of a theory-based educational intervention for enhancing nutrition and physical activity among Iranian women: a randomised control trial.

OBJECTIVE: The relative contribution of health promotion models (HPM) to improve health-related behaviours in intervention programmes is still limited. Here, we tested whether Pender's HPM operationalised in the educational intervention was effective to modify nutrition and physical activity (PA) behaviours among Iranian women. DESIGN: A randomised controlled field trial evaluating the efficacy of an educational intervention based on Pender's HPM to improve PA and nutrition behaviours from August 2016 to October 2016. R version 3.0.2 and SPSS version 16 were used to conduct multiple statistical analyses. SETTING: Ten public healthcare centres in Bojnourd, Iran were randomly divided into intervention and control groups. The experimental group received the full intervention programme, which included nine 4-h training sessions and consulting support via phone contact and social media group. The control group did not receive any intervention. PARTICIPANTS: Women aged 4-6 years (n 202) were randomised to intervention (n 102) and control conditions (n 100) and completed baseline and 3-month follow-up. RESULTS: In the experimental group, the intervention programme had a significant effect (P < 0·05) on all construct of Pender's HPM and behaviour outcome, and the estimates for prior behaviours, self-efficacy, interpersonal influences, feeling, perceived benefits and barriers, commitment and behaviour outcomes in the intervention group were 0·72 (95 % CI 0·31, 0·98), 0·54 (95 % CI 0·27, 0·71), 0·74 (95 % CI 0·27, 0·91), 0·52 (95 % CI 0·19, 0·75), 0·62 (95 % CI 0·22, 0·91), 0·63 (95 % CI 0·30, 0·86) and 0·56 (95 % CI 0·37, 0·85), respectively. CONCLUSIONS: Educational intervention based on Pender's HPM was feasible and highly acceptable to modify PA and nutrition behaviours in the women population.

Dietary protein is the strong predictor of coronary artery disease; a data mining approach.

BACKGROUNDS: Coronary artery disease (CAD) is the major cause of mortality and morbidity globally. Diet is known to contribute to CAD risk, and the dietary intake of specific macro- or micro-nutrients might be potential predictors of CAD risk. Machine learning methods may be helpful in the analysis of the contribution of several parameters in dietary including macro- and micro-nutrients to CAD risk. Here we aimed to determine the most important dietary factors for predicting CAD. METHODS: A total of 273 cases with more than 50% obstruction in at least one coronary artery and 443 healthy controls who completed a food frequency questionnaire (FFQ) were entered into the study. All dietary intakes were adjusted for energy intake. The QUEST method was applied to determine the diagnosis pattern of CAD. RESULTS: A total of 34 dietary variables obtained from the FFQ were entered into the initial study analysis, of these variables 23 were significantly associated with CAD according to t-tests. Of these 23 dietary input variables, adjusted protein, manganese, biotin, zinc and cholesterol remained in the model. According to our tree, only protein intake could identify the patients with coronary artery stenosis according to angiography from healthy participant up to 80%. The dietary intake of manganese was the second most important variable. The accuracy of the tree was 84.36% for the training dataset and 82.94% for the testing dataset. CONCLUSION: Among several dietary macro- and micro-nutrients, a combination of protein, manganese, biotin, zinc and cholesterol could predict the presence of CAD in individuals undergoing angiography.

Comparison of Support Vector Machine, Naïve Bayes and Logistic Regression for Assessing the Necessity for Coronary Angiography.

