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1.  The Soul and the Body in the Philosophy of the Rambam 
Among the wide-spectrum contribution of the Rambam – the Maimonides – in philosophy to the word and to Judaism are his ideas on the body and on the soul and on the relations between them. His major approaches in these subjects are the following: 1) The body is the home of the soul, and the soul guides the body. That means the body and the soul are one unit. 2) The soul has five virtual parts. Each part is responsible for another activity in the human being. 3) Except for the treatment of diseases of the body and the soul with drugs, foods, physical exercise, etc., the Rambam believes that maintaining the health – of the body and of the soul – lies first of all, and probably exclusively, in observing the commandments and improving one’s ways, morals and conduct up to their highest levels, toward all of the world’s creatures. 4) The Rambam is of the opinion that one needs to persist in learning the Torah. One should worship God with awe and love and observe good values and virtues. All of these build the frameworks that maintain mental health and strengthen man’s abilities to develop skills for maintaining bodily health. This is so because body and soul are one – which is the basis of the Rambam’s philosophy of health and medicine.
doi:10.5041/RMMJ.10040
PMCID: PMC3678934  PMID: 23908798
Maimonides; Rambam; soul; body; soul-body
2.  THE SYMBOLS OF CREATIVE ENERGY IN THE LITERATURE ON MYSTICSM AND ON ALCHEMY 
Ancient Science of Life  1989;8(3-4):191-195.
Alchemy as art tries to imitate creation such as spontaneous generation. The magic wands of creation, of Chinese origin, would be a compass and a triangular carpenter's square. Creation is represented by the dual-natured soul, comprising of the spirit (Ruh) and “the” soul (Nafs). The ultimate source is creative energy which emanates form the Divine word of command. Creative energy, in its non-manifest form, would be ultrasonic energy, which can be represented by a humming sourd. This would be sympolized by the humming sound. This would be symbolized by the humming sound of bees represent creative energy and in fig 3 the fiddle, as direct producers of a humming sound.
PMCID: PMC3336720  PMID: 22557649
3.  The soul and the pneuma in the function of the nervous system after Galen. 
Galen's teaching on anatomy and physiology was generally accepted in the Middle Ages and this applies to the part he thought was played by the pneuma in the functions of the body. In this essay I have outlined the advances made after Galen in the study of the nervous system leading eventually to a time when the soul and the pneuma were no longer thought necessary for the proper functioning of the brain and nerves.
PMCID: PMC1294649  PMID: 8046725
4.  Galen's “Soul” 
British Medical Journal  1974;1(5907):581.
PMCID: PMC1633691
6.  THE PORTRAIT OF A MEDIEVAL ALCHEMIST WITH SYMBOLS OF ELEMENTS IMITATING CREATION 
Ancient Science of Life  1988;8(1):44-48.
This paper depicts e paraphernalia of an alchemist who believed in imitating creation and generating a soul thereby. The magic wands of creation are a compass and a triangular carpenter's square. They can produce the dual natured soul Ruh or Spirit symbolized as Cock and Nafs of “the soul” as snake: The real creative energy by nature is ultrasonic energy, characterizing the word of command of the creator. Ultrasonic energy can be produced by fiddle which is depicted also as such a producer. Thus all the elements necessary to imitate creation have been depicted here.
PMCID: PMC3331348  PMID: 22557629
7.  CROSS AS SYMBOL OF SOUL OF ABOUT 4000 B.C 
Ancient Science of Life  1991;10(3):191-193.
The author presents in this article many evidence to prove that the cross is a symbol of soul.
PMCID: PMC3331288  PMID: 22556532
8.  Lifetime exposure to traumatic psychological stress is associated with elevated inflammation in the heart and soul study 
Brain, Behavior, and Immunity  2012;26(4):642-649.
