{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:42:51Z","timestamp":1784536971981,"version":"3.55.0"},"reference-count":61,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T00:00:00Z","timestamp":1675209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ardabil University of Medicine Sciences"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>This study aimed to assess the association between adherence to the Mediterranean diet with serum Nitric oxide, Prostacyclin, and Thromboxane B2 among Prinzmetal angina patients and healthy persons. This case-control study was conducted among 100 Prinzmetal angina patients and 100 healthy persons referred to the Ardabil Imam Khomeini hospital between 2021 and 2022. Blood samples were obtained from all study participants for measurement of serum Nitric oxide, Prostacyclin, and Thromboxane B2. To calculate adherence to the Mediterranean diet, the ten-item screener was used. The serum Nitric oxide in patients who adhered more to the Mediterranean diet was higher than patients with less adherence (coeff. = 0.41 p = 0.04). The serum Prostacyclin level in patients with greater adherence to the Mediterranean diet was 0.34 units higher than patients with less adherence (coeff. = 0.34 p = 0.02). The level of serum Thromboxane B2 had a negative association with adherence to the Mediterranean diet (coeff. = \u22120.48 p = 0.04). The amount of consumption of olive oil, fruits, vegetables, and legumes in healthy people was more than Prinzmetal angina patients. In Prinzmetal angina patients, more adherence to the Mediterranean diet can decrease the serum Thromboxane B2 and increase the serum Nitric oxide and Prostacyclin.<\/jats:p>","DOI":"10.3390\/nu15030738","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T05:04:48Z","timestamp":1675227888000},"page":"738","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Adherence to the Mediterranean Diet Association with Serum Levels of Nitric Oxide, Prostacyclin, and Thromboxane B2 among Prinzmetal Angina Patients and Healthy Persons"],"prefix":"10.3390","volume":"15","author":[{"given":"Mahsa","family":"Mohajeri","sequence":"first","affiliation":[{"name":"Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil 56131-56491, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arrigo F. G.","family":"Cicero","sequence":"additional","affiliation":[{"name":"Medicine and Surgery Sciences Department, Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy"},{"name":"IRCCS AOU S. Orsola-Malpighi University Hospital, 40123 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1007\/s40200-021-00768-5","article-title":"Proportion and mortality of Iranian diabetes mellitus, chronic kidney disease, hypertension, and cardiovascular disease patients with COVID-19: A meta-analysis","volume":"20","author":"Mirjalili","year":"2021","journal-title":"J. Diabetes Metab. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s12944-021-01505-w","article-title":"Visceral adiposity index and atherogenic index of plasma as useful predictors of risk of cardiovascular diseases: Evidence from a cohort study in Iran","volume":"20","author":"Hamzeh","year":"2021","journal-title":"Lipids Health Dis."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Amini, M., Zayeri, F., and Salehi, M. (2021). Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: Results from the global burden of disease study 2017. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-10429-0"},{"key":"ref_4","unstructured":"(2019). Chronic Kidney Disease in the United States, US Department of Health and Human Services."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e005375","DOI":"10.1161\/CIRCOUTCOMES.118.005375","article-title":"Mortality from ischemic heart disease: Analysis of data from the World Health Organization and coronary artery disease risk factors from NCD Risk Factor Collaboration","volume":"12","author":"Towbar","year":"2019","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3034","DOI":"10.1038\/s41598-020-59668-y","article-title":"The patterns of Non-communicable disease Multimorbidity in Iran: A Multilevel Analysis","volume":"10","author":"Khorrami","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_7","first-page":"110","article-title":"Angina\u2013management of chest pain","volume":"16","author":"Peate","year":"2022","journal-title":"BJHCA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1159\/000524948","article-title":"Unstable angina as a component of primary composite endpoints in clinical cardiovascular trials: Pros and cons","volume":"147","author":"Kristensen","year":"2022","journal-title":"Cardiology"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Wi\u015bniewski, O.W., Dydowicz, F., Salamaga, S., Skulik, P., Migaj, J., and Ka\u0142u\u017cna-Oleksy, M. (2022). Risk Factors Predisposing to Angina in Patients with Non-Obstructive Coronary Arteries: A Retrospective Analysis. J. Pers. Med., 12.","DOI":"10.3390\/jpm12071049"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1001\/jama.2021.1527","article-title":"Diagnosis and management of stable angina: A review","volume":"325","author":"Joshi","year":"2021","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100203","DOI":"10.1016\/j.imu.2019.100203","article-title":"Improving the accuracy of prediction of heart disease risk based on ensemble classification techniques","volume":"16","author":"Latha","year":"2019","journal-title":"Inform. Med. Unlocked"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"DISCHARGE Trial Group (2022). CT or invasive coronary angiography in stable chest pain. N. Engl. J. Med., 386, 1591\u20131602.","DOI":"10.1056\/NEJMoa2200963"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1080\/14779072.2021.1991314","article-title":"Angina due to coronary artery spasm (variant angina): Diagnosis and intervention strategies","volume":"19","author":"Nguyen","year":"2021","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.acvd.2018.08.002","article-title":"Vasospastic angina: A literature review of current evidence","volume":"112","author":"Picard","year":"2019","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_15","first-page":"131","article-title":"Modern approaches to the diagnosis and treatment of prinzmetal angina (literary review)","volume":"16","year":"2022","journal-title":"WBPH"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3348\/kjr.2012.13.1.27","article-title":"Coronary vasospastic angina: Assessment by multidetector CT coronary angiography","volume":"13","author":"Kang","year":"2012","journal-title":"Korean J. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.trsl.2013.03.003","article-title":"The endothelial nitric oxide synthase T-786c mutation, a treatable etiology of Prinzmetal\u2019s angina","volume":"162","author":"Glueck","year":"2013","journal-title":"Transl. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/j.amjcard.2009.10.062","article-title":"Endothelial nitric oxide synthase T-786C mutation, a reversible etiology of Prinzmetal\u2019s angina pectoris","volume":"105","author":"Glueck","year":"2010","journal-title":"Am. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1007\/s000180050352","article-title":"Nitric oxide biosynthesis, nitric oxide synthase inhibitors and arginase competition for L-arginine utilization","volume":"55","author":"Boucher","year":"1999","journal-title":"Cell. Mol. Life Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"H631","DOI":"10.1152\/ajpheart.00111.2003","article-title":"Nitric oxide regulates retinal vascular tone in humans","volume":"285","author":"Dorner","year":"2003","journal-title":"Am. J. Physiol. Circ. Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"154010","DOI":"10.1016\/j.jcrc.2022.154010","article-title":"The effect of prostacyclin infusion on markers of endothelial activation and damage in mechanically ventilated patients with SARS-CoV-2 infection","volume":"69","author":"Vigstedt","year":"2022","journal-title":"J. Crit. Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/j.1749-6632.1985.tb11852.x","article-title":"Prostacyclin and variant angina","volume":"454","author":"Numano","year":"1985","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1161\/ATVBAHA.121.317380","article-title":"A Thromboxane A2 Receptor-Driven COX-2\u2013Dependent Feedback Loop That Affects Endothelial Homeostasis and Angiogenesis","volume":"42","author":"Eckenstaler","year":"2022","journal-title":"Arter. Thromb. Vasc. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Szczuko, M., Kozio\u0142, I., Kotl\u0119ga, D., Brodowski, J., and Drozd, A. (2021). The Role of Thromboxane in the Course and Treatment of Ischemic Stroke. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222111644"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e048719","DOI":"10.1136\/bmjopen-2021-048719","article-title":"Impact of aspirin use on clinical outcomes in patients with vasospastic angina: A systematic review and meta-analysis","volume":"11","author":"Lin","year":"2021","journal-title":"BMJ Open"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"25","DOI":"10.3390\/dietetics1010004","article-title":"Personalized Nutritional Intervention to Improve Mediterranean Diet Adherence in Female Patients with Multiple Sclerosis: A Randomized Controlled Study","volume":"1","author":"Papandreou","year":"2022","journal-title":"Dietetics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.maturitas.2019.12.002","article-title":"The Mediterranean diet: A historical perspective on food for health","volume":"132","author":"Cano","year":"2020","journal-title":"Maturitas"},{"key":"ref_28","unstructured":"Petermann-Rocha, F., Ho, F.K., Foster, H., Boopor, J., Parra-Soto, S., Gray, S.R., Mathers, J.C., Celis-Morales, C., and Pell, J.P. (2021). Mayo Clinic Proceedings, Elsevier."