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Background: Heat shock protein 27 (HSP27) is an intracellular chaperone constitutively expressed in many cell types including cardio myocytes and endothelial cells. Circulating levels of HSP27 and anti-HSP27 antibody are higher in patients with CVD. Anti-HSP27 antibody concentrations were also reported to be increased in atherogenesis. We aimed to evaluate serum anti-HSP27 antibody titers in individuals with, or without, MetS in the MASHAD study cohort with large sample size in 6,568 subjects.

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality and one of the main challenges for health systems worldwide. In this study, we aimed to evaluate the association of socio-demographic, lifestyle, psychological and anthropometric factors and underlying diseases such as hypertension (HTN), diabetes mellitus (DM) and metabolic syndrome (MS) with CVD risk among a subpopulation of Iranian adults. Methods: In this prospective study, a total of 235 CVD patients along with 8405 healthy and nonsymptomatic individuals who participated in MASHAD cohort study were enrolled. CVD diagnosis was performed by taking electrocardiogram (ECG) and medical history and performing physical examination for each participant. Health and lifestyle questionnaires, the Beck's anxiety inventory (BAI), Beck's depression inventory (BDI) and the James and Schofield human energy requirements equations were completed for all participants. Anthropometric measurements were also recorded for all subjects. All statistical analyses including chi-square and student independent T-test were performed using SPSS 16.0 software (SPSS Inc., Chicago, IL, USA) at a significant level of 0.05. Results: We found that there were significant associations between CVD risk and age, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), diabetes mellitus (DM) and family history (FH) of CVD in both genders; though, there was a significant negative correlation between physical activity level (PAL) and risk of CVD among men and women. Also hypertension (HTN), metabolic syndrome (MS), depression and anxiety were positively and higher education level was negatively associated with CVD events only in females. While, waist-to-hip ratio (WHR) was an independent predictor of CVD among males (P-value< 0.05). Conclusion: There are several modifiable and non-modifiable risk factors that are independently considered as CVD predictors among the MASHAD study population. It is recommended to prioritize the lifestyle modification, development of local risk calculators and gender-related stratified strategies in order to prevent and manage CVD among the Iranian population. [ABSTRACT FROM AUTHOR]

Introduction: The association between the serum antibody titer of several heat shock proteins (HSPs) and cardiovascular disease (CVD) risk factors so far has been the subject of several previous studies. Aim: To evaluate the association of adiposity indices and HSP-27 antibody titers in healthy individuals. Materials and Methods: Overall 4823 individuals were recruited from Mashhad Stroke and Heart Atherosclerotic Disorders Study (MASHAD study), that included 1496 individuals with normal-weight (body mass index (BMI) <25 kg/m2), 1975 individuals with over-weight (BMI 25-30 kg/m2), and 1352 individuals with obesity (BMI≥ 30 kg/m2). Results: The serum anti-HSP-27 antibody titers were not significantly different among obese individuals [0.21 (0.11 - 0.34) absorbency unit (AU)], over-weight individuals [0.19 (0.10 - 0.33) AU] and normal-weight individuals [0.19 (0.10 - 0.33) AU]. Conclusions: we have found no significant relationship among anti-HSP-27 antibody concentration and degrees of adiposity among Iranian adults. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: One of the common extrapulmonary involvements in COVID-19 is the cardiovascular system. The reported cases of arrhythmias were mainly among patients with such symptoms as dyspnea, palpitation, chest tightness, and syncope. This study aimed to present a COVID-19 case with gastrointestinal symptoms who developed complete Atrioventricular (AV) block. Case Presentation: The patient was a 19-year-old man with an active lifestyle and no previous illnesses who was admitted to the local hospital due to fever, fatigue, constipation, and one episode of syncope. In the primary evaluation, he had bradycardia and elevated C-Reactive Protein (CRP). In addition, the Real-Time fluorescence Polymerase Chain Reaction (RT-PCR) was positive for SARS-COV-2. Thus, he was referred to a tertiary hospital for management. The electrocardiogram revealed complete AV block and elevated cardiac troponin I level. However, echocardiography was normal. The patient was admitted to the intensive care unit and a temporary pacemaker was inserted. Then, the patient was transferred to the COVID ward and stayed there for nine days. During the admission, cardiac rhythm became sinusal and an improvement was observed in the patient's general condition. Thus, he was discharged. In two weekly follow-up visits after discharge, the patient was asymptomatic and the ECG did not change. Follow-up echocardiography was also normal. Conclusions: Cardiac involvement may occur in healthy individuals without cardiac risk factors and respiratory or cardiac presentations due to COVID-19 infection. [ABSTRACT FROM AUTHOR]

