Journal of Kerman University of Medical Sciences

Serum Level of Melatonin and Severity of Coronary Artery Diseases

Document Type : Original Article

Authors

Hamidreza Rashidinejad 1
Hamidreza Nasri 1
Mohammad Ali Pour Ahmadi 2
Mansour Moazenzadeh 1

1 Associate Professor, Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran

2 Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran

https://doi.org/10.22062/jkmu.2021.91607
Abstract
Background: Coronary Artery Disease (CAD) as a complex process will be the most common cause of death in the world by 2020. One of the relatively new factors associated with CAD is the plasma level of melatonin. This study aimed to determine the effect of plasma melatonin level on the occurrence and severity of CAD.
Methods: This cross-sectional study was conducted from August to December 2018 in Kerman, Iran. Eighty-seven adolescents with suspected CAD were selected via the convenience sampling method. Severity of CAD was evaluated by a cardiologist for each patient using Gensini score. The anxiety, depression, and sleep disturbance of participants were examined by HADS and PSIQ questionnaires, respectively. The blood sample of patients was taken at 3:30 a.m. and it was immediately transferred to the laboratory for serum separation. A two-part model was used for data analysis using STATA software.
Results:The mean age (±SD) of the participants was 54.0 (±10.83) years. Less than half of the patients experienced anxiety and depression symptoms during last month (33% and 42%, respectively). Results showed that more than half of the patients (n=51, 57.5%) were diagnosed as CAD patients. According to multivariate regression models, melatonin (AOR=0.96, 95% CI: 0.94, 0.98) and depression (β: 0.79, 95% CI: 0.06, 1.52) were determined as predictors for CAD occurrence and severity, respectively.
Conclusion: Melatonin as a protective factor has an effect on the occurrence and severity of CAD, but the existence of some diseases like mental disorders can lead to a decrease in the plasma concentration of melatonin. By treating depression and improving melatonin synthesis and secretion cycle, the occurrence and severity of CAD may be decreased.