Exposure to traumatic psychological stress increases risk for disease events and mortality in patients with cardiovascular disease (CVD). While the biological mechanisms of these effects are not known, inflammation may play a key role as it is both elevated by psychological stress and involved in the development and progression of CVD. In a prospective study of patients with stable CVD (n = 979), we examined if higher lifetime trauma exposure was associated with elevated levels of inflammation at baseline and at five-year follow-up, and with greater increases in inflammation over time. Inflammation was indexed by a composite score incorporating the inflammatory markers interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and resistin. In follow-up analyses, we adjusted for sociodemographic factors, psychiatric disorders and health behaviors that were significantly associated with trauma exposure. Higher trauma exposure was associated with elevated inflammation at baseline (β = .09, p = .01) and at five-year follow-up (β = .09, p = .03). While levels of inflammation increased from baseline to follow-up in the sample, there was no significant association between trauma exposure and rate of change in inflammation. Findings were robust to adjustments for sociodemographic factors and psychiatric disorders, but health behaviors appeared to contribute to the association between trauma and inflammation at follow-up. This is the first large-scale demonstration of an association between lifetime trauma exposure and inflammation. High lifetime exposure to traumatic stress may contribute to an accelerated rate of CVD progression through elevated inflammation.
doi:10.1016/j.bbi.2012.02.003
PMCID: PMC3322304  PMID: 22366689
Aging; cardiovascular disease; C-reactive protein; immune system; inflammation; interleukin-6; psychological stress; resistin; traumatic psychological stress; tumor necrosis factor-α
9.  Are Eyes Windows to a Deceiver's Soul? Children's Use of Another's Eye Gaze Cues in a Deceptive Situation 
Developmental psychology  2004;40(6):1093-1104.
Three experiments examined 3- to 5-year-olds' use of eye gaze cues to infer truth in a deceptive situation. Children watched a video of an actor who hid a toy in 1 of 3 cups. In Experiments 1 and 2, the actor claimed ignorance about the toy's location but looked toward 1 of the cups, without (Experiment 1) and with (Experiment 2) head movement. In Experiment 3, the actor provided contradictory verbal and eye gaze clues about the location of the toy. Four- and 5-year-olds correctly used the actor's gaze cues to locate the toy, whereas 3-year-olds failed to do so. Results suggest that by 4 years of age, children begin to understand that eye gaze cues displayed by a deceiver can be informative about the true state of affairs.
doi:10.1037/0012-1649.40.6.1093
PMCID: PMC2567061  PMID: 15535759
10.  Usefulness of Diastolic Dominant Pulmonary Vein Flow to Predict Hospitalization for Heart Failure and Mortality in Ambulatory Patients with Coronary Heart Disease (From the Heart and Soul Study) 
The American journal of cardiology  2008;103(4):482-485.
Diastolic dysfunction is usually identified by the combination of characteristic mitral and pulmonary vein flow patterns. However, obtaining a complete set of echocardiographic parameters can be technically difficult and data may conflict. We hypothesized that, as a stand alone variable, diastolic (ventricular diastole) dominant pulmonary vein flow predicts heart failure (HF) hospitalizations and cardiovascular (CV) death. Standard transthoracic echocardiograms were performed in 906 participants from the Heart and Soul Study, a prospective study of the effects of depression on coronary heart disease. Pulmonary vein flow pattern was determined by the dominant velocity time integral. Cardiac events were determined by two independent adjudicators and Cox proportional hazards models were used. Systolic dominant pulmonary vein flow was present in 89% of the participants, and diastolic dominant in the remaining 11%. During an average 4.1 years of follow-up, participants with diastolic dominant pulmonary vein flow had a 25% rate of HF hospitalization and 9% rate of CV death. After multivariate adjustment including left ventricular ejection fraction, diastolic pulmonary vein flow was associated with a three-fold risk for HF hospitalization (p=0.001) and a two-fold risk for HF hospitalization or death (p=0.004). In conclusion, diastolic dominant pulmonary vein flow pattern is a stand alone predictor of adverse cardiac events and its presence is associated with significantly higher rates of HF hospitalizations and CV death.
doi:10.1016/j.amjcard.2008.10.024
PMCID: PMC2680227  PMID: 19195506
pulmonary vein flow; echocardiography; heart failure; prognosis
11.  Preliminary structural characterization of human SOUL, a haem-binding protein 
This manuscript describes the overexpression, purification and crystallization of human SOUL protein (hSOUL). hSOUL is a 23 kDa haem-binding protein that was first identified as the PP23 protein isolated from human full-term placenta.
