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Noro F, Santonastaso F, Marotta A, Bonaccio M, Orlandi S, Tirozzi A, Costanzo S, De Curtis A, Gianfagna F, Di Castelnuovo A, Brighenti F, Cerletti C, Donati MB, de Gaetano G, Iacoviello L, Gialluisi A, Izzi B, de Gaetano G, Donati MB, Bonaccio M, Bonanni A, Cerletti C, Costanzo S, De Curtis A, Di Castelnuovo A, Gialluisi A, Gianfagna F, Persichillo M, Di Prospero T, Vermylen J, Pegoraro R, Spagnolo A, Assanelli D, Rago L, Costanzo S, Olivieri M, Panzera T, Di Castelnuovo A, Bonaccio M, Costanzo S, Esposito S, Gialluisi A, Gianfagna F, Orlandi S, Ruggiero E, Tirozzi A, De Curtis A, Magnacca S, Noro F, Tirozzi A, Persichillo M, Bracone F, Panzera T, Bonanni A. Association of nutritional glycaemic indices with global DNA methylation patterns: results from the Moli-sani cohort. Clin Epigenetics 2022; 14:189. [PMID: 36578055 PMCID: PMC9798643 DOI: 10.1186/s13148-022-01407-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND High dietary glycaemic index (GI) and load (GL) have been associated with increased risk of various cardiometabolic conditions. Among the molecular potential mechanisms underlying this relationship, DNA methylation has been studied, but a direct link between high GI and/or GL of diet and global DNA methylation levels has not been proved yet. We analyzed the associations between GI and GL and global DNA methylation patterns within an Italian population. RESULTS Genomic DNA methylation (5mC) and hydroxymethylation (5hmC) levels were measured in 1080 buffy coat samples from participants of the Moli-sani study (mean(SD) = 54.9(11.5) years; 52% women) via ELISA. A 188-item Food Frequency Questionnaire was used to assess food intake and dietary GI and GL for each participant were calculated. Multiple linear regressions were used to investigate the associations between dietary GI and GL and global 5mC and 5hmC levels, as well as the proportion of effect explained by metabolic and inflammatory markers. We found negative associations of GI with both 5mC (β (SE) = - 0.073 (0.027), p = 0.007) and 5hmC (- 0.084 (0.030), p = 0.006), and of GL with 5mC (- 0.14 (0.060), p = 0.014). Circulating biomarkers did not explain the above-mentioned associations. Gender interaction analyses revealed a significant association of the gender-x-GL interaction with 5mC levels, with men showing an inverse association three times as negative as in women (interaction β (SE) = - 0.16 (0.06), p = 0.005). CONCLUSIONS Our findings suggest that global DNA methylation and hydroxymethylation patterns represent a biomarker of carbohydrate intake. Based on the differential association of GL with 5mC between men and women, further gender-based separate approaches are warranted.
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Affiliation(s)
- Fabrizia Noro
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy
| | - Federica Santonastaso
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy ,grid.510779.d0000 0004 9414 6915Present Address: Human Technopole, Viale Rita Levi Montalcini 1, 20157 Milan, Italy ,grid.4708.b0000 0004 1757 2822Present Address: European School of Molecular Medicine, University of Milan, 20122 Milan, Italy
| | - Annalisa Marotta
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy ,grid.412451.70000 0001 2181 4941Present Address: Center of Predictive Molecular Medicine, Center for Excellence on Ageing and Translational Medicine (CAST), University of Chieti-Pescara, Chieti, Italy
| | - Marialaura Bonaccio
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy
| | - Sabatino Orlandi
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy
| | - Alfonsina Tirozzi
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy
| | - Simona Costanzo
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy
| | - Amalia De Curtis
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy
| | - Francesco Gianfagna
- grid.18147.3b0000000121724807EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy ,grid.477084.80000 0004 1787 3414Mediterranea Cardiocentro, Naples, Italy
| | | | - Furio Brighenti
- grid.10383.390000 0004 1758 0937Department of Food and Drug, University of Parma, Parma, Italy
| | - Chiara Cerletti
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy
| | - Maria Benedetta Donati
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy
| | - Giovanni de Gaetano
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy
| | - Licia Iacoviello
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy ,grid.18147.3b0000000121724807EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Alessandro Gialluisi
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy ,grid.18147.3b0000000121724807EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Benedetta Izzi
- grid.419543.e0000 0004 1760 3561Department of Epidemiology and Prevention, IRCCS Neuromed, Via Dell’Elettronica, 86077 Pozzilli, IS Italy
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Salvetti M, Paini A, Di Castelnuovo A, Assanelli D, Costanzo S, Gianfagna F, Badilini F, Vaglio M, Donati MB, de Gaetano G, Lorenza Muiesan M, Iacoviello L. Correction of QRS voltage for body mass index does not improve the prediction of fatal and nonfatal cardiovascular events. The Moli-sani study. Nutr Metab Cardiovasc Dis 2020; 30:426-433. [PMID: 31791640 DOI: 10.1016/j.numecd.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS The diagnosis of LVH by ECG may particularly difficult in obese individuals. The aim of this study was to prospectively investigate whether the correction for body mass index (BMI) might improve the prognostic significance for cerebro and cardiovascular events of two electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in a large cohort of Italian adults. METHODS AND RESULTS In 18,330 adults (54 ± 11 years, 55% women) from the Moli-sani cohort, obesity was defined using the ATPIII criteria. The Sokolow-Lyon (SL) and Cornell Voltage (CV) criteria were used for ECG-LVH. In overweight and obese subjects, as compared with normal weight, the prevalence of ECG-LVH by the SL index was lower. During follow-up (median 4.3 yrs), 503 cerebro and cardiovascular events occurred. One standard deviation (1-SD) increment in uncorrected and in BMI-corrected SL index and CV was associated with an increased risk of events (HR 1.12, 95% CI 1.02-1.22 and HR 1.16, 95% CI 1.06-1.26 and HR 1.12, 95% CI 1.03-1.23 and HR 1.17, 95% CI 1.07-1.27, respectively for SL and CV). In obese subjects, 1-SD increment in uncorrected CV and in BMI-corrected CV was not associated to a significant risk of events (HR 1.05, 95% CI 0.910-1.22 and HR 1.08, 95% CI 0.95-1.23 respectively). Uncorrected SL index showed a significant association with events, which was marginally stronger with BMI-corrected SL voltage (HR 1.18, 95% CI 1.02-1.37 and HR 1.17, 95% CI 1.04-1.33 respectively, Akaike information criterion change from 3220 to 3218). CONCLUSIONS BMI correction of ECG LVH voltage criteria does not significantly improve the prediction of cerebro and cardiovascular events in obese patients in a large cohort at low cardiovascular risk.
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Affiliation(s)
- Massimo Salvetti
- Department of Clinical & Experimental Sciences, University of Brescia & Department of Internal Medicine, ASST Spedali Civili di Brescia, Italy
| | - Anna Paini
- Department of Clinical & Experimental Sciences, University of Brescia & Department of Internal Medicine, ASST Spedali Civili di Brescia, Italy
| | | | - Deodato Assanelli
- Department of Clinical & Experimental Sciences, University of Brescia & Department of Internal Medicine, ASST Spedali Civili di Brescia, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Francesco Gianfagna
- Mediterranea Cardiocentro, Napoli, Italy; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Varese, 100, Varese, Italy
| | | | | | - Maria B Donati
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical & Experimental Sciences, University of Brescia & Department of Internal Medicine, ASST Spedali Civili di Brescia, Italy.
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Varese, 100, Varese, Italy
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Bonaccio M, Di Castelnuovo A, Costanzo S, Ruggiero E, De Curtis A, Persichillo M, Tabolacci C, Facchiano F, Cerletti C, Donati MB, de Gaetano G, Iacoviello L, Iacoviello L, de Gaetano G, Donati MB, Iacoviello L, Bonaccio M, Bonanni A, Cerletti C, Costanzo S, De Curtis A, de Gaetano G, Di Castelnuovo A, Donati MB, Gianfagna F, Persichillo M, Di Prospero T, Vermylen J, De Paula Carrasco I, Giampaoli S, Spagnuolo A, Assanelli D, Centritto V, Costanzo S, Olivieri M, Olivieri M, Di Castelnuovo A, Bonaccio M, Costanzo S, Gialluisi A, Gianfagna° F, Ruggiero E, De Curtis A, Magnacca S, Izzi B, Gianfagna F, Marotta A, Noro F, Bonanni A, De Lucia F, Persichillo M, Bracone F, De Lucia F, Dudiez S, Rago L, Rago L, Costanzo S, De Curtis A, Iacoviello L, Panzera T, Persichillo M. Chili Pepper Consumption and Mortality in Italian Adults. J Am Coll Cardiol 2019; 74:3139-3149. [DOI: 10.1016/j.jacc.2019.09.068] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/29/2019] [Accepted: 09/23/2019] [Indexed: 12/17/2022]
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Pasini E, Corsetti G, Assanelli D, Testa C, Romano C, Dioguardi FS, Aquilani R. Effects of chronic exercise on gut microbiota and intestinal barrier in human with type 2 diabetes. Minerva Med 2019; 110:3-11. [PMID: 30667205 DOI: 10.23736/s0026-4806.18.05589-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Intestinal dysbiosis has been proposed as a possible contributor of the development of type 2 diabetes (T2D). Indeed, commensal fungi and opportunistic bacteria stimulate the local immune system, altering intestinal permeability with consequent leaky gut, which in turn activates systemic inflammation responsible for insulin resistance. It is also well known that chronic exercise improves glucose control and diabetes-induced damage. The aim of this study was to evaluate the role of chronic exercise on gut flora composition and leaky gut in T2D stable patients. METHODS Thirty clinically stable patients with T2D were studied before and after a six months program of endurance, resistance and flexibility training. Metabolic and anthropometric evaluations were carried out. Gut flora and intestinal permeability were measured in stools by selective agar culture medium and molecular biology measurements of zonulin, which is the protein that modulates enterocyte tight junctions. RESULTS Diabetes causes significant intestinal mycetes overgrowth, increased intestinal permeability and systemic low-grade inflammation. However, exercise improved glycemia, functional and anthropometric variables. Moreover, chronic exercise reduced intestinal mycetes overgrowth, leaky gut, and systemic inflammation. Interestingly, these variables are closely correlated. CONCLUSIONS Exercise controls diabetes by also modifying intestinal microbiota composition and gut barrier function. This data shows an additional mechanism of chronic exercise and suggests that improving gut flora could be an important step in tailored therapies of T2D.
