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Solfanelli G, Giaccio D, Tropea A, Bucicovschi V, Gallo G, Tocci G, Musumeci B, Marcellini L, Barbato E, Volpe M, Battistoni A. Cardiovascular risk and the COVID-19 pandemic: A retrospective observational study in a population of healthcare professionals. Nutr Metab Cardiovasc Dis 2023; 33:1415-1419. [PMID: 37230874 PMCID: PMC10105375 DOI: 10.1016/j.numecd.2023.04.006] [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: 01/11/2023] [Revised: 03/10/2023] [Accepted: 04/05/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND AIM To contain the spread of COVID-19, many countries imposed several restrictive measures, leading to radical changes in daily life behaviors. Healthcare workers experienced additional stress due to the increased risk of contagion, possibly causing an increase in unhealthy habits. We investigated changes in cardiovascular (CV) risk assessed by the SCORE-2 in a healthy population of healthcare workers during the COVID-19 pandemic; an analysis by subgroups was also conducted (sportspeople vs sedentary subjects). METHODS AND RESULTS We compared medical examination and blood tests in a population of 264 workers aged over 40, performed yearly before (T0) and during the pandemic (T1, T2). We found a significant increase in the average CV risk, according to SCORE-2, during the follow-up in our healthy population, with a shift from a mean low-moderate risk profile at T0 (2.35%) to a mean high-risk profile at T2 (2.80%). Furthermore, in sedentary subjects was observed a greater and early increase in SCORE-2 compared to sportspeople. CONCLUSIONS Since 2019, we observed an increase in CV risk profile in a healthy population of healthcare workers, particularly in sedentary subjects, highlighting the need to reassess SCORE-2 every year to promptly treat high-risk subjects, according to the latest Guidelines.
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Affiliation(s)
- G Solfanelli
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy.
| | - D Giaccio
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - A Tropea
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - V Bucicovschi
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - G Gallo
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - G Tocci
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - B Musumeci
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | | | - E Barbato
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - M Volpe
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy; IRCSS San Raffaele, Rome, Italy
| | - A Battistoni
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
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2
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Scirpa R, Follesa F, Battistoni A, Volpe M. P39 ATRIAL MASS IN HEART TRANSPLANTED PATIENT WITH CLINICAL HISTORY OF LYMPHOMA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Atrial thrombosis is an uncommon complication of cardiac transplant, especially when performed with standard technique. Pathogenetic mechanisms might involve atrial anatomy distortion and abnormalities in its contractile function, which induce flow stasis and thrombus formation, mostly on the surgical suture. A 77–year–old man underwent orthotopic heart transplantation in 2000 for post–ischemic dilated cardiomyopathy. In 2019 he was diagnosed with diffuse large B–cell lymphoma treated with chemotherapy. On March 2021, during follow up period, he had a total body CT scan which showed a submandibular space–occupying lesion, likely as a disease recurrence, and a large atrial mass (30x50 mm). For this reason, he was admitted to the emergency department. Echocardiography documented a massive hyperechogenic formation in an enlarged left atrium. In order to rule out a neoplastic nature, a cardiac CMR was performed, confirming the presence of an oval mass adhering to the posterior left atrial wall with partial involvement of pulmonary veins ostia, with inhomogeneous isointense signal on T1–weighted sequences and hyper–isointense signal on T2–weighted sequences, without significant contrast enhancement, likely representing an endoluminal thrombotic formation. Given the patient’s clinical status and his hemodynamic stability, a surgical excision was deferred. The patient was discharged on oral anticoagulant therapy with Warfarin (INR target 2–3). Three months later, a chest CT showed a meaningful mass reduction (11x18mm), which was no longer visible at echocardiography. About 9 months later, complete disappearance of the atrial mass was found at a CT scan. According to scientific literature, differential diagnosis of a newly discovered atrial mass in a transplanted heart includes thrombosis or neoplasia. Thrombosis occurs usually early after surgery, but due to promoting factors, it can arise after many years. The most likely triggering condition is an acquired prothrombotic status: in our case the likely lymphoma recurrence may have led to thrombogenesis. In order to exclude with confidence cardiac metastasis, histological examination would have been necessary. Nevertheless, the meaningful mass reduction, as early as three months after starting oral anticoagulation, and its disappearance nine months after, strongly suggests for atrial thrombosis.
