فهرست مطالب hamidreza roohafza

Context: 

Neuroticism is associated with a heightened experience of bodily sensations and pain. This suggests that psychosocial factors can affect biological mechanisms. However, it is unclear whether fibromyalgia (FM) is associated with neuroticism and how these factors may be related.

 This study attempted to incorporate recent studies on fibromyalgia and neuroticism to comprehensively explain it.

 In this systematic review and meta-analysis based on the PRISMA guidelines (2020), PubMed, Psych INFO, Social Sciences, Scopus, ProQuest, and Google Scholar were searched for quantitative studies published up to August 31, 2022.

 Nineteen cross-sectional studies met the meta-analytic inclusion criteria, totaling 7,881 participants. The meta-analysis demonstrated high levels of neuroticism in fibromyalgia patients compared with control groups (Hedges’ g = 0.78; 95% CI = 0.54 − 1.02; P < 0.001). This meta-analysis provides evidence of the role of neuroticism as a contributing factor in the development and manifestation of fibromyalgia. Meta-regression and subgroup analyses were also conducted to investigate the potential moderators that might have influenced the effect size. The results of the meta-regression and subgroup analyses revealed that the health condition of the control group and the sex of the participants were significant moderators affecting the effect size.

 The results suggest that neuroticism should be specifically assessed and targeted in fibromyalgia interventions, especially in women. Furthermore, there should be particular emphasis on the mechanisms through which neuroticism may contribute to an increased risk of persistent pain and somatic complaints. As a result, fibromyalgia patients with high neuroticism levels should receive multimodal interventions to address neuroticism.

The effectiveness of cardiac rehabilitation (CR) programs following either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has been separately studied. Few studies have compared the effects of similar CR programs between PCI and CABG. This study aimed to compare the effects of CR in patients recruited following either PCI or CABG on coronary heart disease risk factors, psychological variables, and functional capacity. For this retrospective study, the documents of the CR program registry of the Isfahan Cardiovascular Research Institute were reviewed from 2008 to 2021. Patients with ischemic heart disease undergoing PCI or CABG were enrolled in an 8-week exercise-based cardiac rehabilitation program. Demographics, smoking status, clinical data, echocardiographic parameters, laboratory data, functional capacity, and psychological status were assessed. Patients who underwent CABG (n=557) were more likely to be referred to CR than those who underwent PCI (n=440). All variables changed significantly after the CR program compared to their baseline value in both the PCI and CABG groups. However, low-density lipoprotein and total cholesterol levels, peak systolic blood pressure, and resting and peak diastolic blood pressure did not change in any of the groups, and fasting blood sugar (p=0.01) and triglyceride (TG) (p=0.01) levels significantly decreased only in the PCI group. Between-group comparisons indicated that after adjustment, no significant difference was observed between the PCI and CABG groups except for TG, which was significantly reduced in the PCI group (p=0.01). The CR program was equally effective in patients who underwent either PCI or CABG.

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.

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.

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.

Fibromyalgia Syndrome (FMS) is a widespread chronic musculoskeletal pain disorder. Although many treatments are available for fibromyalgia, management remains a challenge. Recent evidence suggests that personality traits may influence fibromyalgia.

According to PRISMA guidelines, this systematic review and meta-analysis explored harm avoidance and self-directedness in fibromyalgia patients using Cloninger's personality model. The meta-analysis included 14 studies evaluating harm avoidance and 11 studies evaluating self-directedness in patients with fibromyalgia compared with healthy individuals. Reported data from primary studies were pooled in a random-effects model using the Hedges' g approach. 

Fibromyalgia patients demonstrated high harm avoidance (Hedges' g= 1.31; 95% CI: 0.97 to 1.65) and low self-directedness (Hedges' g= -0.71; 95% CI: -1.00 to -0.42) comparing to healthy individuals. Additionally, the results showed that high harm avoidance was significantly related to an increased risk of FMS, although high self-directedness played a protective role against it.

The results demonstrated that high harm avoidance and low self-directedness are distinct personality traits in patients with fibromyalgia. Early identification and evaluation of a profile of high harm avoidance and low self-directedness may help conceptualize the underlying complex mechanisms of fibromyalgia. Additionally, it could identify patients who are more prone to entering a vicious cycle of disability and pain. Further research is required to understand the role of personality characteristics better.

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.

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.

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).

