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Abstract Background Emergency percutaneous coronary intervention (PCI) is a common treatment for ST-elevated myocardial infarction (STEMI) patients. However, the coronary slow flow/no reflow phenomenon (CSF/NRP) can occur as a complication during or after the procedure. Identifying predictors of CSF/NRP after emergency PCI in STEMI patients can help clinicians anticipate and prevent this complication. In this study, we aimed to investigate clinical, laboratory, and procedural factors that may contribute to the development of CSF/NRP in STEMI patients undergoing PCI. Results A total of 460 patients were included in this study, with a mean (± SD) age of 60 ± 12.5 years. The incidence of CSF/NRP was 30.2% (n = 139) among the study population. The univariate analysis showed that older age, lower left ventricular ejection fraction (LVEF), initial thrombolysis in myocardial infarction (TIMI)flow grade 0–2, increased creatinine level, lower estimated glomerular filtration rate (eGFR), diffuse target lesion length, and longer length of stent were significantly associated with the occurrence of CSF/NRP (p

Abstract Background Cardiac rehabilitation (CR) is crucial for addressing cardiovascular diseases globally, with a specific emphasis on gender differences. Despite its demonstrated benefits for women, there's limited acceptance globally, especially in low- and middle-income countries. The program aims to optimize risk factors and improve overall patient well-being. Methods A cohort study was performed on those who were candidates for CR programs during 2001–2019. Assessments were performed within one week before and one week after the 8-week CR program. Age, sex, smoking status, clinical data, resting systolic and diastolic blood pressure (SBP and DBP, respectively), echocardiography and laboratory data were obtained. Functional capacity was evaluated using the international physical activity questionnaire, and a treadmill exercise test. Anxiety, depression, general quality of life (QoL), and health-related QoL were selected for psychological status. Then statistical analysis was performed on data. Result In this study, the number of male patients was 1526 (73.69%). The average age of patients in the female group was higher than that of males (58.66 ± 9.08 vs. 56.18 ± 9.94), according to the crude model results, the changes in emotional, social and physical scores were significant (P-value:0.028, 0.018, 0.030), as well as the differences in Mets and smoking were significant (P-value for both

Abstract Background Previous studies have suggested a significant association between diet quality and mental health. However, a limited number of studies have utilized the Prime Diet Quality Score (PDQS) to examine this association. Additionally, no study has yet compared the PDQS and Healthy Eating Index-2015 (HEI-2015) in terms of their association with depression and anxiety. Aim This cross-sectional study aimed to investigate the association between diet quality, measured by the PDQS and HEI-2015, and the odds of depression and anxiety in adults. Methods This study utilized data from the LIPOKAP study, which was conducted between February 2018 and July 2019 in five cities in Iran. We included 1994 adults aged 18 and above who were selected through a multistage cluster sampling method. Participants completed a validated semiquantitative food frequency questionnaire (FFQ) to evaluate their dietary intake. The FFQ was used to calculate the PDQS and HEI-2015. Depression and anxiety levels were determined using the Hospital Anxiety and Depression Scale (HADS). Results The participants had a mean age of 39.79 ± 13.87 years, with females accounting for 1,041 (52.2%) of the total population. PDQS showed a significant inverse association with the odds of depression (OR = 0.45, 95% CI: 0.28–0.71) and anxiety (OR = 0.40, 95% CI: 0.25–0.62) in the fully adjusted model. Similarly, the highest quartile of HEI-2015 showed a significantly lower odds of depression (OR = 0.60, 95% CI: 0.40–0.90) and anxiety (OR = 0.62, 95% CI: 0.42–0.92) compared to the lowest quartile. Conclusion Both PDQS and HEI-2015 were associated with a reduced risk of depression and anxiety. However, the PDQS demonstrated a stronger inverse association with these risks compared to the HEI-2015. This suggests that the PDQS could be a more beneficial dietary pattern for preventing depression and anxiety compared to HEI-2015. Further large-scale studies are required to confirm these findings.

Background: The risk of coronary artery disease in people with high serum cholesterol is more than twice as high as in those with moderate serum cholesterol. Natural medicines, especially herbs, have been the focus of attention for many years because of the desirable and minimal side effects for controlling blood lipids. Purpose: The present study aims to investigate the effect of fenugreek hydrolyzed protein (FHP) on lipid profile in patients with mild-to-moderate hypercholesterolemia. Methods: This study is a confirmatory, triple-blind, two-group parallel, randomized controlled trial, phase 3 conducted on patients aged 18–65 years with mild-to-moderate hypercholesterolemia and low risk for cardiovascular disease. Patients were recruited from a private clinic from May 2021 to June 2021. Sixty patients were randomized with a 1:1 allocation ratio into the FHP group (N = 30) and the placebo group (N = 30). The intervention group was administrated 40 mg/day of FHP for 8 weeks. Patients were examined at baseline and 8 weeks after randomization. The primary outcome was the patient's lipid profile including total cholesterol (TC), high-density lipoprotein (HDL-c), low-density lipoprotein (LDL-c), triglyceride (TG), and non-HDL-c. All participants, caregivers, outcome assessors, and analyzers were blind to the type of intervention. Results: In the intervention group, lipid profile improved through a significant reduction in TC (P < 0.001), LDL-c (P = 0.043), and non-HDL-c (P < 0.001), but no significant changes were observed in the TG level. The mean difference of these variables was -10.07 mg/dl [95 %CI:30.84; 10.70], -8.93 mg/dl [95 %CI:27.07; 9.21], and -10.37 mg/dl [95 %CI:32.26; 11.52] for TC, LDL-c, and non-HDL-c, respectively. FHP successfully decreased LDL-c level by 7 %. There was no significant change in any component of the lipid profile in the comparison group. FHP was well tolerated with only 1 patient experiencing gastrointestinal adverse manifestations. Conclusion: These findings suggest that FHP administration can improve the lipid profile of patients with mild-to-moderate hypercholesterolemia. Considering the low adverse effects of FHP and patients' high tolerance, it can be considered in the management of these patients, who fall into the low-risk cardiovascular disease category, adjuvant to the main therapies. Registration code: IRCT20210125050 142N1

ABSTRACT Objective We examined the accuracy of novel anthropometric indices in predicting the progression of prediabetes to diabetes. Subjects and methods This study was performed on the pre-diabetic sub-population from Isfahan Cohort Study (ICS). Participants were followed up from 2001 to 2013. During every 5-year follow-up survey, patients’ data regarding the incidence and time of incidence of diabetes were recorded. We evaluated the association between the risk of developing diabetes and novel anthropometric indices including: visceral adiposity index (VAI), lipid accumulation products (LAP), deep abdominal adipose tissue (DAAT), abdominal volume index (AVI), A body shape index (ABSI), body roundness index (BRI) and weight-adjusted waist index (WWI). We categorized the indices into two groups according to the median value of each index in the population. We used Cox regression analysis to obtain hazard ratios (HR) using the first group as the reference category and used receiver operating characteristics (ROC) curve analysis for comparing the predictive performance of the indices. Results From 215 included subjects, 79 developed diabetes during the 13-year follow-up. AVI, LAP, BRI, and VAI indicated statistically significant HR in crude and adjusted regression models. LAP had the greatest association with the development of diabetes HR = 2.18 (1.36-3.50) in multivariable analysis. ROC curve analysis indicated that LAP has the greatest predictive performance among indices (area under the curve = 0.627). Conclusion Regardless of baseline confounding variables, prediabetic patients with a higher LAP index may be at significantly higher risk for developing diabetes.

Abstract Background The triglyceride glucose (TyG) index is a new and low-cost marker to determine insulin resistant which may be a predictor of cardiovascular disease (CVD). Although available evidence showed that its association with CVD mortality (CVM) and all-cause mortality (ACM) may differ in different populations, scarce data are available in this regard specially in low and middle-income countries. Purpose To examine the association between TyG index and risk of CVM and ACM in Iranians. Methods This prospective cohort study included 5432 adults (age ≥ 35 years) with no history of CVD events. Fasting glucose and triglyceride were measured at baseline in all participants and TyG index was calculated. Cox frailty model was used to calculate hazard ratios (HRs) for CVM and ACM across the tertiles of TyG index. Results After a median follow-up of 11.25 years, a total number of 191 cardiovascular deaths, and 487 all-cause mortality was recorded. The risk of both CVM and ACM increased across the tertiles of TyG index. In the adjusted model for lifestyle and metabolic variables, the risks of ACM and CVM increased by 41% (95% CI 1.11, 1.81; P for trend = 0.005) and 64% (95% CI 1.07, 2.50; P for trend = 0.024), respectively. However, adjustment for diabetes mellitus disappeared the significance for both ACM and CVM. These associations may vary by sex. TyG was not related to the risk of non-CVD mortality. Conclusion The predicting value of TyG index for ACM and CVM might be mediated by diabetes status. Further studies are required to confirm these findings.