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Affiliation(s)
- R Scirpa
- CATTEDRA DI CARDIOLOGIA, FACOLTÀ DI MEDICINA E PSICOLOGIA, UNIVERSITÀ LA SAPIENZA, ROMA
| | - F Follesa
- CATTEDRA DI CARDIOLOGIA, FACOLTÀ DI MEDICINA E PSICOLOGIA, UNIVERSITÀ LA SAPIENZA, ROMA
| | - A Battistoni
- CATTEDRA DI CARDIOLOGIA, FACOLTÀ DI MEDICINA E PSICOLOGIA, UNIVERSITÀ LA SAPIENZA, ROMA
| | - M Volpe
- CATTEDRA DI CARDIOLOGIA, FACOLTÀ DI MEDICINA E PSICOLOGIA, UNIVERSITÀ LA SAPIENZA, ROMA
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3
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Marino G, Rigattieri S, Giovannelli F, Tommasino A, Berni A, Volpe M. P86 IN–HOSPITAL OUTCOMES OF PORTICO TRANSCATHETER AORTIC VALVE IMPLANTATION WITH THE FLEXNAV AS COMPARED TO THE FIRST–GENERATION DELIVERY SYSTEM. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
technological advancements in transcatheter heart valve platforms, along with increasing operator experience and careful patient selection, are essential to reach high standards of efficacy and safety in transcatheter aortic valve replacement (TAVR). Aim of this study was to evaluate the performance of the new version of the Portico valve delivery system (FlexNav) as compared to the first–generation device.
Materials and Methods
we report the results of a single–center, observational study on patients with severe aortic valve stenosis undergoing TAVR with the Portico valve at our Institution. Consecutive patients treated with the new FlexNav delivery system (DS), available since May, 2020, were compared with patients treated with the first–generation delivery system (1st Gen–DS). In–hospital outcomes were self–adjudicated according to the Valve Academic Research Consortium–3 definition.
Results
50 patients were included in this study; 22 were treated with the FlexNav–DS and the remaining with the 1st Gen–DS. Clinical characteristics were similar between group, expect for older age (82.6 ± 3.6 vs 80.7 ± 3.8; p = 0.07) and higher prevalence of female gender (68.2% vs 39.3%; p = 0.04) in FlexNav–DS group as compared to 1st Gen–DS group, respectively. We observed similar rates of procedural success but higher rate of moderate–to–severe paravalvular leak in 1st Gen–DS as compared to FlexNav–DS group (28.6% vs 4.6%; p = 0.03); major vascular complications were reduced, although not significantly, in the FlexNav–DS as compared to 1st Gen–DS group (4.5% vs 10.7%; p = 0.64).
Conclusion
Our data suggest that the FlexNav DS, thanks to lower profile and enhanced stability during valve deployment, has the potential to allow for to better procedural and clinical results of TAVR with the Portico valve as compared to the 1st Gen–DS.
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Affiliation(s)
- G Marino
- UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA, UOC CARDIOLOGICA CLINICA E RIABILITATIVA, PO SAN FILIPPO NERI, ASL ROMA 1, ROMA; UOC CARDIOLOGIA, AOU SANT‘ANDREA, ROMA; UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA
| | - S Rigattieri
- UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA, UOC CARDIOLOGICA CLINICA E RIABILITATIVA, PO SAN FILIPPO NERI, ASL ROMA 1, ROMA; UOC CARDIOLOGIA, AOU SANT‘ANDREA, ROMA; UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA
| | - F Giovannelli
- UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA, UOC CARDIOLOGICA CLINICA E RIABILITATIVA, PO SAN FILIPPO NERI, ASL ROMA 1, ROMA; UOC CARDIOLOGIA, AOU SANT‘ANDREA, ROMA; UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA
| | - A Tommasino
- UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA, UOC CARDIOLOGICA CLINICA E RIABILITATIVA, PO SAN FILIPPO NERI, ASL ROMA 1, ROMA; UOC CARDIOLOGIA, AOU SANT‘ANDREA, ROMA; UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA
| | - A Berni
- UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA, UOC CARDIOLOGICA CLINICA E RIABILITATIVA, PO SAN FILIPPO NERI, ASL ROMA 1, ROMA; UOC CARDIOLOGIA, AOU SANT‘ANDREA, ROMA; UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA
| | - M Volpe
- UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA, UOC CARDIOLOGICA CLINICA E RIABILITATIVA, PO SAN FILIPPO NERI, ASL ROMA 1, ROMA; UOC CARDIOLOGIA, AOU SANT‘ANDREA, ROMA; UOC CARDIOLOGIA, DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA UNIVERSITÀ DI ROMA, AOU SANT‘ANDREA, ROMA
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Scaldaferri F, Papa A, Napolitano D, Rizzatti G, Pistone MT, Poscia A, Volpe M, Lopetuso LR, Schiavoni E, Guidi L, Gaetani E, Holleran G, Cammarota G, Rapaccini G, Pugliese D, Ojetti V, Franceschi F, Armuzzi A, Gasbarrini A. Changes in admissions, and hospitalization outcomes of IBD patients in an Italian tertiary referral center over a 13-year period. Eur Rev Med Pharmacol Sci 2021; 25:5826-5835. [PMID: 34604974 DOI: 10.26355/eurrev_202109_26801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The management of Inflammatory Bowel Disease (IBD) has changed significantly in recent years, mainly due to the introduction of biologic medications, however, other factors may also have a role. The aim of this study was to evaluate the evolution of IBD admissions, including trends, modality of admission and rates of surgical intervention, in a tertiary care center. PATIENTS AND METHODS Hospitalization of patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were identified between 2000 and 2013, using ICD-9-CM codes for IBD, from our hospital database. The following parameters were evaluated for each admission: type of admission (ordinary vs. day care service), mode of admission (elective vs. emergency care, for ordinary admissions only), admission