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Berteotti M, Gori AM, Giusti B, Fortini A, Grossi G, Ciardetti N, Migliorini A, Lotti E, Valenti R, Di Mario C, Marchionni N, Marcucci R. Clinical impact of high platelet reactivity in patients with atrial fibrillation and concomitant percutaneous coronary intervention on dual or triple antithrombotic therapy. J Thromb Thrombolysis 2023; 55:667-679. [PMID: 36905562 PMCID: PMC10147742 DOI: 10.1007/s11239-023-02784-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 03/12/2023]
Abstract
High platelet reactivity (HPR) on clopidogrel is an established thrombotic risk factor after percutaneous coronary intervention (PCI). The introduction of more potent antiplatelet drugs has partially surpassed this issue. However, in the setting of concomitant atrial fibrillation (AF) and PCI clopidogrel is still the most adopted P2Y12 inhibitor. In the present study all consecutive patients with history of AF discharged from our cardiology ward with dual (DAT) or triple (TAT) antithrombotic therapy after a PCI from April 2018 to March 2021 were enrolled in an observational registry. For all subjects, blood serum samples were collected and tested for platelet reactivity by arachidonic acid and ADP (VerifyNow system) and genotyping of the CYP2C19*2 loss-of-function polymorphism. We recorded at 3 and 12-months follow-up: (1) major adverse cardiac and cerebrovascular events (MACCE), (2) major hemorrhagic or clinically relevant non-major bleeding and (3) all-cause mortality. A total of 147 patients were included (91, 62% on TAT). In 93.4% of patients, clopidogrel was chosen as P2Y12 inhibitor. P2Y12 dependent HPR resulted an independent predictor of MACCE both at 3 and 12 months (HR 2.93, 95% C.I. 1.03 to 7.56, p = 0.027 and HR 1.67, 95% C.I. 1.20 to 2.34, p = 0.003, respectively). At 3-months follow-up the presence of CYP2C19*2 polymorphism was independently associated with MACCE (HR 5.21, 95% C.I. 1.03 to 26.28, p = 0.045). In conclusion, in a real-world unselected population on TAT or DAT, the entity of platelet inhibition on P2Y12 inhibitor is a potent predictor of thrombotic risk, suggesting the clinical utility of this laboratory evaluation for a tailored antithrombotic therapy in this high-risk clinical scenario. The present analysis was performed in patients with AF undergoing PCI on dual or triple antithrombotic therapy. At 1 year follow-up MACCE incidence was consistent, and it was not different in different antithrombotic pattern groups. P2Y12 dependent HPR was a potent independent predictor of MACCE both at 3- and 12-months follow-up. In the first 3 months after stenting the carriage of CYP2C19*2 allele was similarly associated with MACCE. Abbreviation: DAT, dual antithrombotic therapy; HPR, high platelet reactivity; MACCE, major adverse cardiac and cerebrovascular events; PRU, P2Y12 reactive unit; TAT, triple antithrombotic therapy. Created with BioRender.com.
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Affiliation(s)
- M Berteotti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.
| | - A M Gori
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - B Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - A Fortini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - G Grossi
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - N Ciardetti
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - A Migliorini
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - E Lotti
- Thrombosis Center, Careggi University Hospital, Florence, Italy
| | - R Valenti
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - C Di Mario
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - N Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - R Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
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Gresele P, Guglielmini G, Del Pinto M, Calabrò P, Pignatelli P, Patti G, Pengo V, Antonucci E, Cirillo P, Fierro T, Palareti G, Marcucci R. Peripheral arterial disease has a strong impact on cardiovascular outcome in patients with acute coronary syndromes: from the START Antiplatelet registry. Int J Cardiol 2020; 327:176-182. [PMID: 33152418 DOI: 10.1016/j.ijcard.2020.10.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/30/2020] [Revised: 09/24/2020] [Accepted: 10/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) was reported to increase the risk of new cardiovascular events in patients with acute coronary syndromes (ACS). However, most of the evidence comes from randomized clinical trials. We aimed to assess the impact of PAD on cardiovascular outcome and treatment decisions in ACS patients in a current real-life setting. METHODS START-ANTIPLATELET is a multicenter registry enrolling ACS patient. Baseline clinical characteristics and treatment at discharge were recorded and follow-up was repeated at 6-months and 1-year. PAD was defined as intermittent claudication and/or previous revascularization. RESULTS Among 1442 patients enrolled, 103 (7.1%) had PAD. PAD patients were older (71.8 ± 10.6vs66.2 ± 12.6 yrs., p < 0.0001), more frequently hypertensive (90.3vs68.6%, p< 0.0001), hypercholesterolemic (66vs52%, p= 0.037), diabetic (51.5vs24%, p= 0.0001), obese (28.2vs19.3%, p= 0.029) and with previous TIA (7.8vs2.8%, p= 0.005) or stroke (11.7vs3.1%, p< 0.0001). Clinical presentation and acute treatment were similar in non-PAD and PAD patients, but the latter were discharged significantly less frequently on dual antiplatelet therapy (DAPT) (68.9vs85%, p= 0.005). After a median follow-up time of 11.1 months, major cardio/cerebrovascular event-free survival [MACCE, including cardiovascular death, MI, TIA and stroke, target-vessel revascularization (TVR) and major arterial ischemic events] was significantly shorter (9.0vs11.2 months, p= 0.02; HR 3.2, 2.4-8.4) in PAD patients and net adverse cardiovascular events (NACE = MACCE plus major hemorrhages) were significantly more frequent (19.1%vs10.5%, p = 0.049). CONCLUSIONS PAD identifies a subgroup of ACS patients at significantly increased cardiovascular risk, but these patients tend to be undertreated. Patients admitted for ACS should be screened for PAD and optimal medical therapy at discharge should be implemented.
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Affiliation(s)
- P Gresele
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy.
| | - G Guglielmini
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - M Del Pinto
- Division of Cardiology, Perugia Hospital, Italy
| | - P Calabrò
- Department of Translational Medical Sciences University of Campania "Luigi Vanvitelli", Naples, Italy
| | - P Pignatelli
- Department of Clinical, Internistic, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - G Patti
- Department of Traslational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - V Pengo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - E Antonucci
- Arianna Anticoagulazione Foundation, Bologna, Italy
| | - P Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - T Fierro
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - G Palareti
- Arianna Anticoagulazione Foundation, Bologna, Italy
| | - R Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Italy
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Cavallari I, Sagazio E, Antonucci E, Calabro' P, Gragnano F, Cirillo P, Gresele P, Palareti G, Pengo V, Pignatelli P, Marcucci R, Patti G. Ischemic and bleeding risk stratification in diabetic patients after acute coronary syndrome based on insulin requirement. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1552] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Diabetes is a known risk factor for a first or recurrent cardiovascular event, however, its association with an increased risk of bleeding is controversial. To date, no study has explored the prognostic weight of insulin therapy in the setting of ACS.
Purpose
To investigate the differential role of insulin versus no insulin therapy on ischemic and bleeding risks in patients with diabetes and ACS.
Methods
START-ANTIPLATELET is a prospective, real-world multicenter registry including consecutive patients admitted for ACS. For the purpose of this analysis, patients were stratified according to diabetes status and insulin therapy. We compared 1-year rates of major adverse cardiovascular events, a composite of cardiovascular death, myocardial infarction and stroke, and of any bleeding, according to diabetes status (no diabetes, diabetes not on insulin therapy, diabetes on insulin therapy). In addition, we evaluated the net clinical benefit of dual antiplatelet therapy with the newer P2Y12 inhibitors (ticagrelor or prasugrel) vs dual antiplatelet therapy with clopidogrel according to diabetes status.
Results
In an overall population of 907 patients, 198 had diabetes, 10.6% of whom were on insulin. From non-diabetic patients to diabetic patients not on insulin and diabetic patients on insulin there was a stepwise decrease of MACE-free survival (log-rank p 0.039) with incidence of events at 1 year being 3.8%, 6.8% (adjusted p vs no diabetes 0.49) and 12.5% (adjusted p vs no diabetes 0.047), respectively (Figure, panel A). The rates of any bleeding were higher in patients on insulin (20.8% vs 8.8% in those without diabetes and 5.8% in diabetic patients not receiving insulin; log-rank p 0.028; Figure, panel B). Multivariable analysis demonstrated an almost 5-fold increase of any bleeding in diabetic patients with vs without insulin (OR 4.98, 95% CI 1.46–16.92; p=0.010). In the overall population, the incidence of the net composite endpoint including MACE or major bleeding with the use of ticagrelor/prasugrel on top of aspirin was significantly lower compared to use of clopidogrel (4.7% vs 8.4%; OR 0.54, 95% CI 0.30–0.94, p=0.031). This net clinical benefit in patients receiving a newer P2Y12 inhibitor was regardless of the diabetes status (p for interaction 0.48).
Conclusions
In this cohort of ACS patients, the presence of diabetes stratified by insulin therapy was associated with a graded increase in the 1-year rates of MACE. Conversely, insulin therapy significantly contributed to the overall increase of bleeding risk in diabetes.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- I Cavallari
- Campus Bio-Medico University of Rome, Cardiovascular Sciences, Rome, Italy
| | - E Sagazio
- University of Eastern Piedmont, Novara, Italy
| | - E Antonucci
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - P Calabro'
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - F Gragnano
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - P Cirillo
- Parthenope University of Naples, Naples, Italy
| | - P Gresele
- University of Perugia, Perugia, Italy
| | - G Palareti
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - V Pengo
- University of Padua, Padova, Italy
| | | | | | - G Patti
- University of Eastern Piedmont, Novara, Italy
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Moscarella E, Calabro P, Gragnano F, Cesaro A, Pafundi P, Patti G, Cavallari I, Antonucci E, Cirillo P, Pignatelli P, Palareti G, Sasso F, Pengo V, Gresele P, Marcucci R. Effect of body mass index on ischemic and bleeding events in patients presenting with acute coronary syndromes: insights from the START-ANTIPLATELET registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1720] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The protective effect of obesity on mortality in acute coronary syndromes (ACS) patients remains debated. We aimed at evaluating the impact of obesity on ischemic and bleeding events as possible explanations to the obesity paradox in ACS patients.