Abstract Background There is limited evidence regarding the evaluation of the association between the triglyceride glucose (TyG) index, an indicator of insulin resistance, and the incident risk of cardiovascular disease (CVD). Therefore, we aimed to examine the relationship between the TyG index and CVD incidence in a cohort of Iranian adults. Methods This study was performed in the framework of the Isfahan Cohort Study (ICS). The study population included 5,432 individuals aged ≥ 35 years. CVD events, including acute myocardial infarction (MI), stroke, and unstable angina (UA), were diagnosed by physicians. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. The relationship between the TyG index and CVD events was investigated using Cox regression models. Receiver operating characteristics (ROC) curve analysis was used to determine the best cut-off for the TyG index for predicting CVD outcomes. Results During a median follow-up period of 11.2 years, a total number of 819 CVD, 164 MI, 172 stroke, and 384 UA were recorded. Following adjustment for multiple confounders, elevated TyG levels were associated with a higher risk of CVD (HR = 1.48; 95% CI 1.22–1.79; p

Abstract Background considering the diet, as a whole (dietary patterns), can provide more information regarding dietary guidelines to decrease health problems and improve quality of life (QoL) of industrial workers.Therefore, the aims of this study were to identify major dietary patterns and to evaluate their association with quality of life among Iranian industrial employees. Methods This cross-sectional study was conducted on 3,063 employees of Isfahan Steel Company, Isfahan, Iran, in 2015. Dietary data were evaluated through a validated form of a food frequency questionnaire. Exploratory factor analysis was used to extract major dietary patterns,. To assess the QoL, Euro-QoL five- dimension questionnaire was used. Latent class analysis was used to classify participants based on QoL. Multivariable logistic regression was employed to evaluate the association between dietary patterns and QoL. Results Three dietary patterns, i.e. western, healthy and traditional, and two classes, i.e. high and low quality of life. were identified from study participants. Lower adherence to the healthy dietary pattern increased the risk of being in low QoL class in which subjects in the lowest tertile of healthy dietary intake had higher odds of being in low QoL class (adjusted OR (AOR): 1.51, 95% CI: 1.19–1.91). However, subjects in the lowest tertile of traditional diet, low adherence, had 30% lower risk of belonging to the low QoL class (AOR:0.70, 95% CI: 0.55–0.88). Higher adherence to western dietary pattern increased the risk of low quality of life, but it was not statistically significant. Conclusion Higher adherence to a healthy diet and lower adherence to traditional dietary pattern were associated with better QoL in manufacturing employees.

INTRODUCTION: The collected information includes demographic profile, medical history, physical examination, patient risk factors, anthropometric evaluation, medications, echocardiographic results, and exercise testing of all patients who participated in the outpatient cardiac rehabilitation program in Cardiac Rehabilitation Department since 1996 until now. Each patient was assigned an electronic code by which the patient's information could be identified. Subsequently, standard questionnaires were used, such as International physical activity questionnaire (IPAQ) to assess physical activity, MAC NEW to assess the quality of life, Spielberg to measure anxiety, Beck to assess depression, and nutritional questionnaires.RESULTS: The findings were recorded, and the data were analyzed by the web and SPSS software. For all patients, the forms were filled based on a number of variables including backgrounds, registration components, type of referral, diagnosis of underlying heart disease, methods of data collection and entry, details of the educational program, return to work, psychiatric condition, drug regimen, clinical condition, echocardiography findings, functional capacity and exercise test response, smoking status, nutritional habits, and finally their 5-year follow-up for events and re-hospitalization.CONCLUSION: It is necessary for the authors to establish a cardiac rehabilitation registration that can properly display care quality indicators and collect and report standard data from different nations to improve the quality of cardiac rehabilitation services and identify weaknesses.

Abstract To investigate the longitudinal association of different phenotypes of diabetes and obesity with the incidence of cardiovascular disease (CVD), CVD- and all-cause mortality. A total of 5432 adults, aged ≥ 35 years and free of CVD were included in this cohort study. Diabesity phenotypes were defined in six categories based on the presence of diabetes (normal (NG), prediabetes and diabetes) and obesity (obese, non-obese). Fasting blood sugar, 2-h post prandial glucose, or using anti-diabetic medicines were used to define diabetes, and body mass index and waist circumference were used to define obesity. Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident CVD, CVD- and all-cause mortality across these categories. After a median follow-up of 11.25 years, 819 CVD cases, 181 CVD deaths and 488 all-cause deaths occurred. In multivariable-adjusted models and irrespective of obesity definition, the phenotypes of normal glucose-obese, prediabetes-obese and pre-diabetes-non obese were not associated with CVD incidence in comparison with NG-non obese phenotype, however, the phenotypes of diabesity, either defined by general or abdominal obesity, were associated with increased risk of incident CVD events (HR = 1.42, 95% CI 1.01, 1.99, and HR = 1.46, 95% CI 1.07, 1.98, respectively). These findings were sex-specific and only in men with a phenotype of abdominal obesity-diabetes, a positive link was observed for CVD incidence (HR = 1.60, 95% CI 1.01, 2.52). No significant association was found between diabesity and death from CVD or all causes. Diabesity is a predictor of CVD and stroke incidence, but not CVD or all-cause mortality, among Iranians. This association is more pronounced amongst men than women.

مقدمه: سندرم فیبرومیالژیا (FMS) یک اختلال درد مزمن اسکلتی-عضلانی است. اگرچه درمان­های زیادی برای فیبرومیالژیا در دسترس است، مدیریت آن همچنان یک چالش است. شواهد اخیر نشان می­دهد که ویژگی­های شخصیتی ممکن است بر فیبرومیالژیا تأثیر بگذارد.روش‌ کار: بر اساس دستورالعمل‌های PRISMA، این مرور سیستماتیک و متاآنالیز به بررسی آسیب اجتنابی و خودراهبری در بیماران فیبرومیالژیا با استفاده از مدل شخصیتی کلونینگر پرداخت. متاآنالیز شامل 14 مطالعه برای ارزیابی اجتناب از آسیب و 11 مطالعه ارزیابی خودراهبری در بیماران مبتلا به فیبرومیالژیا در مقایسه با افراد سالم بود. داده­های گزارش شده از مطالعات اولیه در یک مدل اثرات تصادفی با استفاده از رویکرد هجز ادغام شدند.نتایج: بیماران مبتلا به فیبرومیالژیا در مقایسه با افراد سالم، اجتناب از آسیب بالا (Hedges' g = 1.31؛ 95% CI: 0.97 تا 1.65) و خودراهبری پایین (Hedges' g = 0.71؛ 95% CI: -1.00 تا -0.42) را در مقایسه با افراد سالم نشان دادند. علاوه بر این، نتایج نشان داد که اجتناب از آسیب بالا به طور قابل توجهی با افزایش خطر FMS مرتبط است، اگرچه خودهدایتی بالا، نقش محافظتی در برابر آن ایفا می­کند.نتیجه­گیری: نتایج نشان داد که آسیب اجتنابی بالا و خودراهبری پایین، از ویژگی­های شخصیتی متمایز بیماران مبتلا به فیبرومیالژیا هستند. شناسایی و ارزیابی زودهنگام آسیب اجتنابی بالا و خودراهبری پایین، ممکن است به مفهوم­سازی مکانیسمهای پیچیده زمینه­ای فیبرومیالژیا کمک کند. علاوه بر این، می‌تواند بیماران مستعد به ورود در یک چرخه معیوب ناتوانی و درد را شناسایی کند. تحقیقات بیشتری برای درک بهتر نقش ویژگی­های شخصیتی مورد نیاز است.

Abstract Background /Aims: Visceral adiposity index (VAI) and lipid accumulation product (LAP) are novel anthropometric indices that have shown an association with metabolic syndrome; however, limited data are available regarding the predictive performance of these indices for the incidence of cardiovascular diseases (CVD) and mortality. Methods This study was performed on the data retrieved from Isfahan Cohort Study (ICS). ICS is an ongoing population‐based cohort study conducted in 3 counties in central Iran. Pearson correlation analysis was performed between LAP, VAI, and metabolic parameters. Cox regression analysis and receiver operative characteristics (ROC) curve analysis were performed in order to evaluate the ability of VAI and LAP for the incidence of CVD, CVD‐associated mortality, and all‐cause mortality. We further compared the predictive performance of VAI and LAP with body mass index (BMI). Results LAP and VAI were significantly correlated with all metabolic variables, including blood pressure, fasting blood glucose, and lipid profile components. Univariate regression analysis indicated a significant association between LAP and VAI and CVD incidence. In multivariate analysis, only VAI was significantly associated with CVD incidence. Regarding CVD mortality, only VAI in the multivariate analysis revealed a significant association. Interestingly, Both VAI and LAP were negatively associated with all‐cause mortality. ROC curve analysis indicated the superior performance of LAP and VAI for predicting CVD incidence compared to BMI; however, BMI was better in predicting all‐cause mortality. Conclusion Compared to BMI, LAP and VAI have better predictive performance for the incidence of CVD. In contrast, BMI was superior to VAI and LAP in the prediction of all‐cause mortality.

