The interaction between a HSP-70 gene variant with dietary calories in determining serum markers of inflammation and cardiovascular risk

Background: The high prevalence of cardiovascular disease (CVD) globally is attributable to an interaction between environmental and genetic factors. Gene × diet interaction studies aim to explore how a modifiable factor interacts with genetic predispositions. Here we have explored the interaction of a heat shock protein (HSP70) gene polymorphism (+1267A>G) with dietary intake and their possible association with serum C-reactive protein (CRP), an inflammatory marker, that is a major component of CVD risk. Methods: HSP70 genotype was determined using a TaqMan real time PCR based method. Genetic variation of the HSP70 gene +1267A>G locus. Dietary intake was assessed using a dietary questionnaire. Serum high sensitivity (Hs) CRP and other cardiovascular risk factors were assessed by routine methods. This included coronary angioplasty to determine the presence of coronary artery stenosis. Results: There were significant differences between serum lipid profile and Hs-CRP across the genotypes for Hsp70. The carriers of G allele had higher serum hs-CRP concentrations, compared with the AA homozygotes, with the wild genotype. Interaction analysis showed the association was modulated by total energy intake; the interaction of high energy intake with GG genotype: RERI= 0.77, AP= 0.26, S=1.6. Conclusion: We have found a significant association between the +1267A>G variant of the HSP70 gene with cardiovascular risk factors and serum hs-CRP concentrations. It is possible that a low energy diet could ameliorate the unfavorable effects of G allele of HSP70

Factors Associated with The Incidence of Coronary Heart Disease in The Mashad: A Cohort Study

Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally, and specifically in Iran. Accurate assessments of Coronary heart disease (CHD) incidence is very necessary for public health. In current study we aimed to investigate the incidence of CHD and importance of several classical, modifiable and un-modifiable risk factors for CHD among an urban population in eastern Iran after 6 years of follow-up. Methods The population of MASHAD cohort study were followed up for 6 years, every 3 years in two step by phone and who reported symptoms of CVD were asked to attend for a cardiac examination, to estimate the incidence of CHD with 95% confidence interval (95% CI) as well multiple logistic regression analysis was performed to assess the association of several baseline characteristics with incidence of CHD event. Evaluation of goodness-of-fit was done using ROC analysis. CHD cases divided into four different classes which include: stable angina, unstable angina pectoris, myocardial infarction and sudden cardiac death. Results In the six years\u27 follow-up of Mashhad study, the incidence rate of all CHD event in men and women in 100,000 people-years with 95% confidence intervals were 1920 (810-3030) and 1160 (730-1590), respectively. The areas under ROC curve (AUC), based on multivariate predictors of CHD outcome, was 0.7825. Conclusion Our findings indicated that the incidence rate of coronary heart diseases in MASHAD cohort study increases with age as well as our final model designed, was able to predict approximately 78% of CHD events in Iranian population

A genetic variant in proline and serine rich coiled-coil 1 gene is associated with the risk of cardiovascular disease

Background: Cardiovascular disease is one of the most common causes of morbidity and mortality worldwide. The Proline and Serine Rich Coiled-Coil 1 gene in 1p13.3 locus has been reported to be associated with low density lipoprotein cholesterol (LDL-C) and coronary artery disease (CAD). The objective of this study was to investigate the association between the rs599839 polymorphism of the Proline and Serine Rich Coiled-Coil 1 (PSRC1) gene with CVD outcomes in a population sample recruited as part of the Mashhad-Stroke and Heart-Atherosclerotic-Disorders (MASHAD) cohort. Methods: Five hundred and nine individuals who had an average follow-up period of 10 years were enrolled as part of the MASHAD cohort. DNA was extracted and genotyped using the TaqMan-real-time-PCR based method. Results: The study found individuals with GA/GG genotypes were at a higher risk of CVDs (OR= 4.7; 95% CI, 2.5-8.7; p< 0.001) in comparison to those with AA genotype; however, the result was not significant for GG genotype data. Conclusions: The results suggest that the GA/GG genotypes of the PSRC1gene locus were at increased risk of CVD in a representative population-based cohort, demonstrating further functional analysis to discover the value of emerging marker as a risk stratification biomarker to recognize high risk cases

Relationship between platelet count and platelet width distribution and serum uric acid 1 concentrations in patients with untreated essential hypertension

