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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.  Understanding Brain, Mind and Soul: Contributions from Neurology and Neurosurgery 
Mens Sana Monographs  2011;9(1):129-149.
Treatment of diseases of the brain by drugs or surgery necessitates an understanding of its structure and functions. The philosophical neurosurgeon soon encounters difficulties when localising the abstract concepts of mind and soul within the tangible 1300-gram organ containing 100 billion neurones. Hippocrates had focused attention on the brain as the seat of the mind. The tabula rasa postulated by Aristotle cannot be localised to a particular part of the brain with the confidence that we can localise spoken speech to Broca’s area or the movement of limbs to the contralateral motor cortex. Galen’s localisation of imagination, reasoning, judgement and memory in the cerebral ventricles collapsed once it was evident that the functional units–neurones–lay in the parenchyma of the brain. Experiences gained from accidental injuries (Phineas Gage) or temporal lobe resection (William Beecher Scoville); studies on how we see and hear and more recent data from functional magnetic resonance studies have made us aware of the extensive network of neurones in the cerebral hemispheres that subserve the functions of the mind. The soul or atman, credited with the ability to enliven the body, was located by ancient anatomists and philosophers in the lungs or heart, in the pineal gland (Descartes), and generally in the brain. When the deeper parts of the brain came within the reach of neurosurgeons, the brainstem proved exceptionally delicate and vulnerable. The concept of brain death after irreversible damage to it has made all of us aware of ‘the cocktail of brain soup and spark’ in the brainstem so necessary for life. If there be a soul in each of us, surely, it is enshrined here.
doi:10.4103/0973-1229.77431
PMCID: PMC3115284  PMID: 21694966
Brain; Brainstem; Mind; Soul; Neurology; Neurosurgery; Philosophy
5.  AN ASPECT OF THE FIVE SOULS OF INDIAN PHYSIOLOGY 
Ancient Science of Life  1988;8(2):113-116.
In this paper the author discusses five souls viz, prana, Apana, Udana, Samana and vyana of Indian physiology. Also aims to show that the last named two souls were unknown to Galen.
PMCID: PMC3331365  PMID: 22557641
6.  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
7.  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
8.  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
9.  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
10.  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
11.  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
12.  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
13.  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
14.  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
15.  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
16.  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
17.  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
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.  Association between kidney function and telomere length: the Heart and Soul Study 
American journal of nephrology  2012;36(5):405-411.
Background
Telomere attrition is a novel risk factor for cardiovascular disease. Studies of telomere length in relation to kidney function are limited. We explored the association of kidney function with telomere length and telomere shortening.
Methods
The Heart and Soul study is a longitudinal study of patients with stable coronary heart disease (CHD). Measures of baseline kidney function included: serum creatinine, creatinine-derived estimated glomerular filtration rate (eGFRCKD-EPI), 24-hour urine measured creatinine clearance, cystatin C, cystatin C-derived estimated glomerular filtration rate (eGFRcys) and urine albumin to creatinine ratio. Telomere length was measured from peripheral blood leukocytes at baseline (N=954) and 5 years later (N=608). Linear regression models were used to test the association of kidney function with i) baseline telomere length and ii) change in telomere length over 5 years.
Results
At baseline, mean eGFRCKD-EPI was 72.6 (± 21.5) ml/min/1.73 m2, eGFRcys was 71.0 (± 23.1) ml/min/1.73 m2 and ACR was 8.6 (±12.3) mg/gm. Only lower baseline eGFRCKD-EPI was associated with shorter baseline telomere length (9.1 [95% CI 1.2–16.9] fewer base pairs for every 5 ml/min/1.73 m2 lower eGFRCKD-EPI). Lower baseline eGFRCKD-EPI (and all other measures of kidney function) predicted more rapid telomere shortening (10.8 [95% CI 4.3–17.3] decrease in base pairs over 5 years for every 5 ml/min/1.73 m2 lower eGFRCKD-EPI). After adjustment for age, these associations were no longer statistically significant.
Conclusions
In patients with CHD, reduced kidney function is associated with i) shorter baseline telomere length and ii) more rapid telomere shortening over 5 years, however these associations are entirely explained by older age.
doi:10.1159/000343495
PMCID: PMC3552638  PMID: 23108000
kidney; CKD; telomere
21.  Evaluating the dissemination of Body & Soul, an evidence-based fruit and vegetable intake intervention: challenges for dissemination and implementation research 
Objective
To evaluate whether the evidence-based Body & Soul program, when disseminated and implemented without researcher or agency involvement and support, would achieve similar results to earlier efficacy and effectiveness trials.