Methods
For the purpose of this sub-study, patients enrolled in the START-ANTIPLATELET registry were stratified according to Body Mass Index (BMI) into three groups: normal, BMI <25kg/m2; overweight, BMI: 25–29.9kg/m2; obese, BMI ≥30kg/m2. The primary endpoint was net adverse clinical endpoints (NACE), defined as a composite of all-cause death, myocardial infarction (MI), stroke, and major bleeding.
Results
Patients were classified as follows: 410 (33.9%) normal, 538 (44.5%) overweight, 261 (21.6%) obese. Compared to the normal weight group, obese and overweight patients had a higher prevalence of cardiovascular risk factors, but were younger, with a better left ventricular ejection fraction (LVEF) and lower PRECISE-DAPT score. At one-year follow-up NACE was more frequently observed in normal than in overweight and obese patients (15.1%,8.6%,and9.6%, respectively; p=0.004), driven by a significantly higher rate of all-cause death (6.3%,2.6%, and 3.8%, respectively; p=0.008), while no significant differences were noted in terms of MI, stroke, and major bleeding. When correcting for confounding variables, BMI loses its power in independently predicting outcomes, failing to confirm the obesity paradox in a real-world ACS population.
Conclusions
Our study conflicts the obesity paradox in real-world ACS population, and suggest that the reduced mortality rate may be explained by a lower bleeding risk in obese patients allowing a more aggressive medical treatment, and by a better LVEF translating into a higher survival rate.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Moscarella
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - P Calabro
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - F Gragnano
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - A Cesaro
- S. Anna-S. Sebastiano Hospital, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - P.C Pafundi
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - G Patti
- University of L'Aquila, L'Aquila, Italy
| | | | | | | | | | | | - F.C Sasso
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - V Pengo
- General University Hospital of Alicante, Alicante, Spain
| | - P Gresele
- University of Perugia, Perugia, Italy
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Gragnano F, Moscarella E, Calabro' P, Cesaro A, Pafundi P, Patti G, Antonucci E, Cirillo P, Pignatelli P, Palareti G, Pelliccia F, Sasso F, Pengo V, Gresele P, Marcucci R. Ticagrelor versus Clopidogrel in high bleeding risk patients presenting with Acute Coronary Syndromes: insights from the multicenter START-ANTIPLATELET registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1730] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Optimal dual antiplatelet therapy in high bleeding risk (HBR) patients with acute coronary syndromes (ACS) remains debated. Although current guidelines recommend the use of potent P2Y12 inhibitors in these patients (according to the labeled indications), clopidogrel is frequently used in clinical practice based on a perceived advantage in terms of safety in the HBR population.
Purpose
We sought to investigate the use of clopidogrel versus ticagrelor in consecutive HBR ACS patients and their impact on ischemic and bleeding events at 1 year.
Methods
ACS patients enrolled in the START-ANTIPLATELET registry with at least 1 HBR criterion were included in the present analysis and stratified according to DAPT type (clopidogrel versus ticagrelor). The primary endpoint was net adverse clinical endpoint (NACE), defined as a composite of all-cause death, myocardial infarction, stroke, and major bleeding. The secondary endpoints were major adverse cardiac and cerebral events (MACE), defined as a composite of all-cause death, myocardial infarction and stroke, each individual component of NACE and MACE, and target vessel revascularization.
Results
Among a total of 1,209 patients with 1-year follow-up in the registry, 383 patients were considered at HBR, of whom 174 (45.4%) were on clopidogrel and 209 (54.6%) on ticagrelor. Clopidogrel was more likely to be administered in patients at increased ischemic and bleeding risk, while ticagrelor in those undergoing percutaneous coronary intervention. Mean DAPT duration was longer in the ticagrelor group than in the clopidogrel group (10.40±4.29 versus 9.35±5.4; p-value=0.03). At 1-year follow-up, the risk of NACE and MACE events was significantly higher in the clopidogrel than in the ticagrelor group (NACE: HR 1.82; 95% CI 1.07–3.09; p-value=0.02; MACE: HR 1.83; 95% CI 1.04–3.24; p-value=0.03) (Figure). After multivariate adjustment for clinical and procedural characteristics, no difference in NACEs nor MACEs was observed between patients on clopidogrel versus ticagrelor (NACE: adjusted HR 1.27; 95% CI 0.71–2.27; p-value=0.42; MACE: adjusted HR 1.19; 95% CI 0.63–2.24; p-value=0.59) (Figure). Age, number of HBR criteria, and mean DAPT duration were independent predictors of NACEs.
Conclusions
In a real-world ACS registry, approximately 50% of patients are at HBR and frequently treated with clopidogrel. In HBR ACS patients, no difference was observed in ischemic and bleeding events between clopidogrel and ticagrelor after adjustment for potential confounders.
Kaplan-Meier curves at 1-year follow-up.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Gragnano
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - E Moscarella
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - P Calabro'
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - A Cesaro
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - P.C Pafundi
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - G Patti
- University of Eastern Piedmont, Novara, Italy
| | | | - P Cirillo
- Federico II University of Naples, Naples, Italy
| | | | | | | | - F.C Sasso
- university of Campania Luigi Vanvitelli, Naples, Italy
| | - V Pengo
- University of Padova, Padua, Italy
| | - P Gresele
- University of Perugia, Perugia, Italy
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Scudiero F, Migliorini A, Stefano PL, Marcucci R, Pennesi M, Carrabba N, Muraca I, Vitale R, Marchionni N, Valenti R. P2697Percutaneous coronary intervention with 2nd generation drug eluting stent versus coronary artery bypass grafting in patients with unprotected left main disease: clinical outcome from a referral center. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease is currently recommended as an alternative to coronary artery bypass grafting (CABG) in patients with low and intermediate SYNTAX score.
Purpose
We sought to compare clinical outcomes of unprotected left main coronary artery disease by PCI or CABG in a “real world” population referred to high volume center.
Methods
All consecutive patients with unprotected left main coronary artery disease treated by PCI with second-generation drug-eluting stent were compared to those treated by CABG. The primary endpoint was the composite of death, non-fatal myocardial infarction (MI) or stroke at 2 years follow-up.
Results
A total of 558 patients were included. The mean age was 71±9 years, diabetes was present in 29%, and 56% of the patients presented with acute coronary syndrome. The distal left main coronary artery was involved in 84.6% of the lesions, the rate of Syntax score >32 was 50%. At 2 years, the primary end-point occurred in 10% of the patients in the PCI group and in 9.6% in the CABG group (p=0.862). The rates of death, non-fatal MI or stroke at 2 years were comparable; conversely the rate of ischemia driven revascularization at 2 years was higher in PCI group than CABG (5.5% and 1.5% p=0.010, respectively in PCI and CABG group).
Kaplan-Meier curves of MACCE
Conclusions
In a “real world” population with unprotected left main coronary artery disease, PCI with second generation stent, as compared to CABG, showed similar rates of the composite end point of death, non-fatal MI or stroke at 2 years, irrespective of coronary anatomy complexity.
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Affiliation(s)
- F Scudiero
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - A Migliorini
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - P L Stefano
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - R Marcucci
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - M Pennesi
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - N Carrabba
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - I Muraca
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - R Vitale
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - N Marchionni
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - R Valenti
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
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Pastori D, Lip GYH, Sciacqua A, Perticone F, Melillo F, Godino C, Marcucci R, Berteotti M, Violi F, Pignatelli P. P3472Modifications of renal function in atrial fibrillation patients treated with different oral anticoagulants: a multicentre cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0344] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A decline of estimated glomerular filtration rate (eGFR) has been described in atrial fibrillation (AF) patients on Vitamin K antagonists (VKAs). Few real-world data on the modifications of eGFR in AF patients treated with non-vitamin K antagonist oral anticoagulants (NOACs) do exist.
Purpose
To evaluate changes of renal function in AF patients treated with VKAs or NOACs.
Methods
Multicentre prospective cohort study including 1,667 patients with non-valvular AF from 5 clinical centres of Internal Medicine and Cardiology in Italy.
Renal endpoints were: 1) median annual decline of eGFR; 2) transition to eGFR <50 ml/min/1.73 m2; 3) eGFR class worsening according to KDIGO 2012 classification. The eGFR was assessed by the CKD-EPI formula at baseline and during follow-up.
Results
Median age was 73.7±9.1 years and 43.3% were women. 743 patients were on VKAs and 924 on NOACs (Dabigatran, Rivaroxaban e Apixaban). Median annual eGFR decline was −2,11 (Interquartile Range [IQR] −5,68/−0,62] in patients on VKAs, −0,27 [IQR −9,00/4,54] with Dabigatran (p<0.001 vs. VKAs), −1,21 [IQR −9,98/4,02] with Rivaroxaban (p=0.004 vs. VKAs) and −1,32 [IQR −8,7/3,99] with Apixaban (p=0.003, vs. VKAs). Use of Dabigatran and Apixaban was associated to a lower transition to eGFR <50 mL/min/1.73 m2, compared to VKAs: adjusted Odds Ratio (aOR) 0.492, 95% Confidence Interval (CI) 0.298–0.813, p=0.006 for Dabigatran; aOR 0.449, 95% CI 0.276–0.728, p=0.001 for Apixaban). Regarding the eGFR class worsening, Dabigatran (aOR 0.70, 95% CI 0.503–0.975, p=0.035), Rivaroxaban (aOR 0.591, 95% CI 0.423–0.825, p=0.002), and Apixaban (aOR 0.591, 95% CI 0.429–0.815, p=0.001) were all associated to a lower rate of eGFR class worsening compared to VKAs.
Forest plot
Conclusions
In this prospective multicentre cohort study, NOACs use was associated with a lower decline of renal function compared to VKAs. Patients on Dabigatran showed the lowest annual rate of eGFR decline and those on Apixaban and Rivaroxaban a lower eGFR class worsening.
