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Mubarik S, Luo L, Naeem S, Mubarak R, Iqbal M, Hak E, Yu C. Epidemiology and demographic patterns of cardiovascular diseases and neoplasms deaths in Western Europe: a 1990-2019 analysis. Public Health 2024; 231:187-197. [PMID: 38703493 DOI: 10.1016/j.puhe.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES Cardiovascular diseases (CVDs) and neoplasms have been considered as public health concerns worldwide. This study aimed to estimate the epidemiological patterns of death burden on CVDs and neoplasms and its attributable risk factors in Western Europe from 1990 to 2019 to discuss the potential causes of the disparities. STUDY DESIGN AND METHODS We collected data on CVDs and neoplasms deaths in 24 Western European countries from the Global Burden of Disease Study. We analyzed patterns by age, sex, country, and associated risk factors. The results include percentages of total deaths, age-standardized death rates per 100,000 population, and uncertainty intervals (UIs). Time trends were assessed using annual percent change. RESULTS In 2019, CVDs and neoplasms accounted for 33.54% and 30.15% of Western Europe's total deaths, with age-standardized death rates of 128.05 (95% UI: 135.37, 113.02) and 137.51 (95% UI: 142.54, 128.01) per 100,000. Over 1990-2019, CVDs rates decreased by 54.97%, and neoplasms rates decreased by 19.54%. Top CVDs subtypes were ischemic heart disease and stroke; top cancers for neoplasms were lung and colorectal. Highest CVD death burdens were in Finland, Greece, Austria; neoplasm burdens in Monaco, San Marino, Andorra. The major risk factors were metabolic (CVDs) and behavioral (neoplasms). Gender differences revealed higher CVDs death burden in males, while neoplasms burden varied by risk factors and age groups. CONCLUSION In 2019, CVDs and neoplasms posed significant health risks in Western Europe, with variations in death burdens and risk factors across genders, age groups, and countries. Future interventions should target vulnerable groups to lessen the impact of CVDs and neoplasms in the region.
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Affiliation(s)
- S Mubarik
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan 430071 China.
| | - L Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
| | - S Naeem
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, China.
| | - R Mubarak
- Department of Economics, PMAS, Arid Agriculture University, Rawalpindi, Pakistan.
| | - M Iqbal
- Department of Psychology, School of Philosophy, Wuhan University, Wuhan, China.
| | - E Hak
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands.
| | - C Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan 430071 China.
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Torres M, Nunes A, Martins JP, Ferreira PL, Pimenta R. Health care expenses impact on the disability-adjusted life years in non-communicable diseases in the European Union. Front Public Health 2024; 12:1384122. [PMID: 38660356 PMCID: PMC11041633 DOI: 10.3389/fpubh.2024.1384122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
Background Non-communicable diseases are a global health problem. The metric Disability-Adjusted Life Years was developed to measure its impact on health systems. This metric makes it possible to understand a disease's burden, towards defining healthcare policies. This research analysed the effect of healthcare expenditures in the evolution of disability-adjusted life years for non-communicable diseases in the European Union between 2000 and 2019. Methods Data were collected for all 27 European Union countries from Global Burden of Disease 2019, Global Health Expenditure, and EUROSTAT databases. Econometric panel data models were used to assess the impact of healthcare expenses on the disability-adjusted life years. Only models with a coefficient of determination equal to or higher than 10% were analysed. Results There was a decrease in the non-communicable diseases with the highest disability-adjusted life years: cardiovascular diseases (- 2,952 years/105 inhabitants) and neoplasms (- 618 years/105 inhabitants). Health expenditure significantly decreased disability-adjusted life years for all analysed diseases (p < 0.01) unless for musculoskeletal disorders. Private health expenditure did not show a significant effect on neurological and musculoskeletal disorders (p > 0.05) whereas public health expenditure did not significantly influence skin and subcutaneous diseases (p > 0.05). Conclusion Health expenditure have proved to be effective in the reduction of several diseases. However, some categories such as musculoskeletal and mental disorders must be a priority for health policies in the future since, despite their low mortality, they can present high morbidity and disability.