Keywords

Coronary Artery Diseases
Depression
Melatonin
  1. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983; 51(3):606.
  2. Dominguez‐Rodriguez A, Abreu‐Gonzalez P, Sanchez‐Sanchez JJ, Kaski JC, Reiter RJ. Melatonin and circadian biology in human cardiovascular disease. J Pineal Res 2010; 49(1):14-22.
  3. Dominguez-Rodriguez A, Abreu-Gonzalez P, Reiter RJ. Clinical aspects of melatonin in the acute coronary syndrome. Curr Vasc Pharmacol 2009; 7(3):367-73.
  4. Reiter RJ, Tan DX, Paredes SD, Fuentes-Broto L. Beneficial effects of melatonin in cardiovascular disease. Ann Med 2010; 42(4):276-85.
  5. Tengattini S, Reiter RJ, Tan DX, Terron MP, Rodella LF, Rezzani R. Cardiovascular diseases: protective effects of melatonin. J Pineal Res 2008; 44(1):16-25.
  6. Yildiz M, Akdemir O. Assessment of the effects of physiological release of melatonin on arterial distensibility and blood pressure. Cardiol Young 2009; 19(2):198-203.
  7. Girotti L, Lago M, Ianovsky O, Elizari MV, Dini A, Lloret SP, et al. Low urinary 6-sulfatoxymelatonin levels in patients with severe congestive heart failure. Endocrine 2003; 22(3):245-8.
  8. Altun A, Yaprak M, Aktoz M, Vardar A, Betul U-A, Ozbay G. Impaired nocturnal synthesis of melatonin in patients with cardiac syndrome X. Neurosci Lett 2002; 327(2):143-5.
  9. Brugger P, Marktl W, Herold M. Impaired nocturnal secretion of melatonin in coronary heart disease. Lancet 1995; 345(8962):1408.
  10. Sakotnik A, Liebmann PM, Stoschitzky K, Lercher P, Schauenstein K, Klein W, et al. Decreased melatonin synthesis in patients with coronary artery disease. Eur Heart J 1999; 20(18):1314-7.
  11. Yaprak M, Altun A, Vardar A, Aktoz M, Ciftci S, Ozbay G. Decreased nocturnal synthesis of melatonin in patients with coronary artery disease. Int J Cardiol 2003; 89(1):103-7.
  12. Cagnacci A, Cannoletta M, Renzi A, Baldassari F, Arangino S, Volpe A. Prolonged melatonin administration decreases nocturnal blood pressure in women. Am J Hypertens 2005; 18(12 Pt 1):1614-8.
  13. Garakyaraghi M, Siavash M, Alizadeh MK. Effects of melatonin on left ventricular ejection fraction and functional class of patients with heart failure: a randomized, double-blind, placebo-controlled trial. Journal of Research in Medical Sciences 2012; Special Issue (1):S13-16.
  14. Sakotnik A, Liebmann PM, Stoschitzky K, Lercher P, Schauenstein K, Klein W, et al. Decreased melatonin synthesis in patients with coronary artery disease. Eur Heart J 1999; 20(18):1314-7.
  15. Borchi E, Bargelli V, Stillitano F, Giordano C, Sebastiani M, Nassi PA, et al. Enhanced ROS production by NADPH oxidase is correlated to changes in antioxidant enzyme activity in human heart failure. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease 2010; 1802(3):331-8.
  16. Murphy PJ, Badia P, Myers BL, Boecker MR, Wright Jr KP. Nonsteroidal anti-inflammatory drugs affect normal sleep patterns in humans. Physiol Behav 1994; 55(6):1063-6.
  17. Vijayasarathy K, Naidu KS, Sastry B. Melatonin metabolite 6-Sulfatoxymelatonin, Cu/Zn superoxide dismutase, oxidized LDL and malondialdehyde in unstable angina. Int J Cardiol 2010; 144(2):315-7.
  18. Şehirli AÖ, Koyun D, Tetik Ş, Özsavcı D, Yiğiner Ö, Çetinel Ş, et al. Melatonin protects against ischemic heart failure in rats. J Pineal Res 2013; 55(2):138-48.
  19. Tan DX, Manchester LC, Reiter RJ, Qi W, Kim SJ, El‐Sokkary GH. Ischemia/reperfusion‐induced arrhythmias in the isolated rat heart: prevention by melatonin. J Pineal Res 1998; 25(3):184-91.
  20. Diez ER, Renna NF, Prado NJ, Lembo C, Ponce Zumino AZ, Vazquez‐Prieto M, et al. Melatonin, given at the time of reperfusion, prevents ventricular arrhythmias in isolated hearts from fructose‐fed rats and spontaneously hypertensive rats. J Pineal Res 2013; 55(2):166-73.
  21. Guo X, Kuzumi E, Charman SC, Vuylsteke A. Perioperative melatonin secretion in patients undergoing coronary artery bypass grafting. Anesth Analg 2002; 94(5):1085-91.
  22. Akpınar Z, Tokgöz S, Gökbel H, Okudan N, Uğuz F, Yılmaz G. The association of nocturnal serum melatonin levels with major depression in patients with acute multiple sclerosis. Psychiatry Res 2008; 161(2):253-7.
  23. Amini P, Maroufizadeh S, Samani RO. Evaluating the factor structure, item analyses, and internal consistency of hospital anxiety and depression scale in Iranian infertile patients. Int J Reprod Biomed 2017; 15(5):287-96.