(1) Background: Coronary angiography is considered to be the most reliable method for the diagnosis of cardiovascular disease. However, angiography is an invasive procedure that carries a risk of complications; hence, it would be preferable for an appropriate method to be applied to determine the necessity for angiography. The objective of this study was to compare support vector machine, naïve Bayes and logistic regressions to determine the diagnostic factors that can predict the need for coronary angiography. These models are machine learning algorithms. Machine learning is considered to be a branch of artificial intelligence. Its aims are to design and develop algorithms that allow computers to improve their performance on data analysis and decision making. The process involves the analysis of past experiences to find practical and helpful regularities and patterns, which may also be overlooked by a human. (2) Materials and Methods: This cross-sectional study was performed on 1187 candidates for angiography referred to Ghaem Hospital, Mashhad, Iran from 2011 to 2012. A logistic regression, naive Bayes and support vector machine were applied to determine whether they could predict the results of angiography. Afterwards, the sensitivity, specificity, positive and negative predictive values, AUC (area under the curve) and accuracy of all three models were computed in order to compare them. All analyses were performed using R 3.4.3 software (R Core Team; Auckland, New Zealand) with the help of other software packages including receiver operating characteristic (ROC), caret, e1071 and rminer. (3) Results: The area under the curve for logistic regression, naïve Bayes and support vector machine were similar-0.76, 0.74 and 0.75, respectively. Thus, in terms of the model parsimony and simplicity of application, the naïve Bayes model with three variables had the best performance in comparison with the logistic regression model with seven variables and support vector machine with six variables. (4) Conclusions: Gender, age and fasting blood glucose (FBG) were found to be the most important factors to predict the result of coronary angiography. The naïve Bayes model performed well using these three variables alone, and they are considered important variables for the other two models as well. According to an acceptable prediction of the models, they can be used as pragmatic, cost-effective and valuable methods that support physicians in decision making.

Relationship between serum high sensitivity C-reactive protein with angiographic severity of coronary artery disease and traditional cardiovascular risk factors.

Serum high-sensitivity C-reactive protein (hs-CRP) is predictive of coronary artery disease (CAD). The aim of this study was to examine the possible association of hs-CRP with presence and severity of CAD and traditional CAD risk factors. This case-control study was carried out on 2,346 individuals from September 2011 to May 2013. Of these 1,187 had evidence of coronary disease, and were subject to coronary angiography, and the remainder were healthy controls (n = 1,159). Characteristics were determined using standard laboratory techniques and serum Hs-CRP levels were estimated using enzyme-linked immunosorbent assay (ELISA) kits, and severity of CAD was assessed according to the score of obstruction in coronary artery. Serum hs-CRP levels were higher in those with severe coronary disease, who had stenosis ≥ 50% stenosis of at least one coronary artery (all p < 0.001 vs. individuals in healthy control), and correlated significantly with the score for coronary artery disease (all p < 0.01). After adjustment for conventional risk factors, regression analysis revealed that smoking habits, fasting blood glucose, total cholesterol, high-density lipoprotein, hs-CRP, blood pressure, anxiety, dietary intake of vitamin E, and cholesterol remained as independent determinants for angiographic severity of CAD. The area under the receiving operating characteristic (ROC) curve for serum hs-CRP was 0.869 (CI 95% 0.721-0.872, p < 0.001). The optimal values for the cut-off point was a serum hs-CRP of 2.78 mg/l (sensitivity 80.20%, specificity 85%) to predict severity of CAD. Increased serum hs-CRP levels are significantly associated with angiographic severity of CAD, suggesting its value as a biomarkers for predicting CAD.

Serum C-reactive protein in the prediction of cardiovascular diseases: Overview of the latest clinical studies and public health practice.

Cardiovascular disease is the most common cause of morbidity and mortality globally. Epidemiological studies using high-sensitivity assays for serum C-reactive protein have shown a consistent association between cardiovascular disease risk and serum C-reactive protein concentrations. C-reactive protein is a biomarker for inflammation, and has been established in clinical practice as an independent risk factor for cardiovascular disease events. There is evidence that serum C-reactive protein is an excellent biomarker of cardiovascular disease and is also an independent and strong predictor of adverse cardiovascular events. Further characterization of the impact and influence of lifestyle exposures and genetic variation on the C-reactive protein response to cardiovascular disease events may have implications for the therapeutic approaches to reduce cardiovascular disease events. This review summarizes the studies that have examined the association between serum C-reactive protein and the risk of cardiovascular disease. We also discuss the impact of independent factors and C-reactive protein genetic polymorphisms on baseline plasma C-reactive protein levels.

The status and characteristics of eutrophication in tropical coastal water.