code, surgical procedures and complication rates. Comparison between pre- and post-biologic therapy introduction years was also performed. RESULTS Between 2000 and 2013 a total of 8834 IBD-related admissions were recorded. Hospitalizations increased linearly reaching a peak in 2006, with a downward trend in the following years. The downward trend was especially marked for patients younger than 40 years. No significant differences in hospitalization trends between CD and UC were recorded. Disease flare represented the cause of hospitalization in approximately 50% of cases. Overall, 10.8% of patients underwent surgery with no difference between the two conditions. Complications occurred in 28.7% of admissions. CONCLUSIONS Hospitalizations for IBD patients have decreased in recent years, especially in younger patients. However, a significant proportion of patients are still admitted to complete diagnostic workup, indicating the need to better implement outpatient services. A clear reduction in surgery occurrence over time could not be observed in our study.
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Affiliation(s)
- F Scaldaferri
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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5
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Selva J, Lorito S, Volpe M, Romano F, Tonini R, Perfetti P, Bernardi F, Taroni M, Scala A, Babeyko A, Løvholt F, Gibbons SJ, Macías J, Castro MJ, González-Vida JM, Sánchez-Linares C, Bayraktar HB, Basili R, Maesano FE, Tiberti MM, Mele F, Piatanesi A, Amato A. Probabilistic tsunami forecasting for early warning. Nat Commun 2021; 12:5677. [PMID: 34584083 PMCID: PMC8479076 DOI: 10.1038/s41467-021-25815-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/23/2021] [Indexed: 02/08/2023] Open
Abstract
Tsunami warning centres face the challenging task of rapidly forecasting tsunami threat immediately after an earthquake, when there is high uncertainty due to data deficiency. Here we introduce Probabilistic Tsunami Forecasting (PTF) for tsunami early warning. PTF explicitly treats data- and forecast-uncertainties, enabling alert level definitions according to any predefined level of conservatism, which is connected to the average balance of missed-vs-false-alarms. Impact forecasts and resulting recommendations become progressively less uncertain as new data become available. Here we report an implementation for near-source early warning and test it systematically by hindcasting the great 2010 M8.8 Maule (Chile) and the well-studied 2003 M6.8 Zemmouri-Boumerdes (Algeria) tsunamis, as well as all the Mediterranean earthquakes that triggered alert messages at the Italian Tsunami Warning Centre since its inception in 2015, demonstrating forecasting accuracy over a wide range of magnitudes and earthquake types.
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Affiliation(s)
- J Selva
- Istituto Nazionale di Geofisica e Vulcanologia, Bologna, Italy.
| | - S Lorito
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
| | - M Volpe
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
| | - F Romano
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
| | - R Tonini
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
| | - P Perfetti
- Istituto Nazionale di Geofisica e Vulcanologia, Bologna, Italy
| | - F Bernardi
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
| | - M Taroni
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
| | - A Scala
- Department of Physics "Ettore Pancini", University of Naples, Naples, Italy
| | - A Babeyko
- German Research Centre for Geosciences (GFZ), Potsdam, Germany
| | - F Løvholt
- Norwegian Geotechnical Institute (NGI), Oslo, Norway
| | - S J Gibbons
- Norwegian Geotechnical Institute (NGI), Oslo, Norway
| | - J Macías
- Grupo EDANYA, Universidad de Málaga, Málaga, Spain
| | - M J Castro
- Grupo EDANYA, Universidad de Málaga, Málaga, Spain
| | | | | | - H B Bayraktar
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
- Department of Physics "Ettore Pancini", University of Naples, Naples, Italy
| | - R Basili
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
| | - F E Maesano
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
| | - M M Tiberti
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
| | - F Mele
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
| | - A Piatanesi
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
| | - A Amato
- Istituto Nazionale di Geofisica e Vulcanologia, Rome, Italy
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6
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Carotenuto P, Barbato A, Indrieri A, Volpe M, Quadrano P, Brillante S, Riccardo S, Mirante L, Cacchiarelli D, Antonella I, Franco B, Salatiello M, Troncone G, Reggiani Bonetti L, Dominici M, Salati M. 74P Targeting mitochondria as a novel therapeutic strategy in biliary tract cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.052] [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] Open
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7
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Dajko M, Poscia A, Posteraro B, Speziale D, Volpe M, Ricciardi W, de Waure C. Streptococcus pneumoniae in hospitalized patients with pneumonia: epidemiology and implications. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Streptococcus pneumoniae (SP) is a major cause of pneumonia worldwide representing a significant problem from the public health viewpoint. The aim of our study was to assess the frequency of SP in hospitalized patients with pneumonia and investigate its relationship with patients' characteristics.
