Predictors of adherence to composite therapy after acute coronary syndromes

AIMS

Adherence to medical therapy following acute coronary syndrome (ACS) affects a patient's prognosis. In this cohort study, we sought to assess the factors that could affect a patient's adherence to therapy after ACS.

METHODS

We prospectively collected information from patients (N = 964) hospitalized at the coronary care unit of the Federico II University Hospital, from 1 January 2015 to 30 June 2017, for ACS. Adherence to three classes of drugs including statins, antiplatelets [dual or single antiplatelet agent (SAPT)] and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB) and their composites were assessed at 1 month, 1 and 2 years after discharge.

RESULTS

At 30 days adherence to prescribed therapy was 94.4% for dual antiplatelet therapy (DAPT), 78.2% for statins, 92.7% for ACE-I/ARB and 70.7% for multitherapy. At 1 year, it was 91.1% for DAPT, 81.2% for ACE-I/ARB, 84.9% for statins and 71.4% for multitherapy. At 2 years, it was 97.1% for SAPT, 78.1% for ACE-I/ARB, 91.8% for statins, 72.8% for multitherapy. Multivariable logistic analysis demonstrated that at each time point, a telephone follow-up assessment predicts nonadherence to multitherapy and that a percutaneous coronary intervention at the index hospitalization is an independent predictor of adherence to composite therapy at 1 month and 1 year.

CONCLUSION

Up to 2 years after ACS, three out of four patients are adherent to multitherapy prescription; percutaneous coronary intervention during the index hospitalization improves a patient's adherence, whereas telephone follow-up is associated with reduced adherence to multitherapy.Campania Salute Network Registry (Clinical Trials.gov Identifier: NCT02211365).

Drug-coated balloon in superficial femoral artery in-stent restenosis

The femoropopliteal artery is one of the commonest sites of involvement in peripheral artery disease (PAD) leading to intermittent claudication and/or critical limb ischemia. Endovascular therapy for superficial femoral artery (SFA) disease has been recognized as a safe and efficient therapy and is recommended by current guidelines as the first-line approach. Although the widespread use of new-generation, self-expanding, nitinol stents in SFA stenosis has reduced the shortcomings associated with plain old balloon angioplasty (POBA), lumen renarrowing at the stented (in-stent restenosis - ISR) level still represents a relevant clinical problem, because of higher risk of recurrent ISR, occlusion and surgical revascularization compared to de-novo lesions. In this setting, different treatment options are available and drug-coated balloons (DCBs) have shown good results in terms of safety and effectiveness. In this review we examine the results of different trials exploring the outcome of using DCBs for the treatment of SFA ISR. The available data demonstrate that SFA ISR can be safely treated with percutaneous transluminal angioplasty with a DCB, with a reduction in recurrent restenosis and target lesion revascularization (TLR) at least at 1 year after POBA. The consistent and positive results of different registries and randomized trials support the use of DCB to reduce SFA ISR recurrence.

PAHs in decaying Quercus ilex leaf litter: mutual effects on litter decomposition and PAH dynamics

The investigation of the relationships between litter decomposition and polycyclic aromatic hydrocarbons (PAHs) is important to shed light not only on the effects of these pollutants on fundamental ecosystem processes, such as litter decomposition, but also on the degradation of these pollutants by soil microbial community. This allows to understand the effect of atmospheric PAH contamination on soil PAH content via litterfall. At this aim, we studied mass and PAH dynamics of Quercus ilex leaf litters collected from urban, industrial and remote sites, incubated in mesocosms under controlled conditions for 361d. The results highlighted a litter decomposition rate of leaves sampled in urban>industrial>remote sites; the faster decomposition of litter of the urban site is also related to the low C/N ratio of the leaves. The PAHs showed concentrations at the beginning of the incubation of 887, 650 and 143 ng g(-1)d.w., respectively in leaf litters from urban, industrial and remote sites. The PAHs in litter decreased along the time, with the same trend observed for mass litter, showing the highest decrease at 361 d for the urban leaf litter. Anyway, PAH dynamics in all the litters exhibited two phases of loss, separated by a PAH increase observed at 246 d and mainly linked to benzo[e]pyrene.