Acknowledgement/Funding
None
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Affiliation(s)
- D Pastori
- Sapienza University of Rome, Department of Internal Medicine and Medical Specialties, Rome, Italy
| | - G Y H Lip
- University of Liverpool, Liverpool, United Kingdom
| | - A Sciacqua
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - F Perticone
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - C Godino
- San Raffaele Hospital, Milan, Italy
| | | | | | - F Violi
- Sapienza University of Rome, Department of Internal Medicine and Medical Specialties, Rome, Italy
| | - P Pignatelli
- Sapienza University of Rome, Department of Internal Medicine and Medical Specialties, Rome, Italy
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Scudiero F, Valenti R, Marcucci R, Sanna GD, Gori AM, Migliorini A, Vitale R, Giusti B, De Vito E, Corda G, Paniccia R, Parodi G. P6406Platelet reactivity in Hepatitis C virus infected patients on dual antiplatelet therapy for acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary artery disease (CAD) has been recognized as a serious and potentially life-threatening complication of Hepatitis C Virus (HCV) infection. High on treatment platelet reactivity has been associated with high risk of ischemic events in patients with CAD, but data regarding the association with HCV infection are still lacking.
Purpose
We sought to assess platelet reactivity on dual anti-platelet therapy and long-term outcome of acute coronary syndrome (ACS) patients infected with HCV.
Methods
ACS patients infected with HCV were matched to ACS patients without HCV for age, sex, diabetes, hypertension and renal function. Primary and secondary study endpoints were the proportion of patients with high on treatment platelet reactivity (HTPR) and long-term outcomes, respectively.
Results
HCV-infected ACS patients had higher levels of platelet reactivity (ADP10-LTA: 56% ± 18% vs. 44% ± 22%; p=0.002; Arachidonic Acid-LTA: 25% ± 21% vs. 16% ± 15%; p=0.011) and higher rate of HTPR on clopidogrel and aspirin compared with non-HCV patients. Multivariable analysis demonstrated HCV-infection to be an independent predictor of HTPR. At follow-up, estimated major adverse clinical events (MACE: cardiac death, non fatal myocardial infarction and any revascularization) were 57% vs. 37%, p=0.006 in HCV-infected ACS and non-HCV, respectively. Also, TIMI major bleeding rates were higher in HCV-infected subjects (11% vs. 3%; p=0.043) as compared with non-infected patients.
Platelet function according to HCV status
Conclusions
ACS patients with HCV infection have increased on treatment platelet reactivity, higher rate of HTPR, MACE and bleedings as compared with non-HCV patients.
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Affiliation(s)
- F Scudiero
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - R Valenti
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - R Marcucci
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - G D Sanna
- University of Sassari, Clinical and Interventional Cardiology, Sassari, Italy
| | - A M Gori
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - A Migliorini
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - R Vitale
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - B Giusti
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - E De Vito
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - G Corda
- University of Sassari, Clinical and Interventional Cardiology, Sassari, Italy
| | - R Paniccia
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - G Parodi
- University of Sassari, Clinical and Interventional Cardiology, Sassari, Italy
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9
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Ceschia N, Pontecorboli G, Migliorini A, Pradella S, Marcucci R, Marchionni N, Valenti R, Carrabba N. P582Different roles of coronary CTA and CMR in a young patient with chest pain. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez108.018] [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: 11/12/2022] Open
Affiliation(s)
- N Ceschia
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - G Pontecorboli
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - A Migliorini
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - S Pradella
- Careggi University Hospital (AOUC), Radiological Department, Florence, Italy
| | - R Marcucci
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - N Marchionni
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - R Valenti
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - N Carrabba
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
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10
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Pontecorboli G, Gabriele M, Cappelli F, Acquafresca M, Pradella S, Morini S, Taborchi G, Martone R, Migliorini A, Carrabba N, Marchionni N, Marcucci R, Valenti R. P387Chest pain and mild left ventricular hypertrophy: a challenging diagnosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.028] [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: 11/13/2022] Open
Affiliation(s)
| | - M Gabriele
- Careggi University Hospital (AOUC), Florence, Italy
| | - F Cappelli
- Careggi University Hospital (AOUC), Florence, Italy
| | | | - S Pradella
- Careggi University Hospital (AOUC), Florence, Italy
| | - S Morini
- Careggi University Hospital (AOUC), Florence, Italy
| | - G Taborchi
- Careggi University Hospital (AOUC), Florence, Italy
| | - R Martone
- Careggi University Hospital (AOUC), Florence, Italy
| | - A Migliorini
- Careggi University Hospital (AOUC), Florence, Italy
| | - N Carrabba
- Careggi University Hospital (AOUC), Florence, Italy
| | - N Marchionni
- Careggi University Hospital (AOUC), Florence, Italy
| | - R Marcucci
- Careggi University Hospital (AOUC), Florence, Italy
| | - R Valenti
- Careggi University Hospital (AOUC), Florence, Italy
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11
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Bernardini A, Pontecorboli G, Milano EG, Ceschia N, Carrabba N, Acquafresca M, Valenti R, Marchionni N, Marcucci R, Di Mario C. 354Left bundle branch block and left ventricular systolic dysfunction as an expression of complex coronary anomaly in a young woman: a multimodality imaging approach. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez126.004] [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: 11/14/2022] Open
Affiliation(s)
- A Bernardini
- University of Florence, Cardiovascular and Thoracic Department, Florence, Italy
| | - G Pontecorboli
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - E G Milano
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - N Ceschia
- University of Florence, Cardiovascular and Thoracic Department, Florence, Italy
| | - N Carrabba
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - M Acquafresca
- Careggi University Hospital (AOUC), Radiology Department, Florence, Italy
| | - R Valenti
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - N Marchionni
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - R Marcucci
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - C Di Mario
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
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12
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Cesari F, Dinu M, Pagliai G, Rogolino A, Giusti B, Gori AM, Casini A, Marcucci R, Sofi F. Mediterranean, but not lacto-ovo-vegetarian, diet positively influence circulating progenitor cells for cardiovascular prevention: The CARDIVEG study. Nutr Metab Cardiovasc Dis 2019; 29:604-610. [PMID: 30952572 DOI: 10.1016/j.numecd.2019.02.005] [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: 12/06/2018] [Revised: 01/29/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
AIM To evaluate the possible association between dietary habits and progenitor cells using data obtained from a randomized crossover trial using two different diets, lacto-ovo-vegetarian (VD) and Mediterranean (MD), the CARDIVEG study. METHODS AND RESULTS Eighty clinically healthy subjects with a low-to-moderate cardiovascular risk profile (61 F; 19 M; mean age: 50.7 ± 11.6 years) were randomly assigned to isocaloric VD and MD diets lasting three months each, and then crossed. The two diets showed no effects on endothelial progenitor cells and circulating endothelial cells but opposite effects on circulating progenitor cells. In fact, VD determined significant (p < 0.05) and negative changes on circulating progenitor cells, with an average geometric variation of -130 cells/106 events for CD34+/CD45-/dim, -80 cells/106 events for CD133+/CD45-/dim, and -84 cells/106 events for CD34+/CD133+/CD45-/dim while MD determined significant (p < 0.05) and positive changes for CD34+/CD45-/dim levels, with a geometric mean increase of +54 cells/106 events. No significant correlations were observed between changes in progenitor cells and changes in inflammatory parameters during the VD phase. On the other hand, during the MD phase negative correlations between changes of CD34+/CD45-/dim and interleukin-6 (R = -0.324; p = 0.004) as well as interleukin-8 (R = -0.228; p = 0.04) and monocyte chemotactic protein-1 (R = -0.277; p = 0.01), were observed. These correlations remained significant also after adjustment for confounding factors only for CD34+/CD45-/dim and interleukin-6 (β = -0.282; p = 0.018) and monocyte chemotactic protein-1 (β = -0.254; p = 0.031). CONCLUSIONS MD, but not VD, reported a significant and positive effect on circulating progenitor cells in a group of subjects at low-to-moderate cardiovascular risk, probably acting through the modulation of inflammatory parameters.
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Affiliation(s)
- F Cesari
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - M Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - G Pagliai
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - A Rogolino
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - B Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - A M Gori
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - A Casini
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy
| | - R Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - F Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy; Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy.