Methods
A deterministic record linkage of hospital discharge and microbiology laboratory surveillance databases of a teaching hospital in Rome was used to identify all patients over 15 years old (y) with a diagnosis of pneumonia and a microbiological ascertainment between November 2010 and March 2013. Pneumonia ICD-9-CM codes were used to identify the study population. The frequency of SP was assessed with respect to patients' characteristics.
Results
1216 (64% males) of a mean age 65 (SD = 18) y patients with pneumonia were identified. Of them, 707 (58%) had a positive microbiological result. Among the latter, mixed bacterial co-infections were detected in 552 (74%) cases. The most frequently isolated organism was SP in 288 (41%) cases. Nevertheless, SP was the sole isolated agent in only 6 (0.8%) cases. There were no significant differences between men and women with respect to the frequency of SP. Eventually, the frequency of SP among patients with a positive microbiological result was higher in the age group 15-64 y than in 65+ y (45% vs 37%, p = 0.038). When considering only subjects with at least one comorbidity the frequency of SP was higher among the 15-64 y age group (53% vs 44% in 15-64 y and 65+ y respectively, p = 0.040).
Conclusions
Our study revealed that SP was the most frequent isolated pathogen in hospitalized patients with pneumonia. However, the SP coexistence with other pathogens was present in the vast majority of cases. Interestingly, SP was highly frequent among people with comorbidities, in particular in the age group 15-64 y. This emphasizes the importance of vaccination in this group of patients.
Key messages
This study shows that more than 40% of pneumonia with a positive microbiological result are caused by Streptococcus pneumoniae. Preventive strategies to limit Streptococcus pneumoniae infections among adults and individuals affected by comorbidities are needed.
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Affiliation(s)
- M Dajko
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Poscia
- ASUR Marche – AV2, UOC ISP Prevenzione e Sorveglianza Malattie Infettive e Cronico Degenerative, Jesi, Italy
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - B Posteraro
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Speziale
- Institute of Microbiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M Volpe
- Health Management, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - W Ricciardi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C de Waure
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Maloberti A, Giannattasio C, Bombelli M, Desideri G, Cicero AFG, Muiesan ML, Rosei EA, Salvetti M, Ungar A, Rivasi G, Pontremoli R, Viazzi F, Facchetti R, Ferri C, Bernardino B, Galletti F, D'Elia L, Palatini P, Casiglia E, Tikhonoff V, Barbagallo CM, Verdecchia P, Masi S, Mallamaci F, Cirillo M, Rattazzi M, Pauletto P, Cirillo P, Gesualdo L, Mazza A, Volpe M, Tocci G, Iaccarino G, Nazzaro P, Lippa L, Parati G, Dell'Oro R, Quarti-Trevano F, Grassi G, Virdis A, Borghi C. Hyperuricemia and Risk of Cardiovascular Outcomes: The Experience of the URRAH (Uric Acid Right for Heart Health) Project. High Blood Press Cardiovasc Prev 2020; 27:121-128. [PMID: 32157643 DOI: 10.1007/s40292-020-00368-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/04/2020] [Indexed: 12/17/2022] Open
Abstract
The latest European Guidelines of Arterial Hypertension have officially introduced uric acid evaluation among the cardiovascular risk factors that should be evaluated in order to stratify patient's risk. In fact, it has been extensively evaluated and demonstrated to be an independent predictor not only of all-cause and cardiovascular mortality, but also of myocardial infraction, stroke and heart failure. Despite the large number of studies on this topic, an important open question that still need to be answered is the identification of a cardiovascular uric acid cut-off value. The actual hyperuricemia cut-off (> 6 mg/dL in women and 7 mg/dL in men) is principally based on the saturation point of uric acid but previous evidence suggests that the negative impact of cardiovascular system could occur also at lower levels. In this context, the Working Group on uric acid and CV risk of the Italian Society of Hypertension has designed the Uric acid Right for heArt Health project. The primary objective of this project is to define the level of uricemia above which the independent risk of CV disease may increase in a significantly manner. In this review we will summarize the first results obtained and describe the further planned analysis.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy. .,Health Science Department, Milano-Bicocca University, Milan, Italy.