A set of methodological tools was tested to assess the sensitivity of several ecological and biological indices to eutrophication while at the same time attempting to explore a linkage among pressures, classification assessment and drivers. Industrial discharges, harbor activities, natural interactions and river discharges are the pressures most related to the eutrophication process in tropical coastal water bodies. Among the eutrophication indices used, TRIX and operational indicators overestimated the eutrophication status in the study area, but EI and chl-a seems to be a rather responsive index to reflect the first stage of eutrophication. It is noteworthy that EI and chl-a showed better overall agreement with the ecological quality status (EcoQ) showing that probably it reflects the indirect relation of macrobenthic with water eutrophication in a better way. An ecological boundary of EI and chl-a from moderate to poor may be needed in order to explain the poor status of relatively eutrophic Klang Strait coastal sites.

E-Health literacy of medical and health sciences university students in Mashhad, Iran in 2016: a pilot study.

BACKGROUND: In order to provide a better healthcare education to the society, health care students should have an acceptable electronic health (E-Health) literacy. OBJECTIVE: The aim of this study was to assess the level of E-Health literacy of Medicine and Health Sciences university students in Mashhad, Iran. METHODS: This cross-sectional study was performed on 192 students of Mashhad University of Medical Sciences using a validated Persian translate of the E-Health literacy scale (P-EHEALS) questionnaire in 2016. Demographic data including age, monthly income, level of education, preference of website for obtaining health related information and minutes of Internet use per day were obtained from the subjects. Independent-samples t-test and analysis of variance (ANOVA) were used for comparison between groups, and Pearson correlation coefficient and linear regression were used to assess the correlation between study parameters and EHEALS score using SPSS version 21. RESULTS: A total of 192 (67.2% female and 32.8% male) subjects with mean age of 24.71±5.30 years participated in the study. Mean P-EHEALS score of the subjects was 28.21±6.95. There was a significant difference in P-EHEALS score between genders (p<0.001), department (p=0.001), education level (p<0.001) and health status (p=0.003) as well as monthly income (p=0.03), website preference categories (p=0.02). Male students were significantly more likely to gain higher P-EHEALS scores. CONCLUSION: The level of E-Health literacy was low in Medical and Health Sciences university students in Mashhad. More studies are needed to assess the contributors to E-Health literacy.

Serum concentrations of MCP-1 and IL-6 in combination predict the presence of coronary artery disease and mortality in subjects undergoing coronary angiography.

Cytokines play a key role in the pathogenesis of coronary artery disease (CAD). The aim of current study was to investigate the relationship between the serum concentrations of 12 cytokines with mortality and extent of CAD in individuals undergoing angiography and healthy controls. 342 CAD patients were recruited and divided into 2 groups: those with ≥50% occlusion in at least one coronary artery [Angiography (+)] or <50% obstruction in coronary arteries [Angiography (-)]. Also 120 healthy subjects were enrolled as control group. Lipid profile, fasting blood glucose, body mass index, and blood pressure were evaluated in all the subjects. An Evidence Investigator® was used for measuring 12 cytokines (IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, MCP-1, IFN-γ, EGF, VEGF) using sandwich chemiluminescent assays. Univariate analysis, multivariate regression models, ROC, and Kaplan-Meier survival curves were used for exploring the candidate markers in CAD patients. Serum level of IFN-γ, IL-4, MCP-1, EGF, IL-6, and IL-8 were markedly higher in angiogram-positive patients, while VEGF concentrations were significantly (P < 0.05) lower, compared to control group. ROC analysis for MCP-1 showed that a cut-off of 61.95 pg/mL had 91% sensitivity and 91% specificity for predicting CAD patients. Moreover, >2.16 pg/mL IL-6 had a > 94% sensitivity and 70% specificity in predicting 2 years mortality in the subjects with a serum MCP-1 > 61.95 pg/ mL, and patients having IL-6/MCP-1 combination had a shorter survival.Our findings demonstrate that CAD patients with serum MCP-1 and IL-6 levels of >61.95 and >2.16 pg/mL had a higher mortality with 94.1% sensitivity and 70.5% specificity for predicting mortality in CAD patients.

hs-CRP is strongly associated with coronary heart disease (CHD): A data mining approach using decision tree algorithm.