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13
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Grifoni E, Gori A, Giusti B, Valenti R, Migliorini A, Basili S, Paniccia R, Elmahdy M, Pulli R, Pratesi C, Antoniucci D, Violi F, Marcucci R. On-Treatment Platelet Reactivity is a Predictor of Adverse Events in Peripheral Artery Disease Patients Undergoing Percutaneous Angioplasty. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.09.005] [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: 10/28/2022]
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14
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De Gregorio MG, Morini S, Berteotti M, Bernardini A, Vergara R, Migliorini A, Carrabba N, Gori AM, Marcucci R, Valenti R. P796Prognostic implication of high residual platelet reactivity and antiplatelet therapy in patients undergoing percutaneous coronary intervention for chronic total occlusion. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p796] [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: 11/12/2022] Open
Affiliation(s)
- M G De Gregorio
- Careggi University Hospital (AOUC), Cardiovascular Department, Florence, Italy
| | - S Morini
- Careggi University Hospital (AOUC), Cardiovascular Department, Florence, Italy
| | - M Berteotti
- Careggi University Hospital (AOUC), Cardiovascular Department, Florence, Italy
| | - A Bernardini
- Careggi University Hospital (AOUC), Cardiovascular Department, Florence, Italy
| | - R Vergara
- Careggi University Hospital (AOUC), Cardiovascular Department, Florence, Italy
| | - A Migliorini
- Careggi University Hospital (AOUC), Cardiovascular Department, Florence, Italy
| | - N Carrabba
- Careggi University Hospital (AOUC), Cardiovascular Department, Florence, Italy
| | - A M Gori
- Careggi University Hospital (AOUC), Dept. Experimental and Clinical Medicine, Florence, Italy
| | - R Marcucci
- Careggi University Hospital (AOUC), Dept. Experimental and Clinical Medicine, Florence, Italy
| | - R Valenti
- Careggi University Hospital (AOUC), Cardiovascular Department, Florence, Italy
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15
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Scudiero F, Arcari L, Bacchi B, Cacciotti L, De Vito E, Marcucci R, Sclafani M, Passaseo I, Marazzi G, Autore C, Citro R, Bossone E, Di Mario C, Parodi G. P1252Discriminatory ability of GRACE risk score to predict outcomes in patients with Takotsubo syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/14/2022] Open
Affiliation(s)
- F Scudiero
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - L Arcari
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Rome, Italy
| | - B Bacchi
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - L Cacciotti
- Ospedale Vannini, Institute of Cardiology, Rome, Italy
| | - E De Vito
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - R Marcucci
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - M Sclafani
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Rome, Italy
| | - I Passaseo
- Ospedale Vannini, Institute of Cardiology, Rome, Italy
| | - G Marazzi
- San Raffaele Pisana Hospital IRCCS, Cardiology Unit, Rome, Italy
| | - C Autore
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Rome, Italy
| | - R Citro
- AOU S. Giovanni e Ruggi, Cardiology unit, Salerno, Italy
| | - E Bossone
- AOU S. Giovanni e Ruggi, Cardiology unit, Salerno, Italy
| | - C Di Mario
- Careggi University Hospital (AOUC), Cardiovascular and Thoracic Department, Florence, Italy
| | - G Parodi
- University of Sassari, Clinical and Interventional Cardiology, Sassari, Italy
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16
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Cini M, Legnani C, Cosmi B, Testa S, Dellanoce C, Paoletti O, Marcucci R, Poli D, Paniccia R, Pengo V, Tripodi A, Palareti G. Comparison of five specific assays for determination of dabigatran plasma concentrations in patients enrolled in the START-Laboratory Register. Int J Lab Hematol 2018; 40:229-236. [DOI: 10.1111/ijlh.12772] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/15/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M. Cini
- Department of Angiology and Blood Coagulation; S. Orsola-Malpighi University Hospital; Bologna Italy
| | - C. Legnani
- Department of Angiology and Blood Coagulation; S. Orsola-Malpighi University Hospital; Bologna Italy
| | - B. Cosmi
- Department of Angiology and Blood Coagulation; S. Orsola-Malpighi University Hospital; Bologna Italy
| | - S. Testa
- Haemostasis and Thrombosis Center; Department of Laboratory Medicine; AO Istituti Ospitalieri; Cremona Italy
| | - C. Dellanoce
- Haemostasis and Thrombosis Center; Department of Laboratory Medicine; AO Istituti Ospitalieri; Cremona Italy
| | - O. Paoletti
- Haemostasis and Thrombosis Center; Department of Laboratory Medicine; AO Istituti Ospitalieri; Cremona Italy
| | - R. Marcucci
- Thrombosis Center; Department of Experimental and clinical Medicine; University of Florence; Florence Italy
| | - D. Poli
- Thrombosis Center; Department of Experimental and clinical Medicine; University of Florence; Florence Italy
| | - R. Paniccia
- Center for Bleeding Disorders; Careggi University Hospital; Florence Italy
| | - V. Pengo
- Department of Cardiothoracic and Vascular Sciences; University Hospital of Padua; Padua Italy
| | - A. Tripodi
- Department of Clinical Sciences and Community Health; Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Università degli Studi di Milano; Milan Italy
- IRCCS Maggiore Hospital Foundation; Milan Italy
| | - G. Palareti
- Cardiovascular Diseases; University of Bologna, Coordinator of the START-Register; Bologna Italy
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17
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Cesari F, Sofi F, Molino Lova R, Vannetti F, Pasquini G, Cecchi F, Marcucci R, Gori AM, Macchi C. Aging process, adherence to Mediterranean diet and nutritional status in a large cohort of nonagenarians: Effects on endothelial progenitor cells. Nutr Metab Cardiovasc Dis 2018; 28:84-90. [PMID: 29167060 DOI: 10.1016/j.numecd.2017.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 06/15/2017] [Revised: 09/09/2017] [Accepted: 09/11/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Adherence to the Mediterranean Diet (MD) has been associated with a longer and better life. The aim of this study was to examine the effects of adherence to the MD, and of nutritional habits on endothelial progenitor (EPCs) and circulating progenitor (CPCs) cells in a cohort of nonagenarians enrolled within the Mugello Study, an epidemiological study aimed at investigating both clinically relevant geriatric items and various health issues, including those related to nutritional status. METHODS AND RESULTS Four hundred twenty-one nonagenarians (306 F, 115 M, mean age: 93.1 ± 3.2 years) were evaluated. Adherence to MD was assessed through the Mediterranean Diet Score. Elderly subjects who were in the fourth quartile of the Mediterranean diet score showed significantly higher EPCs than subjects grouped into the other three quartiles. After adjustment for confounders, elderly subjects who were in the highest quartile of adherence to the MD score reported to have EPCs' levels significantly higher than those who reported lower values of adherence to the MD. Furthermore, by analyzing different food categories, it was reported that daily consumption of olive oil and a higher consumption of fruit and vegetables showed higher CPCs CD34+ and EPCs CD34+/KDR+ than subjects with not daily or lower consumption. CONCLUSION Our results support the hypothesis that the adherence to MD, as well as a daily consumption of olive oil and fruit and vegetables, characteristics of MD, may protect against the development of endothelial dysfunction through increasing EPCs and CPCs in older age.
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Affiliation(s)
- F Cesari
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - F Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Clinical Nutrition Unit, Careggi University Hospital, Florence, Italy; Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy.
| | - R Molino Lova
- Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy
| | - F Vannetti
- Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy
| | - G Pasquini
- Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy
| | - F Cecchi
- Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy
| | - R Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - A M Gori
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - C Macchi
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy
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18
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Grifoni E, Vignoli A, Tenori L, Giusti B, Takis P, Valente S, Carrabba N, Balzi D, Barchielli A, Marchionni N, Gensini G, Marcucci R, Luchinat C, Gori A. P3645Metabolomics by nuclear magnetic resonance identifies patients at high risk of death within two years after acute coronary syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3645] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Scudiero F, Zocchi C, Marcucci R, De Vito E, Gabrielli E, Valenti R, Migliorini A, Gori A, Marchionni N, Antoniucci D, Parodi G. 1202Discriminatory ability of CHA2DS2-VASc score to predict residual platelet reactivity and outcomes in patients with acute coronary syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1202] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Volta A, Gori A, Grifoni E, Marcucci R, Giusti B. 3101Familial hypercholesterolemia: development of a next generation sequencing approach to the disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3101] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Becatti M, Marcucci R, Gori AM, Mannini L, Grifoni E, Alessandrello Liotta A, Sodi A, Tartaro R, Taddei N, Rizzo S, Prisco D, Abbate R, Fiorillo C. Erythrocyte oxidative stress is associated with cell deformability in patients with retinal vein occlusion. J Thromb Haemost 2016; 14:2287-2297. [PMID: 27557753 DOI: 10.1111/jth.13482] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Indexed: 02/03/2023]
Abstract
Essentials Retinal vein occlusion (RVO), characterized by blood hyperviscosity, has an unclear pathogenesis. We aimed to find out if hemorheological profile is altered by oxidative stress in RVO patients. Red blood cell (RBC) oxidative stress is associated to whole blood viscosity and RBC deformability. Reactive oxygen species alter RBC membrane rigidity, playing a key role in RVO pathogenesis. SUMMARY Background Retinal vein occlusion (RVO) is characterized by vision loss resulting from hypoperfusion and hypoxia of the retina. RVO pathogenesis is not yet fully understood, although blood hyperviscosity has been observed. Erythrocyte deformability plays a key role in determining blood viscosity, and it is critical to microvascular perfusion and oxygen delivery. It has been shown that oxidative stress-induced erythrocyte membrane fluidity alterations are linked to the progression of cardiovascular diseases. Objectives To determine whether erythrocytes from RVO patients show signs of oxidative stress, and whether this condition can modify the hemorheologic profile in these patients. Patients and Methods We analyzed the entire hemorheologic profile and erythrocyte oxidative stress - reactive oxygen species (ROS) production and membrane lipid peroxidation - in 128 RVO patients and 128 healthy subjects, matched for age and sex. Fluorescence anisotropy was used to evaluate the fluidity of erythrocyte membranes. Results In RVO patients, erythrocyte oxidative stress was present and positively correlated with whole blood viscosity and erythrocyte deformability. Multivariate linear regression analysis after adjustment for age, cardiovascular risk factors, medications, leukocyte number and mean corpuscular volume indicated that erythrocyte-derived ROS and erythrocyte lipid peroxidation were significantly and positively correlated with erythrocyte membrane viscosity and deformability. Moreover, in vitro experiments demonstrated that ROS have a key role in erythrocyte membrane fluidity. Conclusions Our findings indicate that erythrocyte oxidative stress plays a key role in the pathogenesis of RVO, and pave the way to new therapeutic interventions.