| | - C Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - M Bombelli
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - G Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - A F G Cicero
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - E A Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - M Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - A Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - G Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - R Pontremoli
- Department of Internal Medicine, University of Genoa and Policlinico SanMartino, Genoa, Italy
| | - F Viazzi
- Department of Internal Medicine, University of Genoa and Policlinico SanMartino, Genoa, Italy
| | - R Facchetti
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - C Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - B Bernardino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Galletti
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | - L D'Elia
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | - P Palatini
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - E Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - V Tikhonoff
- Department of Medicine, University of Padua, Padua, Italy
| | - C M Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - P Verdecchia
- Hospital S. Maria della Misericordia, Perugia, Italy
| | - S Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Mallamaci
- Reggio Cal Unit, CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - M Cirillo
- Department of Public Health, "Federico II" University of Naples, Naples, Italy
| | - M Rattazzi
- Department of Medicine, University of Padua, Padua, Italy.,Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - P Pauletto
- Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - P Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - L Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - A Mazza
- Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - M Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - G Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - G Iaccarino
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy
| | - P Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - L Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L'Aquila, Italy
| | - G Parati
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - R Dell'Oro
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - F Quarti-Trevano
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - G Grassi
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - A Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
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9
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Arcari L, Hinojar R, Carr-White G, Zainal H, Zhou H, Vasques M, Rolf A, Hauser I, Vogl TJ, Zehier AM, Volpe M, Nagel E, Puntmann V. 24Excess of myocardial water and fibrosis define myocardial hypertrophy in uremic but not in hypertrophic cardiomyopathy - TrueTypeCKD study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez111.002] [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: 11/13/2022] Open
Affiliation(s)
- L Arcari
- DZHK Centre for Cardiovascular Imaging, Institute of Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
| | - R Hinojar
- University Hospital Ramon y Cajal de Madrid, Department of Cardiology, Madrid, Spain
| | - G Carr-White
- Guys and St Thomas’ NHS Trust, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - H Zainal
- DZHK Centre for Cardiovascular Imaging, Institute of Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
| | - H Zhou
- DZHK Centre for Cardiovascular Imaging, Institute of Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
| | - M Vasques
- DZHK Centre for Cardiovascular Imaging, Institute of Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
| | - A Rolf
- Kerckhoff Clinic, Department of Cardiology, Bad Nauheim, Germany
| | - I Hauser
- JW Goethe University, Department of Nephrology, Frankfurt am Main, Germany
| | - T J Vogl
- JW Goethe University, Department of Radiology, Frankfurt am Main, Germany
| | - A M Zehier
- JW Goethe University, Department of Cardiology, Frankfurt am Main, Germany
| | - M Volpe
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Rome, Italy
| | - E Nagel
- DZHK Centre for Cardiovascular Imaging, Institute of Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
| | - V Puntmann
- DZHK Centre for Cardiovascular Imaging, Institute of Experimental and Translational Cardiovascular Imaging, Frankfurt am Main, Germany
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10
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Arcari L, Limite LR, Russo D, Sclafani M, Volpe M, Autore C, Musumeci MB. P117Cardiac magnetic resonance imaging to solve the diagnostic dilemma in two cases of MINOCA: different sides of the same coin. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez110.015] [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: 11/13/2022] Open
Affiliation(s)
- L Arcari
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Rome, Italy
| | - L R Limite
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Rome, Italy
| | - D Russo
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Rome, Italy
| | - M Sclafani
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Rome, Italy
| | - M Volpe
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Rome, Italy
| | - C Autore
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Rome, Italy
| | - M B Musumeci
- Sapienza University of Rome, Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Rome, Italy
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11
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Burocchi S, Gori M, Cioffi G, Calabrese A, Canova P, De Maria R, Grosu A, Fontana A, Iacovoni A, Ferrari P, Volpe M, Gavazzi A, Senni M. P5661Influence of midwall fractional shortening on incident heart failure and death in asymptomatic subjects at high risk of events. Insights from the DAVID-Berg study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5661] [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)