Design
Prospective group randomized trial.
Setting
Churches with predominantly African American membership.
Participants
A total of 1033 members from the fifteen churches completed baseline surveys. Of these, 562 (54.4%) completed the follow-up survey six months later.
Intervention
Church-based nutrition program for African Americans that included pastoral involvement, educational activities, church environmental changes, and peer counseling.
Main Outcome Measure
Daily fruit and vegetable (FV) intake was assessed at pre- and post-test.
Analysis
Mixed-effects linear models.
Results
At posttest, there was no statistically significant difference in daily servings of FV between the early intervention group participants compared to control group participants (4.7 vs, 4.4, P=0.38). Process evaluation suggested that added resources such as technical assistance could improve program implementation.
Conclusions and Implications
The disseminated program may not produce improvements in FV intake equal to those in the earlier efficacy and effectiveness trials, primarily due to lack of program implementation. Program dissemination may not achieve public health impact unless support systems are strengthened for adequate implementation at the church level.
doi:10.1016/j.jneb.2011.09.002
PMCID: PMC3374882  PMID: 22406012
diet; health behavior; health promotion; program evaluation; African Americans
22.  Windows to the soul: vision science as a tool for studying biological mechanisms of information processing deficits in schizophrenia 
Cognitive and information processing deficits are core features and important sources of disability in schizophrenia. Our understanding of the neural substrates of these deficits remains incomplete, in large part because the complexity of impairments in schizophrenia makes the identification of specific deficits very challenging. Vision science presents unique opportunities in this regard: many years of basic research have led to detailed characterization of relationships between structure and function in the early visual system and have produced sophisticated methods to quantify visual perception and characterize its neural substrates. We present a selective review of research that illustrates the opportunities for discovery provided by visual studies in schizophrenia. We highlight work that has been particularly effective in applying vision science methods to identify specific neural abnormalities underlying information processing deficits in schizophrenia. In addition, we describe studies that have utilized psychophysical experimental designs that mitigate generalized deficit confounds, thereby revealing specific visual impairments in schizophrenia. These studies contribute to accumulating evidence that early visual cortex is a useful experimental system for the study of local cortical circuit abnormalities in schizophrenia. The high degree of similarity across neocortical areas of neuronal subtypes and their patterns of connectivity suggests that insights obtained from the study of early visual cortex may be applicable to other brain regions. We conclude with a discussion of future studies that combine vision science and neuroimaging methods. These studies have the potential to address pressing questions in schizophrenia, including the dissociation of local circuit deficits vs. impairments in feedback modulation by cognitive processes such as spatial attention and working memory, and the relative contributions of glutamatergic and GABAergic deficits.
doi:10.3389/fpsyg.2013.00681
PMCID: PMC3813897  PMID: 24198792
schizophrenia; visual system; fMRI; psychophysics; magnetic resonance spectroscopy
23.  Hostility, Health Behaviors, and Risk of Recurrent Events in Patients With Stable Coronary Heart Disease: Findings From the Heart and Soul Study 
Background
Hostility is a significant predictor of mortality and cardiovascular events in patients with coronary heart disease (CHD), but the mechanisms that explain this association are not well understood. The purpose of this study was to evaluate potential mechanisms of association between hostility and adverse cardiovascular outcomes.
Methods and Results
We prospectively examined the association between self‐reported hostility and secondary events (myocardial infarction, heart failure, stroke, transient ischemic attack, and death) in 1022 outpatients with stable CHD from the Heart and Soul Study. Baseline hostility was assessed using the 8‐item Cynical Distrust scale. Cox proportional hazard models were used to determine the extent to which candidate biological and behavioral mediators changed the strength of association between hostility and secondary events. During an average follow‐up time of 7.4±2.7 years, the age‐adjusted annual rate of secondary events was 9.5% among subjects in the highest quartile of hostility and 5.7% among subjects in the lowest quartile (age‐adjusted hazard ratio [HR]: 1.68, 95% confidence interval [CI]: 1.30 to 2.17; P<0.0001). After adjustment for cardiovascular risk factors, participants with hostility scores in the highest quartile had a 58% greater risk of secondary events than those in the lowest quartile (HR: 1.58, 95% CI: 1.19 to 2.09; P=0.001). This association was mildly attenuated after adjustment for C‐reactive protein (HR: 1.41, 95% CI, 1.06 to 1.87; P=0.02) and no longer significant after further adjustment for smoking and physical inactivity (HR: 1.25, 95% CI: 0.94 to 1.67; P=0.13).