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"AlAufi, N.S., Chan, Y.M., Waly, M.I., Chin, Y.S., Yusof, B.-N.M., and Ahmad, N. (2022). Application of mediterranean diet in cardiovascular diseases and type 2 diabetes mellitus: Motivations and challenges. Nutrients, 14.","DOI":"10.3390\/nu14132777"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1080\/09637486.2021.1941804","article-title":"Mediterranean diet\u2013promotion and dissemination of healthy eating: Proceedings of an exploratory seminar at the Radcliffe institute for advanced study","volume":"73","author":"Drescher","year":"2022","journal-title":"Int. J. Food Sci. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Tsigalou, C., Konstantinidis, T., Paraschaki, A., Stavropoulou, E., Voidarou, C., and Bezirtzoglou, E. (2020). Mediterranean diet as a tool to combat inflammation and chronic diseases. An overview. Biomedicines, 8.","DOI":"10.3390\/biomedicines8070201"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1111\/joim.13333","article-title":"The Mediterranean diet and health: A comprehensive overview","volume":"290","author":"Willett","year":"2021","journal-title":"J. Intern. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e019158","DOI":"10.1161\/JAHA.120.019158","article-title":"Mediterranean Diet Score, Dietary Patterns, and Risk of Sudden Cardiac Death in the REGARDS Study","volume":"10","author":"Shikany","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"g6674","DOI":"10.1136\/bmj.g6674","article-title":"Mediterranean diet and telomere length in Nurses\u2019 Health Study: Population based cohort study","volume":"349","author":"Fung","year":"2014","journal-title":"BMJ"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Chen, G.-C., Neelakantan, N., Mart\u00edn-Calvo, N., Koh, W.-P., Yuan, J.-M., Bonaccio, M., Iacoviello, L., Mart\u00ednez-Gonz\u00e1lez, M.A., Qin, L.-Q., and van Dam, R.M. (2019). Adherence to the Mediterranean Diet and Risk of Stroke and Stroke Subtypes, Springer.","DOI":"10.1007\/s10654-019-00504-7"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1080\/10408398.2019.1565281","article-title":"Mediterranean diet, cardiovascular disease and mortality in diabetes: A systematic review and meta-analysis of prospective cohort studies and randomized clinical trials","volume":"60","author":"Viguiliouk","year":"2020","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.tcm.2019.05.003","article-title":"Blood pressure and the new ACC\/AHA hypertension guidelines","volume":"30","author":"Flack","year":"2020","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_38","first-page":"7312","article-title":"The validity of the International Physical Activity Questionnaire (IPAQ) for adults with progressive muscle diseases","volume":"44","author":"White","year":"2021","journal-title":"Disabil. Rehabil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.clnesp.2020.06.018","article-title":"Translation and cross-cultural adaptation of 14-item Mediterranean Diet Adherence Screener and low-fat diet adherence questionnaire","volume":"39","author":"Vieira","year":"2020","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_40","first-page":"120","article-title":"Physiology","volume":"20","author":"LeBouef","year":"2020","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"4540","DOI":"10.1002\/jcp.27234","article-title":"Muscarinic M5 receptors trigger acetylcholine-induced Ca2+ signals and nitric oxide release in human brain microvascular endothelial cells","volume":"234","author":"Zuccolo","year":"2019","journal-title":"J. Cell. Physiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1080\/20009666.2021.1915534","article-title":"Coronary vasospasm as an etiology of recurrent ventricular fibrillation in the absence of coronary artery disease: A case report","volume":"11","author":"Bhandari","year":"2021","journal-title":"J. Community Hosp. Intern. Med. Perspect."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1093\/gerona\/gly087","article-title":"Nitric oxide boosting effects of the Mediterranean diet: A potential mechanism of action","volume":"73","author":"Shannon","year":"2018","journal-title":"J. Gerontol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2748S","DOI":"10.1093\/jn\/134.10.2748S","article-title":"Enzymes of the L-arginine to nitric oxide pathway","volume":"134","author":"Stuehr","year":"2004","journal-title":"J. Nutr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"106631","DOI":"10.1016\/j.envint.2021.106631","article-title":"L-arginine supplementation to mitigate cardiovascular effects of walking outside in the context of traffic-related air pollution in participants with elevated blood pressure: A randomized, double-blind, placebo-controlled trial","volume":"156","author":"Li","year":"2021","journal-title":"Int. J. Environ."