Human SOUL (hSOUL) is a 23 kDa haem-binding protein that was first identified as the PP23 protein isolated from human full-term placentas. Here, the overexpression, purification and crystallization of hSOUL are reported. The crystals belonged to space group P6422, with unit-cell parameters a = b = 145, c = 60 Å and one protein molecule in the asymmetric unit. X-ray diffraction data were collected to 3.5 Å resolution at the ESRF. A preliminary model of the three-dimensional structure of hSOUL was obtained by molecular replacement using the structures of murine p22HBP (PDB codes 2gov and 2hva), obtained by solution NMR, as search models.
doi:10.1107/S174430910902291X
PMCID: PMC2705645  PMID: 19574650
haem-binding proteins; SOUL
12.  Structural changes in the BH3 domain of SOUL protein upon interaction with the anti-apoptotic protein Bcl-xL 
Biochemical Journal  2011;438(Pt 2):291-301.
The SOUL protein is known to induce apoptosis by provoking the mitochondrial permeability transition, and a sequence homologous with the BH3 (Bcl-2 homology 3) domains has recently been identified in the protein, thus making it a potential new member of the BH3-only protein family. In the present study, we provide NMR, SPR (surface plasmon resonance) and crystallographic evidence that a peptide spanning residues 147–172 in SOUL interacts with the anti-apoptotic protein Bcl-xL. We have crystallized SOUL alone and the complex of its BH3 domain peptide with Bcl-xL, and solved their three-dimensional structures. The SOUL monomer is a single domain organized as a distorted β-barrel with eight anti-parallel strands and two α-helices. The BH3 domain extends across 15 residues at the end of the second helix and eight amino acids in the chain following it. There are important structural differences in the BH3 domain in the intact SOUL molecule and the same sequence bound to Bcl-xL.
doi:10.1042/BJ20110257
PMCID: PMC3174058  PMID: 21639858
apoptosis; Bcl-xL; Bcl-2 homology 3 domain (BH3 domain); crystal structure; NMR; SOUL; surface plasmon resonance; BH, Bcl-2 homology; HEBP, haem-binding protein; HSQC, heteronuclear single-quantum coherence; MPT, mitochondrial permeability transition; rmsd, root mean square deviation; RZPD, Deutsches Ressouroenzentrum für Genomforschung; SPR, surface plasmon resonance
13.  THE TRIDOSHA DOCTRINE TRACED TO BREATH AS SOUL 
Ancient Science of Life  1989;9(1):25.
The author traces in this paper the clue of the Tridosha Doctrine consisting of Air, water and heat. Breath contains all the three. Probably the Tridosha doctrine arose while considering breath as soul.
PMCID: PMC3331300  PMID: 22557670
14.  A home for body and soul: Substance using women in recovery 
Background
We report on an in-depth qualitative study of 28 active and former substance addicted women of low or marginal income on the core components of a harm reduction-based addiction recovery program. These women volunteered to be interviewed about their perceptions of their therapeutic needs in their transition from substance addiction to recovery.
Method
Data were gathered about women’s experiences and essential needs in addiction recovery, what helped and what hindered their past efforts in recovery, and their views of what would constitute an effective woman-centred recovery program. The research was based upon the experience and knowledge of the women in interaction with their communities and with recovery programs. The study was informed by harm reduction practice principles that emphasize the importance of individual experience in knowledge construction, reduction of harm, low threshold access, and the development of a hierarchy of needs in regard to addiction recovery.
Results
Three core needs were identified by study participants: normalization and structure, biopsychosocial-spiritual safety, and social connection. What hindered recovery efforts as identified by participants was an inner urban location, prescriptive recovery, invidious treatment, lack of safety, distress-derived distraction, problem-focused treatment, coercive elements of mutual support groups, and social marginalization. What helped included connection in counselling and therapy, multidisciplinary service provision, spirituality focus, opportunities for learning and work, and a safe and flexible structure. Core components of an effective recovery program identified by women themselves stand in contrast to the views of service providers and policymakers, particularly in regard to the need for a rural location for residential programs, low threshold access, multidisciplinary service provision of conventional and complementary modalities and therapies for integrated healing, long-term multi-phase recovery, and variety and choice of programming.
Conclusion
A key barrier to the addiction recovery of women is the present framework of addiction treatment, as well as current drug laws, policies and service delivery systems. The expectation of women is that harm reduction-based recovery services will facilitate safe, supportive transitioning from the point of the decision to access services, through independent living with community integration.
doi:10.1186/1477-7517-10-39
PMCID: PMC3878194  PMID: 24359089
15.  Process evaluation of Healthy Bodies, Healthy Souls: a church-based health intervention program in Baltimore City 
Health Education Research  2013;28(3):392-404.