The efficacy, safety, and utility of Nigella sativa seeds oil as a complementary treatment for hypertension, glucose control, and lipid metabolism were evaluated. Hypertensive patients in the intervention (n = 26) and placebo (n = 29) groups received 2.5 ml of N. sativa seeds oil and sunflower oil twice daily for 8 weeks, respectively. The levels of systolic and diastolic blood pressure (SBP, DBP), blood lipid profile, and fasting blood sugar (FBS), at different stages of the treatment period (0, 3, 6, 8 weeks), and malondialdehyde (MDA) and glutathione reductase (GR), at the baseline and end of the study, were assessed. SBP level in the intervention group was significantly reduced, compared with the baseline values (p <.001) and the placebo group (p <.05). A significant decline was observed in the levels of DBP, total cholesterols, and low density lipoprotein (LDL) (p <.000), MDA, and FBS (p <.001); also, a significant increase was observed in the levels of high density lipoprotein (HDL) and GR (p <.001). The use of N. sativa seeds oil as an adjunct to common medications exhibited additional antihypertensive effects as well as beneficial effects on glucose control and lipid metabolism in hypertensive patients with no renal, hepatic, and patient‐reported adverse events. [ABSTRACT FROM AUTHOR]

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The dietary inflammatory index (DII) is a novel way of describing diet that has been studied in relation to various health conditions, including cardiovascular disease (CVD) in several populations. We aimed to investigate the association between DII and CVD events among a representative population sample in northeastern Iran. This prospective cohort study was a subsample of 4,672 adults aged 35–65 years, and recruited as part of Mashhad stroke and heart atherosclerotic disorder cohort study population. The DII was computed at baseline according to a 65‐item validated food frequency questionnaire. Cox regression was used to determine the association of DII with incident CVD. One hundred twenty‐four participants developed CVD (including 24 cases of myocardial infarction [MI], 34 cases of stable angina [SA], and 66 cases of unstable angina [UA]). After adjusting for potential confounding factors, a hazard ratios of 1.06 (95% confidence interval: 0.70–1.60), 1.36 (95% confidence interval: 0.52–3.52), 1.33 (95% confidence interval: 0.60–2.94), and 0.86 (95% confidence interval: 0.48–1.53) were found for total CVD, MI, SA, and UA events, respectively, among the participants with proinflammatory diet (DII ≥ 0) versus those with anti‐inflammatory diet (DII < 0). There was no statistically significant association between the DII and total CVD, MI, SA, or UA in this population of middle‐aged Iranian men and women. [ABSTRACT FROM AUTHOR]

Obesity is an important feature of the metabolic syndrome and is associated with an increased risk of type 2 diabetes mellitus, cardiovascular disease, and some cancers. The aim of this study was to determine the relationship between body fat percentage and an imbalance of the prooxidant/antioxidant balance (PAB), serum superoxide dismutase (SOD1) and inflammation (serum hs‐CRP) and increase risk of metabolic syndrome and diabetes mellitus. In this study, 9154 individuals were recruited as part of the Mashhad Stroke and Heart Association Disorder (MASHAD) study. Subjects were categorized into two groups according to body fat percentage as defined >25% in male and > 30% in female, according to gender. Biochemical factors, including serum PAB, SOD1, and hs‐CRP were measured in all subjects. SPSS version 18 was used for statistical analyses for all. GraphPad Prism 6 for figures was used. Of total number of subjects (9154), 6748 (73.7%) were found to have a high body fat (BF) percentage. Serum hs‐CRP and PAB were significantly higher in individuals with a high BF percentage (P < 0.05) but SOD1 was not significantly different between the two groups (P > 0.05). BF percentage, serum PAB and serum hs‐CRP were significantly higher in individuals with metabolic syndrome and diabetes versus those without metabolic syndrome and diabetes mellitus (P < 0.05), however serum SOD1 was significantly lower in individuals with metabolic syndrome (P < 0.005). Oxidative stress and inflammation are two factors that may link the presence of high BF percentage with the development of metabolic syndrome, diabetes, and cardiovascular disease. © 2018 BioFactors, 45(1):35–42, 2019 [ABSTRACT FROM AUTHOR]