Opioid addiction has no effects on post‑PCI angiographic results and in‑hospital survival outcomes in STEMI patients which undergoing emergency PCI.

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.

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.

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.

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.

Mortality of ST‑elevation myocardial infarction (STEMI) patients is increasing in world. This study defines predictors of mortality in patients who have STEMI.

This study was a part of the ST‑elevated myocardial infarction cohort study in Isfahan conducted on 876 acute myocardial infarction (MI) followed for 2 years that 781 patient entered. The effect of predictors of mortality includes demographic, physiological, and clinical characterizes compared in two groups alive and died patients. MACE was defined as nonfatal MI, nonfatal stroke, and atherosclerosis cardiovascular disease‑related death was recorded. Univariate and multiple logistic regression analyses were performed. All analyses performed using SPSS 20.0. P < 0.05 considered statistically significant.

A total 781 patients, 117 (13%) that 72 (8.5%) was in‑hospital died. The mean (standard deviation) age of the patients was 60.92 (12.77) years and 705 (81.3%) patients were males. Significant factors that affected mortality on analysis of demographic and physiological parameters were age (P < 0.001), sex (P = 0.004), transfusion (P = 0.010), STEMI type (P < 0.001), number epicardial territories >50% (P = 0.001), ventilation options (P < 0.001), smoker (P = 0.003), and diabetes (P = 0.026). Significant clinical factors affected mortality were ejection fraction (EF) (P < 0.001), creatinine (P < 0.001), hemoglobin (P < 0.001), low‑density lipoprotein‑cholesterol (LDL‑C) (P = 0.019), and systolic blood pressure (P < 0.001). Multiple logistics regression model definition significant predictors for mortality were age (P < 0.001), heart rate (HR) (P = 0.007), EF (0.039), LDL‑C (P = 0.002), and preangia (P = 0.022).

The set of factors can increase or decrease mortality in these patients. Significant predictors of mortality STEMI patients by 2‑year follow up were age, HR, EF, LDL‑C, and preangia. It seems that more articles need to be done in different parts of Iran to confirm the results.

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.

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.

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<0.001). Cardiovascular events, cardiovascular-related mortality, and all-cause mortality occurred in 478 (17.7%), 101 (3.7%), and 241 (8.9%) individuals, respectively. After controlling for known cardiovascular risk factors, we found an association between ER and cardiovascular events (adjusted hazard ratio [95% confidence interval] =2.36 [1.19–4.68], P=0.014), cardiovascular-related mortality (4.97 [1.95–12.60], P=0.001), and all-cause mortality (2.50 [1.11–5.58], P=0.022) in women. No significant association was found between ER and any study outcomes in men.

ER is common in young men with no apparent long-term cardiovascular risks. In women, ER is relatively rare, but it could be associated with long-term cardiovascular risks.

Background:

This study aimed to investigate readmission risk factors after ST-elevation myocardial infarction (STEMI) during a 3-year follow-up.

This study is a secondary analysis of the STEMI Cohort Study (SEMI-CI) in Isfahan, Iran, with 867 patients. A trained nurse gathered the demographic, medical history, laboratory, and clinical data at discharge. Then the patients were followed up annually for 3 years by telephone and invitation for in-person visits with a cardiologist concerning readmission status. Cardiovascular readmission was defined as MI, unstable angina, stent thrombosis, stroke, and heart failure. Adjusted and unadjusted binary logistic regression analyses were applied.

Of 773 patients with complete information, 234 patients (30.27%) experienced 3-year readmission. The mean age of the patients was 60.92±12.77 years, and 705 patients (81.3%) were males. The unadjusted results showed that smokers were 21% more likely to be readmitted than nonsmokers (OR, 1.21; P=0.015). Readmitted patients had a 26% lower shock index (OR, 0.26; P=0.047), and ejection fraction had a conservative effect (OR, 0.97; P<0.05). The creatinine level was 68% higher in patients with readmission. An adjusted model based on age and sex showed that the creatinine level (OR, 1.73), the shock index (OR, 0.26), heart failure (OR, 1.78), and ejection fraction (OR, 0.97) were significantly different between the 2 groups.

Patients at risk of readmission should be identified and carefully visited by specialists to help improve timely treatment and reduce readmissions. Therefore, it is recommended to pay special attention to factors affecting readmission in the routine visits of STEMI patients.