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Affiliation(s)
- M Becatti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - R Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - A M Gori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Don Carlo Gnocchi Foundation, IRCCS, Florence, Italy
| | - L Mannini
- Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - E Grifoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - A Alessandrello Liotta
- Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - A Sodi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - R Tartaro
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - N Taddei
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - S Rizzo
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - D Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - R Abbate
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - C Fiorillo
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
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Zaca V, Marcucci R, Parodi G, Limbruno U, Notarstefano P, Pieragnoli P, Di Cori A, Bongiorni MG, Casolo G. Management of antithrombotic therapy in patients undergoing electrophysiological device surgery. Europace 2015; 17:840-54. [DOI: 10.1093/europace/euu357] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/13/2014] [Indexed: 11/14/2022] Open
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Becatti M, Marcucci R, Bruschi G, Taddei N, Bani D, Gori AM, Giusti B, Gensini GF, Abbate R, Fiorillo C. Oxidative Modification of Fibrinogen Is Associated With Altered Function and Structure in the Subacute Phase of Myocardial Infarction. Arterioscler Thromb Vasc Biol 2014; 34:1355-61. [DOI: 10.1161/atvbaha.114.303785] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Cioni G, Marcucci R, Pazzi M, Rossi L, Gensini G, Abbate R, Boddi M. C0521: Non-Alcholic Fatty Liver Disease and Subclinical Organ Damage: A New Predictor of Asymptomatic Extracoronary Atherosclerosis and Endothelial Dysfunction. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50178-8] [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: 11/15/2022]
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Cioni G, Silvestri E, Emmi G, Marcucci R, Milco D’Elios M, Pazzi M, Abbate R, Prisco D, Boddi M. C0520: Impairment of Peripheral Vascular Function in Systemic Lupus Erythematous Patients. Differences from the Vascular Pattern of Patients at High Cardiovascular Risk. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50116-8] [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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Giusti B, Marcucci R, Saracini C, Gori AM, Valenti R, Parodi G, Gensini GF, Antoniucci D, Abbate R. Mean platelet volume and platelet count in acute coronary syndrome patients: role of a genetic variants on chr7q22.3 and chr3p13-p21. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cesari F, Marcucci R, Gori AM, Burgisser C, Francini S, Sofi F, Gensini GF, Abbate R, Fattirolli F. Adherence to lifestyles modifications after a Cardiac Rehabilitation program (CR) and Endothelial Progenitor Cells (EPCs): a 6-months follow-up study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5823] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Molino-Lova R, Macchi C, Gori AM, Marcucci R, Polcaro P, Cecchi F, Lauretani F, Bandinelli S, Abbate R, Beghi E, Guralnik JM, Ferrucci L. High sensitivity C-reactive protein predicts the development of new carotid artery plaques in older persons. Nutr Metab Cardiovasc Dis 2011; 21:776-782. [PMID: 20554169 PMCID: PMC2941708 DOI: 10.1016/j.numecd.2010.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 01/25/2010] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIM Previous studies have shown that increased levels of C-reactive protein (CRP) predict cardiovascular events, including stroke, myocardial infarction and death from cardiovascular causes. Previous studies have also shown that increased levels of CRP are strong predictors of the progression of pre-existing carotid artery plaques. However, whether CRP is involved in the development of new plaques, that may or may not be associated with clinical events, in subjects with clean carotid arteries has been scarcely investigated. METHODS AND RESULTS 486 "InCHIANTI" Study participants (200 men and 286 women, 72% aged 65 years and over) free from carotid artery plaques at baseline, also underwent carotid artery scan three years later. We tested the association of baseline characteristics, cardiovascular risk factors and inflammatory markers with the development of new carotid artery plaques. Older participants were significantly more likely to develop new plaques. Independent of age, the relative risks of developing new plaques associated with heavy smoking and family history of atherosclerosis were 1.7 (95%CI 1.5-1.9) and 1.9 (95%CI 1.2-3.1), respectively. Participants with high (>3 μg/mL) and moderate (≥1 and ≤3 μg/mL) CRP levels had a relative risk of 2.2 (95%CI 1.9-2.6) and 1.9 (95%CI 1.6-2.3) respectively, when compared with subjects with low (<1 μg/mL) CRP levels. Surprisingly, risk factors such as hypertension, diabetes, dyslipidemia and overweight/obesity were not significant predictors of the development of new carotid artery plaques. CONCLUSIONS High CRP levels independently predict the development of new plaques in older persons with carotid arteries free from atherosclerotic lesions.
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Affiliation(s)
- R Molino-Lova
- Department of Cardiovascular Rehabilitation, Don Gnocchi Foundation, Florence, Italy.
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Marcucci R, Zanazzi M, Bertoni E, Brunelli T, Fedi S, Evangelisti L, Pepe G, Rogolino A, Prisco D, Abbate R, Gensini G, Salvadori M. Risk factors for cardiovascular disease in renal transplant recipients: new insights. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02074.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fatini C, Sticchi E, Bolli P, Marcucci R, Giusti B, Paniccia R, Gori AM, Gensini GF, Abbate R. Platelet aggregability is modulated by eNOS locus in non-type 2 diabetic patients with acute coronary syndrome. Nutr Metab Cardiovasc Dis 2011; 21:11-17. [PMID: 19819117 DOI: 10.1016/j.numecd.2009.07.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 06/16/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIM Platelet nitric oxide (NO) synthesis is compromised in patients with acute coronary syndrome (ACS), and platelet NO availability may be critically relevant in determining the extent of thrombosis in ACS patients. It has been demonstrated that an impaired responsiveness to the antiaggregatory effects of NO may affect platelet dysfunction in diabetic patients with ACS. Since NO availability may be genetically determined, we have investigated the role of endothelial nitric oxide synthase (eNOS) gene in influencing platelet aggregability in relation to the presence (n=247) or absence (n=883) of type 2 diabetes in ACS patients. METHODS AND RESULTS We have genotyped 1130 consecutive high risk ACS patients on dual antiplatelet therapy, previously investigated in relation to platelet function. eNOS 4a allele frequency was significantly higher in diabetic vs. non-diabetic patients (p=0.02). In non-diabetic patients the eNOS 4a allele significantly modulated platelet aggregability in response to arachidonic acid (AA), but not to collagen and adenosine diphosphate (ADP) stimulus, after Bonferroni correction for multiple testing. After adjustment for age, gender, smoking habit, hypertension and ejection fraction ≤40%, the eNOS 4a allele remained significantly and independently associated with platelet aggregability in response to AA stimulus [β (SE)=0.17 (0.07), p=0.01]. When platelet aggregation values were considered according to the presence or absence of high residual platelet reactivity (RPR) eNOS 4a, but not -786C and 894T, allele was significantly associated with RPR by AA stimulus. The haplotype reconstruction analysis for eNOS gene showed that the -786C/894G/4a and -786C/894G/4b haplotypes significantly influenced platelet aggregation after AA stimulus. CONCLUSIONS Our study indicates that eNOS 4a allele, may be a determinant of higher platelet aggregability and residual platelet reactivity in non-diabetic ACS patients.
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Affiliation(s)
- C Fatini
- Department of Medical and Surgical Critical Care, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.
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Sofi F, Giusti B, Marcucci R, Gori AM, Abbate R, Gensini GF. Cytochrome P450 2C19*2 polymorphism and cardiovascular recurrences in patients taking clopidogrel: a meta-analysis. Pharmacogenomics J 2010; 11:199-206. [DOI: 10.1038/tpj.2010.21] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Barbani F, Marcucci R, Degl'Innocenti S, Rogolino A, Fedi S, Gori A, Bonizzoli M, Zagli G, Peris A, Abbate R. Heparin-induced thrombocytopenia incidence in the ICU: preliminary results. Crit Care 2010. [PMCID: PMC2934403 DOI: 10.1186/cc8599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sodi A, Giambene B, Marcucci R, Sofi F, Bolli P, Abbate R, Prisco D, Menchini U. Atherosclerotic and thrombophilic risk factors in patients with recurrent central retinal vein occlusion. Eur J Ophthalmol 2008; 18:233-8. [PMID: 18320516 DOI: 10.1177/112067210801800211] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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]
Abstract
PURPOSE Atherosclerotic and thrombophilic risk factors may be causes of central retinal vein occlusion (CRVO). The aim of this study was to evaluate the prevalence of the aforesaid risk factors in patients with recurrent CRVOs and patients with a single episode of CRVO. METHODS Seventeen patients with recurrent CRVO and 30 with a single episode of CRVO were enrolled. The atherosclerotic risk factors investigated were hypertension, diabetes, smoking, and dyslipidemia. Specific laboratory tests for the following thrombophilic markers were performed: homocystinemia (Hcy), lipoprotein (a), factor VIII, factor II G20210A and factor V G1691A polymorphisms, lupus anticoagulant, anticardiolipin antibodies, plasminogen activator inhibitor-1, and deficit of vitamins B6, B12, and folic acid. A multivariate analysis, adjusted for age, gender, traditional and thrombophilic risk factors, was performed. Statistical significance was set at p<or=0.05. RESULTS Hypercholesterolemia, hypertriglyceridemia, fasting, and postmethionine hyperhomocysteinemia (HHcy) were more prevalent in recurrent CRVO patients (p<0.001, p<0.001, p=0.006, and p=0.005, respectively). At multivariate analysis, hypercholesterolemia (OR: 5.04, 95% CI 1.39-18.17; p=0.025), hypertriglyceridemia (OR: 5.60, 95% CI 1.52-20.61; p=0.017), fasting HHcy (OR: 5.77, 95% CI 1.39-23.89; p=0.028), and postmethionine HHcy (OR: 10.88, 95% CI 2.50-47.42; p=0.002) were found to be significantly associated with recurrent CRVO. CONCLUSIONS Dyslipidemia and hyperhomocysteinemia are independent risk factors for the occurrence of recurrent CRVO. A complete assessment of atherosclerotic and thrombophilic risk factors in CRVO patients. In addition, the need for a specific treatment is suggested.
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Affiliation(s)
- A Sodi
- Department of Oto-Neuro-Ophthalmological Surgical Sciences, Eye Clinic, Firenze, Italy
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Sofi F, Capalbo A, Marcucci R, Gori AM, Fedi S, Macchi C, Casini A, Surrenti C, Abbate R, Gensini GF. Leisure time but not occupational physical activity significantly affects cardiovascular risk factors in an adult population. Eur J Clin Invest 2007; 37:947-53. [PMID: 17976196 DOI: 10.1111/j.1365-2362.2007.01884.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [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: 11/30/2022]
Abstract
BACKGROUND A large number of studies have demonstrated that regular physical activity during leisure time (LTPA) accounts for a significant protection against cardiovascular diseases (CVD). On the other hand, conflicting findings on the beneficial effects of occupational physical activity (OPA) have been reported. The aim of this study is to evaluate the possible influence of different amounts of LTPA and OPA on circulating levels of several parameters associated with an increased risk of CVD. MATERIALS AND METHODS We studied 932 individuals (365 M; 567 F, with a mean age of 54 years) living in Florence, Italy, who were enrolled in a population study conducted between 2002 and 2004. Subjects were divided into three classes of LTPA and OPA according to a score derived from a questionnaire that assessed the amount of physical activity performed. RESULTS LTPA was inversely related to body mass index (BMI), hip circumference, diastolic blood pressure and triglycerides, as well as directly correlated with high-density lipoprotein (HDL) cholesterol. Likewise, a higher OPA was found to be associated with higher HDL cholesterol levels. Moreover, a multivariate logistical regression analysis, adjusted for possible confounders, showed that a moderate-to-high intensity of LTPA was able to confer a significant protection against having abnormal levels of BMI, waist circumference and triglycerides, main features of the metabolic syndrome, whereas no associations between these parameters and OPA were observed. CONCLUSIONS A moderate-to-high LTPA was found to be significantly associated with a more favourable cardiovascular risk profile in terms of anthropometric, metabolic and lipid parameters among an Italian population. In addition, a relationship between OPA and HDL-cholesterol was reported.