BACKGROUND AND AIMS: Coronary heart disease (CHD) is an important public health problem globally. Algorithms incorporating the assessment of clinical biomarkers together with several established traditional risk factors can help clinicians to predict CHD and support clinical decision making with respect to interventions. Decision tree (DT) is a data mining model for extracting hidden knowledge from large databases. We aimed to establish a predictive model for coronary heart disease using a decision tree algorithm. METHODS: Here we used a dataset of 2346 individuals including 1159 healthy participants and 1187 participant who had undergone coronary angiography (405 participants with negative angiography and 782 participants with positive angiography). We entered 10 variables of a total 12 variables into the DT algorithm (including age, sex, FBG, TG, hs-CRP, TC, HDL, LDL, SBP and DBP). RESULTS: Our model could identify the associated risk factors of CHD with sensitivity, specificity, accuracy of 96%, 87%, 94% and respectively. Serum hs-CRP levels was at top of the tree in our model, following by FBG, gender and age. CONCLUSION: Our model appears to be an accurate, specific and sensitive model for identifying the presence of CHD, but will require validation in prospective studies.

Impact of Cigarette Smoking on Serum Pro- and Anti-Inflammatory Cytokines and Growth Factors.

Inflammation plays a key role in the initiation, progression, and clinical manifestation of atherosclerosis. Cigarette smoking is a risk factor for atherosclerosis and cardiovascular disease. The aim of the current study was to investigate the serum concentrations of 12 cytokines and growth factors (EGF, INF-γ, IL-1α/-1ß/-2/-4/-6/-8/-10, MCP-1, TNF-α, and VEGF) in an Iranian population, including 192 smokers, comparing these values with concentrations in nonsmokers. One hundred and ninety-two cases were enrolled from the Mashhad University of Medical Sciences. Of these cases, 82 were cigarette smokers and 110 were nonsmokers. Sex and age were matched for the two groups. The serum concentration of 12 cytokines and growth factors were determined using EV-3513-cytokine-biochip arrays, by competitive chemiluminescence immunoassays. The level of serum MCP-1 was significantly ( p < .001) lower in the female group of cigarette smokers (mean = 88.1 dL/ng), compared with nonsmokers (mean = 155.6 dL/ng). There were no significant differences for the other cytokines and growth factors between the groups. Our finding demonstrate the association of MCP-1 with cigarette smoking, supporting further studies in larger population on evaluating the role of cigarette smoking on pro-/anti-inflammatory cytokines.

Relationship between serum cytokines receptors and matrix metalloproteinase 9 levels and coronary artery disease.

BACKGROUND: The prevalence of coronary artery disease (CAD) is increasing globally, supporting the need for the identification of novel biomarkers. Therefore in the present study, we have explored the association of SIL2A, SIL6R, STNFRI, STNFRII, and MMP9 in CAD patients. METHODS: Twenty one patients with angiographically defined CAD with more than 50% occlusion, at least, in one coronary artery and twenty healthy subjects (n=20) without the history of cardiovascular symptoms were enrolled. Demographic and biochemical analysis (e.g. Total Cholesterol (TC), Triglyceride (TG), and HDL-C) were measured in all the subjects. The level of cytokines receptor (SIL2A, SIL6R, SIL6R, STNFRI, STNFRII, and matrix metallopeptidase 9 (MMP9) were evaluated. RESULTS: Our results showed the higher level of MMP9 in patients group compared to the control subjects, while no significant differences were detected for other cytokines. In particular the level of MMP9 was significantly (P=.015) increased from 181.16 ng/mL (95%CI: 112.1-199.2) to 192.0 ng/mL (95%CI: 181.5-265.2). Moreover, the sensitivity and specificity of MMP9 were 95.45% and 45%, respectively, as detected by receiver operating characteristic (ROC) curves. CONCLUSION: We demonstrate the significant correlation of MMP-9 with CAD with sensitivity of 95.45%, suggesting its role as a biomarker in CAD patients. Further studies in larger population - preferably multicenter setting - are warranted to explore the functional role of this marker in coronary artery disease.

Association between serum cytokine concentrations and the presence of hypertriglyceridemia.