Plaque instability is a leading cause of morbidity and mortality in coronary artery disease (CAD) patients. Numerous efforts have been made to figure out and manage unstable plaques prior to major cardiovascular events incidence. The current study aims to assess the values of the atherogenic index of plasma (AIP) to detect unstable plaques.

The current case?control study was conducted on 435 patients who underwent percutaneous coronary intervention due to chronic stable angina (stable plaques, n = 145) or acute coronary syndrome (unstable plaques, n = 290). The demographic, comorbidities, chronic  edications, biochemical and hematological characteristics of the patients were entered into the study checklist. The baseline AIP was measuredaccording to the formula of triglycerides/high?density lipoprotein logarithm. Binary logistic regression was applied to investigate the standalone association of AIP with plaque instability. Receiver operating curve (ROC) was depicted to determine a cut?off, specificity, and sensitivity of AIP in unstable plaques diagnosis.

AIP was an independent predictor for atherogenic plaque unstability in both crude (odds ratio [OR]: 3.677, 95% confidence interval [CI]: 1.521–8.890; P = 0.004) and full?adjusted models (OR: 15, 95% CI:2.77–81.157; P = 0.002). According to ROC curve, at cut?point level of 0.62, AIP had sensitivity and specificity of 89.70% and 34% to detect unstable plaques, respectively (area under the curve: 0.648, 95% CI: 0.601–0.692, P < 0.001).

According to this study, at the threshold of 0.62, AIP as an independent biomarker associated with plaque instability can be considered a screening tool for patients at increased risk for adverse events due to unstable atherosclerotic plaques.

To investigate the effects of comprehensive, integrated interventions on dyslipidemia Knowledge and Practices (LIPOKAP) using population and high-risk approaches.

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. 

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.

The validity and reliability of all developed questionnaires that can examine knowledgeand practice  changes as a result of intervention activities were acceptable.

 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).

 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.

 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).

 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.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, with a significant rise in prevalence during recent decades. Considering its remarkable morbidity and mortality rates, AF has become a significant concern worldwide. To our knowledge, this is the first study to assess the prevalence of AF in Iran.
The current cross-sectional study is a part of the Isfahan Cohort Study (ICS), which has evaluated 6504 adults aged over 35 years and followed them up since 2001. An echocardiogram was taken from all the participants and interpreted by 2 skilled residents of cardiology. AF diagnosis was made based on the ICD-10-CM codes (I480-I484, I489), and its prevalence was determined.
Thirteen out of 6504 study participants (prevalence=0.19%) at a mean age of 61.8± 9.5 years were diagnosed with AF. AF was slightly predominant among males (53.8% vs 46.2%). Diabetes mellitus, ischemic heart disease, and peripheral vascular disease were present in 1 (7.7%), 2 (15.4%), and 1 (7.7%) cases with AF, respectively.
The remarkably low rate of AF in this study compared with other investigations may be due to the lower age of the assessed population, less alcohol consumption in Iranian society, and failure to find cases with paroxysmal and transient AF. (Iranian Heart Journal 2022; 23(2): 53-60)

As the diagnostic criteria for psychosomatic research‑structured interview (DCPR‑SI) is a rater‑assessed questionnaire, it has not been used vastly in community‑based studies and clinics. Describing and investigating self‑assessed form of DCPR are an attempt to apply it easier and more worthwhile for medical settings. The aim of this study was to describe and present self‑assessed form of DCPR self‑assessed (DCPR‑SA) and test its validity and reliability.

The DCPR‑SI was translated to Persian according to the best practice methodology and the guideline for adaptation of self‑report measures. In this cross‑sectional study, 540 patients and healthy individuals were recruited and answered DCPR‑SA and some related questionnaires. Inter‑rater (test–interview) and test–retest reliability were determined. Construct, concurrent, discriminant, and known‑group validity were tested.

The kappa coefficients were expressed substantial and almost perfect agreement (0.617–0.784, P ≤ 0.05). In addition, phi correlation coefficients were indicated adequate test–retest reliability for each cluster (0.548–0.754, P ≤ 0.05). Three domains (anxiety‑related symptoms, functional symptoms, and dysfunctional traits and emotional patterns) were confirmed by factor analysis. The results of the discriminate validity analysis were promising.

The findings show that the DCPR‑SA is valid and reliable and can be used by medical professionals as a psychosomatic screening tool and can be used properly in Persian‑speaking population.