},{"key":"ref_46","first-page":"e131733","article-title":"L-Citrulline increases nitric oxide and improves control in obese asthmatics","volume":"4","author":"Holguin","year":"2019","journal-title":"J. Clin. Investig."},{"key":"ref_47","first-page":"E915","article-title":"Acute ingestion of citrulline stimulates nitric oxide synthesis but does not increase blood flow in healthy young and older adults with heart failure","volume":"309","author":"Kim","year":"2015","journal-title":"Am. J. Physiol. Metab."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.numecd.2014.09.001","article-title":"Effects of total dietary polyphenols on plasma nitric oxide and blood pressure in a high cardiovascular risk cohort","volume":"25","author":"Pons","year":"2015","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"E34","DOI":"10.1017\/S0029665121000355","article-title":"Olive oil phenols and their metabolites modulate nitric oxide balance in Human Aortic Endothelial Cells","volume":"80","author":"Serreli","year":"2021","journal-title":"Proc. Nutr. Soc."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.amjmed.2020.12.017","article-title":"Fish consumption and cardiovascular health: A systematic review","volume":"134","author":"Krittanawong","year":"2021","journal-title":"Am. J. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1001\/jamainternmed.2021.0036","article-title":"Associations of fish consumption with risk of cardiovascular disease and mortality among individuals with or without vascular disease from 58 countries","volume":"181","author":"Mohan","year":"2021","journal-title":"JAMA Intern. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"3131","DOI":"10.1016\/j.bbamem.2016.10.002","article-title":"Eicosapentaenoic acid reduces membrane fluidity, inhibits cholesterol domain formation, and normalizes bilayer width in atherosclerotic-like model membranes","volume":"1858","author":"Mason","year":"2016","journal-title":"Biochim. Biophys. Acta\u2014Biomembr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1024\/0301-1526\/a000311","article-title":"Alpha-linolenic acid intake prevents endothelial dysfunction in high-fat diet-fed streptozotocin rats and underlying mechanisms","volume":"42","author":"Zhang","year":"2013","journal-title":"Vasa"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Ruxton, C., and Myers, M. (2021). Fruit juices: Are they helpful or harmful? An evidence review. Nutrients, 13.","DOI":"10.3390\/nu13061815"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Gu, C., Howell, K., Dunshea, F.R., and Suleria, H.A.R. (2019). Lc-esi-qtof\/ms characterisation of phenolic acids and flavonoids in polyphenol-rich fruits and vegetables and their potential antioxidant activities. Antioxidants, 8.","DOI":"10.3390\/antiox8090405"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.3945\/ajcn.111.031088","article-title":"Effects of red orange juice intake on endothelial function and inflammatory markers in adult subjects with increased cardiovascular risk","volume":"95","author":"Buscemi","year":"2012","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"479","DOI":"10.3945\/ajcn.113.074237","article-title":"Flavonoid-rich fruit and vegetables improve microvascular reactivity and inflammatory status in men at risk of cardiovascular disease\u2014FLAVURS: A randomized controlled trial","volume":"99","author":"Macready","year":"2014","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/j.numecd.2010.01.009","article-title":"The effect of increased dietary fruit and vegetable consumption on endothelial activation, inflammation and oxidative stress in hypertensive volunteers","volume":"21","author":"McCall","year":"2011","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Chen, H., Zhang, S., Wang, H., Jiang, Y., Bao, L., Wu, W., and Qi, R. (2021). Inhibitory Effect of Fruitflow on Platelet Function: A Randomized Placebo-Controlled Trial in Elderly Subjects. Res. Sq.","DOI":"10.21203\/rs.3.rs-95541\/v2"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1161\/CIRCRESAHA.120.315892","article-title":"Nutrition, thrombosis, and cardiovascular disease","volume":"126","author":"Violi","year":"2020","journal-title":"Circ. Res."},{"key":"ref_61","first-page":"e001011","article-title":"Importance of maintaining a low omega-6\/omega-3 ratio for reducing platelet aggregation, coagulation and thrombosis","volume":"6","author":"DiNicolantonio","year":"2019","journal-title":"Arch. Dis. Child"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/3\/738\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:20:43Z","timestamp":1760120443000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/3\/738"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,1]]},"references-count":61,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["nu15030738"],"URL":"https:\/\/doi.org\/10.3390\/nu15030738","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,1]]}}}