OBJECTIVE: Hypertriglyceridemia is an established risk factor for coronary-heart-disease. Inflammatory cytokines are known to be important mediators of atherogenesis; however, the relationship between the concentrations of specific inflammatory cytokines and the presence of hypertriglyceridemia has not been well established. The purpose of this study was to investigate the relationship between the serum levels of several pro- and anti-inflammatory cytokines and the presence of hypertriglyceridemia. DESIGN AND METHODS: Four hundred and eighty-four subjects with/without established hypertriglyceridemia were recruited. Anthropometric parameters and biochemical analysis (including a full fasting lipid profile) were determined. The serum levels of several cytokines and growth factors including IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, MCP-1, IFN-γ, EGF, and VEGF were measured followed by univariate and multivariate analyses. RESULTS: Individuals with hypertriglyceridemia had a significantly higher body mass index, total-cholesterol and triglyceride, compared to the group without hypertriglyceridemia. Serum levels of MCP-1, TNF-α and IL-8 were significantly higher in subjects with hypertriglyceridemia [e.g., IL-8 from 7.8ng/L (95% CI: 4.6-18.9) versus 5.7ng/L (95% CI: 3.6-11.9), P<0.05]. The multivariate analysis showed that the increased serum concentration of TNF-α was independently associated with high-density lipoprotein cholesterol (HDL-C), while the serum levels of IL-8 and MCP-1 were associated with hypertriglyceridemia. CONCLUSION: Subjects with serum triglycerides of ≥2.25mmol/L had an altered cytokine-profile, particularly with respect to serum IL-8, MCP-1 and TNF-α, which might partially account for its adverse clinical-consequences. Further-investigations in a large multi-center setting are warranted to unravel the potential functional-importance of these cytokines in individuals with hypertriglyceridemia.

Relationship between serum cytokine and growth factor concentrations and coronary artery disease.

BACKGROUND: We have assessed the association between serum concentrations of 12 cytokines/growth factors and angiographically-defined coronary artery disease, comparing the concentrations in four groups (one control group and three case groups). METHODS: We studied a total of 426 subjects including; 98 control subjects and 3 case groups. The patient groups consisted of: coronary artery bypass graft (CABG) candidates (n=48) and patients undergoing coronary angiography, with, or without obstructive coronary artery disease. Twelve cytokines (IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, MCP-1, IFN-γ, EGF, and VEGF) were measured using a sandwich chemi-luminescence assays, on the Evidence Investigator® system. RESULTS: The four groups were well matched for demographic and clinical characteristics, except waist circumference, fasting blood glucose (FBG), total and LDL cholesterol and diastolic blood pressure that were significantly higher in case groups compared to the control group (P<0.05 for all). There were significant differences between control group and the other three groups regarding the measured cytokines, such as IL-1α, IL-8, MCP-1, and VEGF (P<0.01). Furthermore, IL-4, IL-6 and EGF were also significantly different between the control, obstructive coronary disease and CABG candidate groups (P<0.01). Analysis of the ROC curve showed 92.1% sensitivity, 99.2% specificity and 100% positive predictive value (PPV) for VEGF in its ability to distinguish the CABG group at the cut-off point of 37.18 pg/ml. CONCLUSION: The results of this study suggest that cytokines such as IL-1α, IL-4, IL-8, IL-10 and VEGF may play major roles in pathogenesis of CAD.

Serum inflammatory cytokines and depression in coronary artery disease.

BACKGROUND: Severe depression may be accompanied by immune dysregulation and is also associated with increased risk of coronary artery disease (CAD). OBJECTIVES: We investigated serum levels of 10 cytokines and their relationship with depression in patients with cardiovascular diseases as well as healthy subjects in northeast of Iran. PATIENTS AND METHODS: The study was carried out on 462 subjects (120 healthy subjects and 342 candidates undergoing angiography). The healthy subjects were referred for routine annual checkups or pre-employment examinations; they did not have clinically evident CAD. A questionnaire was used to obtain demographic data and the Beck depression inventory (BDI) was applied to assess depression. The Evidence Investigator(®) platform was used for cytokines assays for IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, MCP-1 and IFN-γ, using sandwich chemiluminescent method. The statistical analysis was performed using SPSS version 11.5. RESULTS: The mean age was 53.3 ± 11.5, 54.8 ± 11.3, and 59.5 ± 11.3 in healthy, angiography (-), and angiography (+) subjects, respectively (P < 0.05). There were significant differences in serum levels of IL-4, IL-6, IL-10, and MCP-1 cytokines, comparing subjects with CAD and healthy persons (P < 0.05). When all subjects were divided to with and without depression regardless of their cardiovascular status, there was a significant difference in serum levels of IL-8 and IL-6 between the groups (P < 0.05). When the subgroup with features of CAD was selected and divided to those with and without depression, there was also a significant difference in serum levels of IL-8 and TNF-α (P < 0.05). CONCLUSIONS: The positive interaction between depression and CAD was probably mediated by inflammatory mechanisms.