- S Burocchi
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Gori
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - G Cioffi
- Villa Bianca Hospital, Trento, Italy
| | - A Calabrese
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - P Canova
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - R De Maria
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - A Grosu
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - A Fontana
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - A Iacovoni
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - P Ferrari
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - M Volpe
- Sant' Andrea Hospital, Rome, Italy
| | - A Gavazzi
- FROM Research Foundation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - M Senni
- Ospedale Papa Giovanni XXIII, Bergamo, Italy
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12
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Costantino S, Akhmedov A, Melina G, Mohammed SA, Wijnen W, Othman A, Hornemann T, Volpe M, Sinatra R, Camici GG, Luscher TF, Paneni F. 1431Modulation of JunD by miR-494-3p causes intra-myocardial lipid accumulation and obesity cardiomyopathy: a study in mice and humans. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1431] [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)
- S Costantino
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - A Akhmedov
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - G Melina
- Sapienza University of Rome, Department of Cardiac Surgery, Sant'Andrea Hospital, Rome, Italy
| | - S A Mohammed
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - W Wijnen
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - A Othman
- University Hospital Zurich, Institute for Clinical Chemistry, Zurich, Switzerland
| | - T Hornemann
- University Hospital Zurich, Institute for Clinical Chemistry, Zurich, Switzerland
| | - M Volpe
- Sapienza University of Rome, Department of Clinical and Molecular Medicine, Rome, Italy
| | - R Sinatra
- Sapienza University of Rome, Department of Cardiac Surgery, Sant'Andrea Hospital, Rome, Italy
| | - G G Camici
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - T F Luscher
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - F Paneni
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
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13
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Galati G, Leone O, Cappelletti A, Molfetta R, Volpe M, Ancona F, Magni V, Capogrosso C, Stella S, Castelvecchio S, Rapezzi C, Margonato A. P2585Coronary microvascular pathology as the major determinant of severe fibrosis in end-stage hypertrophic cardiomyopathy (HCM). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2585] [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)
- G Galati
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - O Leone
- S.Orsola-Malpighi University Hospital, Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Cappelletti
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - R Molfetta
- IRCCS, Policlinico San Donato, Cardiac Surgery Division, Cardiovascular Department, San Donato Milanese, Italy
| | - M Volpe
- IRCCS, Policlinico San Donato, Cardiac Surgery Division, Cardiovascular Department, San Donato Milanese, Italy
| | - F Ancona
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - V Magni
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - C Capogrosso
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - S Stella
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - S Castelvecchio
- IRCCS, Policlinico San Donato, Cardiac Surgery Division, Cardiovascular Department, San Donato Milanese, Italy
| | - C Rapezzi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - A Margonato
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
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14
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Galati G, Di Lenarda A, Cappelletti A, Volpe M, Ancona F, Mazzavillani M, Magni V, Capogrosso C, Stella S, Castelvecchio S, Margonato A. P2597Clinicopathological profiles responsible for advanced heart failure, heart transplantation, left ventricular assist device implantation and death for heart failure in Hypertrophic cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2597] [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)
- G Galati
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - A Di Lenarda
- Cardiovascular Center A.S.S. 1 of Trieste, Cardiovascular Department, Trieste, Italy
| | - A Cappelletti
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - M Volpe
- IRCCS, Policlinico San Donato, Cardiac Surgery Division, Cardiovascular Department, San Donato Milanese, Italy
| | - F Ancona
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - M Mazzavillani
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - V Magni
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - C Capogrosso
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - S Stella
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
| | - S Castelvecchio
- IRCCS, Policlinico San Donato, Cardiac Surgery Division, Cardiovascular Department, San Donato Milanese, Italy
| | - A Margonato
- San Raffaele Hospital and Scientific Institute (IRCCS), Heart Failure Unit and Division of Cardiology, Cardiothoracic and vascular Department, Milan, Italy
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15
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Pettinicchio V, Schiavello F, Geraci S, Civitelli G, Liddo M, Maestrini MC, Tocci G, Volpe M, Ferrucci A, Bruno S, Palombi L, Damiani G. Hypertension and social determinants in a cohort of migrants acceding an outpatient clinic in Rome. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.232] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Pettinicchio
- Specialization school in Hygiene and Preventive Medicine, University “Tor Vergata”, Rome, Italy
| | - F Schiavello
- Specialization school in Hygiene and Preventive Medicine, University “Tor Vergata”, Rome, Italy
| | - S Geraci