Hematological parameters have emerged as independent determinants of high serum concentrations of uric-acid and predictive-factors in the evaluation of the total cardiovascular-risk in patients with essential-hypertensive. Here we have investigated the possible relationships between hematological-factors and serum uric-acid levels in hypertensive-patients recruited as part of Mashhad-Stroke and Heart-Atherosclerotic-Disorders cohort study. Two-thousand three-hundred and thirty four hypertensive individuals were recruited from this cohort and these were divided into two groups; those with either high or low serum uric acid concentrations. Demographic, biochemical and hematological characteristics of population were evaluated in all the subjects. Logistic-regression-analysis was performed to determine the association of hematological-parameters with hypertension. Of the 2334 hypertensive-subjects, 290 cases had low uric-acid, and 2044 had high serum uric acid concentrations. Compared with the low uric acid group, the patients with high serum uric acid, had higher values for several hematological parameters, whilst platelet counts (PLT) were lower. Multiple linear regression analysis showed that PLT and serum hs-CRP were correlated with serum uric acid level. Stepwise multiple logistic regression model confirmed that PDW and gender were independent determinant of a high serum uric acid. PDW and PLT appear to be independently associated with serum uric acid level in patients with hypertension

The Improvement of the Atrial Flutter Rhythm upon the Removal of the Infected Permanent Pacemaker Lead

Pacemaker infection has multiple risk factors. Its presentation is most often similar to infected endocarditis and the diagnosis is made through studying blood cultures. Transesophageal echocardiography can confirm the diagnosis. The most common microorganisms are staphylococcus speciesis. As a matter of fact, complete pacemaker removal appears to be the only definite treatment. We presented a case of infected pacemaker lead which was firstly referred with fever and nephritic syndrome. She had intermittent atrial flutterrhythm. Therefore, a total infected pacemaker system was removed under cardiopulmonary bypass support. Yet, the lead was firmly attached to the septal leaflet of tricuspid valve while leaflet repair was needed. As a result, atrial flutter rhythm was converted into sinus rhythm after an incidental interruption of the macroreentrant circuit in the process of the tricuspid leaflet surgery

The Effect of a Clinical Decision Support System on Improving Adherence to Guideline in the Treatment of Atrial Fibrillation: An Interrupted Time Series Study

To evaluate the effect of a computerized Decision Support System (CDSS) on improving adherence to an anticoagulation guideline for the treatment of atrial fibrillation (AF). This study had an interrupted time series design. The adherence to the guideline was assessed at fortnightly (two weeks) intervals from January 2016 to January 2017, 6 months before and 6 months after intervention. Newly diagnosed patients with AF were included in the offices of ten cardiologists. Stroke and major bleeding risks were calculated by the CDSS which was implemented via a mobile application. Treatment recommendations based on the guideline were shown to cardiologists. The segmented regression model was used to evaluate the effect of CDSS on level and trend of guideline adherence for the treatment of AF. In our analysis, 373 patients were included. The trend of adherence to the anticoagulation guideline for the treatment of AF was stable in the pre-intervention phase. After the CDSS intervention, mean of the adherence to the guideline significantly increased from 48% to 65.5% (P-value  < 0.0001). The trend of adherence to the guideline was stable in the post-intervention phase. Our results showed that the CDSS can improve adherence to the anticoagulation guideline for the treatment of AF. Registration ID: IRCT2016052528070N

Safety and Efficacy of Fingolimod in Iranian Patients with Relapsing-remitting Multiple Sclerosis

Introduction: Fingolimod is the first confirmed oral immune-modulator to treat Relapsing-Remitting Multiple Sclerosis (RRMS). This study aimed to investigate the safety and efficacy of fingolimod therapy in Iranian patients with RRMS. Methods: In our trial, 50 patients resistant to conventional interferon therapy were assigned to receive fingolimod 0.5 mg per day for 12 months. The number of Dadolinium (Gd)-enhanced lesions, enlarged T2 lesions, and relapses over 12 months were considered as endpoints and compared to baseline. Liver biochemical evaluations and lymphocyte count were done at baseline and in months 3, 6, and 12 of the study. Patients were also monitored for possible cardiovascular events within the first 24 h and other side effects routinely. Results: Among the patients who completed the trial, the number of Gd-enhanced and enlarged T2 lesions over 12 months significantly decreased (P=0.03 and P<0.001, respectively). The proportion of relapse-free patients was higher compared to the onset of fingolimod administration. There were no significant alterations in the Expanded Disability Status Scale (EDSS) scores. A slight, transient increase was recorded in liver enzymes among the participants. Lymphocyte count reduced by 61% at month 1 and displayed a gradual increase until month 12. No bradycardia and macular edema were recorded. Conclusion: These findings indicate an effective first-line fingolimod therapy for the first time in Iranian patients with RRMS. The decrease in the number of new attacks and the amelioration of MRI lesions were the benefits of fingolimod therapy, suggesting that it is preferred to other medicines to treat RRMS in Iran

Factors influencing the status of appropriate and inappropriate shocks delivered by an implantable cardioverter defibrillator