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Affiliation(s)
- F Sofi
- Thrombosis Centre, University of Florence, and Azienda Ospedaliero-Universitaria Careggi, Italy
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Paniccia R, Antonucci E, Gori AM, Marcucci R, Giglioli C, Antoniucci D, Gensini GF, Abbate R, Prisco D. Different methodologies for evaluating the effect of clopidogrel on platelet function in high-risk coronary artery disease patients. J Thromb Haemost 2007; 5:1839-47. [PMID: 17723123 DOI: 10.1111/j.1538-7836.2007.02656.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [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: 12/20/2022]
Abstract
BACKGROUND Two point-of-care (POC) systems have been recently proposed as rapid tools with which to evaluate residual platelet reactivity (RPR) in coronary artery disease (CAD) patients. OBJECTIVES AND METHODS We compared Platelet Function Analyzer-100 (PFA-100) closure times (CTs) by collagen/adenosine 5'-diphosphate (ADP) (C/ADP CT) cartridge and the VerifyNow P2Y12 Assay (VerifyNow) with light transmission aggregation (LTA) induced by 2 and 10 micromol L(-1) ADP in 1267 CAD patients on dual antiplatelet therapy who underwent percutaneous coronary intervention. We also performed the vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay by cytofluorimetric analysis in a subgroup of 115 patients. RESULTS Cut-off values for identifying RPR were: > or = 54% and > or = 66% for LTA induced by 2 and 10 micromol L(-1) ADP respectively, and > or = 264 P2Y12 Reaction Units (PRU) for VerifyNow. The cut-off for PFA-100 C/ADP CT was > or = 68 s. RPR was detected in 25.1% of patients by 2 mumol L(-1) ADP-induced LTA (ADP-LTA), in 23.2% by 10 micromol L(-1) ADP-LTA, in 24.4% by PFA-100, and in 24.7% by VerifyNow. PFA-100 results did not parallel those obtained with LTA. VerifyNow showed a significant correlation (rho = 0.62, P < 0.001) and significant agreement (k = 0.34, P < 0.001) with LTA induced by 2 micromol L(-1) ADP. The correlation was similar but the agreement was better between VerifyNow and 10 micromol L(-1) ADP-LTA (rho = 0.64, P < 0.0001; k = 0.43, P < 0.001). Significant relationships were found between VASP platelet reactivity index and both ADP-LTA and VerifyNow. PFA-100 C/ADP CT did not significantly correlate with any of the other assays. CONCLUSIONS Our results show a significant correlation between LTA and VerifyNow but not the PFA-100 C/ADP assay. Clinical validation studies for POC systems are necessary.
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Affiliation(s)
- R Paniccia
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Itlay.
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Evangelisti L, Attanasio M, Sofi F, Pepe G, Marcucci R, Fatini C, Valente S, Giglioli C, Abbate R, Gensini G. GENETIC ANALYSIS OF PEROXISOME PROLIFERATOR-ACTIVATED RECEPTORS-GAMMA (PPARG) PROMOTERS: ACUTE CORONARY SYNDROME PATIENTS VERSUS CONTROLS. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb00550.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: 11/30/2022]
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Abstract
STUDY DESIGN Case-control study. AIM OF THE STUDY Investigate the presence of additional endogenous risk factors of deep-vein thrombosis (DVT). SETTING Regional Spinal Unit of Florence, Italy. METHODS A total of 43 patients with spinal lesion and a history of DVT during the acute stage of their neurological impairment (Group A) were comprehensively evaluated and the blood concentrations of the following risk factors, that are presumably associated with DVT, were determined: antithrombin III (ATIII), protein C (PC), protein S (PS), factor V Leiden, gene 200210A polymorphism, homocysteine (Hcy), inhibitor of plasminogen activator-1 (PAI-1) and lipoprotein A (LpA). The control group (Group B) consisted of 46 patients matched to Group A for sex, age, neurological status and prophylactic treatment during the acute stage, with no history of DVT. Statistical analysis was performed using the Mann-Whitney and Fisher's exact tests. RESULTS Of the individuals in Group A, 14% had no risk factor and 86% had at least one; however, in Group B 54% had no endogenous risk factors and 46% had at least one. None of the individuals in either group had a deficit in their coagulation inhibitors (ATIII, PC and PS), and the LpA level was equivalent in the two groups. The levels of Hcy and PAI-1 were significantly higher in Group A. CONCLUSIONS Increases in the levels of plasma Hcy and PAI-1 are demonstrated to be independent risk factors for developing a DVT.
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Affiliation(s)
- S Aito
- Spinal Unit, Careggi University Hospital, Florence, Italy
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Bertoni E, Rosati A, Larti A, Merciai C, Zanazzi M, Rosso G, Gallo M, Marcucci R, Salvadori M. Chronic kidney disease is still present after renal transplantation with excellent function. Transplant Proc 2006; 38:1024-5. [PMID: 16757252 DOI: 10.1016/j.transproceed.2006.03.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 10/24/2022]
Abstract
According to a k/DOQI work group, chronic kidney disease (CKD) can be present also in subjects with glomerular filtration rate (GFR) >90 mL/min or a serum creatinine (sCr) below 1.3 mg/dL. The aim of this study was to document the prevalence of clinical or biologic abnormalities among 190 cadaveric renal transplant patients with excellent and stable renal function at 6 months after transplantation as well as 5 years later. The recipients were 82 women and 108 men of mean age at transplantation of 44.56 +/- 11.73 years. All patients were on Neoral-based immunosuppression with at least 5-year follow-up. Mean sCr was 1.18 +/- 0.2 mg/dL. Mean GFR was 78.57 +/- 27.06 mL/min. Systolic blood pressure was >130 mm Hg in 56.6%, although 78.3% of patients were on antihypertensive therapy; 34.3% were anemic; 75.4% had serum cholesterol >200 mg/dL; 62.2% had serum triglyceride levels >170 mg/dL. Serum intact parathyroid hormone >100 pg/mL was observed in 38% of patients and 43% were on vitamin D supplementation, and 11.4% had developed posttransplant diabetes mellitus. With respect to controls, von Willebrand factor was higher in 81.2% (P < .0001; RR = 11); serum homocysteine levels in 75% (P < 0.001; RR = 7.61); PAI-1 in 37.5% (P = .0009; RR = 4). At 5 years posttransplantation we observed an overall improvement in these abnormalities. The vast majority of renal transplant patients with excellent graft function belong to stage 1 of CKD being affected by hypertension, dyslipidemia, anemia, and residual hyperparathyroidism. Markers of endothelial dysfunction were largely abnormal, a condition that could predispose to cardiovascular events.
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Affiliation(s)
- E Bertoni
- Renal Unit, Careggi University Hospital, Florence, Italy
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Marcucci R, Gori AM, Giannotti F, Baldi M, Verdiani V, Del Pace S, Nozzoli C, Abbate R. Markers of hypercoagulability and inflammation predict mortality in patients with heart failure. J Thromb Haemost 2006; 4:1017-22. [PMID: 16689753 DOI: 10.1111/j.1538-7836.2006.01916.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [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: 11/30/2022]
Abstract
BACKGROUND AND AIMS Plasma levels of inflammatory markers are increased in chronic heart failure (HF) and are also subclinical indicators of future HF. Inflammation is strictly correlated with clotting activation, but the association between inflammation, hypercoagulability and prognosis in HF has not been previously reported. METHODS AND RESULTS Markers of inflammation (interleukin-6; IL-6, and C-reactive protein; CRP) and hypercoagulability (D-dimer; DD, and thrombin-antithrombin III complex; TAT) were prospectively assessed in 214 subjects with New York Heart Association (NYHA) functional class II-IV HF. During a median follow-up of 8.5 months, 32 patients had an event: 13 died and 19 were hospitalized because of worsening of HF. IL-6, DD and TAT levels were all significantly associated with increased risk of death after adjustment for other known HF prognostic factors (age, gender, traditional cardiovascular risk factors, NYHA class, systolic left ventricular function, renal failure, hemoglobin, serum sodium) in a Cox multivariate proportional hazard model (P = 0.003, P = 0.01 and P = 0.02, respectively). When these markers were added simultaneously to the known prognostic factors in a new Cox multivariate model, only DD levels were significant predictors of mortality (hazard ratio [95% confidence interval; CI]: 11 [2.7-45.1], P = 0.001). The Kaplan-Meier curve revealed a significantly better outcome in patients with DD below 450 ng mL(-1). NT-pro-BNP was the only significant predictor of rehospitalization (HR [95% CI]: 5.3 [2.0-13.8], P < 0.001). CONCLUSION Hypercoagulability and inflammation, as assessed by DD, TAT and IL-6 levels, are associated with an increased mortality risk in HF.