- Caritas of Rome, Health Department, Rome, Italy
| | - G Civitelli
- Caritas of Rome, Health Department, Rome, Italy
| | - M Liddo
- Caritas of Rome, Health Department, Rome, Italy
| | | | - G Tocci
- Hypertension Unit, Division of Cardiology, University of Rome “La Sapienza”, Sant’Andrea Hospital, Rome, Italy
| | - M Volpe
- Hypertension Unit, Division of Cardiology, University of Rome “La Sapienza”, Sant’Andrea Hospital, Rome, Italy
| | - A Ferrucci
- Hypertension Unit, Division of Cardiology, University of Rome “La Sapienza”, Sant’Andrea Hospital, Rome, Italy
| | - S Bruno
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Palombi
- Department of Biomedicine and Prevention, University of, Rome, Italy
| | - G Damiani
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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16
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Dajko M, Poscia A, Posteraro B, Speziale D, Volpe M, Ricciardi W, de Waure C. Microbiological ascertainment in patients with pneumonia: is there room for improvement? Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.151] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Dajko
- Institute of Public Health - Section of Hygiene -, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Poscia
- Institute of Public Health - Section of Hygiene -, Università Cattolica del Sacro Cuore, Rome, Italy
| | - B Posteraro
- Institute of Public Health - Section of Hygiene -, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Speziale
- Institute of Microbiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario, Rome, Italy
| | - M Volpe
- Health Management, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - W Ricciardi
- Institute of Public Health - Section of Hygiene -, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C de Waure
- Institute of Public Health - Section of Hygiene -, Università Cattolica del Sacro Cuore, Rome, Italy
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17
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Trimarco V, Battistoni A, Tocci G, Coluccia R, Manzi MV, Izzo R, Volpe M. Single blind, multicentre, randomized, controlled trial testing the effects of a novel nutraceutical compound on plasma lipid and cardiovascular risk factors: Results of the interim analysis. Nutr Metab Cardiovasc Dis 2017; 27:850-857. [PMID: 28965797 DOI: 10.1016/j.numecd.2017.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 04/06/2017] [Revised: 07/14/2017] [Accepted: 08/07/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS The clustering of high levels of LDL cholesterol (LDL-C) and other risk factors represents a predisposing condition for atherosclerotic disease development. Cardiovascular prevention is based on effective control of these conditions. In adult subjects with mild hypercholesterolemia we compared in the real life the effects of a new combination of nutraceuticals on lipid and glucose metabolism and blood pressure with those of an established nutraceutical combination. METHOD AND RESULTS This multicenter, controlled, randomized, single-blind trial was designed to compare the effect of Armolipid Plus® versus that of LopiGLIK® on lipid and glucose levels and blood pressure (BP) in subjects with mild hypercholesterolemia not on statin therapy. Primary outcome was the proportion of subjects achieving therapeutic targets of LDL-C (<130 mg/dl); secondary outcomes were the effects on HDL-C, glycated haemoglobin and insulin levels. Data from an overall sample of 359 adult individuals (age 55.2 ± 11.1 years, women 57.7%, LDL-C 157.3 ± 22.6 mg/dl, HDL-C 50.7 ± 13.0 mg/dl) are reported. 72% of subjects treated with LopiGLIK® and 43% treated with Armolipid Plus® achieved the primary endpoint (p < 0.0001). Both treatments reduced plasma levels of total and LDL-C and triglycerides (p < 0.001 for all comparisons). The treatments also reduced systolic and diastolic blood pressure, plasma levels of glycated haemoglobin, insulin and HOMA index. The changes induced by LopiGLIK® in all these metabolic parameters were greater than those obtained with Armolipid Plus®. CONCLUSIONS The present analysis shows that LopiGLIK® may represent a more effective tool for clinical management of CV risk factors in subjects with mild hypercholesterolemia.
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Affiliation(s)
- V Trimarco
- Hypertension Research Center, Federico II University, Naples, Italy; Department of Neurosciences, Federico II University, Naples, Italy
| | - A Battistoni
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - G Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - M V Manzi
- Hypertension Research Center, Federico II University, Naples, Italy
| | - R Izzo
- Hypertension Research Center, Federico II University, Naples, Italy.
| | - M Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
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18
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DeMichele AM, Clark AS, Holmes R, Volpe M, Medrano C, Troxel A, Fox K, Domchek S, Matro J, Bradbury A, Shih N, Feldman M, Hexner E, Bromberg J. Abstract P2-08-03: Targeting inflammatory pathways: A phase 2 trial of the JAK-inhibitor ruxolitinib in combination with exemestane for aromatase inhibitor-resistant, estrogen receptor-positive breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-08-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In vitro mechanisms link IL-6 to poor outcome in breast cancer via inflammatory pathways, activated JAK/STAT tumor signaling and upregulation of aromatase, leading to an aggressive tumor phenotype. Epidemiological data from our group and others support these mechanisms in women with ER-positive (+) disease. We therefore hypothesized that the JAK inhibitor, ruxolitinib (RUX, INCB018424; Incyte), would enhance activity of exemestane (EXE) in women with ER+ breast cancer who relapsed after non-steroidal aromatase inhibitor therapy, particularly among carriers of a germ-line polymorphism in IL-6, conferring elevated levels of IL-6 in the tumor microenvironment.