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Affiliation(s)
- Evasio Pasini
- Division of Cardiac Rehabilitation, Maugeri Scientific Clinical Institutes for Research and Care, Lumezzane, Brescia, Italy
| | - Giovanni Corsetti
- Division of Human Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy -
| | - Deodato Assanelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cristian Testa
- Laboratory of Clinical Microbiology and Virology, Functional Point Ltd., Bergamo, Italy
| | - Claudia Romano
- Division of Human Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco S Dioguardi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Roberto Aquilani
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
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Pounis G, Costanzo S, Bonaccio M, Di Castelnuovo A, de Curtis A, Ruggiero E, Persichillo M, Cerletti C, Donati MB, de Gaetano G, Iacoviello L, Iacoviello L, Donati MB, de Gaetano G, Vermylen J, De Paula Carrasco I, Giampaoli S, Spagnuolo A, Assanelli D, Centritto V, Spagnuolo P, Staniscia D, Bonanni A, Cerletti C, De Curtis A, Di Castelnuovo A, Lorenzet R, Mascioli A, Olivieri M, Rotilio D, Bonaccio M, Costanzo S, Gianfagna F, Giacci M, Padulo A, Petraroia D, Magnacca S, Marracino F, Spinelli M, Silvestri C, dell'Elba G, Grippi C, De Lucia F, Vohnout B, Verna A, Di Lillo M, Di Stefano I, Pampuch A, Pannichella A, Vizzarri AR, Barbato D, Bracone F, Di Giorgio C, Panebianco S, Chiovitti A, Caccamo S, Caruso V, Cugino D, Zito F, Ferri A, Castaldi C, Mignogna M, Guszcz T, Barisciano P, Buonaccorsi L, Centritto F, Cutrone A, Fanelli F, Santimone I, Sciarretta A, Sorella I, Plescia E, Molinaro A, Cavone C, Galuppo G, D'Angelo D, Ramacciato R, Persichillo M. Reduced mortality risk by a polyphenol-rich diet: An analysis from the Moli-sani study. Nutrition 2018; 48:87-95. [DOI: 10.1016/j.nut.2017.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/09/2017] [Accepted: 11/01/2017] [Indexed: 12/23/2022]
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Assanelli D. Serial measures of microparticles during intense physical activity in untrained subjects with different endothelial abnormalities: new useful biomarkers for individual evaluation? Eur J Prev Cardiol 2018; 25:637-638. [PMID: 29411630 DOI: 10.1177/2047487318757548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Deodato Assanelli
- Chair of Sport Internal Medicine, Department of Sport-Internal Medicine, Universita degli Studi di Brescia, Italy
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Assanelli D. Usefulness of lung ultrasound in the management of patients with heart failure. Intern Emerg Med 2018; 13:11-12. [PMID: 29071663 DOI: 10.1007/s11739-017-1754-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/16/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Deodato Assanelli
- Center of Sport-Internal Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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Ferrari R, Bollani G, Ettori F, Bonetti P, Bersatti F, Archetti S, Ruggeri G, Bonanome A, Martini G, Assanelli D. Factor V G1691A, apo E4 Allele, Hyperhomocysteinemia and MTHFR C677T in a Young Patient with Myocardial Infarction. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Iacoviello L, Bonaccio M, Di Castelnuovo A, Costanzo S, Rago L, De Curtis A, Assanelli D, Badilini F, Vaglio M, Persichillo M, Macfarlane PW, Cerletti C, Donati MB, de Gaetano G. Frontal plane T-wave axis orientation predicts coronary events: Findings from the Moli-sani study. Atherosclerosis 2017; 264:51-57. [PMID: 28772106 DOI: 10.1016/j.atherosclerosis.2017.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS The orientation of the frontal plane T-wave axis (T axis) is a reliable measure of ventricular repolarisation. We investigated the association between T-axis and the risk of coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), stroke and cardiovascular (CVD) mortality. METHODS A sample of 21,287 Moli-sani participants randomly recruited from the general adult (≥35 y) Italian population, free of CVD disease, were followed for a median of 4.4 years. T-axis was measured from a standard 12-lead resting ECG. RESULTS After adjusting for CVD risk factors, subjects with abnormal T-axis showed an increase in the risk of both CHD (Hazard Ratio (HR) = 2.65; 95% CI = 1.67-4.21), HF (HR = 2.56; 1.80-3.63), AF (HR = 2.48; 1.56-3.94) and CVD mortality (HR = 2.83; 1.50-5.32). The association with CHD and HF, but not with AF or CVD death, remained significant after further adjustment for ECG abnormalities. Subjects with abnormal T-axis showed higher levels of subclinical inflammation, hs-troponin I and hs-NT-proBNP (p < 0.001 for all). However, further adjustment for troponin I and/or NT-proBNP determined a reduction of HRs ranging from 12.1 to 24.0% for CHD, while additional adjustment for inflammation markers did not change any association. CONCLUSIONS An abnormal T-axis orientation is associated with an increased risk of both CHD and HF, independently of common CVD risk factors and other ECG abnormalities. This association was partially explained by increased hs-troponin I and hs-NT-proBNP levels.
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Affiliation(s)
- Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Augusto Di Castelnuovo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Livia Rago
- EPICOMED Research, SRL, Campobasso, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | | | | | | | - Mariarosaria Persichillo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | | | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Maria Benedetta Donati
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
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Börjesson M, Assanelli D, Carré F, Dugmore D, Panhuyzen-Goedkoop NM, Seiler C, Senden J, Solberg EE. ESC Study Group of Sports Cardiology: recommendations for participation in leisure-time physical activity and competitive sports for patients with ischaemic heart disease. ACTA ACUST UNITED AC 2016; 13:137-49. [PMID: 16575266 DOI: 10.1097/01.hjr.0000199494.46708.5a] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Evidence for the proper management of ischemic heart disease (IHD) in the general population is well established, but recommendations for physical activity and competitive sports in these patients are scarce. The aim of the present paper was to provide such recommendations to complement existing ESC and international guidelines on rehabilitation and primary/secondary prevention. DESIGN AND METHODS Due to the lack of studies in this field, the current recommendations are the result of consensus among experts. Sports are classified into low/moderate/high dynamic and low/moderate/high static, respectively. RESULTS Patients with a definitive IHD and higher probability of cardiac events are not eligible for competitive sports (CS) but for individually designed leisure time physical activity (LPA); patients with definitive IHD and lower probability of cardiac events as well as those with no IHD but with a positive exercise test and high risk profile (SCORE > 5%) are eligible for low/moderate static and low dynamic (IA-IIA) sports and individually designed LPA. Patients without IHD and a high risk profile+ a negative exercise-test and those with a low risk profile (SCORE < 5%) are allowed all LPA and competitive sports with a few exceptions. CONCLUSIONS Individually designed LPA is possible and encouraged in patients with and without established IHD. Competitive sports may be restricted for patients with IHD, depending on the probability of cardiac events and the demands of the sport according to the current classification.
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Bonaccio M, Di Castelnuovo A, Rago L, de Curtis A, Assanelli D, Badilini F, Vaglio M, Costanzo S, Persichillo M, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. T-wave axis deviation is associated with biomarkers of low-grade inflammation. Findings from the MOLI-SANI study. Thromb Haemost 2015; 114:1199-206. [PMID: 26155907 DOI: 10.1160/th15-02-0177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/26/2015] [Indexed: 11/05/2022]
Abstract
T-wave axis deviation (TDev) may help identifying subjects at risk for major cardiac events and mortality, but the pathogenesis of TDev is not well established; in particular, the possible association between TDev and inflammation is unexplored and unknown. We aimed at investigating the association between low-grade inflammation and TDev abnormalities by conducting a cross-sectional analysis on 17,507 subjects apparently free from coronary heart and haematological diseases enrolled in the MOLI-SANI study. TDev was measured from a standard 12-lead resting electrocardiogram. High sensitivity (Hs) C-reactive protein (CRP), leukocyte (WBC) and platelet counts, neutrophil or granulocyte to lymphocyte ratios were used as markers of inflammation. In multivariable model subjects reporting high CRP levels had higher odds of having borderline and abnormal TDev (OR=1.70; 95 %CI: 1.53-1.90 and OR=1.72; 95 %CI: 1.23-2.41, respectively); the association was still significant, although reduced, after controlling for body mass index (OR=1.17; 95 %CI: 1.05-1.32, for borderline and OR=1.46; 95 %CI: 1.03-2.08, for abnormal). Similarly, higher neutrophil or granulocyte to lymphocyte ratios were associated with increased odds of having abnormal TDev. Neither platelet nor leukocyte counts were associated with abnormal TDev. The relationship between CRP with TDev abnormalities was significantly stronger in men, in non- obese or normotensive individuals, and in those without metabolic syndrome. In conclusion, C-reactive protein and some cellular biomarkers of inflammation such as granulocyte or neutrophil to lymphocyte ratios were independently associated with abnormal TDev, especially in subjects at low CVD risk. These results suggest that a low-grade inflammation likely contributes to the pathogenesis of T- wave axis deviation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Licia Iacoviello
- Licia Iacoviello, Laboratory of Molecular and Nutritional Epidemiology, Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Via dell'Elettronica, 86077 Pozzilli (Isernia), Italy, Tel.: +39 0865929664, Fax:+39 0865927575, E-mail:
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Vinetti G, Mozzini C, Desenzani P, Boni E, Bulla L, Lorenzetti I, Romano C, Pasini A, Cominacini L, Assanelli D. Supervised exercise training reduces oxidative stress and cardiometabolic risk in adults with type 2 diabetes: a randomized controlled trial. Sci Rep 2015; 5:9238. [PMID: 25783765 PMCID: PMC4363871 DOI: 10.1038/srep09238] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 02/12/2015] [Indexed: 01/17/2023] Open
Abstract
To evaluate the effects of supervised exercise training (SET) on cardiometabolic risk, cardiorespiratory fitness and oxidative stress status in 2 diabetes mellitus (T2DM), twenty male subjects with T2DM were randomly assigned to an intervention group, which performed SET in a hospital-based setting, and to a control group. SET consisted of a 12-month supervised aerobic, resistance and flexibility training. A reference group of ten healthy male subjects was also recruited for baseline evaluation only. Participants underwent medical examination, biochemical analyses and cardiopulmonary exercise testing. Oxidative stress markers (1-palmitoyl-2-[5-oxovaleroyl]-sn-glycero-3-phosphorylcholine [POVPC]; 1-palmitoyl-2-glutaroyl-sn-glycero-3-phosphorylcholine [PGPC]) were measured in plasma and in peripheral blood mononuclear cells. All investigations were carried out at baseline and after 12 months. SET yielded a significant modification (p < 0.05) in the following parameters: V'O2max (+14.4%), gas exchange threshold (+23.4%), waist circumference (−1.4%), total cholesterol (−14.6%), LDL cholesterol (−20.2%), fasting insulinemia (−48.5%), HOMA-IR (−52.5%), plasma POVPC (−27.9%) and PGPC (−31.6%). After 12 months, the control group presented a V'O2max and a gas exchange threshold significantly lower than the intervention group. Plasma POVC and PGPC were significantly different from healthy subjects before the intervention, but not after. In conclusion, SET was effective in improving cardiorespiratory fitness, cardiometabolic risk and oxidative stress status in T2DM.