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Affiliation(s)
- Margarida Torres
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida, Porto, Portugal
| | - Alcina Nunes
- UNIAG, Instituto Politécnico de Bragança, Bragança, Portugal
| | - João P. Martins
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida, Porto, Portugal
- CEAUL – Centro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
- Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Coimbra, Portugal
| | - Pedro L. Ferreira
- Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Coimbra, Portugal
- Faculty of Economics, University of Coimbra, Coimbra, Portugal
| | - Rui Pimenta
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida, Porto, Portugal
- Centre for Health Studies and Research of University of Coimbra, Centre for Innovative Biomedicine and Biotechnology, Coimbra, Portugal
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Huang Q, Yang J, Liu GX, Zi H, Tang SD, Jia HC, Li W, Xu XF, Zeng XT. Changes in disease burden and global inequalities in bladder, kidney and prostate cancers from 1990 to 2019: a comparative analysis based on the global burden of disease study 2019. BMC Public Health 2024; 24:891. [PMID: 38528465 DOI: 10.1186/s12889-024-18353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Bladder, kidney and prostate cancers make significant contributors to cancer burdens. Exploring their cross-country inequalities may inform equitable strategies to meet the 17 sustainable development goals before 2030. METHODS We analyzed age-standardized disability-adjusted life-years (ASDALY) rates for the three cancers based on Global Burden of Diseases Study 2019. We quantified the inequalities using slope index of inequality (SII, absolute measure) and concentration index (relative measure) associated with national sociodemographic index. RESULTS Varied ASDALY rates were observed in the three cancers across 204 regions. The SII decreased from 35.15 (95% confidence interval, CI: 29.34 to 39.17) in 1990 to 15.81 (95% CI: 7.99 to 21.79) in 2019 for bladder cancers, from 78.94 (95% CI: 75.97 to 81.31) in 1990 to 59.79 (95% CI: 55.32 to 63.83) in 2019 for kidney cancer, and from 192.27 (95% CI: 137.00 to 241.05) in 1990 to - 103.99 (95% CI: - 183.82 to 51.75) in 2019 for prostate cancer. Moreover, the concentration index changed from 12.44 (95% CI, 11.86 to 12.74) in 1990 to 15.72 (95% CI, 15.14 to 16.01) in 2019 for bladder cancer, from 33.88 (95% CI: 33.35 to 34.17) in 1990 to 31.13 (95% CI: 30.36 to 31.43) in 2019 for kidney cancer, and from 14.61 (95% CI: 13.89 to 14.84) in 1990 to 5.89 (95% CI: 5.16 to 6.26) in 2019 for prostate cancer. Notably, the males presented higher inequality than females in both bladder and kidney cancer from 1990 to 2019. CONCLUSIONS Different patterns of inequality were observed in the three cancers, necessitating tailored national cancer control strategies to mitigate disparities. Priority interventions for bladder and kidney cancer should target higher socioeconomic regions, whereas interventions for prostate cancer should prioritize the lowest socioeconomic regions. Additionally, addressing higher inequality in males requires more intensive interventions among males from higher socioeconomic regions.
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Affiliation(s)
- Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Yang
- Department of Urology, The First People's Hospital of Tianmen in Hubei Province, The Affiliated Hospital of Hubei University of Science and Technology, Tianmen, China
| | - Guo-Xiong Liu
- Department of Urology, Xianyang Central Hospital, Xianyang, China
| | - Hao Zi
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shi-Di Tang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hai-Chang Jia
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Li
- Department of Oncology, The First People's Hospital of Tianmen in Hubei Province, The Affiliated Hospital of Hubei University of Science and Technology, Tianmen, China.
| | - Xiao-Feng Xu
- Department of Urology, Xianyang Central Hospital, Xianyang, China.
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Jiang W, Li X, Wang R, Du Y, Zhou W. Cross-country health inequalities of four common nutritional deficiencies among children, 1990 to 2019: data from the Global Burden of Disease Study 2019. BMC Public Health 2024; 24:486. [PMID: 38360585 PMCID: PMC10870451 DOI: 10.1186/s12889-024-17942-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Nutritional deficiencies remain serious medical and public health issues worldwide, especially in children. This study aims to analyze cross-country inequality in four common nutritional deficiencies (protein-energy malnutrition, dietary iron deficiency, vitamin A deficiency and iodine deficiency) among children from 1990 to 2019 based on Global Burden of Disease (GBD) 2019 data. METHODS Prevalence and disability-adjusted life years (DALYs) data as measures of four nutritional deficiency burdens in people aged 0 to 14 years were extracted from the GBD Results Tool. We analyzed temporal trends in prevalence by calculating the average annual percent change (AAPC) and quantified cross-country inequalities in disease burden using the slope index. RESULTS Globally, the age-standardized prevalence rates of dietary iron deficiency, vitamin A deficiency and iodine deficiency decreased, with AAPCs of -0.14 (-0.15 to -0.12), -2.77 (-2.96 to -2.58), and -2.17 (-2.3 to -2.03) from 1999 to 2019, respectively. Significant reductions in socio-demographic index (SDI)-related inequality occurred in protein-energy malnutrition and vitamin A deficiency, while the health inequality for dietary iron deficiency and iodine deficiency remained basically unchanged. The age-standardized prevalence and DALY rates of the four nutritional deficiencies decreased as the SDI and healthcare access and quality index increased. CONCLUSIONS The global burden of nutritional deficiency has decreased since 1990, but cross-country health inequalities still exist. More efficient public health measures are needed to reduce disease burdens, particularly in low-SDI countries/territories.