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Affiliation(s)
- R Marcucci
- Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
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Sofi F, Cesari F, Marcucci R, Fatini C, Gori A, Rogolino A, Sticchi E, Fedi S, Abbate R, Gensini G. Mo-P2:177 Protein Z levels and prognosis in patients with acute coronary syndromes. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80312-0] [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: 10/23/2022]
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Cecchi E, Marcucci R, Poli S, Ciuti G, Poli D, Ferrini S, Antonucci E, Abbate R, Gensini G, Mannini L. We-P11:227 Hyperviscosity as a possible risk factor for cerebral ischemic complications in nonvalvular atrial fibrillation patients. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81580-1] [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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Sofi F, Cesari F, Vigiani S, Fatini C, Marcucci R, Giglioli C, Valente S, Abbate R, Gensini GF, Fedi S. Protein Z plasma levels in different phases of activity of coronary atherosclerosis. J Thromb Haemost 2005; 3:2254-8. [PMID: 16129020 DOI: 10.1111/j.1538-7836.2005.01536.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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: 11/29/2022]
Abstract
We previously reported that low protein Z plasma levels are associated with acute coronary syndromes (ACS). Aim of the present study was to evaluate protein Z levels in different phases of activity of coronary atherosclerosis. Protein Z plasma levels were measured in 166 (131 male and 35 female) patients consecutively admitted to the University of Florence with a diagnosis of ACS (group A), 166 (131 male and 35 female) patients selected by age and gender in relation to group A from those with a clinical history of ACS who remained symptom- and/or event-free over the last year before the investigation (group B); and 332 (262 male and 70 female) controls comparable for age and gender with the other two groups. None had liver or renal dysfunction nor showed a positivity for antiphospholipid antibodies or for factor V Leiden mutation. Patients under warfarin therapy were excluded. Mean protein Z plasma levels were found to be significantly (P < 0.0001) lower in group A (1475 +/- 684.1 ng mL(-1)) and group B (1327.6 +/- 690.7 ng mL(-1)) as compared with control group (1650.1 +/- 634.5 ng mL(-1)), while no significant differences existed between the two groups of patients (P = 0.06). A logistic regression analysis, performed after the division of the study population into quartiles of protein Z levels and adjusted for all possible confounders, showed a significant increased risk of ACS for the lowest (<1213 ng mL(-1)) as compared with the highest quartile of protein Z in both groups of patients [group A odds ratio (OR): 2.7, 95% CI 1.3-5.5, P = 0.007; group B OR: 3.2, 95% CI 1.1-8.9, P = 0.02). In conclusion, these results strengthen our previous data on low protein Z plasma levels in ACS and indicate a possible dose-response effect of decreasing protein Z plasma levels on the coronary atherosclerotic disease.
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Affiliation(s)
- F Sofi
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Italy.
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Sofi F, Vecchio S, Giuliani G, Martinelli F, Marcucci R, Gori AM, Fedi S, Casini A, Surrenti C, Abbate R, Gensini GF. Dietary habits, lifestyle and cardiovascular risk factors in a clinically healthy Italian population: the 'Florence' diet is not Mediterranean. Eur J Clin Nutr 2005; 59:584-91. [PMID: 15741987 DOI: 10.1038/sj.ejcn.1602112] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [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: 11/08/2022]
Abstract
OBJECTIVE To evaluate dietary habits and lifestyle of Italian subjects, to provide current data on adequacy of the nutritional guidelines and recommendations especially in relation to primary prevention of cardiovascular diseases and to assess the influence of dietary habits on lipid profile and homocysteine levels. DESIGN Cross-sectional. SETTING Population-based study. SUBJECTS A sample of 520 clinically healthy subjects (211 males, 309 females) with a mean age of 46 y, living in Florence area, Italy. INTERVENTIONS Dietary pattern was assessed by trained dietitians through a semiquantitative food questionnaire. Fasting blood samples were drawn for assessment of lipid profile, homocysteine and circulating vitamins. RESULTS Contribution from total fats was over 30% in about 70% of subjects and intake of saturated fatty acids (SFA) was above the recommended values in at least 40% of the study population. Furthermore, almost the whole (99.6%) population reported low intake of polyunsaturated fatty acids (PUFA). High levels of total cholesterol were present in over 40% of the study population, whereas abnormal values of LDL-cholesterol were observed in about 30%. High levels of homocysteine were found in 11.7% of the study population. An extremely high percentage of subjects reported low intake of vitamins, especially with regard to folic acid (89%), vitamin B(6) (70.1%) and vitamin E (99.6%). In a multiple linear regression model, circulating levels of vitamin B(12) and folic acid, and intake of alcohol and vitamin C resulted in being independently associated with homocysteine plasma levels. CONCLUSIONS In a typical Mediterranean country, general outlines of Mediterranean diet are not completely followed, especially concerning total fats, SFA, PUFA and vitamins' intake. SPONSORSHIP Ministero della Salute (Italy) - 'Progetto per la Salute e la Prevenzione di Malattia' 2001-2003.
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Affiliation(s)
- F Sofi
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Viale Morgagni 85, Florence, Italy.
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Bergesio F, Monzani G, Guasparini A, Ciuti R, Gallucci M, Cristofano C, Castrignano E, Cupisti A, Barsotti G, Marcucci R, Abbate R, Bandini S, Gallo M, Tosi PL, Salvadori M. Cardiovascular risk factors in severe chronic renal failure: the role of dietary treatment. Clin Nephrol 2005; 64:103-12. [PMID: 16114786 DOI: 10.5414/cnp64103] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lipoprotein abnormalities and increased oxidized LDL (OxLDL) are often observed in uremia and are reported to play a central role in the development of cardiovascular disease (CVD). Vegan diet, known for its better lipoprotein profile and antioxidant vitamins content, could protect against CVD. Aim of this study was to investigate the influence of vegan diet supplemented with essential amino acids (EAA) and ketoanalogues (VSD) on both traditional and non-traditional cardiovascular risk factors (CVRF). METHODS Twenty-nine patients (18 M, 11 F) aged 55 years (range 29-79 years) with advanced chronic renal failure (median sCr: 5.6 mg/dl) on very low protein vegetarian diet (0.3 g/kg/day) supplemented with a mixture of EAA and ketoacids (VSD) and 31 patients (20 M, 11 F) aged 65 years (range 29 - 82 years) on conventional low-protein diet (CD: 0.6 g/kg/day) with a similar renal function (median sCr: 5.2 mg/dl), were investigated for lipids and apolipoprotein parameters (traditional CVRF) as well as for oxidative stress (oxidized LDL, antibodies against OxLDL and thiobarbituric acid-reactive substances (TBARS)), total homocysteine (tHcy), lipoprotein(a) (Lp(a)), albumin and c-reactive protein (CRP) (non-traditional CVRF) including vitamins A, E, B12 and folic acid. RESULTS Compared to patients on CD, those on VSD showed increased HDL cholesterol levels (p < 0.005) with a reduction of LDL cholesterol (p < 0.01) and an increase of apoA1/apoB ratio (p < 0.02). Among non-traditional CVRF, a mild but significant reduction of OxLDL (p < 0.05) with lower TBARS concentrations (p < 0.01) and a significant reduction of total homocysteine (p < 0.002), Lp(a) (p < 0.002) and CRP levels (p < 0.05) were also observed in these patients. Concentrations of vitamin E and A were not different between the two groups while vitamin B12 and folic acid resulted markedly increased in patients on VSD. OxLDL significantly correlated with total and LDL cholesterol, triglycerides and Apo B in CD but not in VSD patients. Patients on CD also showed a significant correlation between urea and CRP. After a multivariate analysis, only urea (p < 0.001) and OxLDL (p < 0.006) were associated to a risk of CRP > 0.3 mg/dl. CONCLUSIONS These results indicate a better lipoprotein profile in patients on vegan diet including non-traditional CVRF. In particular, these patients show a reduced oxidative stress with a reduced acute-phase response (CRP) as compared to patients on conventional diet. We hypothesize that urea, significantly lower in patients on VSD, may account, possibly together with the reduction of other protein breakdown products, for the decreased acute-phase response observed in these patients. Our findings suggest that low-protein diets, and vegan in particular, may exert a beneficial effect on the development of cardiovascular disease in patients with end-stage renal disease (ESRD).
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Affiliation(s)
- F Bergesio
- Department of Nephrology, Dialysis and Transplantation, Azienda Ospedale Careggi, Florence, Italy.
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Marcucci R, Zanazzi M, Bertoni E, Rosati A, Fedi S, Lenti M, Prisco D, Castellani S, Abbate R, Salvadori M. Homocysteine-Lowering Therapy and Carotid Intima-Media Thickness in Renal Transplant Recipients. Transplant Proc 2005; 37:2491-2. [PMID: 16182720 DOI: 10.1016/j.transproceed.2005.06.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 10/25/2022]
Abstract
The aim of this study was to document, in hyperhomocysteinemic renal transplant recipients, the effect of vitamin supplementation on carotid intima-media thickness (cIMT). Fifty-six hyperhomocysteinemic stable renal transplant recipients were randomly assigned to either vitamin supplementation (group A) or placebo treatment (group B). All patients underwent high-resolution B mode ultrasound to measure IMT of common carotid arteries before and after 6 months of vitamin supplementation. In group A, cIMT significantly decreased after treatment, whereas no significant changes were observed in group B. In conclusion, our results demonstrate a beneficial effect of the treatment of hyperhomocysteinemia by vitamin supplementation on an early sign of atherosclerosis in a group of renal transplant recipients.
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Affiliation(s)
- R Marcucci
- Surgical and Medical Critical Care, Clinica Medica Generale e Cliniche Specialistiche, University of Florence, Italy
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46
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Marcucci R, Brogi D, Sofi F, Giglioli C, Valente S, Liotta AA, Lenti M, Gori AM, Prisco D, Abbate R, Gensini GF. PAI-1 and homocysteine, but not lipoprotein (a) and thrombophilic polymorphisms, are independently associated with the occurrence of major adverse cardiac events after successful coronary stenting. Heart 2005; 92:377-81. [PMID: 15994914 PMCID: PMC1860841 DOI: 10.1136/hrt.2005.061895] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [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: 01/13/2023] Open
Abstract
OBJECTIVE To evaluate the role of factor V Leiden, prothrombin G20210A polymorphism, plasminogen activator inhibitor type 1 (PAI-1) 4G/5G polymorphism, PAI-1, homocysteine, and lipoprotein (a) (Lp(a)) in the occurrence of major adverse cardiac events (MACE) in patients with acute coronary syndromes who underwent coronary stenting. DESIGN 520 patients (375 men and 145 women) with acute coronary syndromes and 520 age and sex matched controls were enrolled. MACE were recorded for 109 patients. Heterozygosity for factor V Leiden, prothrombin G20210A polymorphism, and 4G/5G polymorphism did not significantly differ between patients with and without MACE. A significantly higher percentage of patients with increased homocysteine (28% v 19%, p < 0.001) and PAI-1 concentrations (25% v 16%, p < 0.001) had MACE with respect to those who did not. In Kaplan-Meier survival analysis, the overall risk of MACE was significantly higher among patients with increased PAI-1 (p = 0.006) and homocysteine concentrations (p = 0.04). Cox regression analysis adjusted for age, sex, traditional cardiovascular risk factors, renal function, systolic left ventricular function, the number of stenosed vessels, and history of percutaneous coronary intervention or coronary artery bypass grafting showed that homocysteine (odds ratio 7.5, 95% confidence interval (CI) 1.1 to 57.7, p < 0.05) and PAI-1 concentrations (odds ratio 5.3, 95% CI 1.2 to 23.8, p < 0.05) within the fifth quintile (with respect to the first) were significant and independent risk factors for the future occurrence of MACE. CONCLUSIONS Increased PAI-1 and homocysteine concentrations are independent risk factors for MACE after successful coronary stenting, whereas Lp(a) and thrombophilic polymorphisms are not predictive.