Soaring obesity rates in the United States demand comprehensive health intervention strategies that simultaneously address dietary patterns, physical activity, psychosocial factors and the food environment. Healthy Bodies, Healthy Souls (HBHS) is a church-based, community-participatory, cluster-randomized health intervention trial conducted in Baltimore City to reduce diabetes risk among urban African Americans by promoting healthy dietary intake, increased physical activity and improvement to the church food environment. HBHS was organized into five 3–8-week phases: Healthy Beverages, Healthy Desserts, Healthy Cooking, Healthy Snacking and Eating Out and Physical Activity. A three-part process evaluation was adopted to evaluate implementation success: an in-church instrument to assess the reach, dose delivered and fidelity of interactive sessions; a post-intervention exposure survey to assess individual-level dose received in a sample of congregants and an evaluation form to assess the church food environment. Print materials were implemented with moderate to high fidelity and high dose. Program reach was low, which may reflect inaccuracies in church attendance rather than study implementation issues. Intervention components with the greatest dose received were giveaways (42.0–61.7%), followed by taste tests (48.7–53.7%) and posters (34.3–65.0%). The dose received of general program information was moderate to high. The results indicate successful implementation of the HBHS program.
doi:10.1093/her/cyt049
PMCID: PMC3649211  PMID: 23525780
16.  The Apoptosome: Heart and Soul of the Cell Death Machine 
Neoplasia (New York, N.Y.)  1999;1(1):5-15.
Abstract
Apoptosis is a fundamental biologic process by which metazoan cells orchestrate their own self-demise. Genetic analyses of the nematode C elegans identified three core components of the suicide apparatus which include CED-3, CED-4, and CED-9. An analogous set of core constituents exists in mammalian cells and includes caspase-9, Apaf-1, and bcl-2/xl, respectively. CED-3 and CED-4, along with their mammalian counterparts, function to kill cells, whereas CED-9 and its mammalian equivalents protect cells from death. These central components biochemically intermingle in a ternary complex recently dubbed the “apoptosome.” The C elegans protein EGL-1 and its mammalian counterparts, pro-apoptotic members of the bcl-2 family, induce cell death by disrupting apoptosome interactions. Thus, EGL-1 may represent a primordial signal integrator for the apoptosome. Various biochemical processes including oligomerization, adenosine triphosphate ATP/dATP binding, and cytochrome c interaction play a role in regulating the ternary death complex. Recent studies suggest that cell death receptors, such as CD95, may amplify their suicide signal by activating the apoptosome. These mutual associations by core components of the suicide apparatus provide a molecular framework in which diverse death signals likely interface. Understanding the apoptosome and its cellular connections will facilitate the design of novel therapeutic strategies for cancer and other disease states in which apoptosis plays a pivotal role.
PMCID: PMC1716059  PMID: 10935465
apoptosis; apoptosome; cell death; death receptor
17.  Telomere Length Trajectory and Its Determinants in Persons with Coronary Artery Disease: Longitudinal Findings from the Heart and Soul Study 
PLoS ONE  2010;5(1):e8612.
Background
Leukocyte telomere length, an emerging marker of biological age, has been shown to predict cardiovascular morbidity and mortality. However, the natural history of telomere length in patients with coronary artery disease has not been studied. We sought to investigate the longitudinal trajectory of telomere length, and to identify the independent predictors of telomere shortening, in persons with coronary artery disease.
Methodology/Principal Findings
In a prospective cohort study of 608 individuals with stable coronary artery disease, we measured leukocyte telomere length at baseline, and again after five years of follow-up. We used multivariable linear and logistic regression models to identify the independent predictors of leukocyte telomere trajectory. Baseline and follow-up telomere lengths were normally distributed. Mean telomere length decreased by 42 base pairs per year (p<0.001). Three distinct telomere trajectories were observed: shortening in 45%, maintenance in 32%, and lengthening in 23% of participants. The most powerful predictor of telomere shortening was baseline telomere length (OR per SD increase = 7.6; 95% CI 5.5, 10.6). Other independent predictors of telomere shortening were age (OR per 10 years = 1.6; 95% CI 1.3, 2.1), male sex (OR = 2.4; 95% CI 1.3, 4.7), and waist-to-hip ratio (OR per 0.1 increase = 1.4; 95% CI 1.0, 2.0).