Hypertriglyceridemia is a common form of dyslipidemia and is associated with several comorbidities, such as increased risk of pancreatitis and cardiovascular diseases (CVD). The white blood cell (WBC) count is a non-specific inflammatory marker associated with a wide variety of diseases such as diabetes, hypertension, and atherosclerotic cardiovascular disease. The objective of this study was to perform a genderstratified examination of the association between hypertriglyceridemia and hematological parameters in a large sample of Iranian population. The triglyceride (TG) levels and hematological parameters were measured in 9,780 participants (40% males and 60% females) aged 35-65 years, enrolled in a population-based cohort (MASHAD) study in northeastern Iran. Participants were stratified into three groups based on the definition of hypertriglyceridemia: TG<150 mg/dl (n=6521), TG=150-199 mg/dl (n=1597), and TG≥200 mg/dl (n=1662). A complete blood count (CBC) was obtained for all the subjects. The mean WBC count increased with increasing severity of hypertriglyceridemia among both men and women. Participants with high and very high TG levels had significantly higher WBC count, RBC count, platelet count, hemoglobin, hematocrit, and mean corpuscular hemoglobin concentration and significantly lower RDW. After performing multivariate logistic regression, WBC count and RDW were independently related to hypertriglyceridemia. In conclusion, hypertriglyceridemia is associated with elevated WBC count which may partly explain the observed association between hypertriglyceridemia and CVD. [ABSTRACT FROM AUTHOR]

Metabolic syndrome is a clustering of metabolic abnormalities that include central obesity, dyslipidemia, insulin resistance, and increased blood pressure. The aim of this study was to evaluate and identify the risk factors associated with metabolic syndrome by using a decision tree algorithm as a data mining tool. A total of 6578 individuals were included in the analysis using a body mass index (BMI) cutoff >= 25 kg/m for the definition of overweight, in accordance with International Diabetic Federation (IDF) criteria. Subjects with obesity plus two or more of the criteria for defining metabolic syndrome were included in the metabolic syndrome group. Of the 6578 subjects, 70% (4539 subjects) were selected as a 'training' dataset and 30% (2039 cases) were used as the testing dataset to evaluate the performance of decision tree. Two models were evaluated. In model I, age, sex, educational level, marriage and job status, fasted serum triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), uric acid, fasting blood glucose (FBG), high sensitive C-reactive protein (Hs-CRP), systolic (SBP) and diastolic (DBP) blood pressure, and physical activity level were considered as input variables and in model II, age, gender, Hs-CRP, white blood cell (WBC), red blood cell (RBC), hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), Platelets (PLT), red cell distribution width (RDW), and platelet distribution width (PDW) were used as input variables. The validation of the model was assessed by constructing a receiver operating characteristic (ROC) curve. The results showed that in model I, serum fasted TG was the most important associated risk factor for metabolic syndrome. In model II, serum Hs-CRP was identified as a risk factor of metabolic syndrome. The sensitivity, specificity, accuracy, and the area under the ROC curve (AUC) values for model I were 99%, 94%, 97% and 0.972 and for model II were 74%, 77%, 76% and 0.812, respectively. Our findings in model I suggest that the IDF criteria are suitable for identifying individuals within the Iranian population into those with, or without MetS. Furthermore, model II showed that serum Hs-CRP concentrations were identified as a risk factor for metabolic syndrome within the Iranian population. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIM: Obesity is a major risk factor for type 2 diabetes mellitus and cardiovascular disease (CVD). Little is known about the metabolic profile across categories of body mass index (BMI), particularly within Asian populations. We assessed the prevalence and distribution of body size phenotypes among Iranian adults from a representative sample from Mashhad. METHOD: The Mashhad Stroke Heart Atherosclerosis Disorder (MASHAD) study cohort of 9761 adults (3903 men) aged 35-65 years were cross-categorized by BMI and metabolic status into: normal-weight metabolically healthy (NWMH), normal-weight metabolically abnormal (NWMA), overweight metabolically healthy (OvMH), overweight metabolically abnormal (OvMA), obese metabolically healthy (OMH) and obese metabolically abnormal (OMA). Metabolic normality/ abnormality was defined by the presence of any two of the following: 1) elevated blood pressure or known hypertension on treatment, 2) high serum fasted triglycerides; 3) low serum HDL-cholesterol, 4) high blood glucose or the presence of diabetes mellitus, 5) serum CRP > 90th percentile. RESULTS: The distribution of obesity phenotypeswas 11.6% (NWMH), 15.6% (NWMA), 10.6% (OvMH), 31.3% (OvMA), 4.9% (OMH), and 25.5% (OMA) overall. Equivalent figures were 13.1%, 24.0%, 7.7% 37.3%, 1.5% and 16.2% in men; 10.7%, 10.2%, 12.5%, 27.4%, 7.2% and 31.8% inwomen, p < 0.001 for gender differences. Multi variables logistic regression models comprising age gender and each of the metabolic factors was associated with 3.2% to 5.3% variations in BMI categories. CONCLUSION: The present study showed that a considerable proportion normal-weight Iranians display cardiometabolic abnormalities especially men, while a significant percentage of obese individuals, particularly women are metabolically healthy. [ABSTRACT FROM AUTHOR]