Abstract There has been a steady rise in the incidence of cardiovascular disease (CVD) in the Iranian population. The aim of this study is to investigate the association between Global Dietary Index (GDI) and CVD risk among the Iranian adult population. This study was conducted based on Isfahan Cohort Study, a longitudinal study that collected data between 2001 and 2013 on 6405 adults. Dietary intakes were assessed by a validated food frequency questionnaire to calculate GDI. All participants were followed every two years by phone call to ask about death, any hospitalization, or cardiovascular events to examine CVD events. The Average age of participants was 50.70 ± 11.63 and the median of GDI score was 1 (IQR: 0.29). A total of 751 CVD events (1.4 incidence rate, per 100 person-year) occurred during 52,704 person-years of follow-up. One-unit GDI increase was associated with a higher risk of MI by 72% (HR: 1.72; 95% CI 1.04–2.84), stroke by 76% (HR: 1.76; 95% CI 1.09–2.85) and CVD by 30% (HR: 1.48; 95% CI 1.02–2.65). In addition, a one-unit GDI increase was associated with a higher risk of coronary heart disease more than 2 times (HR: 2.32; 95% CI 1.50–3.60) and CVD mortality and all-cause mortality over than 3 times [(HR: 3.65; 95% CI 1.90–7.01) and (HR: 3.10; 95% CI 1.90–5.06), respectively]. Higher GDI had a significant relationship with the increased risk of CVD events and all-cause mortality. Further epidemiological studies in other populations are suggested to confirm our findings.

Abstract Background Cardiovascular diseases (CVD) are the predominant cause of early death worldwide. Identification of people with a high risk of being affected by CVD is consequential in CVD prevention. This study adopts Machine Learning (ML) and statistical techniques to develop classification models for predicting the future occurrence of CVD events in a large sample of Iranians. Methods We used multiple prediction models and ML techniques with different abilities to analyze the large dataset of 5432 healthy people at the beginning of entrance into the Isfahan Cohort Study (ICS) (1990–2017). Bayesian additive regression trees enhanced with “missingness incorporated in attributes” (BARTm) was run on the dataset with 515 variables (336 variables without and the remaining with up to 90% missing values). In the other used classification algorithms, variables with more than 10% missing values were excluded, and MissForest imputes the missing values of the remaining 49 variables. We used Recursive Feature Elimination (RFE) to select the most contributing variables. Random oversampling technique, recommended cut-point by precision-recall curve, and relevant evaluation metrics were used for handling unbalancing in the binary response variable. Results This study revealed that age, systolic blood pressure, fasting blood sugar, two-hour postprandial glucose, diabetes mellitus, history of heart disease, history of high blood pressure, and history of diabetes are the most contributing factors for predicting CVD incidence in the future. The main differences between the results of classification algorithms are due to the trade-off between sensitivity and specificity. Quadratic Discriminant Analysis (QDA) algorithm presents the highest accuracy (75.50 ± 0.08) but the minimum sensitivity (49.84 ± 0.25); In contrast, decision trees provide the lowest accuracy (51.95 ± 0.69) but the top sensitivity (82.52 ± 1.22). BARTm.90% resulted in 69.48 ± 0.28 accuracy and 54.00 ± 1.66 sensitivity without any preprocessing step. Conclusions This study confirmed that building a prediction model for CVD in each region is valuable for screening and primary prevention strategies in that specific region. Also, results showed that using conventional statistical models alongside ML algorithms makes it possible to take advantage of both techniques. Generally, QDA can accurately predict the future occurrence of CVD events with a fast (inference speed) and stable (confidence values) procedure. The combined ML and statistical algorithm of BARTm provide a flexible approach without any need for technical knowledge about assumptions and preprocessing steps of the prediction procedure.

Abstract The relationship between protein intake and mortality is still controversial. We prospectively examined the associations of dietary protein sources with all-cause mortality risk in the Isfahan cohort study (ICS). A total of 5431 participants, aged ≥ 35 years, were enrolled in the ICS, in 2001 and followed through 2013. The frequency of protein intakes from different sources was estimated through a validated food frequency questionnaire at baseline. Any new case of death was recorded over the follow-up duration. Hazard ratio (HR)s and 95% confidence interval (CI)s were estimated through Cox proportional hazards regression models. During a median follow-up of 11.3 years, 483 deaths were documented. Higher intakes of plant proteins (HR = 0.64, 95% CI 0.46, 0.91) and animal proteins (HR = 1.52, 95% CI 1.13, 2.05) were associated with a decreased and increased risk of mortality, respectively. Additional adjustment for some mediators did not considerably affect the associations for animal protein (HR = 1.55, 95% CI 1.15, 2.09), whereas led to a tendency towards lower risk for plant protein in the top quintile compared with the bottom one (HR = 0.67, 95% CI 0.48, 0.95; P trend = 0.06). Among specific major sources, higher intakes of nuts and fish were associated with a 27% (95% CI 0.58, 0.93) and 21% (95% CI 0.62, 1.01) lower risk of mortality, respectively. The inverse association between plant protein and mortality risk might be mediated by some metabolic disorders. However, our results suggest an independent positive association for animal protein and all-cause mortality.

Background Sleep duration and daytime napping and obesity are related to adiposity; however, it is not clear whether the association between daytime napping and adiposity measures can differ by sleep duration. Aim To clarify the association between daytime napping and general and abdominal obesity based on sleep duration of participants. Subjects and methods This cross-sectional study was conducted on 1,683 individuals (837 men and 846 women) aged ≥ 35 years. Height, weight and waist circumference (WC) were measured according to the standard protocols. Body mass index (BMI) was calculated. Self-reported sleep duration (in a 24-hour cycle) was recorded. The odds of general and abdominal obesity were compared between nappers and non-nappers, stratified by their sleep duration (≤ 6 h, 6–8 h, ≥ 8 h). Results The mean (SD) age of participants was 47.48 ± 9.35 years. Nappers with a short sleep duration (≤ 6 h) had greater BMI and higher risk for overweight/obesity compared with counterpart non-nappers after adjustment for potential confounders (OR = 1.61, 95% CI = 1.07–2.41). In subjects with moderate sleep duration (6–8 h), nappers had a tendency towards higher BMI in comparison with non-nappers (28.04 ± 0.25 vs. 26.93 ± 0.51 kg/m2; p = 0.05), however, no significant difference was observed for the risk of obesity. Daytime napping was not related to the risk of obesity in long sleepers. No significant association was observed for abdominal obesity measures. Conclusions Daytime napping is associated with increased risk of overweight/obesity in short sleepers. However, in subjects with longer sleep duration, it is not related to the risk of overweight/obesity.

BACKGROUND: To investigate the effects of comprehensive, integrated interventions on dyslipidemia Knowledge and Practices (LIPOKAP) using population and high-risk approaches.METHODS: The baseline of this national, multicentric community trial was conducted on three groups: the general population (adults over the age of 18 and their children aged 6-18), patients with dyslipidemia and their caregivers, and health professionals (physicians, nurses, health providers, and health workers). The general population was selected using multi-stage random sampling, while patients and health professionals were recruited using the consecutive sampling method. The research was carried out in urban and rural areas of five Iranian counties. The sampling method and sample size were similar in baseline and post-intervention surveys. Approximately 8-month intervention programs were carried out on the target groups, which generally included educational strategies. The intervention activities addressed the management, prevention, and control and were tailored to each target group, focusing on lifestyle and self-care. RESULTS: All questionnaires’ content validity ratio, content validity index, and Cronbach’s alpha were over 0.68, 0.83, and 0.73, respectively. We enrolled 2456 adults and 850 of their children, 3331 dyslipidemia patients, 1699 caregivers, and 1800 health professionals.CONCLUSIONS: The validity and reliability of all developed questionnaires that can examine knowledgeand practice changes as a result of intervention activities were acceptable.

Functional disorders represent a prevalent health issue, significantly impacting both individuals and healthcare systems. This multidisciplinary dataset aims to enhance our comprehension of the complex interplay among various factors that contribute to functional somatic syndromes. The dataset comprises data from seemingly healthy adults (aged 18-65) in Isfahan, Iran, who were randomly selected and monitored for four consecutive years. The research data encompasses seven distinct datasets: (a) functional symptom evaluations across multiple body organs, (b) psychological assessments, (c) lifestyle factors, (d) demographic and socioeconomic variables, (e) laboratory measurements, (f) clinical examinations, and (g) historical information. A total of 1930 participants were enrolled at the study's outset in 2017. The first, second, and third annual follow-up rounds were completed with 1697 (2018), 1616 (2019), and 1176 (2020) participants, respectively. This dataset is made available for further analysis by a diverse range of researchers, healthcare policymakers, and clinicians.

Background/Aims: Accumulating evidence based on a few studies suggests a relationship between depression and functional constipation. This study examined whether depression is associated with a higher risk of functional constipation and whether it is gender specific. Methods: This cross-sectional study was carried out on 3,362 adults aged 18-55 years. In this study, functional gastrointestinal symptoms were determined using an Iranian reliable and valid version of the modified Rome III questionnaire. The Iranian validated version of the hospital anxiety and depression scale was used to evaluate the psychological health. Scores of eight or more on the depression subscale in the questionnaire were considered the presence of depression. Simple and multiple binary logistic regression were used for data analysis. Results: The mean±SD age of participants was 36.29±7.87 years, and 58.5% were female. The prevalence of depression and constipation in the study sample was 28.6% and 23.9%, respectively. In the full adjusted model, in the total sample, depressed people showed a significantly higher risk of constipation; adjusted OR (AOR), 1.69 (95% CI, 1.37-2.09). Although a significant association was observed between depression and constipation in both genders, the association was stronger in men than women (AOR, 2.28; 95% CI, 1.50, 3.63 vs. AOR, 1.55; 95% CI, 1.21, 1.99). Conclusions: These study findings showed that depressed people are at a significantly higher risk of being affected by constipation. The current study findings justify the importance of mental health evaluations in all patients with functional gastrointestinal disorders, particularly among constipated individuals.