Background and Aim: The QRS duration is a strong predictor of mortality, particularly in heart failure patients. However, studies on the usefulness of QRS duration, as a predictor of ventricular arrhythmic events in ICD patients, have proved to be contradictory. Since in patients with implantable cardioverter defibrillator (ICD), all of the malignant ventricular arrhythmias are recorded and treated with appropriate shock (i.e. appropriate shock and inappropriate shock), in the present study the relationship between the QRS duration and status of appropriate or inappropriate ICD shocks was evaluated. Materials and Methods: In this cross-sectional study 65 patients with implanted cardioverter defibrillator were included to prevent their undue death. Before the implantation, QRS duration in the surface ECG was measured and recorded. Furthermore, variables such as age, gender, indication for ICD implantation, family history of sudden cardiac death, and QTc interval before ICD implantation were recorded. During follow-up visits of the patients, ICDs were interrogated and appropriate and inappropriate therapies were traced. Finally logistic regression in SPSS statistical software (V: 11.5) was used for data analysis.  Results: Mean age of the patients was 17.208±47.92 years. Eighteen patients (27.7%) were females and 58 (89.2%) had a family history of sudden cardiac death. Mean QRS duration and QTc interval were 36.78 ± 117.94 msec and 62.42±466.97 msec, respectively. There was no statistically significant relationship between QRS duration and status of appropriate and inappropriate ICD shocks. Among the studied parameters, there was only a significant relationship between status of appropriate or inappropriate ICD shocks and the different manufacturers of ICD devices.  Conclusion: QRS duration does not have a significant relationship with status of appropriate and inappropriate ICD shocks. This may not predict arrhythmic events in ICD patients

The association between a variant of the cyclin-dependent kinase inhibitor 2A/B gene and risk of cardiovascular disease

Background Cardiovascular disease (CVD) is the most common cause of morbidity and mortality globally. Despite progress being made in the diagnosis and treatment of CVDs, one third of deaths are due to CVDs. We have investigated the association between the rs1333049 polymorphism of the cyclin-dependent kinase inhibitor 2A/B (CDKN2A/B) gene with CVD outcomes in a population sample recruited as part of the Mashhad-Stroke and Heart-Atherosclerotic-Disorders (MASHAD) cohort. Methods and results Five hundred and nine individuals who had a median follow-up period of 10 years were recruited as part of the MASHAD cohort. Anthropometric, and biochemical parameters were assessed followed by genotyping using TaqMan-real-time-PCR based method. Our data showed that carriers of the GG genotype were significantly more likely to develop CVD, compared to those with a CC or CG genotypes (OR: 4.77, 95%CI: 2.62–8.68, p = 0.001). Similar result we also found in second population which were follow up for 10 years. In particular cases who had an event in recessive genetic model (CC vs CG + GG) had a higher risk of developing CVD (OR: 5.57, 95%CI: 2.80–11.06, p = 0.001). Conclusion We have found that carriers of the GG genotype of the CDKN2A/B gene locus were at increased risk of CVD in a representative population-based cohort, indicating further functional analysis to explore the value of emerging marker as a risk stratification biomarker to identify high risk cases

Depression and anxiety both associate with serum level of hs-CRP: a gender- stratified analysis in a population-based study

Background: Depression and anxiety are two important mood disorders that are frequently associated with chronic diseases such as cardiovascular diseases (CVDs). Hyper-inflammation is related to both CVDs and psychological conditions such as depression and anxiety. Therefore, inflammation may partially explain the relationship between depression and cardiovascular disease. Objective: The objective of this study was to perform a gender-stratified examination of the association between symptoms of depression/anxiety disorders and serum hs-CRP and inflammation linked conditions in a large Iranian population. Methods: Symptoms of depression and anxiety disorders and serum hs-CRP levels were measured in 9759 participants (40% males and 60% females) aged 35–65 years, enrolled in a population-based cohort (MASHAD) study in north-eastern Iran. Symptoms of depression and anxiety were evaluated with Beck Depression and Anxiety Inventories. According to the scores of depression and anxiety, individuals were categorized into four groups of no or minimal, low, moderate and severe categories. Results: The median serum hs-CRP concentration increased with increasing severity of depression and anxiety disorders. Male participants with severe depression had significantly higher levels of hs-CRP (p < 0.001); however, this relationship was less marked among women (p = 0.04). Subjects with severe anxiety also had significantly higher levels of hs-CRP (p < 0.001). Moreover, women with severe depression and anxiety had higher BMI. There was also a positive association between current smoking habit and depression/anxiety disorders. Conclusion: Depression and anxiety disorders are associated with elevated levels of hs-CRP, particularly among men. Also, there is a significant positive association between depression/anxiety disorders and inflammation linked conditions such as smoking and obesity; however, in the case of obesity this association is only present in women