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Affiliation(s)
- Wenkai Jiang
- The Second Clinical Medical College, Lanzhou University, No. 222 Tianshui Road (South), Cheng-Guan District, 730030, Lanzhou City, Gansu Province, China
| | - Xiao Li
- The Second Clinical Medical College, Lanzhou University, No. 222 Tianshui Road (South), Cheng-Guan District, 730030, Lanzhou City, Gansu Province, China
| | - Ruiying Wang
- The First Clinical Medical College, Lanzhou University, 730030, Lanzhou, China
| | - Yan Du
- The Second Clinical Medical College, Lanzhou University, No. 222 Tianshui Road (South), Cheng-Guan District, 730030, Lanzhou City, Gansu Province, China
| | - Wence Zhou
- The Second Clinical Medical College, Lanzhou University, No. 222 Tianshui Road (South), Cheng-Guan District, 730030, Lanzhou City, Gansu Province, China.
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Baspakova A, Abitova AZ, Mussin NM, Kaliyev AA, Yerimbetova G, Zhumagaliyeva S, Ashimova Z, Zhilisbayeva KR, Umbetova AA, Nurtazina AU, Tamadon A. Sex differentials in the prevalence of behavioral risk factors and non-communicable diseases in adult populations of West Kazakhstan. Front Public Health 2024; 12:1333887. [PMID: 38420037 PMCID: PMC10899439 DOI: 10.3389/fpubh.2024.1333887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction The prevalence of non-communicable diseases (NCDs) is increasing worldwide. Several modifiable risk factors, such as smoking, alcohol drinking, physical inactivity, and obesity, have been linked to the development of NCDs in both genders. Understanding the prevalence of these risk factors and their associated factors is crucial for effective intervention planning in adult populations. This study aimed to provide an overview of the prevalence and associated factors of these risk behaviors among different genders of adults in West Kazakhstan. Methods A cross-sectional study was conducted in four regions of West Kazakhstan. A stratified multistage sampling technique was utilized to obtain a representative sample size of 4,800 participants aged 18 -69 years. Trained researchers administered face-to-face interviews using validated questionnaires to gather information pertaining to sociodemographic characteristics, smoking habits, alcohol drinking, dietary patterns, physical activity levels, body mass index (BMI), and prevalent diseases. Results This study, which included 4,800 participants from West Kazakhstan, revealed some striking numerical findings. The overall prevalence rates of behavioral risk factors and metabolic conditions were as follows: smoking was 13.6% (95%CI: 3.2-24.0%), alcohol drinking was 47.0% (27.7-66.3%), current obesity was 22.3% (9.0-35.6%), and physical inactivity was 80.7% (55.4-106.0%). In addition, the overall prevalence rates of metabolic conditions were 25.6% (11.3-39.9%) for hypertension, 7.5% (0.2-15.2%) for diabetes, 11.8% (2.1-21.5%) for high cholesterol, and 13.0% (2.8-23.2%) for cardiovascular diseases. Additionally, a higher prevalence of high cholesterol was observed in men, and a greater prevalence of heart disease was identified in women. Multinomial logistic regression revealed that physical inactivity was associated with hypertension, diabetes, and heart disease, while obesity was linked to hypertension, high cholesterol, and heart disease. Discussion This study in West Kazakhstan identified variations in the prevalence of behavioral risk factors and NCDs, highlighting gender, age, and regional disparities. Notably, men showed higher rates of smoking and alcohol drinking, while women exhibited a greater prevalence of physical inactivity and obesity. Gender and regional differences were evident, with the West Kazakhstan region standing out for distinct patterns. Tailored interventions are crucial to address these disparities and enhance public health in the region.