Background: This study was conducted with the aim to investigate the effectiveness of a psychological bioenergy economy intervention on the cardiac function and inflammatory factors in patients with myocardial infarction (MI). Methods: This randomized controlled trial (RCT) was performed on 60 post-MI patients who referred to the Cardiovascular Research Institute, Isfahan, Iran, in 2019. The intervention group received an energy-based bioenergetics intervention that consisted of rehabilitation training and nutrition patterns training. In the control group, only rehabilitation training and nutrition pattern training was provided in 8 sessions. Quantitative data were expressed as mean ± standard deviation (SD). Between-group differences of data departing from normal distribution were analyzed using the Mann-Whitney U test. All statistical analyses were performed in SPSS software. Results: The enrolled patients included 60 post-MI patients (27.3% women in the intervention group, and 18.2% in the control group). We lost 16 patients during the study. Fasting blood sugar was higher in the control group before the intervention (106.7 ± 14.1 vs. 96.3 ± 11.0; P < 0.001). Systolic blood pressure was significantly higher in the control group before the intervention (P = 0.04). There was no significant difference in total cholesterol, TG, HDL, and LDL after the intervention compared to before the intervention in either groups. Intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) did not change during the intervention in either groups (P < 0.05). Conclusion: Our results displayed that the psychological intervention based on bioenergy economy has no significant effect on cardiac function and inflammatory factors in patients with MI. However, it is suggested that this study be repeated on a larger population.

Background: Cardiovascular diseases (CVDs) are the main cause of death in Iran and the incidence of CVDs ‎is observed during individuals’ active ages. The quality of healthcare includes the doctor-patient relationship and, like other chronic conditions, it plays an important role in the treatment of CVDs. This relationship varies among health providers from different cultures. The purpose of this study was to demonstrate the variables effective on and perceived needs for building doctor-patient relationships from health providers' point of view which can help patients with CVDs in Iran. Methods: The present qualitative study was performed in 2018 in Iran. We conducted a focus group with open-ended questions on the general study subject. Participants were selected using purposive sampling method based on their job experiences related to the subject of the study. We used the descriptive coding method for data analysis. Results: Themes that affected the quality of the doctor-patient relationship include better communication among the health delivery system staff, patients having an active role in treatment decisions, physicians’ interpersonal communicative skills, physicians’ experiences, and the therapy setting in Iran.

Abstract Background There are many studies on high-sensitivity C-reactive protein (hs-CRP) association with cardiovascular disease (CVD); however, just a few studies investigated whether the low-density lipoprotein cholesterol (LDL-C) could participate in hs-CRP prognostic strength. This study aimed to determine the alliance of hs-CRP and LDL-C in different concentrations in occurrence cardiovascular events in the Isfahan Cohort Study (ICS). Methods 3277 participants aged 35 and above were included in the current analysis. We evaluated the association of elevated hs-CRP levels (≥ 3 mg/dL) and CVD events including myocardial infarction, ischemic heart disease, stroke, CVD, CVD mortality, and all-cause mortality in those with LDL-C ≥ or

Background: Statins use is the most important treatment for high LDL cholesterol in patients with premature coronary artery disease (CAD). Previous reports have shown racial and gender differences in statin use in the general population, but this wasn't studied in premature CAD based on different ethnicities. Methods and results: Our study includes 1917 men and women with confirmed diagnosis of premature CAD. Logistic regression model was used to evaluate the high LDL cholesterol control in the groups and the OR with 95% confidence interval (CI) was reported as the effect size. After adjustment for confounders, the odds of controlling LDL in women taking Lovastatin, Rosuvastatin, and Simvastatin were 0.27 (0.03, 0.45) lower in comparison with men. Also, in participant who took 3 types of statins, the odds of controlling LDL were significantly different between Lor and Arab compared with Fars ethnicity. After adjustment to all confounders (full model), the odds of controlling LDL were lower for Gilak in Lovastatin, Rosuvastatin, and Simvastatin by 0.64 (0.47, 0.75); 0.61 (0.43, 0.73); 0.63 (0.46, 0.74) respectively and higher for Arab in Lovastatin, Rosuvastatin, and Simvastatin by 4.63 (18.28, 0.73); 4.67 (17.47, 0.74); 4.55 (17.03, 0.71) respectively compared to Fars. Conclusions: Major differences in different gender and ethnicities may have had led to disparities in statin use and LDL control. Awareness of the statins impact on high LDL cholesterol based on different ethnicities can help health decision-makers to close the observed gaps in statin use and control LDL to prevent CAD problems.

BackgroundConsidering the importance of cardiovascular disease (CVD) risk prediction for healthcare systems and the limited information available in the Middle East, we evaluated the SCORE and Globorisk models to predict CVD death in a country of this region.MethodsWe included 24 427 participants (11 187 men) aged 40-80 years from four population-based cohorts in Iran. Updating approaches were used to recalibrate the baseline survival and the overall effect of the predictors of the models. We assessed the models’ discrimination using C-index and then compared the observed with the predicted risk of death using calibration plots. The sensitivity and specificity of the models were estimated at the risk thresholds of 3%, 5%, 7%, and 10%. An agreement between models was assessed using the intra-class correlation coefficient (ICC). We applied decision analysis to provide perception into the consequences of using the models in general practice; for this reason, the clinical usefulness of the models was assessed using the net benefit (NB) and decision curve analysis. The NB is a sensitivity penalized by a weighted false positive (FP) rate in population level.ResultsAfter 154 522 person-years of follow-up, 437 cardiovascular deaths (280 men) occurred. The 10-year observed risks were 4.2% (95% CI: 3.7%-4.8%) in men and 2.1% (1.8-2%.5%) in women. The c-index for SCORE function was 0.784 (0.756-0.812) in men and 0.780 (0.744-0.815) in women. Corresponding values for Globorisk were 0.793 (0.766-0.820) and 0.793 (0.757-0.829). The deviation of the calibration slopes from one reflected a need for recalibration; after which, the predicted-to-observed ratio for both models was 1.02 in men and 0.95 in women. Models showed good agreement (ICC 0.93 in men, and 0.89 in women). Decision curve showed that using both models results in the same clinical usefulness at the risk threshold of 5%, in both men and women; however, at the risk threshold of 10%, Globorisk had better clinical usefulness in women (Difference: 8%, 95% CI: 4%-13%).ConclusionOriginal Globorisk and SCORE models overestimate the CVD risk in Iranian populations resulting in a high number of people who need intervention. Recalibration could adopt these models to precisely predict CVD mortality. Globorisk showed better performance clinically, only among high-risk women.

Background and Objective: Cardiovascular Disease (CVD) is the leading cause of death in developing countries. Inflammation significantly contributes to the process of atherosclerosis. Therefore, evaluating White Blood Cells (WBC) and platelet counts as markers of inflammatory as well as hematocrit as a marker of blood viscosity may predict coronary events. The present study aimed to evaluate the relationship between hematological indices and the incidence of cardiovascular events. Materials and Methods: This study was based on the results of the Isfahan Cohort Study (ICS) which was a long-term, population-based study of 6504 adults over the age of 35 years with no history of CVD who were followed up for any incidence of CVD from 2001 to 2015. Basic levels of hematological indices were measured by entering the study. Results: About 49.5% of the population were male. The mean age of the population and individuals with CVD were about 51 and 57.6 years, respectively. Significant relationships were observed between systolic and diastolic blood pressures, fasting blood glucose, triglyceride, cholesterol, Low-Density Lipoprotein (LDL) levels, and waist circumference with the incidence of cardiovascular events (P

Background Dietary patterns emphasizing plant foods might be neuroprotective and exert health benefits on mental health. However, there is a paucity of evidence on the association between a plant-based dietary index and mental health measures. Objective This study sought to examine the association between plant-based dietary indices, depression and anxiety in a large multicentric sample of Iranian adults. Methods This cross-sectional study was performed in a sample of 2,033 participants. A validated food frequency questionnaire was used to evaluate dietary intakes of participants. Three versions of PDI including an overall PDI, a healthy PDI (hPDI), and an unhealthy PDI (uPDI) were created. The presence of anxiety and depression was examined via a validated Iranian version of the Hospital Anxiety and Depression Scale (HADS). Results PDI and hPDI were not associated to depression and anxiety after adjustment for potential covariates (age, sex, energy, marital status, physical activity level and smoking). However, in the crude model, the highest consumption of uPDI approximately doubled the risk of depression (OR= 2.07, 95% CI: 1.49, 2.87; PConclusions An unhealthy plant-based dietary index is associated with a higher risk of depression and anxiety, while plant-based dietary index and healthy plant-based dietary index were not associated to depression and anxiety.