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Affiliation(s)
- Giovanni Vinetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Mozzini
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Paolo Desenzani
- Diabetology Unit, Azienda Ospedaliera Spedali Civili di Brescia, Montichiari, Italy
| | - Enrico Boni
- 1st Division of General Medicine, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Laura Bulla
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Isabella Lorenzetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudia Romano
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Pasini
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Luciano Cominacini
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Deodato Assanelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Assanelli D, Levaggi R, Carré F, Sharma S, Deligiannis A, Mellwig KP, Tahmi M, Vinetti G, Aliverti P. Cost-effectiveness of pre-participation screening of athletes with ECG in Europe and Algeria. Intern Emerg Med 2015; 10:143-50. [PMID: 25164412 DOI: 10.1007/s11739-014-1123-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study is to evaluate the cost-effectiveness of ECG in combination with family and personal history and physical examination in order to detect cardiovascular diseases that might cause sudden death in athletes. The study was conducted on a cohort of 6,634, mainly young professional and recreational athletes, 1,071 from Algeria and 5,563 from Europe (France, Germany and Greece). Each athlete underwent medical history, physical examination, and resting 12-lead ECG. 293 athletes (4.4 %), 149 in Europe (2.7 %) and 144 in Algeria (13.4 %) required further tests, and 56 were diagnosed with cardiovascular disease and thus disqualified. The cost-effectiveness ratio (CER) was calculated as the ratio between the cost of screening and the number of statistical life-years saved by the intervention. The estimated reduced risk of death deriving from treatment or disqualification resulted in the saving of 79.1 statistical life-years in Europe and 136.3 in Algeria. CER of screening was 4,071 purchasing-power-parity-adjusted US dollars ($PPP) in Europe and 582 $PPP in Algeria. The results of this study strongly support the utilisation of 12-lead ECG in the pre-participation screening of young athletes, especially in countries where secondary preventive care is not highly developed.
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Affiliation(s)
- Deodato Assanelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,
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Assanelli D, Ermolao A, Carre F, Deligiannis A, Mellwig K, Mellwig K, Tahmi M, Cesana BM, Levaggi R, Aliverti P, Sharma S. Standardised pre-competitive screening of athletes in some European and African countries: the SMILE study. Intern Emerg Med 2014; 9:427-34. [PMID: 23709052 DOI: 10.1007/s11739-013-0955-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
Most of the available data on the cardiovascular screening of athletes come from Italy, with fewer records being available outside of Italy and for non-Caucasian populations. The goals of the SMILE project (Sport Medicine Intervention to save Lives through ECG) are to evaluate the usefulness of 12-lead ECGs for the detection of cardiac diseases in athletes from three European countries and one African country and to estimate how many second-level examinations are needed subsequent to the initial screening in order to classify athletes with abnormal characteristics. A digital network consisting of Sport Centres and second and third opinion centres was set up in Greece, Germany, France and Algeria. Standard digital data input was carried out through the application of 12-lead ECGs, Bethesda questionnaires and physical examinations. Two hundred ninety-three of the 6,634 consecutive athletes required further evaluation, mostly (88.4 %) as a consequence of abnormal ECGs. After careful evaluation, 237 were determined to be healthy or apparently healthy, while 56 athletes were found to have cardiac disorders and were thus disqualified from active participation in sports. There was a large difference in the prevalence of diseases detected in Europe as compared with Algeria (0.23 and 4.01 %, respectively). Our data confirmed the noteworthy value of 12-lead resting ECGs as compared with other first-level evaluations, especially in athletes with asymptomatic cardiac diseases. Its value seems to have been even higher in Algeria than in the European countries. The establishment of a digital network of Sport Centres for second/third opinions in conjunction with the use of standard digital data input seems to be a valuable means for increasing the effectiveness of screening.
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Assanelli D, Di Castelnuovo A, Rago L, Badilini F, Vinetti G, Gianfagna F, Salvetti M, Zito F, Donati MB, de Gaetano G, Iacoviello L. T-wave axis deviation and left ventricular hypertrophy interaction in diabetes and hypertension. J Electrocardiol 2013; 46:487-91. [DOI: 10.1016/j.jelectrocard.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Indexed: 10/26/2022]
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Assanelli D, Rago L, Di Castelnuovo A, Badilini F, Vaglio M, Gianfagna F, Salvetti M, Zito F, Donati MB, de Gaetano G, Iacoviello L. T-wave axis deviation and left ventricular hypertrophy interaction in diabetes and hypertension (MOLI-SANI project). J Electrocardiol 2013. [DOI: 10.1016/j.jelectrocard.2013.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Assanelli D, Rago L, Di Castelnuovo A, Badilini F, Vaglio M, Gianfagna F, Salvetti M, Zito F, Donati MB, de Gaetano G, Iacoviello L. T-wave axis deviation and left ventricular hypertrophy interaction in the MOLI-SANI project. J Electrocardiol 2013. [DOI: 10.1016/j.jelectrocard.2013.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vaglio M, Rago L, Di Castelnuovo A, Assanelli D, Badilini F, Salvetti M, Donati MB, de Gaetano G, Iacoviello L. C-reactive protein level is linked to T-wave axis deviation in a healthy Italian population: results from the MOLI-SANI project. J Electrocardiol 2012. [DOI: 10.1016/j.jelectrocard.2012.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Corsetti G, Pasini E, Ferrari-Vivaldi M, Romano C, Bonomini F, Tasca G, Dioguardi F, Rezzani R, Assanelli D. Metabolic Syndrome and Chronic Simvastatin Therapy Enhanced Human Cardiomyocyte Stress before and after Ischemia- Reperfusion in Cardio-Pulmonary Bypass Patients. Int J Immunopathol Pharmacol 2012; 25:1063-74. [DOI: 10.1177/039463201202500423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Metabolic syndrome (MetS) is a set of metabolic alterations including high levels of low-density lipoprotein (LDL), which increase the risk of cardiomyopathy often leading to surgery. Despite inducing myopathy, statins are widely used to lower LDL. Cardiopulmonary bypass (Cpb) causes oxidative stress and metabolic injury, altering mitochondrial expression (Grp75) and endoplasmic reticulum (Grp78) chaperones, apoptotic enzymes (Bcl2 family) and increasing cardiomyocyte lipid/lipofuscin storage. We believe that cardiomyocytes from patients with MetS may be more sensitive to surgical stress, in particular after simvastatin therapy (MetS+Stat). The study group included ten patients with MetS, ten patients with Mets+Stat and ten healthy subjects. Myocardial biopsies were obtained both before and after-Cpb. Grp75, Grp78, Bax, Bcl2, lipids, lipofuscin and fibrosis were evaluated by immuno/histochemistry. MetS cardiomyocytes had higher Grp75, Bax, fibrosis and lipofuscin. MetS+Stat had lower Grp75 and higher Grp78 expressions, high Bax, fewer fibrosis and higher lipofuscin content. Cpb did not vary the fibrosis and lipids/lipofuscin content, although it influenced the chaperones and Bax expression in all groups. These changes were more profound in patients with MetS and even more so in patients with MetS+Stat. The results suggest that MetS and MetS+Stat cardiomyocytes were more highly stressed after-Cpb. Interestingly, simvastatin caused high stress even before-Cpb.