Conclusions/Significance
Leukocyte telomere length may increase as well as decrease in persons with coronary artery disease. Telomere length trajectory is powerfully influenced by baseline telomere length, possibly suggesting negative feedback regulation. Age, male sex, and abdominal obesity independently predict telomere shortening. The mechanisms and reversibility of telomeric aging in cardiovascular disease deserve further study.
doi:10.1371/journal.pone.0008612
PMCID: PMC2797633  PMID: 20072607
18.  The Soul’s Wisdom: Stories of Living and Dying 
Current Oncology  2008;15(Suppl 2):s107.es48-s107.es52.
Cancer can lead to spiritual transformation, which can be seen as a form of alchemy. During this process, patients, family members, and even professional caregivers can find themselves having spiritual experiences that go beyond any they had previously encountered. This paper provides qualitative descriptions of the “Field” or “Soul Wisdom” experienced by patients and caregivers.
PMCID: PMC2528551  PMID: 18769614
Spirituality
19.  And to end on a poetic note: Galen’s authorial strategies in the pharmacological books 
This paper examines the authorial strategies deployed by Galen in his two main pharmacological treatises devoted to compound remedies: Composition of Medicines according to Types and Composition of Medicines according to Places. Some of Galen’s methods of self assertion (use of the first person; writing of prefaces) are conventional. Others have not received much attention from scholars. Thus, here, I examine Galen’s borrowing of his sources’ ‘I’; his use of the phrase ‘in these words’; and his recourse to Damocrates’ verse to conclude pharmacological books. I argue that Galen’s authorial persona is very different from that of the modern author as defined by Roland Barthes. Galen imitates and impersonates his pharmacological sources. This re-enactment becomes a way to gain experience (peira) of remedies and guarantees their efficacy.
doi:10.1016/j.shpsa.2011.12.019
PMCID: PMC3396420
Galen; Pharmacology; Compilation; Authority; Authorship; peira
20.  Biomarkers to Predict Recurrent Cardiovascular Disease: the Heart and Soul Study 
The American journal of medicine  2008;121(1):50-57.
Purpose:
To evaluate the ability of six biomarkers to improve prediction of cardiovascular events among persons with established coronary artery disease.
Background:
Cardiovascular risk algorithms are designed to predict the initial onset of coronary artery disease, but are less effective in persons with pre-existing coronary artery disease.
Methods:
We examined the association of N-terminal prohormone brain natriuretic peptide (Nt-proBNP), cystatin C, albuminuria, C-reactive protein (CRP), interleukin-6 (IL-6), and fibrinogen with cardiovascular events in 979 Heart and Soul Study participants with coronary artery disease after adjusting for demographic, lifestyle and behavior variables; cardiovascular risk factors, cardiovascular disease severity, medication use and left ventricular ejection fraction. The outcome was a composite of stroke, myocardial infarction, or coronary heart disease death during an average of 3.5 years of follow-up.
Results:
During follow-up, 142 (15%) participants developed cardiovascular events. The highest quartiles (versus lower 3 quartiles) of five biomarkers were individually associated with cardiovascular risk after multivariate analysis: Nt-proBNP Hazard Ratio=2.13 (95% confidence interval, 1.43 - 3.18); cystatin C 1.72 (1.10 - 2.70); albuminuria 1.71 (1.15 - 2.54); CRP 2.00 (1.40 - 2.85); and IL-6 1.76 (1.22 - 2.53). When all biomarkers were included in multivariable analysis, only Nt-proBNP, albuminuria and CRP remained significant predictors of events [HR (95% CI), 1.88 (1.23 - 2.85), 1.63 (1.09 - 2.43), 1.82 (1.24 - 2.67) respectively]. The area under the receiver operator curve (AUC) for clinical predictors alone was 0.73 (95% CI, 0.68-0.78); adding Nt-proBNP, albuminuria and CRP significantly increased the AUC to 0.77 (95% CI, 0.73-0.82, p<0.005).