It has been estimated that in the next decade, IHD prevalence, DALYs and deaths will increase more significantly in EMR than in any other region of the world. This study aims to provide a comprehensive description of the trends in the burden of ischemic heart disease (IHD) across the countries of the Eastern Mediterranean Region (EMR) from 1990 to 2019. Data on IHD prevalence, disability-adjusted life years (DALYs), mortality, DALYs attributable to risk factors, healthcare access and quality index (HAQ), and universal health coverage (UHC) were extracted from the Global Burden of Disease (GBD) database for EMR countries. The data were stratified based on the social demographic index (SDI). Information on cardiac rehabilitation was obtained from publications by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), and additional country-specific data were obtained through advanced search methods. Age standardization was performed using the direct method, applying the estimated age structure of the global population from 2019. Uncertainty intervals were calculated through 1000 iterations, and the 2.5th and 97.5th percentiles were derived from these calculations. The age-standardized prevalence of IHD in the EMR increased from 5.0% to 5.5% between 1990 and 2019, while it decreased at the global level. In the EMR, the age-standardized rates of IHD mortality and DALYs decreased by 11.4% and 15.4%, respectively, during the study period, although both rates remained higher than the global rates. The burden of IHD was found to be higher in males compared to females. Bahrain exhibited the highest decrease in age-standardized prevalence (-3.7%), mortality (-65.0%), and DALYs (-69.1%) rates among the EMR countries. Conversely, Oman experienced the highest increase in prevalence (14.5%), while Pakistan had the greatest increase in mortality (30.0%) and DALYs (32.0%) rates. The top three risk factors contributing to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particulate matter pollution. The trend analysis over the 29-year period (1990-2019) revealed that high fasting plasma glucose (64.0%) and high body mass index (23.4%) exhibited increasing trends as attributed risk factors for IHD DALYs in the EMR. Our findings indicate an increasing trend in the prevalence of IHD and a decrease in mortality and DALYs in the EMR. These results emphasize the need for well-planned prevention and treatment strategies to address the risk factors associated with IHD. It is crucial for the countries in this region to prioritize the development and implementation of programs focused on health promotion, education, prevention, and medical care.

Abstract Background and objectives A short form of the General Health Questionnaire (GHQ-12) is a useful screening instrument for assessing mental health. Furthermore, Quality of life (QoL) is a critical treatment outcome in many clinical and health care research settings. This study aimed to reassess the dimensionality of GHQ-12 using Multidimensional Graded Response Model (MGRM) and evaluate how its extracted dimensions are associated with the QoL's domains. Methods Isfahan Cohort Study 2 (ICS2) is a population-based, ongoing prospective cohort study among adults aged 35 years and older who were free of cardiovascular diseases (CVDs) at the beginning of the study in 2013. A total of 1316 participants, all living in urban and rural areas of Isfahan and Najafabad, Iran was completed the GHQ-12 and WHO QoL-brief version at baseline. Five competing MGRMs with different latent structures were specified for GHQ-12. Factor scores derived from the best fitted model were used to associate with various domains of QoL. Results: The Three-Dimensional model for GHQ-12 was the best-fitted model explaining the Social Function (SF), Self Confidence (SC), and Anxiety/Depression (A/D) as three correlated yet different latent dimensions of mental health. Our findings in full adjusted multivariate regression models showed that a one-SD increase in dimensions of SC and SF was associated with a 38- to 48%-SD and 27- to 38%-SD increase in the domains scores of QoL, respectively. Moreover, for each one‐SD increase in score of A/D dimension, the domains scores of QoL decreased by 29- to 40%-SD. The highest to the lowest standardized coefficients for all latent dimensions of mental health were respectively related to the psychological, physical health, social relationships, and environmental condition domains of QoL. Furthermore, SC, A/D, and SF dimensions of GHQ-12 showed the highest to the lowest degree of association with all domains of QoL. Conclusions Our findings confirm that the GHQ-12 as a multidimensional rather than unitary instrument measures distinct dimensions of mental health. Furthermore, all aspects of QoL changed when the intensity of latent dimensions of mental health increased. Moreover, the psychological domain of QoL is the most affected by all latent dimensions of mental health, followed by physical health, social relationships, and environmental condition domains. It seems that in an attempt to full recovery as assessed by improved QoL outcomes, treatment of clinical symptoms may not be sufficient. Identifying and differentiating the structures of mental health in each community as well as implementing intervention programs aimed at focusing on specific dimensions may help in the prevention of further deterioration of mental health and improved QoL in the community.

Abstract Due to scarce epidemiologic data linking dietary protein intakes and metabolic syndrome (MetS), we aim to determine the longitudinal association of different types of dietary protein with the incidence of MetS among Iranians adults. The study was conducted in the framework of the Isfahan Cohort Study (ICS) on 6504 adults, aged ≥ 35 years, and free of MetS at baseline. A validated food frequency questionnaire was used for assessing usual dietary intakes. MetS was defined according to the Joint Scientific Statement. Mixed-effects logistic regression was applied to examine the associations between changes in weekly frequency consumption of protein and MetS status. After a median follow-up of 11.25 years, in multivariate-adjusted model, each additional frequency consumption of total protein intake (OR 0.83; 95% CI 0.81–0.85), animal protein (OR 0.80; 95% CI 0.77–0.83), plant protein (OR 0.70; 95% CI 0.64–0.76), red meat (OR 0.74; 95% CI 0.70–0.78), poultry (OR 0.73; 95% CI 0.68–0.78), egg (OR 0.79; 95% CI 0.72–0.88) and nuts and seeds (OR 0.77; 95% CI 0.71–0.84) was associated with reduced risk of MetS. No significant association was found for processed meat (OR 0.96; 95% CI 0.87–1.01) and legumes and soy (OR 0.96; 95% CI 0.86–1.07) with MetS. Our results suggest an independent inverse association between total protein, animal and plant protein and the risk of MetS. These associations did not differ by sex. Although our results can be considered to be a strategy to reduce MetS risk by dietary guidelines, randomized clinical trials are required to confirm our findings.

Background: We aimed to investigate the association between persistent early repolarization (ER) in healthy individuals and long-term cardiovascular events and mortality rates in a large cohort study. Methods: Demographic characteristics, medical records, 12-lead electrocardiograms (ECGs), and laboratory data were retrieved and analyzed from the Isfahan Cohort Study. The participants were followed up biannually via telephone interviews and 1 live structured interview in between until 2017. Individuals who had ER in all their ECGs were considered persistent ER cases. Study outcomes were cardiovascular events (unstable angina, myocardial infarction, stroke, and sudden cardiac death), cardiovascular-related mortality, and all-cause mortality. The independent t test, the χ2 test, the Mann-Whitney U test, and the Cox regression models were used for statistical analyses. Results: The study population consisted of 2696 subjects (50.5% female). Persistent ER was found in 203 subjects (7.5%), with a higher frequency in men (6.7% vs 0.8%; P

Abstract Background Psychosomatic symptoms, characterized by physical-bodily complaints not fully explained by organic reasons, are highly prevalent. The present study aimed to culturally adapt and evaluate the psychometric properties of Psychosomatic Symptoms Questionnaire 39-item version (PSQ-39) among Iranian general adult population. Methods This study included 996 Persian-speaking people, living in Isfahan, Iran. The translation of the PSQ-39 was performed using the forward-backward method. Test-retest reliability was evaluated through Intraclass correlation (ICC) coefficient and internal consistency by using Cronbach’s α. Construct validity was investigated by using both exploratory (EFA) and confirmatory (CFA) factor analysis. Short Form Health Survey (SF-36) was used to assess divergent validity. Known-group validity was also assessed. Results The Persian version of the PSQ-39 showed excellent test-retest reliability in all domains (ICCs: 0.95–0.99). The computed Cronbach’s alpha coefficients for domains of PSQ-39 were in the range good to excellent. The PSQ-39 showed good known-group validity and differentiated patients from the general population (Area under the curve [AUC] of 0.78 (95% CI: 0.73, 0.84). Construct validity evaluated by EFA led to extraction of seven factors (Cardiorespiratory, musculoskeletal, psychological, gastrointestinal, general, body balance and Globus), and the CFA confirmed the adequacy of extracted factors by EFA (CFI = 0.91, TLI = 0.90, PCFI = 0.77, PNFI = 0.71, CMIN = 1413.18 (df = 654), CMIN/DF = 2.16, and RMSEA = 0.06). Significant negative correlations between all domains of PSQ and SF-36 revealed an acceptable divergent Validity. Conclusions The Persian version of the PSQ-39 is a reliable and valid questionnaire with applicability in a broad range of Persian language populations for assessing common psychosomatic symptoms in research as well as in clinical practice.