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Affiliation(s)
- G. Corsetti
- Division of Human Anatomy, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - E. Pasini
- “S. Maugeri Foundation” IRCCS, Medical Centre, Lumezzane, Brescia, Italy
| | - M. Ferrari-Vivaldi
- Cardiovascular Surgery Department, San Rocco Hospital, Ome, Brescia, Italy
| | - C. Romano
- Division of Internal Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - F. Bonomini
- Division of Human Anatomy, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - G. Tasca
- Division of Cardiac Surgery “A. Manzoni” Hospital, Lecco, Italy
| | - F.S. Dioguardi
- Department of Internal Medicine, University of Milan, Milan, Italy
| | - R. Rezzani
- Division of Human Anatomy, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - D. Assanelli
- Division of Internal Medicine, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Iacoviello L, Rago L, Costanzo S, Di Castelnuovo A, Zito F, Assanelli D, Badilini F, Donati MB, de Gaetano G. The Moli-sani project: computerized ECG database in a population-based cohort study. J Electrocardiol 2012; 45:684-9. [PMID: 23021814 DOI: 10.1016/j.jelectrocard.2012.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Indexed: 01/15/2023]
Abstract
Computerized electrocardiogram (ECG) acquisition and interpretation may be extremely useful in handling analysis of data from large cohort studies and exploit research on the use of ECG data as prognostic markers for cardiovascular disease. The Moli-sani project (http://www.moli-sani.org) is a population-based cohort study aiming at evaluating the risk factors linked to chronic-degenerative disease with particular regard to cardiovascular disease and cancer and intermediate metabolic phenotypes such as hypertension, diabetes, dyslipidemia, obesity, and metabolic syndrome. Between March 2005 and April 2010, 24 325 people aged 35 years or older, living in the Molise region (Italy), were randomly recruited. A follow-up based on linkage with hospital discharge records and mortality regional registry and reexamination of the cohort is ongoing and will be repeated at prefixed times. Each subject was administered questionnaires on personal and medical history, food consumption, quality of life (FS36), and psychometry. Plasma serum, cellular pellet, and urinary spots were stored in liquid nitrogen. Subjects were measured blood pressure, weight, height, and waist and hip circumferences, and underwent spirometry to evaluate pulmonary diffusion capacity, gas diffusion, and pulmonary volumes. Standard 12-lead resting ECG was performed by a Cardiette ar2100-view electrocardiograph and tracings stored in digital standard communication protocol format for subsequent analysis. The digital ECG database of the Moli-sani project is currently being used to assess the association between physiologic variables and pathophyiosiologic conditions and parameters derived from the ECG signal. This computerized ECG database represents a unique opportunity to identify and assess prognostic factors associated with cardiovascular and metabolic diseases.
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Affiliation(s)
- Licia Iacoviello
- Laboratory of Genetic and Environmental Epidemiology, Research Laboratories, Fondazione di Ricerca e Cura Giovanni Paolo II, Università Cattolica, Campobasso, Italy.
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Pasini E, Le Douairon Lahaye S, Flati V, Assanelli D, Corsetti G, Speca S, Bernabei R, Calvani R, Marzetti E. Effects of treadmill exercise and training frequency on anabolic signaling pathways in the skeletal muscle of aged rats. Exp Gerontol 2012; 47:23-8. [DOI: 10.1016/j.exger.2011.10.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/19/2011] [Accepted: 10/04/2011] [Indexed: 02/07/2023]
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Pasini E, Flati V, Paiardi S, Rizzoni D, Porteri E, Aquilani R, Assanelli D, Corsetti G, Speca S, Rezzani R, De Ciuceis C, Agabiti-Rosei E. Intracellular molecular effects of insulin resistance in patients with metabolic syndrome. Cardiovasc Diabetol 2010; 9:46. [PMID: 20809949 PMCID: PMC2940873 DOI: 10.1186/1475-2840-9-46] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 09/01/2010] [Indexed: 01/21/2023] Open
Abstract
Aim of the study Patients with metabolic syndrome (MetS) have an increased risk of cardiovascular disease. Data obtained from muscle biopsies have demonstrated altered insulin signaling (IS) in patients with MetS. The IS regulates critical cell functions including molecular-regulated cellular metabolite fluxes, protein and energetic metabolism, cell proliferation and apoptosis with consequent regulation of cell life including endothelial homeostasis and blood coagulation. However, little is known about blood cell IS in MetS patients. The aim of this study was to develop a method to evaluate IS in peripheral lymphocytes to identify altered intracellular molecules in patients with MetS to use as risk biomarkers of vascular thrombosis. Patients and Methods We investigated 40 patients with MetS and 20 controls. MetS was defined according to guidelines from the US National Cholesterol Education Program Adult Treatment Panel III. Blood samples were taken from all participants. Total mononuclear cells were isolated from peripheral blood using density gradient centrifugation. IS molecules were evaluated using Western blot analysis followed by computer-assisted densitometer evaluation. Results Lymphocytes of MetS patients showed a reduced mTOR expression (the mammalian target of rapamycin) which is a fundamental molecule of IS. Major impairment of IS was confirmed by reduced upstream and downstream mTOR molecules which regulate fundamental cells metabolic functions. Conclusions In patients with MetS, we found a reduction of mTOR and other mTOR-related molecules involved in insulin resistance, cell repair, coagulation and vasculogenesis. A reduced expression of mTOR may reflect an increased risk of vascular thrombosis.
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Affiliation(s)
- Evasio Pasini
- Salvatore Maugeri Foundation, IRCCS, Medical Center of Lumezzane, Brescia, Italy
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Pirola I, Cappelli C, Delbarba A, Scalvini T, Agosti B, Assanelli D, Bonetti A, Castellano M. Anabolic steroids purchased on the Internet as a cause of prolonged hypogonadotropic hypogonadism. Fertil Steril 2010; 94:2331.e1-3. [PMID: 20416868 DOI: 10.1016/j.fertnstert.2010.03.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 03/13/2010] [Accepted: 03/17/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To report a case of hypogonadotropic hypogonadism due to the chronic abuse of anabolic steroids purchased over the Internet. DESIGN Case report. SETTING Endocrinology unit of the University of Brescia. PATIENT(S) A 34-year-old man. INTERVENTION(S) A single dose (100 μg) of triptorelin (triptorelin test). MAIN OUTCOME MEASURE(S) Clinical symptoms, androgen normalization, levels of serum testosterone, follicle-stimulating hormone, and luteinizing hormone. RESULT(S) Within 1 month, the patient's serum testosterone was in the normal range, and he reported a return to normal energy and libido. CONCLUSION(S) The World Anti-Doping Code has proved to be a very powerful and effective tool in the harmonization of antidoping efforts worldwide, but it is insufficient to combat this illegal phenomenon. To tackle the serious side effects caused by doping we believe that it is necessary to increase monitoring and adopt severe sanctions, particularly with regard to Internet sites.
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Affiliation(s)
- Ilenia Pirola
- Internal Medicine and Endocrinology Unit, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy
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Corsetti G, Pasini E, D'Antona G, Nisoli E, Flati V, Assanelli D, Dioguardi FS, Bianchi R. Morphometric changes induced by amino acid supplementation in skeletal and cardiac muscles of old mice. Am J Cardiol 2008; 101:26E-34E. [PMID: 18514623 DOI: 10.1016/j.amjcard.2008.02.078] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aging is associated with progressive structural disorganization of muscular and cardiac fibers, decreasing functional capacity, and increased rates of disease and death. Aging is also characterized by disturbances in protein synthesis with impaired cellular organelle functions, particularly in the mitochondria. The availability of amino acids is a key factor for the overall metabolism of mammals and exogenous supplements of amino acid mixtures (AAm) could be a valid therapeutic strategy to improve quality of life, avoiding malnutrition and muscle wasting in the elderly. We investigated the morphoquantitative effects of long-term AAm supplementation on the mitochondria and sarcomeres (by electron microscope) and on collagen matrix deposition (by histologic techniques) in both skeletal and cardiac muscles of young and aged mice. Our data showed that old animals have fewer mitochondria and massive fibrosis in both muscles. Long-term AAm supplementation increased the number and volume of mitochondria and sarcomeres and decreased fibrosis in both skeletal muscle and hearts in old rats. These findings indicate that AAm restored muscular morphologic parameters and probably improved the mechanical performance of these organs.
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Pasini E, Corsetti G, Bandera F, Tolomio S, Salvetti M, Pedretti E, Orini S, Indelicato A, Berrino F, Assanelli D. Nutritional status and physical activity of a selected sample of elderly healthy italian people. Mediterr J Nutr Metab 2008. [DOI: 10.1007/s12349-008-0007-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Inama G, Pedrinazzi C, Durin O, Nanetti M, Donato G, Pizzi R, Assanelli D. Microvolt T-wave alternans for risk stratification in athletes with ventricular arrhythmias: correlation with programmed ventricular stimulation. Ann Noninvasive Electrocardiol 2008; 13:14-21. [PMID: 18234002 DOI: 10.1111/j.1542-474x.2007.00196.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Aim of our study is to evaluate the role of T-wave alternans (TWA) to stratify the risk of sudden cardiac death in athletes (Ath) with complex ventricular arrhythmias (VA), and to document a possible correlation between TWA and electrophysiological testing (EPS) results. METHODS We studied 85 Ath with VA (61 M, mean age 32 +/- 11 years). In all cases a cardiological evaluation was performed, including TWA and EPS. The patients were evaluated during a follow-up of 30 +/- 21 months. The end point was the occurrence of sudden death (SD) or malignant ventricular tachyarrhythmias (VT). RESULTS TWA was negative in 57 Ath (68%), positive in 15 (18%) and indeterminate in 13 (14%). All subjects with negative TWA did not show induction of VT at EPS, with significant correlation between negative TWA and negative EPS (P < 0.001). All Ath with positive TWA also had VT induced by a EPS, with significant correlation (P < 0.001). By contrast, our data did not show significant correlation between indeterminate TWA and positive or negative EPS. However, there was significant correlation between abnormal TWA test (positive + indeterminate) and inducibility of VT at EPS (P < 0.001). During follow-up we observed a significant difference in end point occurrence (VT or SD) between Ath with negative or abnormal TWA and between Ath with negative or positive EPS. CONCLUSION TWA confirm its role as a simple and noninvasive test, and it seems useful for prognostic stratification of Ath with VA.
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Affiliation(s)
- Giuseppe Inama
- Department of Cardiology, Ospedale Maggiore, Crema, Italy.