Cardiovascular diseases are the leading causes of mortality all around the world. Patients with Ischemic heart disease (IHD) are at an increased risk of ischemic events; therefore, secondary prevention measures should continue for these patients. Although Cardiac rehabilitation (CR) is one of the secondary prevention measures for IHD patients which has favorable clinical outcomes, only 50% of patients are referred and among them, a small percentage attends CR. Therefore, other strategies should be considered, one of which is home‑based cardiac rehabilitation.

A multicenter, parallel‑group randomized controlled trial has been conducting in three hospitals in Isfahan and patients have been assigned into a 1:1 ratio for the evaluation of the effectiveness of home‑based cardiac rehabilitation versus usual care. Psycho‑educational consultation based on the Health Action Process Approach including heart‑healthy diet, stress management, lifestyle changes, smoking cessation, and physical activity has been performed. Primary outcomes, including the quality of life, psychological and smoking status, body mass index, blood pressure, blood cholesterol level, and physical activity level have been measured at 6 months after the randomization and intervention. One year after the intervention, primary and secondary outcomes, including cardiovascular events, the frequency of hospital admissions, and the death rates due to cardiovascular reasons will be assessed.

HBCR program can increase patient accessibility to CR services its implantation can be reduce burden IHD.

Considering 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.

We 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.

After 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%).

Original 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.

 Depression is common in patients with cardiovascular disease (CVD). Home-based cardiac rehabilitation (HBCR) is a program that alleviates depression. This study aimed to determine and compare HBCR programs and usual care (UC) effects on depression control in patients with ischemic heart disease (IHD).

 This clinical trial study was performed on 259 patients with IHD that were randomly allocated to the HBCR and UC groups for stress management. Data were collected using the "Beck Depression Inventory" (BDI) at baseline and 6 and 12 months. Generalized estimating equation (GEE) models were applied to examine the associations between times of the groups and changes in outcomes over the study times. Data analysis was done in SPSS softwareat the significance level of 0.05.

 A total of 247 participants with a mean age of 55.22 ± 7.40 years participated in this study, and 209 (84.6%) of the study participants were men. Among patients, 128 patients in the UC program and 119 patients in the HBCR program attended at least one of the pre-determined visits (months 6 and 12). The patterns of change of the depression parameter were similar through the course of the study between the two groups (P = 0.04). In the HBCR group, the depression reduced continuously from baseline to 6 months, baseline to 12 months, and 6 to 12 months (P < 0.05). In the UC group, depression was significantly reduced from baseline to 6 months and from baseline to 12 months.

 HBCR was effective in continuous reducing of depression scores in long-term follow-up of patients with IHD. These findings suggest that HBCR can alleviate depression in patients who do not participate in hospital-based cardiac rehabilitation (CR).

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.

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.

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<0.001 for all). Hematocrit, hemoglobin, RBC, and WBC measures were significantly associated with the incidence of cardiovascular events (P=0.002 for all). There was no significant relationship between platelet levels and the incidence of cardiovascular events.

Hematological indices including WBC and RBC counts as well as hemoglobin and hematocrit levels can predict the incidence of cardiovascular events.

 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.

 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.

 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.
 

Evaluation of socioeconomic status (SES) is an important aspect in community-based health studies and it is a major predictor of health and nutritional status as well as mortality and morbidity from many diseases. This study aimed to construct and validate socioeconomic status short-from questionnaire (SES-SQ) in Iranian population.

This cross-sectional methodological study was conducted among 1437 Iranian general population. Face and content validity of the developed questionnaire was evaluated qualitatively. Internal consistency, construct validity using exploratory factor analysis (EFA) and latent class analysis (LCA), and convergent and known-group validity were also evaluated.

The SES-SQ consisted of 6 items. The overall Cronbach’s alpha was 0.64, showing acceptable internal consistency. EFA resulted in two factors explaining 47.78% of total variance. Three SES classes (low/middle/high) were extracted by LCA. The score of SES-SQ ranged from 0 to 17; two cutoff scores of 4.5 and 8.5 were determined by receiver operating characteristic (ROC) analysis for differentiating low from middle and middle from high SES classes, respectively.

An efficient, reliable, and valid short-form questionnaire was developed for evaluating SES in Iranian general population. The relevancy of questionnaire items is not lost over time.