Conclusions
Hostility was a significant predictor of secondary events in this sample of outpatients with baseline stable CHD. Much of this association was moderated by poor health behaviors, specifically physical inactivity and smoking.
doi:10.1161/JAHA.113.000052
PMCID: PMC3835215  PMID: 24080907
coronary artery disease; epidemiology; hostility; mortality; observational studies
24.  Multisystem resiliency moderates the major depression–Telomere length association: Findings from the Heart and Soul Study 
Brain, behavior, and immunity  2013;33:10.1016/j.bbi.2013.05.008.
Major depressive disorder (MDD) has been associated with reduced leukocyte telomere length (LTL). It is not known, however, whether psychosocial and behavioral protective factors moderate this association. In the current study, we examine whether multisystem resiliency – defined by healthy emotion regulation, strong social connections, and health behaviors (sleep and exercise) – predicts LTL and mitigates previously demonstrated associations between depression diagnosis and LTL. LTL was measured, using a quantitative PCR assay, in 954 patients with stable cardiovascular disease in the Heart and Soul Study. In a fully adjusted model, high multisystem resiliency predicted longer LTL (b = 80.00, SE = 27.17, p = .003), whereas each individual factor did not. Multisystem resiliency significantly moderated the MDD-LTL association (p = .02). Specifically, MDD was significantly related to LTL at 1 SD below the mean of multisystem resiliency (b = −142.86, SE = 56.46, p = .01), but not at 1 SD above the mean (b = 49.07, SE = 74.51, p = .51). This study suggests that MDD associations with biological outcomes should be examined within a psychosocial–behavioral context, because this context shapes the nature of the direct relationship. Further research should explore the cognitive, neural, and other physiological pathways through which multisystem resiliency may confer biological benefit.
doi:10.1016/j.bbi.2013.05.008
PMCID: PMC3855878  PMID: 23727245
Major depressive disorder; Telomeres; Cell aging; Resiliency; Social connections; Emotion regulation; Physical activity
25.  Urine Calcium Excretion, Cardiovascular Events and Mortality in Outpatients with Stable Coronary Artery Disease (From the Heart and Soul Study) 
The American journal of cardiology  2012;110(12):1729-1734.
We sought to evaluate the association of urine calcium excretion (UCaE), which reflects systemic calcium absorption, with CV events and mortality in outpatients with prevalent coronary heart disease (CHD). Calcium supplementation is associated with vascular calcification and adverse cardiovascular (CV) outcomes in patients with end-stage renal disease. Recent studies have raised concern that this phenomenon may also extend to the general population. However, prior studies assessed oral calcium intake, which correlates poorly with systemic calcium absorption. We measured UCaE from 24 hour urine collections provided by 903 outpatients who were recruited from 2000 to 2002. We used Cox proportional hazard models to evaluate the association of baseline UCaE with a primary endpoint of any CV event (myocardial infarction, heart failure, stroke, or CV mortality). During a mean follow-up of 6±3 years, 287 subjects (32%) had a CV event. Following multivariate adjustment for demographics, traditional CV risk factors, and kidney function, there was no association between UCaE and the primary endpoint of any CV event (per 10 mg/day greater UCaE: HR 1.00 95% CI 0.98–1.02). Evaluation of individual CV outcomes revealed a lower rate of MI with higher UCaE (HR 0.97, 95% CI 0.94–1.00). Greater UCaE is not associated with higher overall CV event rates or mortality in outpatients with stable CHD. In contrast, greater UCaE is associated with a modestly lower rate of MI. These findings suggest that greater systemic calcium absorption does not confer CV harm in outpatients with prevalent CHD.
doi:10.1016/j.amjcard.2012.08.007
PMCID: PMC3511634  PMID: 22975467
Calcium; Calcium Supplements; Cardiovascular Events; Coronary Artery Disease; Urine Calcium Excretion; Vascular Calcification

Results 1-25 (393642)