Abstract Background Cardiovascular diseases (CVDs) are associated with an unhealthy lifestyle, including poor diet. Indices reflecting the overall quality of diets are more effective than single food or nutrient-based approaches in clarifying the diet disease relationship. The present study aims to use latent variable modeling to examine the longitudinal joint relationships between the latent profiles of CVDs risk factors and the diet quality index (DQI). Methods A total of 4390 Iranian adults aged 35 and older within the framework of the Isfahan Cohort Study were included in the current secondary analysis. DQI focused on food groups, including fast foods, sweets, vegetables, fruits, fats, and proteins, based on a validated food frequency questionnaire. The score of DQI has a range between 0 (indicating healthy and high diet quality) and 2 (indicating unhealthy and low diet quality). Blood pressure (BP), anthropometric measurements, blood glucose, serum lipids, and high-sensitivity C-Reactive Protein (hs-CRP) were measured according to standard protocols in 2001, 2007, and 2013 to evaluate the profiles of CVDs risk factors. A Bayesian Multidimensional Graded Responses Linear Mixed Model was used for data analysis. Results At baseline, the participants’ mean ± standard deviation age was 50.09 ± 11.21, and 49.5% of them were male. Three latent profiles of CVDs risk factors were derived: (1) Fit Pre-Metabolic Syndrome (FPMS) profile characterized by normal anthropometric indices and some impaired metabolic risk factors; (2) DysLipoproteinemia Central Obese (DLCO) profile with abdominal obesity and impaired low-density lipoprotein cholesterol as well as other normal risk factors; (3) Impaired Laboratory Inflammatory State (ILIS) profile with impaired high-density lipoprotein cholesterol and hs-CRP and other normal risk factors. In general, higher scores of the extracted latent profiles indicated more impaired function in the related risk factors. After controlling for various potential fixed and time-varying confounding variables, a significant positive longitudinal association was found between FPMS, DLCO, and ILIS profiles and DQI (β (95% CrI): 0.26 (0.03,0.51), 0.14 (0.01,0.27), and 0.24 (0.11,0.38), respectively), demonstrating that lower overall diet quality was associated with more impaired function of the related risk factors. Conclusions More adherence to a healthy quality diet is associated with lower levels of all emerging latent profiles of CVDs risk factors. Increasing the knowledge of the community about the importance of the quality of consumed foods may help to prevent CVDs. It is recommended that further investigations, particularly interventional studies, be conducted to confirm our results.

Introduction Isfahan functional disorders (ISFUN) cohort study aims to describe the interplay of genetic and environmental factors in shaping the characteristics of functional somatic syndromes (FSS). This study is primarily intended to investigate the epidemiology, risk factors, course and prognosis of FSSs in a sample of adult Iranian population. The other aim is to develop a new delimitation of FSSs based on an integrated multidisciplinary approach comprising of phenotypic and multiomics data.Methods and analysis ISFUN is a population-based prospective cohort study designed to follow a population of randomly selected seemingly healthy adults (18–65 years) through annual visits during a 4-year observation period. Structured questionnaires are used for data collection and clinical assessment of the participants. Questionnaire-based diagnosis of FSSs are validated in a medical interview. Human DNA genotyping, microbial amplicon sequencing and urine analysis is under progress for genomics, microbiota and metabolomics profiling, respectively. Enrolment began in September 2017, and study completion is expected in 2022. A total number of 1943 participants were initially recruited.Ethics and dissemination Ethical approval for data collection was granted by the National Research Ethics Committee of the Iranian Ministry of Health and Medical Education and the Research Ethics Committee of Isfahan University of Medical Sciences (IR.MUI.REC.1395.1.149). Following the description of the study procedure, we obtained written informed consent from all study participants. Study findings will be disseminated through peer-reviewed publications and presentations at scientific meetings.

Background: Taking into account the possible role of psychological factors in cardiovascular diseases (CVDs) and the fact that they interfere with the biological factors that cause CVDs, this research was designed to evaluate the efficacy of solution-focused therapy on mental health, life orientation, mental health, and meaningfulness of life in patients with CVDs. Methods: This was a quasi-experimental analysis with a pretest-posttest design, follow-up, and a control group. All cardiovascular patients who had referred to the Isfahan Cardiovascular Research Center, Isfahan, Iran, between January and March 2019 and had a history of heart attack or open-heart surgery in the previous month were included in the statistical population of this study. In this study, 30 patients with CVDs wishing to participate in the study were selected using convenience sampling from among patients who had the inclusion criteria and were randomly assigned to experimental and control groups (each group included 15 patients). Data were collected using Life Orientation Test (LOT), Meaning in Life Questionnaire‎ (MLQ), and General Health ‎Questionnaire (GHQ‎)‎. The collected data were analyzed using repeated measures analysis of variance (ANOVA) and analysis of covariance (ANCOVA) in SPSS software. Results: The results indicate that there was a significant difference between the solution-focused therapy and control groups in terms of the mean scores of physical symptoms (F = 95.46; P < 0.0001), anxiety (F = 70.36; P < 0.0001), social functional dysfunction (F = 54.11; P < 0.0001), depression (F = 26.70; P < 0.0001), life orientation (F = 22.36; P < 0.0001), and meaningfulness of life (F = 68.21; P < 0.0001). Conclusion: The findings of this study have shown that solution-focused therapy is beneficial for mental health, life orientation, and meaningfulness of life in patients with CVDs and can be used in treatment centers to enhance the status of these patients.

Abstract Aims Current studies indicate that melatonin can counteract renin–angiotensin–aldosterone system and sympathetic over activity in heart failure (HF) and might have a protective and repairing effect on cardiovascular injuries, skeletal muscle weakness, and metabolic abnormalities, which are common pathological processes in patients with HF. The MeHR trial (Melatonin for Heart Failure with Reduced Ejection Fraction) aims to evaluate the effect of oral melatonin on myocardial, skeletal muscle, and metabolic dysfunctions in HF, which leads to lower quality of life and increased morbidity and mortality in these patients. Methods and results This is a double‐blind randomized clinical trial with two parallel arms of 1:1 allocation, which recruits 90 outpatients with HF with reduced ejection fraction. Participants receive 10 mg tablets of melatonin or placebo for 24 weeks. The primary outcomes are changes in echocardiographic indexes of HF and serum levels of N terminal pro brain natriuretic peptide. Secondary outcome is a composite clinical endpoint score including all‐cause mortality, hospitalization for HF, and change in the quality of life during the study. Other outcomes are the evaluation of melatonin attributable adverse effects, flow‐mediated vasodilation, skeletal muscle mass, exercise capacity, and serum markers of inflammation, oxidative stress, and metabolism. Statistical analysis will include simple unadjusted analyses for the detection of differences between groups and changes in outcomes and also a generalized linear mixed model to explore potential associations between outcomes and participant characteristics. Conclusions The results of this comprehensive study might elucidate the safety of oral melatonin in patients with HF and provide some evidence on its effectiveness as an adjunctive therapy to enhance the well‐being of these patients.

BACKGROUND: Reported prevalence of congenital heart diseases (CHDs) varies widely among studies worldwide. The incidence of CHD, total number of pediatric and adult grown-up congenital heart disease (GUCH), is not determined in Iran. Therefore, we have designed a system to register the information of patients with CHD for the first time in our country.METHODS: CHD registry is a database in which the patients' data are collected by five pediatric cardiologists from three referral hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, and five outpatient clinics. We enrolled patients with CHD either as new cases who were referred for evaluation of potential CHD or those who were being followed within the outpatient clinics and entered their whole information in a website specifically designed for it. All the information was collected from checklist by those pediatric cardiologistsRESULTS: From April 2017 to April 2020, after developing the forms and website, the Quality Control Committee evaluated the first 558 files. 73 files (13%) needed major revisions. Among them, 34 (46%) files were omitted totally and the 39 remaining files were revised and completed. After that revision, we changed our checklist and gathered about 1600 patients accordingly.CONCLUSION: Registry of CHDs not only improves epidemiologic studies but also assists researchers to understand how much a disease management is useful and how to raise the quality of cares and outcomes. Moreover, this provides a better insight for policymakers to understand the extent of health-related problems as well as the issues related to the prevention and management of CHDs all around the world.

BACKGROUND: Premature coronary artery disease (CAD) is still prevalent worldwide and may differ in various ethnicities. Due to the presence of different ethnicities in Iran, the Iran-premature coronary artery disease (I-PAD) study aimed to determine the frequency of premature CAD and related risk factors based on each ethnicity.METHODS: In this multi-center case-control study, 4000 patients with premature CAD from ten different ethnicities who lived in different cities of Iran and underwent coronary angiography were enrolled (women aged ≤ 70 and men ≤ 60 years). Patients with CAD defined as obstruction equal or above 75% in at least a single coronary artery or left main ≥ 50% were included in the case group, while patients with normal coronary arteries were included in the control group. Lifestyle behaviors, cardiometabolic risk factors, anthropometric measurements, and other variables were collected. Serum, whole blood, buffy coat, plasma, urine, stool, and saliva samples were stored.RESULTS: The number of patients enrolled until April 2020 was 2071. The mean age of patients was 53.51 ± 7.52 and 934 (45.09%) of patients were women. To date, about 39.6% of the patients were normal. Also, about 26.0% were with one-vessel disease (1VD), 15.0% with two-vessel disease (2VD), and 15.2% with three-vessel disease (3VD). More than 30000 patients' biosamples from across the country have been stored.CONCLUSION: Knowing the frequency of premature CAD according to different ethnicities with major differences in their lifestyle behaviors and risk factors can assist health decision-makers. In addition, I-PAD biosamples will be an invaluable source.