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Affiliation(s)
- Akmaral Baspakova
- Department for Scientific Work, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Anara Zh. Abitova
- Department for Scientific Work, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Nadiar M. Mussin
- General Surgery, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Asset A. Kaliyev
- General Surgery, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Gulmira Yerimbetova
- Department for Scientific Work, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Saltanat Zhumagaliyeva
- Department for Scientific Work, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Zhanat Ashimova
- Department for Scientific Work, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Kulyash R. Zhilisbayeva
- Department for Scientific Work, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Aigerim A. Umbetova
- Department for Scientific Work, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Alma U. Nurtazina
- Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Amin Tamadon
- Department Natural Sciences, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
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Orlova NM, Kovtun GI, Holovchanska-Pushkar SE, Pylypchuk VL, Palamar IV, Tkachenko OV, Zadorozhniuk OV. Non-communicable diseases and their risk factors in Ukraine: analysis of the global burden of disease 2019 study. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:682-689. [PMID: 38865623 DOI: 10.36740/wlek202404111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVE Aim: To analyse the burden and risk factors of Non-Communicable diseases (NCDs) in Ukraine to determine the ways to prevent them. PATIENTS AND METHODS Materials and Methods: Using a statistical method, NCDs DALYs (Disability-Adjusted Life Years) in Ukraine were analyzed in dynamics for 1990-2019 and in comparison, with European and EU countries based on the data from "Global Burden of Disease, 2019" research. RESULTS Results: The burden of NCDs in Ukraine is 1.5 time higher than in European and EU countries. The most negative dynamic trends and significant differences between indicators in Ukraine and EU countries (with an excess of 2 or more times) were identified for DALYs due to cardiovascular diseases, digestive diseases and substance use disorders. In Ukraine the burden of NCDs can be reduced on 25.9% by normalization of systolic blood pressure, on 21.2% by optimizing diet, on18.5% by quitting smoking, on 17.6% by lowering LDL cholesterol, on 16.5% by normalizing body weight and on 9.2% by quitting alcohol abuse. CONCLUSION Conclusions: Ukraine should develop and implement a modern system for monitoring and assessing the NCDs burden and their risk factors; strengthen the capacity of public health institutions and their ability to attract communities to implement interventions to control NCDs modified risk factors, increase awarnes and the population's responsible attitude towards their health; strengthen the ability and motivate primary health care to provide quality primary prevention, screening and timely diagnosis and treatment of chronic NCDs.
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Affiliation(s)
| | | | | | | | - Inna V Palamar
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
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Fogacci F, Yerlitaş Sİ, Giovannini M, Zararsız G, Lido P, Borghi C, Cicero AFG. Sex X Time Interactions in Lp(a) and LDL-C Response to Evolocumab. Biomedicines 2023; 11:3271. [PMID: 38137492 PMCID: PMC10741148 DOI: 10.3390/biomedicines11123271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
The aim of this study was to evaluate whether there were significant sex x time interactions in lipoprotein(a) (Lp(a)) and low-density lipoprotein cholesterol (LDL-C) response to treatment with the Proprotein Convertase Subtilisin/Kexin type 9 inhibitor (PCSK9i) Evolocumab, in a real-life clinical setting. For this purpose, we pooled data from 176 outpatients (Men: 93; Women: 83) clinically evaluated at baseline and every six months after starting Evolocumab. Individuals who had been on PCSK9i for less than 30 months and nonadherent patients were excluded from the analysis. Over time, absolute values of Lp(a) plasma concentrations significantly decreased in the entire cohort (p-value < 0.001) and by sex (p-value < 0.001 in men and p-value = 0.002 in and women). However, there were no sex-related significant differences. Absolute plasma concentrations of LDL-C significantly decreased over time in the entire cohort and by sex (p-value < 0.001 always), with greater improvements in men compared to women. The sex x time interaction was statistically significant in LDL-C (all p-values < 0.05), while absolute changes in Lp(a) were not influenced by either sex or time (all p-value > 0.05). Our data partially reinforce the presence of differences in response to treatment to PCSK9i between men and women and are essential to gain a better understanding of the relationship between LDL-C and Lp(a) lowering in response to PCSK9i. Further research will clarify whether these sex-related significant differences translate into a meaningful difference in the long-term risk of ASCVD.
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Affiliation(s)
- Federica Fogacci
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy; (F.F.); (M.G.); (C.B.)
| | - Serra İlayda Yerlitaş
- Department of Biostatistics, Erciyes University School of Medicine, 38039 Kayseri, Turkey; (S.İ.Y.); (G.Z.)
- Drug Application and Research Center (ERFARMA), Erciyes University, 38280 Kayseri, Turkey
| | - Marina Giovannini
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy; (F.F.); (M.G.); (C.B.)
| | - Gökmen Zararsız
- Department of Biostatistics, Erciyes University School of Medicine, 38039 Kayseri, Turkey; (S.İ.Y.); (G.Z.)
- Drug Application and Research Center (ERFARMA), Erciyes University, 38280 Kayseri, Turkey
| | - Paolo Lido
- Italian Medicines Agency (AIFA), 00187 Rome, Italy;
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy; (F.F.); (M.G.); (C.B.)
- Unit of Cardiovascular Internal Medicine, Department of Cardiac, Thoracic, Vascular Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40100 Bologna, Italy
| | - Arrigo F. G. Cicero
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy; (F.F.); (M.G.); (C.B.)
- Unit of Cardiovascular Internal Medicine, Department of Cardiac, Thoracic, Vascular Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40100 Bologna, Italy
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