  24. Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes 2003; 1:14.
  25. Moghaddam JF, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath 2012; 16(1):79-82.
  26. Raygan F, Ostadmohammadi V, Bahmani F, Reiter RJ, Asemi Z. Melatonin administration lowers biomarkers of oxidative stress and cardio-metabolic risk in type 2 diabetic patients with coronary heart disease: a randomized, double-blind, placebo-controlled trial. Clin Nutr 2019; 38(1):191-6.
  27. Matsuda R, Kohno T, Kohsaka S, Fukuoka R, Maekawa Y, Sano M, et al. The prevalence of poor sleep quality and its association with depression and anxiety scores in patients admitted for cardiovascular disease: a cross-sectional designed study. Int J Cardiol 2017; 228:977-82.
  28. Auld F, Maschauer EL, Morrison I, Skene DJ, Riha RL. Evidence for the efficacy of melatonin in the treatment of primary adult sleep disorders. Sleep Med Rev 2017; 34:10-22.
  29. Zisapel N. New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation. Br J Pharmacol 2018; 175(16):3190-9.
  30. Jafarian Amiri SR, Zabihi A, Babaie Asl F, Sefidchian A, Bijanee A. Sleep quality and associated factors in hospitalized patients in Babol, Iran. Hormozgan Medical Journal 2011; 15(2):144-51. [In Persian].
  31. Hoevenaar-Blom MP, Spijkerman AM, Kromhout D, van den Berg JF, Verschuren WM. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN study. Sleep 2011; 34(11):1487-92.
  32. Wiebe ST, Cassoff J, Gruber R. Sleep patterns and the risk for unipolar depression: a review. Nat Sci Sleep 2012; 4:63-71.
  33. Srivastava P, Gupta R, Chari D, Rawat A, Goel D. Comparison of prevalence of obstructive sleep apnea, restless legs syndrome, and poor sleep quality in patients with coronary artery disease and depression. Somnologie 2016; 20(2):144-9.
  34. Pandi-Perumal SR, Moscovitch A, Srinivasan V, Spence DW, Cardinali DP, Brown GM. Bidirectional communication between sleep and circadian rhythms and its implications for depression: lessons from agomelatine. Prog Neurobiol 2009; 88(4):264-71.
  35. Palacios J, Khondoker M, Mann A, Tylee A, Hotopf M. Depression and anxiety symptom trajectories in coronary heart disease: associations with measures of disability and impact on 3-year health care costs. J Psychosom Res 2018; 104:1-8.
  36. Hansen MV, Halladin NL, Rosenberg J, Gögenur I, Møller AM. Melatonin for pre‐and postoperative anxiety in adults. Cochrane Database of Systematic Reviews 2015; 4.
  37. Ferracioli-Oda E, Qawasmi A, Bloch MH. Meta-analysis: melatonin for the treatment of primary sleep disorders. PloS One 2013; 8(5):e63773.
  38. Madsen MT, Isbrand A, Andersen UO, Andersen LJ, Taskiran M, Simonsen E, et al. The effect of MElatonin on Depressive symptoms, Anxiety, CIrcadian and Sleep disturbances in patients after acute coronary syndrome (MEDACIS): study protocol for a randomized controlled trial. Trials 2017; 18(1):81.
  39. O’Neil A, Fisher AJ, Kibbey KJ, Jacka FN, Kotowicz MA, Williams LJ, et al. Depression is a risk factor for incident coronary heart disease in women: An 18-year longitudinal study. J Affect Disord 2016; 196:117-24.
  40. Seldenrijk A, Vogelzangs N, Batelaan NM, Wieman I, van Schaik DJ, Penninx BJ. Depression, anxiety and 6-year risk of cardiovascular disease. J Psychosom Res 2015; 78(2):123-9.
  41. Rugulies R. Depression as a predictor for coronary heart disease: a review and meta-analysis. Am J Prev Med 2002; 23(1):51-61.
  42. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol 2006; 48(8):1527-37.
  43. Schopfer DW, Regan M, Heidenreich PA, Whooley MA. Depressive symptoms, cardiac disease severity, and functional status in patients with coronary artery disease (from the Heart and Soul Study). Am J Cardiol 2016; 118(9):1287-92.
  44. Cohen BE, Edmondson D, Kronish IM. State of the art review: depression, stress, anxiety, and cardiovascular disease. American Journal of Hypertension 2015; 28(11):1295-302.
  45. Bradley SM, Rumsfeld JS. Depression and cardiovascular disease. Trends in Cardiovascular Medicine 2015; 25(7):614-22.

 

 

Journal of Kerman University of Medical Sciences
Volume 28, Issue 2
March and April 2021
Pages 116-126

Home

Editorial Board

Guide for Authors

Submit Manuscript

Guide for Reviewers

Contact Us