Conclusion:
Among persons with prevalent coronary artery disease, biomarkers reflecting hemodynamic stress, kidney damage, and inflammation added significant risk discrimination for cardiovascular events.
doi:10.1016/j.amjmed.2007.06.030
PMCID: PMC2239343  PMID: 18187073
biomarkers; coronary artery disease; cardiovascular events; N-terminal prohormone brain natriuretic peptide; cystatin C; albuminuria; C-reactive protein; interleukin-6; fibrinogen
21.  Interleukin 6 and Atrial Fibrillation in Patients with Coronary Artery Disease: Data from the Heart and Soul Study 
American heart journal  2007;155(2):303-309.
Background
Previous studies suggest that markers of inflammation are elevated in patients with atrial fibrillation (AF). However, because inflammation has been implicated in contributing to risk of both AF and coronary artery disease (CAD), which are often present in the same populations, it is important to control for confounding by the presence of CAD. We therefore examined several biomarkers of inflammation and ultimately genotyped IL-6 polymorphisms in AF patients in a cohort of subjects with known CAD.
Methods
We performed a cross-sectional analysis of 971 participants in the Heart and Soul Study, 46 of whom had AF. IL-6, CRP, tumor necrosis factor-α, CD-40 ligand, monocyte chemoattractant protein-1, and fibrinogen levels were measured.
Results
In both unadjusted and adjusted analyses, IL-06 was the only biomarker significantly associated with AF (median IL-6 3.76 pg/ml and 2.52 pg/ml in those with and without AF, respectively, p=0.0005; adjusted odds ratio [OR] 1.77 p=0.032). The IL-6 –174CC genotype was significantly associated with the presence of AF in the adjusted analysis (OR 2.34, p=0.04) and with higher IL-6 levels (p=0.002).
Conclusions
In this cohort of subjects with CAD, AF was significantly associated with elevated IL-6 levels and the IL-6 –174CC genotype. No associations were found with other biomarkers, including CRP. This suggests that IL-6 is a uniquely important mediator in the pathophysiology of AF.
doi:10.1016/j.ahj.2007.09.006
PMCID: PMC2247366  PMID: 18215601
22.  Red Blood Cell Docosahexaenoic Acid and Eicosapentaenoic Acid Concentrations Are Positively Associated with Socioeconomic Status in Patients with Established Coronary Artery Disease: Data from the Heart and Soul Study12 
The Journal of nutrition  2008;138(6):1135-1140.
Traditional cardiac risk factors only partially explain the biological mechanisms by which persons of lower socioeconomic status (SES) have higher cardiovascular risk. Dietary factors, resulting in lower circulating levels of (n-3) fatty acids, may also contribute to the increased risk of cardiovascular disease (CVD) in patients with low SES. We tested whether low SES is associated with RBC levels of (n-3) fatty acids in patients with coronary heart disease. We performed a cross-sectional analysis of 987 adults with stable coronary artery disease (CAD) recruited from San Francisco area outpatient clinics. Four SES measures (household income, education, occupation, and housing status) were assessed by self-report. RBC fatty acid levels of 2 (n-3) fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), were measured in venous blood samples from fasting subjects. Participants with lower household income, education, occupation, and housing status had lower RBC levels of (n-3) fatty acids (P < 0.001 for all 4 measures). In multivariable models, household income, education, and occupation remained strongly associated with DHA and EPA levels after adjustment for demographic factors, BMI, physical activity, statin use, and kidney function (P < 0.001 for all 3 measures). Housing status was not associated with DHA or EPA after multivariable adjustment. Among patients with CAD, 3 indicators of low SES, household income, education, and occupation, were strongly associated with lower RBC levels of (n-3) fatty acids. Our results raise the possibility that (n-3) fatty acids may be an important mediating factor in the association between low SES and CVD.
PMCID: PMC2675885  PMID: 18492846
23.  Prognostic Value of Leukocyte Telomere Length in Patients with Stable Coronary Artery Disease: Data from the Heart and Soul Study (R1) 
Background
Telomere shortening has been proposed as a marker of biological aging. Whether leukocyte telomere length is associated with mortality among patients with stable coronary artery disease (CAD) is unknown.