Myocardial infarction (MI) is one of the leading causes of mortality globally. Although it is most prevalent in the elderly, it may occur in young adults (men ≤ 55 years or women ≤ 65 years) as premature MI (PMI). As awareness of genetic risks may lead to effective prevention of PMI, we aim to investigate the association of two susceptible single nucleotide polymorphisms (SNPs) in the LPA gene with PMI in the Iranian population, rs1801693 and rs7765781, identified in previous genome-wide association studies (GWAS).

A total number of 85 patients with PMI and 85 healthy controls were recruited from December 2015 to March 2016 from Isfahan, Iran. Peripheral blood samples were collected from all individuals. Deoxyribonucleic acid (DNA) was extracted and genotyped at rs1181693 and rs7765781 polymorphisms, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results were statistically analyzed to find any possible association of the two polymorphisms with PMI by SPSS software and P-values less than 0.05 were considered to be statistically significant.

Statistical analysis displayed no significant difference between rs1801693 (P = 0.815)/rs7765781 (P = 0.746) alleles in patients with PMI and healthy control subjects.

There is no meaningful association between rs1801693/rs7765781 and PMI incidence in the Iranian population.

Cardiovascular disease (CVD) is one of the most important causes of mortality and morbidity in Iran. Secondary prevention of acute myocardial infarction (AMI) is necessary. The main aim of this cohort is evaluating clinical, paraclinical, management, and 5-year major events of the participants in Isfahan, Iran.

All consecutive patients with AMI hospitalized in Chamran Hospital, Isfahan, during 1 year from march 2015 were recruited and followed for 5 years. ST-Elevation Myocardial Infarction Cohort Study (SEMI-CI) has been initiated as a longitudinal study to evaluate course of patients with AMI in Iran, adherence to evidence-based secondary prevention drug, and five-year events such as death, re-myocardial infarction (REMI), re-hospitalization, congestive heart failure (CHF), and referring to another procedure [percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and resynchronization therapy].

A total of 867 patients with ST-elevation myocardial infarction (STEMI) with mean age of 60.91 ± 12.76 years were recruited. 705 (81.3%) subjects were men with mean age of 59.63 ± 12.59 years. 470 (54.2%) patients had anterior AMI (ant-AMI) and the rest had other types of AMI. The ejection fraction (EF) mean was 37.80 ± 11.74 percent. A total of 30 (3.5%) cases of AMI had not received reperfusion. 445 (51.4%) had primary PCI and 392 (45.2%) had thrombolysis at first revascularization strategy. In-hospital death occurred in 72 participants (8.3%). Drug during hospital included: at discharge, 767 (88.5%) received aspirin, 787 (90.7%) statin, 697 (80.4%) beta-blocker, and 480 (55.4%) angiotensin-converting enzyme (ACE) inhibitor.

According to the best of our knowledge, it is among few cohorts in Eastern Mediterranean Region (EMR) in patients with AMI. This paper showed methodology of this study in patients with STEMI and its follow-up protocol. We can use this result in policy-making for improving secondary prevention strategies.

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.

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.

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.

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.

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.

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.

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.

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. Keywords: Coronary Artery Disease; Ethnic Groups; Risk

Besides the traditional cardiovascular risk factor, some novel risk factors like occupation and career can play an important role in cardiovascular disease (CVDs) incidence.

To assess the association between occupational categories and their positions with cardiovascular events (CVEs) in an Iranian male population.

We followed 2134 men aged 35–65 years for 14 years during the Isfahan Cohort Study (2001–2015) for CVEs including ischemic heart disease and stroke. Firstly, Occupations were classified into 10 categories of International Standard Classification of Occupation (ISCO). Each category was then classified into one of the 4 pre-specified categories, namely high/low skilled white collars and high/low skilled blue collars. White-collar workers referred to managerial and professional workers in contrast with blue collar workers, whose job requires manual labor.

The mean age of studied participants was 46.9 (SD 8.3) years. 286 CVE incidents were recorded; unstable angina had the highest rate (46%); fatal stroke, the lowest (3%). There were no significant difference was observed between white and blue collars in terms of CVE incidence, as well as their high and low skilled subgroups. Hazard ratio analysis indicated a significantly higher risk of CVEs only for low-skilled white-collar workers (crude HR 1.47, 95% CI 1.01 to 2.13); this was not significant after adjustment for confounding variables.

There is no association between occupational categories and incidence of cardiovascular events among Iranian male population.