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Pasini E, Corsetti G, Bandera F, Tolomio S, Salvetti M, Pedretti E, Orini S, Indelicato A, Berrino F, Assanelli D. Nutritional status and physical activity of a selected sample of elderly healthy Italian people. Mediterranean Journal of Nutrition and Metabolism 2008. [DOI: 10.3233/s12349-008-0007-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- E. Pasini
- “S. Maugeri Foundation” IRCCS, Medical Centre of Lumezzane, Brescia, Italy
| | - G. Corsetti
- Division of Human Anatomy, Department of Biomedical Sciences and Biotechnology, University of Brescia, Viale Europa 11, 25124 Brescia, Italy. e-mail:
| | - F. Bandera
- Department of Sports Medicine, University of Brescia, Brescia, Italy
| | - S. Tolomio
- Department of Sports Medicine, University of Padova, Padua, Italy
| | - M. Salvetti
- Department of Sports Medicine, University of Brescia, Brescia, Italy
| | - E. Pedretti
- Department of Sports Medicine, University of Brescia, Brescia, Italy
| | - S. Orini
- Department of Medical and Surgical Sciences, Geriatric Unit, University of Brescia, Italy
| | | | - F. Berrino
- Department of Preventive and Predictive Medicine, Fondazione Istituto Nazionale dei Tumori, Milan, Italy
| | - D. Assanelli
- Department of Sports Medicine, University of Brescia, Brescia, Italy
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Grassi M, Kisialiou A, Assanelli D, Mozzini C, Archetti S, Pezzini A. Evidence of major genes effects on serum homocysteine and fibrinogen levels, and premature ischemic heart disease in Italian extended families. Hum Hered 2008; 66:50-60. [PMID: 18223316 DOI: 10.1159/000114165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 09/04/2007] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The purpose of the present study was to investigate the effect of novel genetic factors on plasma levels of total homocysteine (tHcy) and fibrinogen (FIB). As tHcy and FIB have been consistently associated to increased risk of ischemic heart disease (IHD) and acute myocardial infarction (MI) also genes-trait-MI mediational effects were tested. METHODS A complex segregation analysis, and a mediation analysis of a highly selected group of 44 extended families (302 subjects), each including at least one member with fatal premature (<50 years) IHD were carried out. RESULTS tHcy and FIB levels turned out to be influenced by at least two major genes. A significant tHcy latent class-MI association (OR = 3.24; 95% CI, 1.37 to 7.68), and a non-significant tHcy plasma level-MI association (OR = 1.65 per 1 = log 10 mumol/l, 95% CI, 0.56 to 4.81) were estimated, suggesting a direct influence of the homocysteine major gene as suppressor of plasma tHcy levels effect. In contrast, FIB latent class-MI association (OR = 0.97; 95% CI, 0.31 to 3.05) and FIB level-MI association (OR = 1.32 per 1 = 70 g/l; 95% CI, 0.88 to 2.00) were not statistically significant. CONCLUSION These data provide evidence for a major latent gene effect influencing variation in tHcy plasma levels, which is independent on C677T MTHFR polymorphism, and significantly affecting the risk of MI.
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Affiliation(s)
- Mario Grassi
- Dipartimento di Scienze Sanitarie Applicate, Sezione di Statistica Medica & Epidemiologia, Università di Pavia, Pavia, Italy
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Corsetti G, Pasini E, Assanelli D, Bianchi R. Effects of acute caffeine administration on NOS and Bax/Bcl2 expression in the myocardium of rat. Pharmacol Res 2007; 57:19-25. [PMID: 18082418 DOI: 10.1016/j.phrs.2007.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 07/11/2007] [Accepted: 07/16/2007] [Indexed: 11/27/2022]
Abstract
Caffeine is the most frequently ingested neuroactive drug in the world and it is largely used to delay fatigue and improve physical activity. Caffeine can modulate NO synthesis in cells and may influence muscular function by modifying the cellular cycle life-death. There is little data concerning the relationship between caffeine in the heart, NOS expression and apoptosis and no data regarding the acute effect of high doses of caffeine in the in vivo myocardium. We therefore studied hemodynamic NOS and Bax/Bcl2 expression in the rat myocardium after a single cafffeine administration. Thirty-two male rats were divided into six groups: the first was iv-injected with caffeine (16 mg/kg), the second with caffeine + L-NAME (30 mg/kg), the third with caffeine + L-arg (0.5 g/kg), the fourth with caffeine + L-NAME + L-arg and finally the fifth with saline. Mean arterial blood pressure (MAP) was monitored for 30 min, then the animals were killed. The sixth group was injected with caffeine and killed after 2 h. The hearts were isolated and processed by immunohistochemistry. We found that caffeine increased MAP temporarily while caffeine + L-NAME increased it for a longer period. In the control myocardium, all NOS isoforms were expressed. The Bcl2 were strongly expressed inside the perinuclear cytoplasm whereas Bax was very faintly detectable in the peripheral cytoplasm. In caffeine and caffeine + L-NAME treated animals, NOS expression disappeared. Bax and Bcl2 expression did not vary. The l-arg administration reversed these caffeine and L-NAME effects on NOS expression. Two hours after caffeine, NOS expression increased and Bax and Bcl2 expression did not vary, although Bcl2 was mainly expressed in the peripheral cytoplasm. We conclude that improved caffeine-induced physical performance could also be related to caffeine's ability to interfere with endogenous myocardial NO synthesis. Furthermore, we suggest that myocardial cell plays an effective anti-apoptotic role against acute caffeine administration.
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Affiliation(s)
- Giovanni Corsetti
- Division of Human Anatomy, Department of Biomedical Sciences and Biotechnology, University of Brescia, viale Europa 11, 25124 Brescia, Italy
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Quaquaruccio G, Latella M, Graziano M, Di Castelnuovo A, Lorenzet R, Napoleone E, Giannuzzi P, Gattone M, Assanelli D, Novak N, Trevisan M, de Gaetano G, Donati M, Iacoviello L. TISSUE FACTOR GENE TAG-SNPS AND HAPLOTYPES AND THE RISK OF MYOCARDIAL INFARCTION. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb00925.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Corsetti G, Pasini E, Assanelli D, Saligari E, Adobati M, Bianchi R. Acute caffeine administration decreased NOS and Bcl2 expression in rat skeletal muscles. Pharmacol Res 2007; 55:96-103. [PMID: 17236787 DOI: 10.1016/j.phrs.2006.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 09/26/2006] [Accepted: 10/03/2006] [Indexed: 11/19/2022]
Abstract
Caffeine (Caf) is largely used to delay fatigue, improving physical activity. However, its role remains elusive, and there are no hemodynamic or immunohistochemical data regarding its effects on skeletal muscle. We studied the hemodynamic and NOS expression of Bax/Bcl2 in skeletal muscle after single Caf administration. Thirty-two male rats were divided into six groups: the first was iv-injected with Caf (16mg/kg), the second with Caf+L-NAME, the third with Caf+L-arg, the fourth with Caf+L-NAME+L-arg, fifth with saline. Mean arterial blood pressure (MAP) was monitored for 30', then the animals were killed. The sixth group was injected with Caf and killed after 2h. The quadriceps were isolated and processed by immunohistochemistry. We found that Caf increased MAP temporarily, while Caf+L-NAME increased it for a longer period. In untreated muscle, all NOS isoforms was expressed with different intensity and localisation, and Bcl2 was strongly expressed among the myofibrils. In Caf and Caf+L-NAME treated animals, NOS expression was lost; Bcl2 expression decreased among myofibrils but increased inside the subsarcolemma. The L-arg administration reversed these Caf and L-NAME effects. Two hours after Caf, NOS expression increased. We concluded that improved physical performance could be related to Caf's ability to interfere with the endogenous muscular synthesis of NO.
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Affiliation(s)
- Giovanni Corsetti
- Division of Human Anatomy, Department of Biomedical Sciences and Biotechnology, University of Brescia, Italy
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Grassi M, Assanelli D, Pezzini A. Direct, reverse or reciprocal causation in the relation between homocysteine and ischemic heart disease. Thromb Res 2007; 120:61-9. [PMID: 16908053 DOI: 10.1016/j.thromres.2006.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2006] [Revised: 05/31/2006] [Accepted: 06/14/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whether mild hyperhomocysteinemia is a risk factor for ischemic heart disease (IHD) or it is a secondary epiphenomenon remains unknown. We tested the alternative hypotheses that the Hcy-IHD relation is due to direct, reversal or reciprocal causality. METHODS Ninety-four families from 32 pedigrees (296 members) including subjects who died for a premature (<50 years) IHD and with at least one family member with also a premature IHD were selected. Three Structural Equation Models were created, in which causal (Model 1), reversal (Model 2), and reciprocal (Model 3) tHcy-IHD relation were tested. Results were confirmed by testing "Pearl's instrumental inequalities". RESULTS A significant tHcy-IHD association was found in Model 1 (OR=1.38, 95% CI: 1.01 to 1.88, for any increase of +10 micromol/l in tHcy), as opposed to a non-significant association in the other models (Model 2: MD=+1.63 micromol/l, 95% CI: -1.72 to +4.99 micromol/l; Model 3: OR=0.69, 95% CI: 0.17 to 2.78 for tHcy predictor of IHD; MD=-0.46 micromol/l, 95% CI: -2.41 to 1.48 micromol/l, for IHD predictor of tHcy). "Pearl's instrumental inequalities" qualify MTHFR as an instrument relative to the tHcy-IHD relation. A suppression effect may explain the non-significant total MTHFR-IHD relation (OR=1.275, 95% CI: 1.02 to 1.71 for the indirect MTHFR-tHcy-IHD path; OR=0.52, 95% CI: 0.17 to 1.64 for the direct MTHFR-IHD path). CONCLUSION Our findings support the assumption of a triangular genotype-phenotype-disease mediation process in the Hcy-IHD relation, and indirectly, of a causal relationship between moderately elevated plasma tHcy levels and IHD.