Introduction: Torsades de pointes may occur secondary to medication-induced prolonged QTc interval on ECG. Number of medications makes the patient prone to this deadly tachycardia. Case presentation: We report four cases of methadone-induced Torsades de pointes. Conclusion: ECG was normal after slow, gradual discontinuation of methadone and the patients were ready for discharge. [ABSTRACT FROM AUTHOR]

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: IRCT2016052528070N1. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is becoming one of the important health care problems around the world. Physical activity as the foundation of the cardiac rehabilitation program is poorly adhered by patients with HF. This study aimed to understand the experiences of patients with HF in terms of adherence to physical activity., Materials and Methods: This study was conducted using conventional qualitative content analysis. Data were collected by semistructured telephone interviews with 25 patients with HF through open-ended questions. Data were collected from patients with HF in Birjand and Mashhad hospitals and heart departments from December 2021 to March 2022. Data were analyzed using Max-QDA10 and data analysis was continuous, comparative, and simultaneous with data collection., Results: After data analysis, three main categories were identified: (1) patient-related barriers and facilitators, (2) support system-related barriers and facilitators, and (3) environmental barriers and facilitators. These categories were subdivided into two main themes: (1) threatening disease and (2) challenging disease., Conclusion: The results showed that beyond patient-related, support system-related, and environmental categories, perceiving the disease as a challenge or a threat is crucial in the activity of patients with HF. Nurses and other health care providers can train problem-solving behaviors to patients with HF to improve their physical and mental well-being. It is suggested that theoretical-behavioral approaches can be used in future clinical trials to improve adherence to physical activity., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Education and Health Promotion.)

Background: Metabolic syndrome (MetS) is a cluster of clinical and metabolic features that include central obesity, dyslipidemia, hypertension and impaired glucose tolerance. These features are accompanied by increased oxidative stress and impaired antioxidant defenses. Vitamin E is a major factor in the non-enzymatic antioxidant defenses. The aim of present study was to investigate the association between serum levels of vitamin E and the presence of MetS and its components in a sample population of Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study., Methods: This cross-sectional study was carried out in 128 subjects with MetS and 235 subjects without MetS. MetS was defined according to the International-Diabetes-Federation criteria. Serum levels of vitamin E were measured using the HPLC method. Anthropometric and biochemical parameters were measured using standard protocols.  Results. MetS patients had significantly lower serum levels of vitamin E (Vit E), Vit E/Total cholesterol (TC), and Vit E/ (TC+triglyceride(TG)) compared to the control group (P < 0.05).  Vit E/ (TG+TC) was also significantly lower in diabetics or those with elevated levels of high sensitive C-reactive protein (hs-CRP). Additionally, there was a significant association between Vit E/ (TG + Total Cho) and the number of components of the metabolic syndrome (p= 0.02) Conclusions. There is a significant inverse association between indices of Vit E status and the presence of MetS. Moreover, a significantly lower Vit E/ (TC+TG) was observed along with individuals with increasing numbers of components of the MetS.

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., Competing Interests: Conflict of interest The authors declared no conflict of interest., (Copyright© 2021 Iranian Neuroscience Society.)