Polycyclic aromatic hydrocarbon contamination in an urban area assessed by Quercus ilex leaves and soil

We investigated the PAH contamination of Naples urban area, densely populated and with high traffic flow, by analyses of environmental matrices: soil and Quercus ilex leaves. Being some PAHs demonstrated to have hazardous effects on human health, the accumulation of carcinogenic and toxic PAHs (expressed as B(a)Peq) was evaluated in the leaves and soil. The main sources of the PAHs were discriminated by the diagnostic ratios in the two matrices. The urban area appeared heavily contaminated by PAHs, showing in soil and leaves total PAH concentrations also fivefold higher than those from the remote area. The soil mainly accumulated heavy PAHs, whereas leaves the lightest ones. Median values of carcinogenic PAH concentrations were higher in soil (440 ng g(-1) d.w.) and leaves (340 ng g(-1) d.w.) from the urban than the remote area (60 and 70 ng g(-1) d.w., respectively, for soil and leaves). Also, median B(a)Peq concentrations were higher both in soil and leaves from the urban (137 and 63 ng g(-1) d.w., respectively) than those from the remote area (19 and 49 ng g(-1) d.w., respectively). Different from the soils, the diagnostic ratios found for the leaves discerned PAH sources in the remote and urban areas, highlighting a great contribution of vehicular traffic emission as main PAH source in the urban area.

Improved biomonitoring of airborne contaminants by combined use of holm oak leaves and epiphytic moss

Concentrations of 12 elements (Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb and Zn) and 16 EPA-listed PAHs were detected in Quercus ilex leaves and the epiphytic moss Leptodon smithii collected at urban, periurban and extraurban holm oak stands, in two Italian Regions (Campania and Tuscany). Levels of environmental contaminants were generally higher in leaves and moss from urban areas than periurban and extraurban ones and samples from Campania had the highest PAH content. The epiphytic moss accumulated higher concentrations of trace elements than leaves and the latter showed a higher accumulation capability for PAHs, especially for those with low molecular weight. The different bioaccumulation in leaves and moss were explained in terms of their distinctive morphological and ecophysiological characteristics. The combined approach seems a promising tool for the monitoring of a wide range of pollutants in Mediterranean urban and extraurban environments.

Leaf accumulation of trace elements and polycyclic aromatic hydrocarbons (PAHs) in Quercus ilex L

Quercus ilex L. leaves were collected four times in one year at six urban sites and one remote area in order to determine trace element and PAH accumulation through concomitant analyses of unwashed and water-washed leaves. Both unwashed and washed leaves showed the highest amounts of trace elements and PAHs in the urban area. Unwashed leaves showed greater differences between urban and remote areas and among the urban sites than washed leaves for trace element and PAH concentrations. Water-washing resulted in a significant (P<0.001) decrease in leaf concentrations of Cr, Cu, Fe, Pb, V and Zn. By contrast, Cd and total PAH concentrations showed no differences between unwashed and washed leaves.

Assessment of nutritional status and trace element contamination of holm oak woodlands through analyses of leaves and surrounding soils

The nutritional status and trace element contamination of holm oak woodlands in Vesuvius National Park were assessed by analyses of Quercus ilex L. leaves and surrounding soils. The concentrations of Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, V and Zn were measured in 1-year-old leaves, and in the soils at 0-5 and 15-20 cm depths. The potentially available concentrations were also measured for the soils. The leaf element concentrations were similar to the Q. ilex chemical fingerprint, thus indicating a good nutritional status and the absence of short-term trace element depositions. Total K and V were more abundant in the deep soil layers than in the surface ones, whereas Cd and Pb showed higher values in the surface soils. This suggests that long-term soil accumulations of Cd and Pb are due to atmospheric input. The soil availabilities of Cd, Pb and Zn were high, and Cr availability was very low. A correlation between the available concentrations in the deep soil layers and leaf concentrations was found only for Zn.