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Affiliation(s)
- Mario Grassi
- Dipartimento di Scienze Sanitarie Applicate, Sezione di Statistica Medica ed Epidemiologia, Università degli Studi di Pavia, Pavia, Italia
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Porteri E, Pasini E, Flati V, Paiardi S, Assanelli D, Corsetti G, Speca S, Bianchi R, Rizzardi N, Rizzoni D, Agabiti Rosei E. Impaired Insulin Signalling in the Heart and Skeletal Muscle of Spontaneously Hypertensive Rats, and Effects of Treatment with an Angiotensin Receptor Blocker or with an ACE Inhibitor. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Porteri E, Pasini E, Flati V, Paiardi S, Assanelli D, Corsetti G, Speca S, Bianchi R, Rizzardi N, Rizzoni D, Agabiti Rosei E. Impaired Insulin Signalling in Lympho/Monocytes of Patients with Metabolic Syndrome. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Pezzini A, Grassi M, Del Zotto E, Assanelli D, Archetti S, Negrini R, Caimi L, Padovani A. Interaction of homocysteine and conventional predisposing factors on risk of ischaemic stroke in young people: consistency in phenotype-disease analysis and genotype-disease analysis. J Neurol Neurosurg Psychiatry 2006; 77:1150-6. [PMID: 16624841 PMCID: PMC2077547 DOI: 10.1136/jnnp.2005.076083] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2005] [Revised: 03/08/2006] [Accepted: 04/07/2006] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES Whether the association between mild hyperhomocysteinaemia and ischaemic stroke is the consequence of a predisposing genetic background or is due to the confounding influence of established predisposing factors remains to be determined. METHODS Plasma total homocysteine (tHcy) concentration and the distribution of the C677T genotypes of the methylenetetrahydrofolate reductase gene (MTHFR) were compared in 174 consecutive patients with stroke aged <45 years and 155 age and sex-matched controls. The effect of conventional risk factors on the relationship between phenotype-disease and genotype-disease was analysed by two-way and three-way interaction analysis and by the classification and regression trees (CART) model. RESULTS tHcy concentrations were markedly higher in patients with ischaemic stroke (median 11.9 micromol/l, range 2.0-94.0) than in controls (median 9.8 micromol/l, range 4.7-49.6). An increased risk was also associated with the TT677 genotype (odds ratio (OR) 1.98; 95% confidence interval (CI) 1.04 to 3.78) and with the T allele (1.40; 95% 1.03 to 1.92) of the MTHFR gene. A differential effect of Hcy levels on risk of stroke was observed according to the distribution of environmental-behavioural risk factors, with a stronger influence in the subcategory of people with hypertension and smokers (OR 24.8; 95% CI 3.15 to 196). A comparable environmental-dependent TT677 MTHFR genotype-stroke association was observed in the genotype-disease analysis. CONCLUSIONS A consistency of phenotype-disease analysis and genotype-disease analysis is indicated by analysing specific subcategories of patients, defined by the distribution of established risk factors. The assumption that the Hcy-stroke relationship is unlikely due to a reverse-causality bias is indirectly supported by our data.
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Affiliation(s)
- A Pezzini
- Clinica Neurologica, Università degli Studi di Brescia, Ple Spedali Civili, 1, 25100 Brescia, Italy.
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Rubel P, Fayn J, Nollo G, Assanelli D, Li B, Restier L, Adami S, Arod S, Atoui H, Ohlsson M, Simon-Chautemps L, Télisson D, Malossi C, Ziliani GL, Galassi A, Edenbrandt L, Chevalier P. Toward personal eHealth in cardiology. Results from the EPI-MEDICS telemedicine project. J Electrocardiol 2006; 38:100-6. [PMID: 16226083 DOI: 10.1016/j.jelectrocard.2005.06.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 06/10/2005] [Indexed: 11/22/2022]
Abstract
Despite many attempts to improve the management of acute myocardial infarction, only small trends to shorter time intervals before treatment have been reported. The self-care solution developed by the European EPI-MEDICS project (2001-2004) is a novel, very affordable, easy-to-use, portable, and intelligent Personal ECG Monitor (PEM) for the early detection of cardiac ischemia and arrhythmia that is able to record a professional-quality, 3-lead electrocardiogram (ECG) based on leads I, II, and V2; derive the missing leads of the standard 12-lead ECG (thanks to either a generic or a patient-specific transform), compare each ECG with a reference ECG by means of advanced neural network-based decision-making methods taking into account the serial ECG measurements and the patient risk factors and clinical data; and generate different levels of alarms and forward the alarm messages with the recorded ECGs and the patient's Personal electronic Health Record (PHR) to the relevant health care providers by means of a standard Bluetooth-enabled, GSM/GPRS-compatible mobile phone. The ECG records are SCP-ECG encoded and stored with the PHR on a secure personal SD Card embedded in the PEM device. The alarm messages and the PHR are XML encoded. Major alarm messages are automatically transmitted to the nearest emergency call center. Medium or minor alarms are sent on demand to a central PEM Alarm Web Server. Health professionals are informed by a Short Message Service. The PEM embeds itself a Web server to facilitate the reviewing and/or update of the PHR during a routine visit at the office of the general physician or cardiologist. Eighty PEM prototypes have been finalized and tested for several weeks on 697 citizens/patients in different clinical and self-care situations involving end users (188 patients), general physicians (10), and cardiologists (9). The clinical evaluation indicates that the EPI-MEDICS concept may save lives and is very valuable for prehospitalization triage.
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Affiliation(s)
- Paul Rubel
- INSERM ERM107: MTIC, Hôpital Cardiologique de Lyon, 69500 Bron, France.
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37
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Grassi M, Assanelli D, Mozzini C, Albertini F, Salvadori G, Archetti S, Negrini R, Galeazzi G, Pezzini A. Modeling premature occurrence of acute coronary syndrome with atherogenic and thrombogenic risk factors and gene markers in extended families. J Thromb Haemost 2005; 3:2238-44. [PMID: 16194201 DOI: 10.1111/j.1538-7836.2005.01512.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The interaction between genetic and environmental risk factors in determining premature cardiovascular events has been largely investigated in case-control association studies. By contrast, few family based analyses have been performed so far. PATIENTS/METHODS From a series of 2936 subjects aged 45-64, we selected probands who died for a premature (<50 years) ischemic heart disease (IHD) and with at least one family member with a history of IHD also occurring under the age of 50. Ninety-four families from 32 pedigrees including 296 subjects were identified. In this population, we analyzed the relationship between background risk factors [age, gender, the G1691A polymorphisms of factor V gene, the C677T polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene, the 844ins68bp polymorphisms of the cystathionine-beta-synthase (CBS) gene, and the apolipoprotein E (APOE) polymorphisms] and environmental risk factors, both atherogenic (smoke, hypertension, diabetes, dyslipidemia, obesity) and thrombogenic (smoke, homocysteine, fibrinogen) by a Markov block-recursive modeling approach. RESULTS None of the studied polymorphisms had an independent direct effect on the risk of IHD. As opposed to atherogenic factors, thrombogenic factors (homocysteine and fibrinogen) turned out to be possible mediators of the indirect effect of the MTHFR gene on IHD risk (OR: 1.30; 95% CI: 1.01-1.69, for every 8 mm increase in plasma levels of homocysteine in TT-carriers compared with CT/CC-carriers (OR: 1.11; 95% CI: 1.01-1.22), for every 20 g L(-1) increase in plasma levels of fibrinogen in TT-carriers compared with CT/CC-carriers). CONCLUSION Plasma levels of homocysteine and fibrinogen may be interpreted as intermediate factors mediating the effect of predisposing genes on the risk premature cardiovascular disease.
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Affiliation(s)
- M Grassi
- Department of Health Sciences, Section of Medical Statistics and Epidemiology, University of Pavia, Pavia, Italy
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Pelliccia A, Fagard R, Bjørnstad HH, Anastassakis A, Arbustini E, Assanelli D, Biffi A, Borjesson M, Carrè F, Corrado D, Delise P, Dorwarth U, Hirth A, Heidbuchel H, Hoffmann E, Mellwig KP, Panhuyzen-Goedkoop N, Pisani A, Solberg EE, van-Buuren F, Vanhees L, Blomstrom-Lundqvist C, Deligiannis A, Dugmore D, Glikson M, Hoff PI, Hoffmann A, Hoffmann E, Horstkotte D, Nordrehaug JE, Oudhof J, McKenna WJ, Penco M, Priori S, Reybrouck T, Senden J, Spataro A, Thiene G. Recommendations for competitive sports participation in athletes with cardiovascular disease: A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005; 26:1422-45. [PMID: 15923204 DOI: 10.1093/eurheartj/ehi325] [Citation(s) in RCA: 523] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Antonio Pelliccia
- National Institute of Sports Medicine, Italian National Olympic Committee, Via dei Campi Sportivi 46, 00197 Rome, Italy.
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Pezzini A, Grassi M, Del Zotto E, Archetti S, Spezi R, Vergani V, Assanelli D, Caimi L, Padovani A. Cumulative Effect of Predisposing Genotypes and Their Interaction With Modifiable Factors on the Risk of Ischemic Stroke in Young Adults. Stroke 2005; 36:533-9. [PMID: 15692115 DOI: 10.1161/01.str.0000155741.31499.c2] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Combinations of multiple predisposing polymorphisms and their interactions with modifiable factors may result in synergistic effects on the risk of ischemic stroke. These mechanisms are more likely to play a relevant role in younger individuals. METHODS The cumulative effect of the 20210A variant of prothrombin gene, the 1691A variant of factor V gene, the TT677 genotype of the methylenetetrahydrofolate reductase (MTHFR) gene, and the epsilon4-carriership of the apolipoprotein (APOE) gene, as well as their interactions with modifiable predisposing factors, were determined in a series of 163 stroke patients aged younger than 45 years and 158 controls. RESULTS Odds ratios (ORs) for stroke were 1.73 (95% confidence interval [CI], 1.20 to 2.51) in subjects with 1 polymorphism and 3.00 (95% CI, 1.43 to 6.30) in those with > or =2. Compared with nonsmokers with none of the studied polymorphisms, ORs for stroke were 1.88 (95% CI, 1.18 to 3.00) and 3.55 (95% CI, 1.40 to 8.98) for nonsmokers with 1 and 2 polymorphisms, respectively, and 3.99 (95% CI, 2.00 to 7.96) and 15.99 (95% CI, 4.01 to 63.3) for smokers. Compared with nonhypertensive subjects bearing no polymorphisms, ORs were 1.91 (95% CI, 1.28 to 2.87) and 3.68 (95% CI, 1.64 to 8.26) for nonhypertensive subjects with 1 and 2 polymorphisms, 3.28 (95% CI, 1.01 to 10.7) and 10.79 (95% CI, 1.01 to 115.4) for hypertensive. CONCLUSIONS These data suggest a gene-dose effect of the examined prothrombotic and proatherogenic gene variants and a synergistic effect of these polymorphisms and modifiable risk factors in the pathogenesis of cerebral ischemia in young adults.