Association of heat shock protein70-2 (HSP70-2) gene polymorphism with coronary artery disease in an Iranian population.

BACKGROUND: Coronary artery disease (CAD) is an inflammatory process and a major cause of mortality and morbidity. The (heat shock protein70-2) HSP70-2 gene is reported to be associated with coronary artery disease possibly by affecting the regulation of pro-inflammatory cytokines such as TNF-α. The association between CAD and the HSP70-2 gene +1267A>G polymorphism has been studied in some populations but there are no data about this association in the Iranian population. AIM: We have investigated the association between the HSP70-2 gene +1267A>G polymorphism and angiographically defined CAD within an Iranian population. METHODS: We determined the presence of the HSP70-2 gene +1267A>G polymorphism in 628 patients with CAD and 307 healthy individuals using PCR-RFLP. Of the patients, 433 (68%) had >50% stenosis (CAD+) and the remaining 195 patients had <50% stenosis (CAD-), based on coronary angiography. Angiogram positive patients were subdivided into three groups: those with single (n=113), double (n=134), and triple vessels (n=186) disease. RESULTS: A significant higher frequency of AG+GG genotypes (G allele carriers) was observed in angiogram positive and angiogram negative groups compared to controls in a dominant analysis model of the HSP70-2 gene +1267A>G position (51.2 vs. 43.2, P=0.002, OR=1.37) (51.0 vs. 43.2, P=0.01, OR=1.37). The allele frequency of the HSP70-2 G was also significantly higher in angiogram positive and angiogram negative groups compared to the control group (51.2 vs. 43.2, P=0.002, OR=1.37) (51.0 vs. 43.2, P=0.01, OR=1.37). CONCLUSION: These results suggest that HSP70-2 +1267 polymorphism may influence the risk of CAD in Iranian population, however further studies are needed to clarify the role of other HSP70-2 gene polymorphisms in the pathogenesis of the CAD.

Anxiety, depression, coronary artery disease and diabetes mellitus; an association study in ghaem hospital, iran.

BACKGROUND: There is an increasing trend in the prevalence of coronary artery disease (CAD) in Iran. OBJECTIVES: The present study aimed to investigate the relationship of anxiety, depression, diabetes and coronary artery disease among patients undergoing angiography in Ghaem Hospital, Mashhad, Iran. PATIENTS AND METHODS: This case-control study was conducted between September 2011 and August 2012 among 200 patients undergoing coronary angiography for symptoms of coronary disease at Ghaem Hospital, Mashhad, Iran. The control group consisted of 697 healthy adults recruited from the individuals who attended the clinic for routine medical checkups or pre-employment examinations. The Beck anxiety and depression inventory scores and fasting blood glucose results were assessed in all the subjects. Data were analyzed using SPSS version 16. P < 0.05 was regarded as statistically significant. RESULTS: The mean age of patients was 57.52 ± 9.33 years old and for the control group it was 55.35 ± 8.45 years; there was no significant difference between the subjects (P = 0.647) regarding age. There was also no significant difference in gender distribution between the patients and control groups (P = 0.205). There was however a significant difference in anxiety and depression scores between the patients and healthy controls (P < 0.001). There was a significant positive correlation between anxiety score and depression score in both groups when data were analyzed by Pearson test. (P < 0.001, r = 0.604 and r = 0.521). Moreover, there was a significant positive linear correlation between the depression/anxiety scores and fasting blood glucose concentrations in the patients group (r = 0.3, P < 0.001) and a weak negative correlation in the healthy controls (r = -0.096, P < 0.05). CONCLUSIONS: Depression and anxiety are potentially important factors among patients with angiographically-defined CAD. There appear to be significant associations between glucose tolerance and anxiety and depression in these patients.