Temporal and spatial variation in C, N, S and trace element contents in the leaves of Quercus ilex within the urban area of Naples

This paper presents a comparative analysis of the concentrations of C, N and S and several trace elements (Fe, Mn, Na, Zn, Cu, V, Pb, Ni, Cr, Cd) in leaves of Quercus ilex, an evergreen oak, collected in the urban area of Naples in 1989 and 1996. The samplings were carried out from 25 urban sites (roads with different traffic flows as well as urban and suburban parks) and from two remote areas as controls. Relative to 1989, the values measured in 1996 denote a strong decrement of S, Fe, Na, Pb, and Cr, with the exception of S in control sites. By contrast, C, N and Cd contents were higher in 1996 than in 1989. Cu and Ni showed a conspicuous increment in control sites as well as in urban sites facing the sea and in the parks, while in all the other urban sites these elements decreased remarkably. No significant difference was found in the leaf contents of Mn, Zn and V measured in 1989 relative to 1996. Both in 1989 and 1996 the contents of N, S, Fe, Na, Cu, Pb, V, Ni, Cr and Cd were significantly higher in leaves from urban sites than in the controls, reflecting the high degree of contamination of the urban area. Concentration factors expressed as the ratio of road/control values for most of the elements were still very high in leaves collected in 1996, though remarkably lower than in 1989.

Trace metal biomonitoring in the soil and the leaves of Quercus ilex in the urban area of Naples

The concentrations of Pb, Cu, Fe, and Mn were analyzed in surface deposit and tissue of Quercus ilex leaves from several sites of the urban area of Naples, exposed to different degrees of air pollution. These included some major roads with heavy traffic loads, squares, and three urban parks. The soil from the trunk base area of Q. ilex trees in the same sites was also analyzed for total and available metal contents. Pb, Cu, and Fe contents in the surface deposit and leaf tissue were significantly higher (p < 0.01) in leaves from roadside sites than in leaves from parks; significant correlations were found between deposit- and tissue-contents of Pb, Cu, and Fe. Mn content in leaves from roadside sites and in leaves from parks were similar and Mn content in the leaf deposit was irrelevant. Significant differences (p < 0.001) in both total and available Pb and Cu soil content were found between sampling sites. Also for available Fe and Mn soil content differences among sites were relevant, although the highest values were measured in soil from urban parks. A positive correlation between leaf and soil metal content was found only for Pb, thus suggesting that trace metal contents of leaves directly depend on atmospheric depositions. Seasonal variations of Pb, Cu, and Fe were pronounced at a polluted site, whereas no relevant seasonal variation was observed at a control site; moreover, metal accumulation was high at the polluted site. Mn content and seasonal dynamics were comparable at control and polluted sites.

Gas exchange of two CAM species of the genus Cissus (vitaceae) differing in morphological features

Pattern and magnitude of stem gas exchange were studied under controlled conditions on two CAM species of the genus Cissus differing in morphological features. In the cactus-like liana Cissus quadrangularis, at water vapour deficit of the air (VPD) lower than 400 mPa Pa(-1) during daytime, under 24/16°C and 27/16°C temperature regime, CO2 uptake occurred during daytime and nighttime but night fixation was responsible for 74 and 77% respectively of the CO2 fixed during the whole diurnal cycle; the contribution of night fixation increased up to 84% at VPD of 590 mPa Pa(-1) under 27/15°C. In Cissus sp., a slightly succulent xerophytic liana with mesophytic deciduous leaves, at 27°C day temperature and VPD of 520-540 mPa Pa(-1), under both 12 and 16°C night temperature, CO2 uptake occurred exclusively during the night; however at lower day temperatures (18-20°C) and lower VPD (169-269 mPa Pa(-1)) substantial CO2 uptake was observed in the light. Transpiration was higher in Cissus sp. than in Cissus quadrangularis under all of the conditions applied; moreover night transpiration in Cissus sp. contributed more to total day transpiration as compared with Cissus quadrangularis. The results support the opinion that the nocturnal gas exchange has a preeminent role in Cissus sp. as compared with Cissus quadrangularis. Indeed under conditions which enhance evaporative demand even well-watered plants of Cissus sp. resort totally to night fixation. In contrast Cissus quadrangularis which shows a larger resistance to water loss and possesses an abundant water storing parenchyma as compared with Cissus sp. resorts totally to night CO2 fixation only under drought stress.