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Affiliation(s)
- Alessandro Pezzini
- Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili, 1, 25100 Brescia, Italia.
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Corrado D, Pelliccia A, Bjørnstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005; 26:516-24. [PMID: 15689345 DOI: 10.1093/eurheartj/ehi108] [Citation(s) in RCA: 682] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The 1996 American Heart Association consensus panel recommendations stated that pre-participation cardiovascular screening for young competitive athletes is justifiable and compelling on ethical, legal, and medical grounds. The present article represents the consensus statement of the Study Group on Sports Cardiology of the Working Group on Cardiac Rehabilitation and Exercise Physiology and the Working Group on Myocardial and Pericardial diseases of the European Society of Cardiology, which comprises cardiovascular specialists and other physicians from different European countries with extensive clinical experience with young competitive athletes, as well as with pathological substrates of sudden death. The document takes note of the 25-year Italian experience on systematic pre-participation screening of competitive athletes and focuses on relevant issues, mostly regarding the relative risk, causes, and prevalence of sudden death in athletes; the efficacy, feasibility, and cost-effectiveness of population-based pre-participation cardiovascular screening; the key role of 12-lead ECG for identification of cardiovascular diseases such as cardiomyopathies and channelopathies at risk of sudden death during sports; and the potential of preventing fatal events. The main purpose of the consensus document is to reinforce the principle of the need for pre-participation medical clearance of all young athletes involved in organized sports programmes, on the basis of (i) the proven efficacy of systematic screening by 12-lead ECG (in addition to history and physical examination) to identify hypertrophic cardiomyopathy-the leading cause of sports-related sudden death-and to prevent athletic field fatalities; (ii) the potential screening ability in detecting other lethal cardiovascular diseases presenting with ECG abnormalities. The consensus document recommends the implementation of a common European screening protocol essentially based on 12-lead ECG.
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Assanelli D, Bonanome A, Pezzini A, Albertini F, Maccalli P, Maccalli P, Grassi M, Archetti S, Negrini R, Negrini R, Visioli F. Folic acid and vitamin E supplementation effects on homocysteinemia, endothelial function and plasma antioxidant capacity in young myocardial-infarction patients. Pharmacol Res 2005; 49:79-84. [PMID: 14597156 DOI: 10.1016/j.phrs.2003.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We examined the effects of folate (either alone or co-supplemented with Vitamin E) on endothelial function in hyperhomocysteinimic patients and correlated results with serum antioxidant capacity. A randomized trial was carried out in 30 young patients with recent acute myocardial infarction (AMI) and high plasma homocysteine concentrations. Intervention consisted of high doses of folate, either alone (group A) or in combination with Vitamin E (group B), for three months. Main outcome measures were endothelial function, serum antioxidant capacity, and homocysteinemia. Folic acid treatment reduced plasma homocysteine concentrations in both groups by 41% and, as compared with baseline values, was associated with a significant (P<0.001) improvement of endothelial function (from 0.322 (0.03) to 0.450 (0.02)mm in group A and from 0.338 (0.03) to 0.584 (0.04)mm in group B). However, there was no difference in endothelial function improvement between folic acid and folic acid plus Vitamin E group. Plasma antioxidant capacity significantly (P<0.001) increased in both groups. In conclusion, beneficial effects of folic acid on vasomotion appear to be independent of antioxidant action but, rather, seem to be strongly associated with reduction of homocysteinemia. Confirming previous reports, the effects of Vitamin E are still equivocal.
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Affiliation(s)
- Deodato Assanelli
- Institute of Internal Medicine, University of Brescia, Brescia, Italy
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Iacoviello L, Di Castelnuovo A, Gattone M, Pezzini A, Assanelli D, Lorenzet R, Del Zotto E, Colombo M, Napoleone E, Amore C, D'Orazio A, Padovani A, de Gaetano G, Giannuzzi P, Donati MB. Polymorphisms of the Interleukin-1β Gene Affect the Risk of Myocardial Infarction and Ischemic Stroke at Young Age and the Response of Mononuclear Cells to Stimulation In Vitro. Arterioscler Thromb Vasc Biol 2005; 25:222-7. [PMID: 15539626 DOI: 10.1161/01.atv.0000150039.60906.02] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives—
To investigate the role of interleukin-1β (IL-1β) gene polymorphisms as a link between inflammation, coagulation, and risk of ischemic vascular disease at young age.
Methods and Results—
A total of 406 patients with myocardial infarction (MI) at young age, frequency-matched for age, sex, and recruitment center, with 419 healthy population-based controls and 134 patients with ischemic stroke at young age, matched by age and sex, with 134 healthy population-based controls, were studied. Subjects carrying the TT genotype of the −511C/T IL-1β polymorphism showed a decreased risk of MI (odds ratio [OR], 0.36; 95% CI, 0.20 to 0.64) and stroke (OR, 0.32; 95% CI, 0.13 to 0.81) after adjustment for conventional risk factors. In both studies, the T allele showed a codominant effect (
P
=0.0020 in MI;
P
=0.021 in stroke). Mononuclear cells from volunteers carrying the T allele showed a decreased release of IL-1β and a decreased expression of tissue factor after stimulation with lipopolysaccharide compared with CC homozygotes. The presence of a monoclonal antibody against IL-1β during cell stimulation resulted in a marked reduction of tissue factor activity expression.
Conclusions—
-511C/T IL-1β gene polymorphism affects the risk of MI and ischemic stroke at young age and the response of mononuclear cells to inflammatory stimulation.
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Affiliation(s)
- L Iacoviello
- Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Italy.
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Assanelli D, Bonanome A, Grassi M, Archetti S, Negrini R, Pezzini A, Curello S, Visioli F. Determinants of early-onset cardiovascular disease: a case-control study of young myocardial infarction patients. Ital Heart J 2004; 5:604-11. [PMID: 15554031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND The present case-control investigation was undertaken with the aim of thoroughly assessing the risk profile of young coronary patients and to correlate it with their endothelium-dependent vasodilation and with the presence of atherosclerotic lesions. METHODS Forty-eight subjects (age < 41 years) diagnosed with myocardial infarction were screened. They were matched 1:1, for age and sex, with controls. We evaluated the serum total, HDL-, and LDL-cholesterol, triacylglycerols, fibrinogen, homocysteine, folic acid, vitamin B12, vitamin E, antioxidant capacity, and uric acid levels, and we also analyzed the patients for the presence of Helicobacter pylori and of methylenetetrahydrofolate reductase and cystathionine beta-synthase genetic mutations. Post-ischemic vasodilation of the brachial artery was evaluated and the intima-media thickness of the carotid arteries was measured at echo-Doppler. RESULTS A statistical modeling selection between block variables revealed that smoking, the apoepsilon genotype, dyslipidemia, fibrinogen, vitamin E concentrations, and intima-media thickness were important predictors of cardiovascular disease, with an accuracy of 91.7%. CONCLUSIONS On the basis of these results, we believe that acute coronary events in young subjects should be followed by a screening of their siblings, as they might be at higher risk for cardiovascular disease.
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Assanelli D, Cottarelli C, Salvadori G, Rubino F, Fernando F, Biffi A. [Work, cardiopathy, and sports]. Med Lav 2004; 95:119-23. [PMID: 15218743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Heart disease is the main cause of early disability and premature death in Europe. Regular physical activity may prevent heart disease, diabetes, ictus, and obesity. Nevertheless, a certain resistance to a dynamic lifestyle, lack of free time, lack of motivation and other factors are frequently encountered. OBJECTIVES To stress the importance of physical activity in the prevention of cardiovascular disease. METHODS A literature review of the main risk factors for cardiovascular disease was carried out. RESULTS AND CONCLUSION It has been shown that physical exercise is beneficial to the cardiovascular apparatus and to the bones and joints, by improving some metabolic parameters. Recent studies have shown that a personalized, moderate physical activity should be suggested for primary and secondary prevention, in particular for subjects with coronary artery disease and left ventricular dysfunction. An increase in sports activity and physical exercise at work and at school is recommended so as to improve quality of life and promote home rehabilitation. Some promising experience has already been made among workers and their families with excellent results, as shown by a follow-up period of three years.
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Affiliation(s)
- D Assanelli
- Università degli Studi di Brescia, P.le Spedali Civili 1, 25123 Brescia.
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Pezzini A, Grassi M, Del Zotto E, Bazzoli E, Archetti S, Assanelli D, Akkawi NM, Albertini A, Padovani A. Synergistic effect of apolipoprotein E polymorphisms and cigarette smoking on risk of ischemic stroke in young adults. Stroke 2004; 35:438-42. [PMID: 14726545 DOI: 10.1161/01.str.0000112973.00867.98] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The effect of apolipoprotein E (APOE) polymorphisms on stroke risk may be influenced by the coexistence of modifiable predisposing conditions. We explored the interactions of APOE genotypes and conventional risk factors in a case-control study of young adults with cerebral infarct. METHODS We analyzed 124 consecutive patients (age, 34.7+/-7.3 years) and 147 age- and sex-matched controls. APOE genotypes were determined by restriction fragment-length polymorphism analysis. RESULTS The prevalence of the epsilon4 allele and epsilon34 genotype was slightly higher in cases than in controls (0.125 versus 0.071 and 0.242 versus 0.136, respectively). Carriers of the epsilon34 genotype and epsilon4 allele were associated with an increased risk of stroke on multivariate analysis compared with the epsilon33 genotype and non-epsilon4 carriers, respectively (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.10 to 4.76; and OR, 2.27; 95% CI, 1.13 to 4.56). ORs for stroke were 2.99 (95% CI, 1.64 to 5.45), 2.69 (95% CI, 1.25 to 5.77), and 5.39 (95% CI, 1.59 to 18.30) for smokers with the epsilon33 genotype, nonsmokers with the epsilon34 genotype, and smokers with the epsilon34 genotype, respectively, compared with nonsmokers with the epsilon33 genotype. Similar results were obtained when epsilon4 carriers and non-epsilon4 carriers were compared in the same interaction model. No significant interaction between APOE and hypertension was found. CONCLUSIONS In young adults, the APOE epsilon4 allele and cigarette smoking act synergistically, increasing an individual's propensity to have a cerebral ischemic event. This finding may help in determining an individual's predisposition to stroke and more targeted preventive interventions.