Methods and Results
We measured leukocyte telomere length in 780 patients with stable CAD in a prospective cohort study. Participants were categorized by quartiles of telomere length. Hazard Ratios (HRs) and 95% confidence intervals were calculated for all-cause mortality, heart failure (HF) hospitalization, and cardiovascular (CV) events. After 4.4 years of follow-up there were 166 deaths. Compared with participants in the highest telomere length quartile, those in the lowest quartile were at increased risk of death (age-adjusted HR 1.8; 95% CI 1.2–2.9). After multivariate adjustment for clinical (HR 2.1; CI 1.3–3.3), inflammatory (HR 2.0; CI 1.2–3.2), and echocardiographic (HR 1.9; CI 1.0–3.5) risk factors, patients in the lowest quartile of telomere length remained at significantly increased risk of death compared to those in the highest quartile. Patients in the lowest quartile of telomere length were also at significantly increased risk of HF hospitalization (HR 2.6; CI 1.1–6.0) but not CV events (HR 1.7; CI 0.9–3.5)
Conclusions
Reduced leukocyte telomere length is associated with all-cause mortality in patients with stable CAD. The prognostic value of short telomeres in predicting death is not completely captured by existing clinical, inflammatory, and echocardiographic markers of risk.
doi:10.1161/ATVBAHA.108.167049
PMCID: PMC2675880  PMID: 18467646
Telomere; Aging; Leukocyte; Prognosis; Coronary
24.  Depression and Cardiac Function in Patients With Stable Coronary Heart Disease: Findings From the Heart and Soul Study 
Psychosomatic medicine  2008;70(4):444-449.
Objective
To determine whether depression is associated with worse cardiac disease severity in patients with stable coronary heart disease (CHD). There is considerable evidence that depression is a risk factor for adverse cardiovascular events in patients with CHD. However, a frequent criticism of this literature is that the association between depression and adverse cardiovascular outcomes may be confounded by worse baseline cardiac disease severity in depressed patients.
Method
In a sample of 1020 outpatients with stable CHD, we examined the association between major depression (assessed using the Computerized National Institute of Mental Health Diagnostic Interview Schedule) with measures of cardiac disease severity, including systolic dysfunction, diastolic dysfunction, exercise-induced ischemia, and cardiac wall motion abnormalities. Cross-sectional univariate and multivariate models controlling for demographic and clinical variables were computed.
Results
Of the 1020 participants, 224 (22%) had current (past month) major depression. After adjustment for age, major depression was not associated with systolic dysfunction, diastolic dysfunction, inducible ischemia, or cardiac wall motion abnormalities. Similarly, multivariate models revealed no significant relationship between major depression and cardiac disease severity.
Conclusions
Overall, we found little evidence that depression is associated with worse cardiac disease severity. This suggests that greater baseline cardiac disease severity is unlikely to be responsible for the increased risk of CHD events in depressed patients.
doi:10.1097/PSY.0b013e31816c3c5c
PMCID: PMC2675877  PMID: 18434493
depression; cardiac function; coronary heart disease
25.  Prognostic Value of Left Ventricular End-Systolic Volume Index as a Predictor of Heart Failure Hospitalization in Stable Coronary Artery Disease: Data from the Heart and Soul Study 
Objective
Left ventricular (LV) end-systolic volume indexed to body surface area (ESVI) is a simple yet powerful echocardiographic marker of LV remodeling that can be measured easily. The prognostic value of ESVI and its merit relative to other markers of LV remodeling in patients with coronary heart disease are unknown.
Methods
We examined the association of ESVI with hospitalization for heart failure (HF) and mortality in a prospective study of patients with coronary heart disease.
Results
Of the 989 participants, 110 (11%) were hospitalized for HF during 3.6 ± 1.1 years of follow-up. Among participants in the highest ESVI quartile (>25 mL/m2), 67 of 248 (27%) developed HF compared with 8 of 248 (3%) among those in the lowest quartile. The association between ESVI and HF hospitalization persisted after adjustment for potential confounders (hazard ratio 5.0, 95% confidence interval, 1.5–16.9; P = .01).
Conclusion
ESVI >25 mL/m2 is an independent predictor of hospitalization for HF in patients with stable coronary heart disease.
doi:10.1016/j.echo.2008.11.005
PMCID: PMC2675872  PMID: 19084372
Coronary artery disease; End-systolic volume index; Heart failure hospitalization; Left ventricular remodeling

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