BACKGROUND: There is still a controversy in the preferred method of reperfusion in acute ST-segment elevation myocardial infarction (STEMI), when the achievement of well-defined "golden time" is difficult. We sought to evaluate the procedural and in-hospital outcomes of the strategy of "thrombolytic administration and rescue or routine percutaneous coronary intervention (PCI)" versus "primary PCI (PPCI)" strategy in acute STEMI.METHODS: In this observational prospective study, the data of 237 patients with acute STEMI presented or referred to Chamran Cardiovascular Research Center in Isfahan, Iran, were collected (PROVE/ACS study). Baseline characteristics, thrombolysis in myocardial infarction (TIMI) flow grade of infarct-related artery (IRA), left ventricular ejection fraction (LVEF), and in-hospital outcomes were evaluated.RESULTS: The mean age of patients was 61.4 ± 13.0 years, 86.9% were men, 13.1% were diabetic, and 67.9% had anterior STEMI. Patients in the "thrombolytic then PCI" group were younger, more smoker, more often male with higher body weight and lower systolic blood pressure (SBP). The pre-PCI TIMI flow grade 3 was more often seen in the "thrombolytic then PCI" group (39.4% vs. 21.0%, P < 0.001) and less thrombectomy was performed in this group of patients (12.9% vs. 26.7%, P = 0.011). Time to reperfusion was significantly longer in PPCI group (182.4 ± 233.7 minutes vs. 44.6 ± 93.4 minutes, respectively, P < 0.001). No difference in mortality, mean of LVEF, and incidence of atrial fibrillation (AF) was observed in two groups.CONCLUSION: If the PPCI strategy could not be performed in the golden time, the strategy of thrombolytic administration and rescue or routine PCI leads to more initial IRA patency and less thrombectomy with similar clinical outcomes.

Depression, anxiety and stress are common psychological disorders (PDs). This study aimed to assess the odds of co-occurrence of mentioned PDs in total sample and different levels of socio-demographic characteristics, specifically among a large sample of general adults. In a cross-sectional, community-based study conducted among 4763 Iranian adults, depression and anxiety were assessed with Hospital Anxiety and Depression Scale (HADS) and stress with General Health Questionnaire (GHQ). The loglinear analysis was applied to investigate their comorbidities. Based on selected models with pair-comorbidity of anxiety with stress, depression with stress, and anxiety with depression, the results showed the odds of comorbidity between anxiety and depression (odds ratio (OR) =12.29, 95%CI: 9.58-15.80), depression and stress (OR = 7.80, 95%CI: 6.55-10.18), and stress and anxiety (OR = 4.62, 95%CI: 3.71-5.75). Also, ORs of pair-comorbidities were the same, except between stress and anxiety for men compared to women (adjusted-OR = 6.47, 95%CI: 4.44-9.49 versus 3.85, 95%CI: 2.95-5.00) and comorbidity between stress and depression for the participants with lower than 40 years compared to others (adjusted-OR = 9.03, 95%CI: 7.17-11.36 versus 6.41, 95%CI: 4.90-8.41), p< 0.05. Stress comorbidity with depression was higher level than other pair-comorbidities. Obvious discrepancies were also observed in terms of ORs of pair-comorbidities between three mentioned disorders in different levels of SDCs.

Background. Most of the patients with hypertension (HTN) who undergo medical therapy unaccompanied by psychological and behavioral interventions may not achieve their goal in HTN treatment. Self-care is a key factor in controlling HTN. Given that depression, stress, and anxiety are the most psychological disorders in chronic illnesses. Their impact on self-care, quality of life, and HTN control must be studied more. Methods. We analyzed the difference in medication adherence in 252 patients with low vs. high psychological distress. Also, patients with controlled and uncontrolled HTN were compared according to their psychological distress scores. We further assessed the relation of psychological distress, self-care, and medication adherence with patients’ demographic characteristics. Results. 61.3% of our participants were female with a mean age of 60.6 ± 11.35 and male participants had a mean age of 60.5 ± 11.55. The psychological distress score was significantly higher in women with uncontrolled HTN (p value = 0.044). Also, individuals with controlled HTN tend to have a higher medication adherence score (p value = 0.01) and higher self-care score (p value = 0.033). Hypertensive females had a higher psychological distress score (3.35 ± 2.05) and a lower self-care score (64.05 ± 8.16). There was a positive relationship between age and drug adherence. The self-care score was higher (65.95 ± 7.88) in patients having lower psychological distress levels. Conclusion. A lower psychological distress score can result in better self-care, enhancing the probability of better HTN control; thus, psychological interventions may be necessary for the treatment of HTN. However, more studies are needed to assess the effectiveness of this intervention.

Background: The objectives of this study were to assess the relation of blood groups and the rate of successful angioplasty in patients with ST-elevated myocardial infarction (STEMI) and also to investigate long-term adverse outcomes follow-up. Materials and Methods: In this study, 500 eligible patients with definitive diagnosis of STEMI who underwent primary percutaneous coronary intervention (PCI) were followed up for 3 years. The patient's angiography images were examined and thrombolysis in myocardial infarction (TIMI) flow rate and coronary artery patency rate were evaluated in different ABO blood groups. All patients were followed up after 3 years based on major adverse cardiovascular events. Results: There was no significant difference in coronary artery patency rate between the patients of the different blood types with respect to TIMI flow before (P = 0.19) and after revascularization (P = 0.69). The incidence of atrial fibrillation (AF) in blood Group A was the highest. Death in the blood Groups AB and O was significantly higher than the other groups. No significant differences were seen in different blood groups in the frequency of mortality (P = 0.13), myocardial infarction (P = 0.46), heart failure (P = 0.83), re-hospitalization, angiography (P = 0.90), PCI (P = 0.94), coronary artery bypass graft (P = 0.26), implantable cardioverter defibrillator (ICD) implantation (P = 0.26), and mitral regurgitation (P = 0.88). Conclusion: The incidence of AF in blood Group A and inhospital mortality in blood Groups AB and O were the highest. The blood group may be considered in assessment of clinical risk in STEMI patients.

Background: Cardiac rehabilitation (CR) is scantly available in Iran, although it is the cost-benefit strategy in cardiac patients, It has not been established how CR is delivered within Iran. This study aimed to determine: (a) availability, density and unmet need for CR, and (b) nature of CR services in Iran by province. Materials and Methods: In this cross-sectional sub-study of the global CR audit, program availability was determined through cardiovascular networks. An online survey was then disseminated to these programs in June 2016–2017 which assessed capacity and characteristics; a paper-based survey was disseminated in 2018 to nonresponding and any new programs. CR density and need was computed based on annual incidence of acute myocardial infarction (AMI) in each province. Results: Of the 31 provinces, 12 (38.7%) had CR services. There were 30 programs nationally, all in capital cities; of these, programs in 9 (75.0%) provinces, specifically 22 (73.3%) programs, participated. The national CR density is 1 spot per 7 incident AMI patients/year. Unmet need is greatest in Khuzestan, Tehran and west Azerbaijan, with 44,816 more spots needed/year. Most programs assessed cardiovascular risk factors, and offered comprehensive services, delivered by a multi-disciplinary team, comprised chiefly of nurses, dietitians and cardiologists. Median dose is 14 sessions/program in supervised programs. A third of programs offered home-based services. Conclusion: Where programs do exist in IRAN, they are generally delivered in accordance with guidelines. Therefore, we must increase capacity in CR services in all provinces to improve secondary prevention services.

Background: Despite recognizing the traditional coronary artery disease (CAD) risk factors, some secondary factors, such as opioid substance abuse, have to be considered. We aimed to assess the relationship between opioid consumption and emergency percutaneous coronary intervention (PCI) revascularization results, according to Thrombolysis in Myocardial Infarction (TIMI) flow and in-hospital survival outcomes in ST-elevation myocardial infarction (STEMI) patients. Materials and Methods: This case–control study was conducted on 186 patients (93 patients in each group) with acute STEMI, who were referred to Chamran Heart Center, Isfahan, Iran. Opioid addiction was diagnosed by patients' records and confirmed by conducting an interview based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria. Patients in both groups were evaluated and compared for angioplasty results based on the TIMI flow grade and in-hospital cardiovascular events and complications. Results: Ninety-one patients (97.84%) of each group were male, and opioid-addicted patients were younger than the non-opioid users (52.95 9.91 vs. 57.90 12.17, P = 0.003). Among the CAD risk factors, prevalence of dyslipidemia was significantly higher in non-opioid users, whereas cigarette smoking was higher in opioid-addicted patients (P < 0.050). There was no significant difference between the two groups regarding pre- and post-procedural myocardial infarction complications as well as mortality rate (P > 0.050). Also, there were no significant differences between the opioid and non-opioid users regarding TIMI flow grading, and successful PCI rate based on achieving TIMI III was 60.21% versus 59.1% in opiate-dependent and non-opioid users, respectively (P = 0.621). Conclusion: Opioid addiction has no effects on post-PCI angiographic results and in-hospital survival outcomes in STEMI patients which undergoing emergency PCI.

Backgroud: Because of the important role of adhering to treatment to reduce major adverse cardiovascular events and mortality, studying the factors affecting treatment adherence (TA) is warranted. This study aimed to identify the impact of psychosomatic factors on adhering to treatment among patients with acute myocardial infarction. Materials and Methods: This is a cohort study as a part of the Isfahan ST-segment-elevated Myocardial Infarction Cohort Study. Psychosomatic factors such as health anxiety, illness denial, irritable mood, and demoralization were assessed among 867 patients at the first visit. The patients were followed for 2 years; TA and major adverse cardiovascular events were checked annually in survivors. Results: The results from binary logistic regression applied to find the association between TA and psychosomatic factors showed that the patients with health anxiety, irritable mood, and demoralization were significantly poor adherent to treatment (odds ratio [95% confidence interval]: 1.39 [1.02, 2.73], 1.51 [1.02, 2.37], and 1.66 [1.02, 2.91]), respectively. The associations remained the same when adjusted for various potential confounders. Conclusions: Psychosomatic factors played an essential role in adhering to treatment among patients with acute myocardial infarction. As a result, appropriate psychological interventions may help the patients adhere to their treatment better.