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Affiliation(s)
- R Marcucci
- Dipartimento del Cuore e dei Vasi, Thrombosis Centre, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
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47
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Zanazzi M, Poli D, Antonucci E, Marcucci R, Rosati A, Bertoni E, Salvadori M, Abbate R, Prisco D, Gensini GF. Venous Thromboembolism in Renal Transplant Recipients: High Rate of Recurrence. Transplant Proc 2005; 37:2493-4. [PMID: 16182721 DOI: 10.1016/j.transproceed.2005.06.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/30/2022]
Abstract
Few data are available on the incidence of venous thromboembolism occurring in renal transplant recipients and optimal duration of oral anticoagulant therapy after thrombotic episode. Our study was performed to evaluate the risk of thrombosis recurrence in patients developing a first episode. Among 484 renal transplant patients 34 (7%) developed a first thromboembolism and were referred to the Thrombosis Centre: 28 patients (group 1) were prospectively studied, after stopping anticoagulants. Group 1 was compared with a group of 84 patients without an history of renal disease who had suffered from a first thrombotic episode and were matched for age, sex, and type of thrombotic event (group 2). During follow-up, 14/28 group 1 patients and 8/84 group 2 patients experienced thrombotic recurrence (P = .0001). Our data outline the high risk of recurrence in renal transplant recipients. Strategies for recurrence prevention are needed taking into account the high bleeding risk of anticoagulants in renal transplant patients.
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Affiliation(s)
- M Zanazzi
- Renal Unit, Thrombosis Centre, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
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48
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Marcucci R, Alessandrello Liotta A, Cellai AP, Rogolino A, Berloco P, Leprini E, Pagnini P, Abbate R, Prisco D. Cardiovascular and thrombophilic risk factors for idiopathic sudden sensorineural hearing loss. J Thromb Haemost 2005; 3:929-34. [PMID: 15869586 DOI: 10.1111/j.1538-7836.2005.01310.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [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: 12/13/2022]
Abstract
BACKGROUND In recent years there has been a significant increase in the diagnosis of sudden sensorineural hearing loss (SSHL) in western, countries with an incidence of 20 of 100,000 people affected every year. No clear causes for this disease have been found thus far, but cochlear ischemia has been hypothesized in patients in whom an infectious episode or acoustic neurinoma have been excluded. OBJECTIVES The aim of this case-control study was to investigate a number of acquired and inherited thrombophilic risk factors [antithrombin, protein C and S; factor V (FV) Leiden, FII polymorphism; lupus anticoagulant (LA); anticardiolipin (aCL) antibodies; fasting homocysteine (Hcy); lipoprotein(a) (Lp(a)); plasminogen activator inhibitor-1 (PAI-1)] in addition to cardiovascular risk factors in patients with idiopathic SSHL (ISSHL). PATIENTS AND METHODS We investigated 155 patients (67 male/88 female; age: 55 (range 19-79 years) with a diagnosis of ISSHL within 30 days from the onset of symptoms, and 155 controls (67 male/88 female; age 54 (range 19-78 years). Fasting Hcy levels were significantly higher in patients than in controls [11.6 (6.7-60) micromol/L vs. 8.7 (5.0-24) micromol/L] as well as PAI-1 levels [19 (2-95) mg/dL vs. 14.5 (4.0-87) mg/dL]. Lupus anticoagulant was present in 13 of 155 (8.4%) patients; 20 patients (12.9%) had positivity of aCL (four IgM and 16 IgG). In no patient was a deficiency of physiological clotting inhibitors antithrombin, protein C and protein S found. No significant differences between patients and controls were observed for Lp(a) plasma levels [111 (1-1146) mg/L vs. 103 (11-695) mg/L] and for the presence of FV Leiden (4.5% vs. 4.5%) and FII variant G20210A (3.8% vs. 3.2%). RESULTS AND CONCLUSIONS Independent risk factors for ISSHL at the multivariate analysis (adjusted for age, sex and the traditional cardiovascular risk factors) were the positivity of aCL: OR 5.6 (95% CI 2.0-15.3); cholesterol levels within the second and third tertiles (with respect to the first tertile): T2 = OR 4.8 (95% CI 1.9-12.6)/T3 = OR 19 (95% CI 7-50.1); PAI-1 and Hcy levels within the third tertile (with respect to the first tertile): OR 20 (95% CI 7.8-78) and OR 4.0 (95% CI 2.0-8.1), respectively. These preliminary data suggest that hypercholesterolemia, hyperhomocysteinemia, elevated PAI-1 levels and anticardiolipin antibodies are associated with ISSHL, so indirectly supporting the hypothesis of a vascular occlusion in the pathogenesis of the disease.
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Affiliation(s)
- R Marcucci
- Dipartimento del Cuore e dei Vasi, University of Florence, Italy.
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Marcucci R, Sofi F, Fedi S, Lari B, Sestini I, Cellai AP, Pulli R, Pratesi G, Pratesi C, Gensini GF, Abbate R. Thrombophilic risk factors in patients with severe carotid atherosclerosis. J Thromb Haemost 2005; 3:502-7. [PMID: 15748240 DOI: 10.1111/j.1538-7836.2005.01173.x] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Carotid stenosis and atrial fibrillation are the strongest risk factors for ischemic stroke. Ongoing prevention efforts include the identification of novel factors that increase the risk for carotid atherosclerosis. The aim of this study was to determine the thrombophilic risk profile of patients with severe carotid stenosis by evaluating a number of genetic and metabolic risk factors [factor (F)II G20210A, factor V Leiden, MTHFR C677T polymorphisms, anticardiolipin antibodies (aCL), lipoprotein(a) (Lp(a)), and homocysteine (Hcy)]. The study population consisted of 615 patients [(410 M/205 F; median age 73 (26-94) years] with severe (> 70%) carotid stenosis, and 615 apparently healthy subjects [(410 M/205 F; age 73 (31-92) years]. On multivariate analysis, independent risk factors were elevated Hcy [odds ratio (OR) 7.6, 95% confidence interval (CI) 4.8, 11.8] and Lp(a) levels (OR 2.9, 95% CI 2.1, 3.9), the presence of aCL (OR 5.7, 95% CI 3.1, 10.4) and heterozygosity for FII G20210A polymorphism (OR 2.8, 95% CI 1.3, 5.9). In the subgroup of women, independent risk factors for severe carotid atherosclerosis were: high levels of Hcy and Lp(a) and the presence of aCL, whereas hyperhomocysteinemia, elevated Lp(a) levels, aCL, FII G20210A and MTHFR 677TT polymorphisms remained independent risk factors in the subgroup of men. The results of the present study demonstrate that the prevalence of the thrombophilic risk factors is increased in patients with severe carotid atherosclerosis.
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Affiliation(s)
- R Marcucci
- Thrombosis Center, University of Florence, Dipartimento del Cuore e dei Vasi, Center for the Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases to Develop Novel Therapies, Firenze, Italy.
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Marcucci R, Brunelli T, Fedi S, Pepe G, Giusti B, Gori AM, Prisco D, Falai M, Margheri M, Abbate R, Gensini GF. Relevance of post-methionine homocysteine and lipoprotein (a) in evaluating the cardiovascular risk in young CAD patients. Eur J Clin Invest 2005; 35:1-7. [PMID: 15638812 DOI: 10.1111/j.1365-2362.2005.01439.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aims of our study were to evaluate the prevalence of high lipoprotein (a) [Lp(a)] and homocysteine levels - both in the fasting state (FHcy) and post-methionine (PMHcy) - in young coronary artery disease (CAD) patients, and to investigate the role of genetic and environmental factors for hyperhomocysteinaemia. MATERIALS AND METHODS We studied 140 patients with angiographically documented CAD (24 women </= 55 years and 116 men </= 50 years) and 140 healthy subjects as controls. RESULTS Both FHcy [13.2 (5.4-45.8) vs. 9.0 (5.1-24) micromol L(-1)); P < 0.0001] and PMHcy [(39.4 (9.0-66.4) vs. 25.2 (16.4-33.9); P < 0.0001] were significantly higher in patients than in controls. Lp(a) levels were significantly higher in patients than in controls (200 (3-1486) mg L(-1) vs. 97 (10-412) mg L(-1); P < 0.0001). At the multivariate analysis, adjusted for the classical cardiovascular risk factors and creatinine levels, the OR (95% CI) for CAD at young age significantly increased in the fourth quartile of the distribution of FHcy, PMHcy and Lp(a) levels [FHcy: 14.9 (4.1-58), P < 0.0001; PMHcy: 19.2 (4.0-86.3); P < 0.0001; Lp(a): 19.6 (4.7-78.6): < 0.0001]. Vitamin deficiencies were detected in 28/140 (20%) patients. The prevalence of the homozygous C677T (+/+) methylenetetrahydrofolatereductase genotype was higher, but not significantly different, in patients (22.8%) than in controls (18.6%). The allele frequency of the 844ins68 insertion variant in the cystathionine beta-synthase gene was 0.08 in the control group and 0.06 in the patient group. CONCLUSIONS Results of the present study indicate the usefulness of including fasting and post-methionine Hcy, and Lp(a) determination in the diagnostic panels of young CAD patients, in order to obtain a better assessment of their cardiovascular risk profile.
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Affiliation(s)
- R Marcucci
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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