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Affiliation(s)
- Alessandro Pezzini
- Clinica Neurologica, Università degli Studi di Brescia, P. le Spedali Civili, 1, 25100 Brescia, Italia.
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Rubel P, Fayn J, Simon-Chautemps L, Atoui H, Ohlsson M, Telisson D, Adami S, Arod S, Forlini MC, Malossi C, Placide J, Ziliani GL, Assanelli D, Chevalier P. New paradigms in telemedicine: ambient intelligence, wearable, pervasive and personalized. Stud Health Technol Inform 2004; 108:123-32. [PMID: 15718638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
After decades of development of information systems dedicated to health professionals, there is an increasing demand for personalized and non-hospital based care. An especially critical domain is cardiology: almost two third of cardiac deaths occur out of hospital, and victims do not survive long enough to benefit from in-hospital treatments. We need to reduce the time before treatment. But symptoms are often interpreted wrongly. The only immediate diagnostic tool to assess the possibility of a cardiac event is the electrocardiogram (ECG). Event and transtelephonic ECG recorders are used to improve decision making but require setting up new infrastructures. The European EPI-MEDICS project has developed an intelligent Personal ECG Monitor (PEM) for the early detection of cardiac events. The PEM embeds advanced decision making techniques, generates different alarm levels and forwards alarm messages to the relevant care providers by means of new generation wireless communication. It is cost saving, involving care provider only if necessary and requiring no specific infrastructure. This solution is a typical example of pervasive computing and ambient intelligence that demonstrates how personalized, wearable, ubiquitous devices could improve healthcare.
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Gardella R, Zoppi N, Assanelli D, Muiesan ML, Barlati S, Colombi M. Exclusion of candidate genes in a family with arterial tortuosity syndrome. ACTA ACUST UNITED AC 2004; 126A:221-8. [PMID: 15054833 DOI: 10.1002/ajmg.a.20589] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Arterial tortuosity syndrome (ATS) is a rare hereditary disorder with variable clinical presentation including tortuosity and elongation of the major arteries, often associated with pulmonary artery stenosis, pulmonary hypertension, and skin and joint laxity, suggestive of a connective tissue disorder. ATS is transmitted in an autosomal recessive mode, but the causal gene is unknown. We report an Italian pedigree with three inbred families in which five patients show signs of ATS. In particular, four adult patients present arterial tortuosity and elongation of the main arteries. Two of these patients, with the most severe degree of arterial tortuosity, also show severe peripheral stenosis of the main pulmonary artery. The fifth young patient shows a severe pulmonary valve stenosis in the absence of arterial tortuosity. All patients show signs of Ehlers-Danlos syndrome (EDS): soft skin with abundant subcutaneous tissue and joint laxity, hernias, and disorganization of the extracellular matrix (ECM) of fibronectin (FN) and of actin microfilaments in cultured skin fibroblasts. Linkage analysis of the genes involved in EDS and other connective tissue disorders, excluded COL1A1, COL1A2, COL2A1, COL3A1, COL5A1, COL5A2, COL5A3, COL6A1, COL6A2, ADAMTS2, ELN, FN1, TNXA, and TNXB as candidate genes in the family under study, thus indicating that ATS is a distinct clinical and molecular entity.
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Affiliation(s)
- Rita Gardella
- Division of Biology and Genetics, Department of Biomedical Sciences and Biotechnology, University of Brescia, Brescia, Italy
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Ciccarone E, Di Castelnuovo A, Assanelli D, Archetti S, Ruggeri G, Salcuni N, Donati MB, Capani F, Iacoviello L. Homocysteine levels are associated with the severity of peripheral arterial disease in Type 2 diabetic patients. J Thromb Haemost 2003; 1:2540-7. [PMID: 14675090 DOI: 10.1111/j.1538-7836.2003.00500.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Homocysteine levels are positively associated with the risk of cardiovascular disease. They might be determined by both MTHFR677C-->T polymorphisms and folate or B-vitamin status. OBJECTIVES To investigate the possible association between plasma homocysteine levels and its genetic or environmental determinants and either the presence or the severity of peripheral arterial disease (PAD), in Type 2 diabetic patients. METHODS From a cohort of 944 patients with Type 2 diabetes, 135 patients with PAD were selected, and frequency-matched for age and sex with 219 Type 2 diabetic control patients without macrovascular complications. According to the increasing severity of the disease, patients were divided into PAD1 (only diffuse calcifications of the arteries without any stenosis or occlusion), PAD2 (one or two stenosis or occlusions) and PAD3 (three or more). RESULTS Homocysteine levels were similar in control and case patients (10.3 micromol L-1 vs. 10.7 micromol L-1, P = 0.53); however, a significant increase was found in PAD3 patients: odds ratio = 2.77 (95% confidence interval 1.14, 6.72) for patients with homocysteine levels above the median vs. those under the median in multivariate analysis. Although all significantly associated with homocysteine levels, neither MTHFR genotype nor folic acid or vitamin B12 levels were associated with severity of PAD. A significant interaction (P < 0.05) was found between folic acid and MTHFR polymorphism in determining the levels of homocysteine. CONCLUSIONS In Type 2 diabetes, homocysteine was associated with the angiographic severity of PAD, but neither the genotypes nor vitamin levels contributed to this association.
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Affiliation(s)
- E Ciccarone
- Angela Valenti Laboratory of Genetic and Environmental Risk Factors for Thrombotic Disease, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy
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Gouaux F, Chautemps LS, Fayn J, Adami S, Arzi M, Assanelli D, Forlini MC, Malossi C, Martinez A, Ohlsson M, Placide J, Ziliani GL, Rubel P. Pervasive self-care solutions in telecardiology. Typical use cases from the EPI-MEDICS project. Stud Health Technol Inform 2003; 95:119-24. [PMID: 14663973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
In western countries, heart disease is the main cause of premature death. Most of cardiac deaths occur out of hospital. Because of a continuously growing elderly population, the number of heart attacks is steadily increasing. Symptoms are often interpreted incorrectly. Victims do not survive long enough to benefit from inhospital treatments. To reduce the time before treatment, the only useful diagnostic tool to assess the presence of a cardiac event is the electrocardiogram (ECG). Event and transtelephonic ECG recorders are used to improve decision-making but require setting up new infrastructures. The pervasive solution proposed by the European EPI-MEDICS project is an intelligent Personal ECG Monitor for the early detection of cardiac events. It includes part of the patient electronic health record (EHR), embeds a web server and decision-making techniques, generates different alarm levels and forwards alarm messages to the relevant care providers by means of new generation wireless communication. It is cost saving, involving care providers only if necessary, without requiring to set-up specific infrastructures. Healthcare becomes personalized, wearable and ubiquitous.
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Pezzini A, Del Zotto E, Magoni M, Costa A, Archetti S, Grassi M, Akkawi NM, Albertini A, Assanelli D, Vignolo LA, Padovani A. Inherited thrombophilic disorders in young adults with ischemic stroke and patent foramen ovale. Stroke 2003; 34:28-33. [PMID: 12511746 DOI: 10.1161/01.str.0000046457.54037.cc] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The pathogenic link between patent foramen ovale (PFO) and stroke remains unknown in most cases. We investigated the association between inherited thrombophilic disorders and PFO-related strokes in a series of young adults in the setting of a case-control study. METHODS We investigated 125 consecutive subjects (age, 34.7+/-7.3 years) with ischemic stroke and 149 age- and sex-matched control subjects. PFO was assessed in all patients with transcranial Doppler sonography with intravenous injection of agitated saline according to a standardized protocol. Genetic analyses for the factor V (FV)(G1691A) mutation, the prothrombin (PT)(G20210A) variant, and the TT677 genotype of methylenetetrahydrofolate reductase (MTHFR) were performed in all subjects. RESULTS A pathogenic role of PFO was presumed in 36 patients (PFO+). Interatrial right-to-left shunt either was not detected or was considered unrelated to stroke occurrence in the remaining 89 patients (PFO-). The PT(G20210A) variant was more frequent in the PFO+ group compared with control subjects and the PFO- group (PFO+ versus control subjects, 11% versus 2%; 95% CI, 0.04 to 0.94; PFO+ versus PFO-, 11% versus 1.1%; 95% CI, 1.09 to 109; P=0.047). A similar distribution was observed for subjects carrying either the PT(G20210A) variant or the FV(G1691A) mutation (PFO+ versus control subjects, 19.4% versus 5.3%; 95% CI, 0.08 to 0.75; PFO+ versus PFO-, 19.4% versus 3.3%; 95% CI, 1.45 to 26.1; P=0.021). Combined thrombophilic defects were observed in 3 subjects of the PFO+ group, in 2 control subjects (8.3% versus 1.3%; 95% CI, 0.01 to 0.66; P=0.015), and in 0 subjects in the PFO- group. A trend toward a difference in the frequency of the FV(G1691A) mutation between PFO+ and control subjects was found after bivariate analysis (11% versus 3.3%; P=0.068) but not after multinomial logistic regression analysis. No significant association was found in the distribution of the TT MTHFR genotype in the 3 groups. CONCLUSIONS In young adults, the PT(G20210A) variant and, to a lesser extent, the FV(G1691A) mutation may represent risk factors for PFO-related cerebral infarcts. A role of systemic thrombophilic disorders in the pathogenesis of this specific subtype of stroke may be hypothesized.
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Affiliation(s)
- Alessandro Pezzini
- Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia.
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