Abstract Background Although the dietary inflammatory index (DII) has been evaluated in relation to psychological disorders risk, the association between DII and psychosomatic complaints is unclear. This study aimed to determine the association between DII, as a proxy measure of the inflammatory potential of the diet, and psychosomatic complaints. Methods This cross-sectional study included 2818 people from the general population, aged 19 to 69 years, of Isfahan province in Iran. Dietary intake was assessed using a validated dish-based food-frequency questionnaire. Psychosomatic complaints were assessed using a self-administered validated Persian questionnaire. Twenty-seven nutrients or foods were included in the calculation of DII. Each of them received a score based on their inflammatory ability, thus, a higher DII score indicated a more pro-inflammatory diet. The risk of being in the top median of a psychosomatic complaints profile across the tertiles of DII was assessed using logistic regression. Results Four psychosomatic complaints profiles (psychological, gastrointestinal, neuro-skeletal and pharyngeal- respiratory) were identified. After controlling for potential confounders, individuals in the top tertile of DII had higher odds for experiencing high somatic complaints scores for the psychological (odds ratio (OR) = 1.44, 95% confidence interval (CI): 1.10, 1.89; P trend = 0.009), gastrointestinal (OR = 1.22, 95% CI: 0.99, 1.75; P = 0.058) or neuro-skeletal (OR = 1.56, 95% CI: 1.10, 2.22; P = 0.013) profile. The association for pharyngeal-respiratory complaints did not remain significant after adjustment for stressful life events, medical condition, and anti-psychotropic medicine use. Conclusion The significant positive link between DII and the various psychosomatic complaints profiles suggests that a diet with anti-inflammatory potential might be favourably related to psychosomatic complaints. Further studies, particularly clinical trials and longitudinal studies, are warranted to investigate the inflammatory potential of diet in relation to psychosomatic complaints.

Abstract Objective To compare the prevalence of psychosomatic symptoms and their mean scores of profiles in diabetic patients and sample of sex-age-matched healthy controls. Methods This case-control study was conducted on 87 patients with type 2 diabetes. The control group consisted of 259 age- and gender-matched healthy participants. Psychosomatic symptoms were assessed using a comprehensive 31-item questionnaire, and psychological problems were evaluated by 12-item General Health Questionnaire and Hospital Anxiety and Depression Scale. Factor analysis, independent Student’s t test, analysis of variance, and chi-square test were used for analyzing of data. Results The frequency of 18 psychosomatic symptoms was significantly higher in diabetic patients with psychological problems compared with controls (P

Background and purpose: Stressful life events can lead to psychological problems, heart disease, stroke, etc. Multidimensional nature of stress calls for advanced statistical methods that could evaluate these dimensions based on symptoms of stress. Therefore, current study aimed at identifying and redefining the dimensions of the stressful life events (SLE) questionnaire using a higher order factor model. Materials and methods: This cross-sectional study was done in 4763 people participating in a project called SEPAHAN in Isfahan, Iran 2010. The perceived stress level was evaluated by the Iranian version of SLE questionnaire. First and second order exploratory and confirmatory factor models were applied for data analysis using AMOS V20. Results: According to exploratory factor analysis, 11 domains of stress (first order factors) were extracted from 44 items, which explained 51.42% of the total variance. Based on these domains, two dimensions were identified as second-order factors (stressors), including individual and social stressors that explained 17.3% and 25.6% of total variance, respectively. The similar structure was identified both in total sample and in men and women separately. Also, the results in exploratory factor analysis were confirmed by confirmatory factor analysis (CFI =0.78, GFI =0.89, RMSEA =0.05). It was found that the second-order factor model well fitted to the dimensions of the questionnaire identified. Conclusion: SLE questionaire has11 domains and two higher dimensions (individual and social stressors). Studying the types of stressors could be used in preventive strategies against mental health problems and also in training useful copying styles.

Objective: Patients’ beliefs and emotions toward an illness can influence their coping responses, illness behaviors, adherence to treatment, quality of life, and even the psychoneuroimmune responses. The aim of present study was to develop and validate a novel questionnaire assessing both rational and irrational beliefs of patients regarding their illness. Method: In a cross sectional methodological study, the items of the Illness Belief Network (IBN) were developed regarding patients and clients’ opinions about and attribution of their disease extracted from 400 clinical interviews and were coded based on Leventhal’s self-regulation model. An expert panel coded the items. A total of 400 patients with different medical conditions completed the questionnaire. Participants additionally rated the Illness Perceptions Questionnaire in its revised form (IPQ-R) to assess convergent validity. Construct validity was examined by conducting exploratory and confirmatory factor analysis. The Cronbach alpha and Intracluster Correlation Coefficient (ICC) were used for examining Internal consistency and test-retest reliability of the IBN. Results: The IBN questionnaire was finalized with 84 items, and the results of factor analysis revealed 5 factors: psychosocial causes, environmental causes, control, meaning, and consequence/timeline; extracted factors were confirmed by confirmatory factor analysis. Cronbach’s α coefficient for scale was 0.92 and it ranged from 0.79 to 0.89 for the subscales. IBN indicated excellent test-retest reliability results based on ICC 0.842(95%CI: 0.798-0.846). The correlation coefficients of all items exceeded the prespecified acceptable value of 0.40, indicating satisfactory item discriminant validity, and correlation between IBN and IPQ-R subscales were statistically significant (all p values < 0.01), indicating acceptable convergent validity. Conclusion: The IBN questionnaire is a valid and reliable phenomenological, non-judging, and clinical tool to assess patient’s rational and irrational or faith-based beliefs about the illness. This tool can be used to improve doctor-patient communication by exploring the complex nature of human thinking.

Background and Aim: There are few pieces of evidence on the association between nut consumption and the risk of cardiovascular disease (CVD) in the Eastern Mediterranean Region. This study investigated the relationship of nut consumption with the risk of CVD and all-cause mortality in the Iranian population.Methods and Results: This population-based prospective cohort study was carried out in 6,504 randomly selected participants aged ≥35 years in central Iran (2001–2013) in the framework of the Isfahan Cohort Study. Dietary data were collected by a validated 48-item food frequency questionnaire. Subjects or their next of kin were interviewed biannually, looking for the possible occurrence of cardiovascular events and all-cause mortality. During the median follow-up of 135 months and 52,704.3 person-years, we found a total of 751 CVD events. In unadjusted model, participants in the highest quartile of nut intake had a lower CVD risk {hazard ratio (HR) [95% confidence interval (CI)]: 0.57(0.47–0.70); P for trend < 0.001}, CVD mortality [HR (95% CI): 0.54 (0.33–0.72); P for trend < 0.001], and all-cause mortality [HR (95% CI): 0.24 (0.14–0.42); P for trend < 0.001]. In the fully adjusted model, the association was diluted, and no significant relationship was found between nut intake and CVD events and all-cause mortality, except for CVD mortality in the highest quartile vs. the lowest one [HR (95% CI): 0.55 (0.30–0.98)].Conclusion: Nut intake had an inverse association with the risk of CVD mortality. It is suggested to perform studies to examine the association of individual types of nuts and different preparation methods on CVD risk and mortality.

Background: Workers have to spend a substantial proportion of their income on foods and despite the high prevalence of stress among them, little is known about the association of dietary patterns and mental health disorders in this group. We examined whether dietary patterns are associated with depression and anxiety risk in the Iranian workers of steel mill company. Materials and Methods: We conducted a cross-sectional study among 3060 workers (2803 males and 260 females) in 2015. Dietary intake was assessed using a validated semiquantitative food frequency questionnaire during the preceding year, and depression and anxiety were evaluated using a Persian-validated Hospital Anxiety and Depression Scale. Major dietary patterns were determined using exploratory factor analysis and the risk of depression and anxiety was assessed across the tertiles of dietary patterns using logistic regression. Results: Three dietary patterns were identified: healthy (loaded by fruit, vegetables and skim dairy products), Western (loaded by processed foods, butter and sweets), and Iranian traditional diet (loaded by refined grains, red meat, poultry and legumes). After adjustment for various confounders, individuals in the highest tertile of healthy diet had lower risk of depression (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.32, 0.68) and anxiety (OR: 0.71; 95% CI: 0.52, 0.99) compared with those in the first tertile, whilst greater adherence to the Iranian traditional diet was associated with increased risk of depression (OR: 1.82; 95% CI: 1.24, 2.67) and anxiety (OR: 1.50; 95% CI: 1.08, 2.09). The Western-style diet was marginally associated with increased risk of depression, but not anxiety. Conclusion: Overall, we found healthy diet might be associated with decreased risk of depression and anxiety, but the Iranian traditional diet might be associated with increased risk of depression and anxiety. Therefore, to improve public health, Iranian traditional diet should be adjusted according to the healthy diet recommendations.