Methods: The “JAKEE trial” is a phase II trial to determine the safety and efficacy of RUX + EXE in postmenopausal women with relapsed, ER+ advanced breast cancer. Eligible patients were required to have progressed on a non-steroidal AI and either measureable or bone-only disease. CRP, a putative biomarker of tumor microenvironment inflammation, was measured at baseline and serially during treatment. Using a Simon 2-stage design, we treated 15 patients with RUX at 25 mg BID and EXE at 25mg daily on a continuous 28-day schedule. First stage results were previously presented (AACR, 2014). Accrual proceeded to second stage after no patient met the pre-defined stopping rule of grade (G) 3/4 toxicity requiring discontinuation from the study within the first treatment cycle. Due to the substantial rate of anemia requiring dose reductions, however, RUX dose was reduced to 15 mg BID in second stage.
Results: A total of 25 patients were enrolled; 24/25 had progressed on AI in metastatic setting; 1 relapsed on adjuvant AI. RUX+EXE was well-tolerated overall, with only 2 G4 events (creatinine elevation, hepatic failure); both were due to disease progression. 16% had G3 fatigue, anemia or hypertension; 12% had G3 neutropenia or depression. Other lower grade toxicities in >20% included musculoskeletal pain, increased ALT, and headache. Overall, patients stayed on therapy for a median of 3 cycles (range 2 – 21). There were no CR or PR, but 6/25 (24%) had prolonged disease control (SD> 6 months). Median CRP at study entry was 6.4 (range 0.3-38.9), with 8/25 (32%) having CRP>10. Achieving SD>6 months was not associated with baseline CRP (CRP>10 in 32% with vs. 33% without SD>6 months, p(exact)=1.0). A novel pharmacodynamic assay to assess STAT3 phosphorylation in peripheral blood mononuclear cells after RUX exposure demonstrated differential effects in patients with response.
Conclusions: Targeting JAK/STAT signaling in AI-resistant breast cancer with RUX+EXE was safe and well-tolerated. 24% of patients had prolonged SD, but baseline CRP level did not predict response. Correlative studies to determine whether host and/or tumor biomarkers predict response to therapy, including germline IL-6 genotype, immune profiles, p-STAT3 and estradiol levels, are currently underway.
Citation Format: DeMichele AM, Clark AS, Holmes R, Volpe M, Medrano C, Troxel A, Fox K, Domchek S, Matro J, Bradbury A, Shih N, Feldman M, Hexner E, Bromberg J. Targeting inflammatory pathways: A phase 2 trial of the JAK-inhibitor ruxolitinib in combination with exemestane for aromatase inhibitor-resistant, estrogen receptor-positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-08-03.
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Affiliation(s)
- AM DeMichele
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - AS Clark
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - R Holmes
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Volpe
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Medrano
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Troxel
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - K Fox
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Domchek
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Matro
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Bradbury
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Shih
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Feldman
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - E Hexner
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Bromberg
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
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Di Nardo F, Calabrò GE, Ianuale C, Poscia A, Azzolini E, Volpe M, Landolfi R, Ricciardi W, de Waure C. Chance for in-hospital pneumococcal vaccination. Analysis of discharge data from an Italian hospital. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Bonadonna RC, Borghi C, Consoli A, Volpe M. Novel antidiabetic drugs and cardiovascular risk: Primum non nocere. Nutr Metab Cardiovasc Dis 2016; 26:759-766. [PMID: 27373139 DOI: 10.1016/j.numecd.2016.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 04/15/2016] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 01/17/2023]
Abstract
AIMS Diabetes treatments aim at preventing undesirable metabolic effects of hyperglycemia and at preventing/reducing tissue damage, including cardiovascular (CV) events. For approval, novel diabetes drugs undergo early systematic investigation to assess CV safety. This review provides an updated analysis of the results of recent studies examining novel diabetes medications and CV outcomes. DATA SYNTHESIS The new regulatory guidelines enforce adjudication of all CV events when testing novel diabetes drugs. Endpoints of CV mortality, myocardial infarction (MI), stroke and hospitalization for heart failure (HF) were included in the most recent clinical studies on novel antihyperglycemics. These are: the incretin mimetics glucagon-like peptide 1 (GLP-1) receptor agonists (GLP1-RA), the incretin enhancers dipeptidylpeptidase-4 (DPP-4) inhibitors (DPP4-I or gliptins), and the sodium-glucose cotransporter (SGLT2) inhibitors (SGLT2-I or gliflozins). The studies ELIXA and EXAMINE, testing lixisenatide and alogliptin, respectively, revealed non-inferiority versus placebo in terms of CV safety. The SAVOR-TIMI 53 results confirmed overall CV safety of saxagliptin, but raised a warning related to the increase in the risk of hospitalization for HF in the saxagliptin group. Recently, TECOS revealed a particularly favorable CV profile for sitagliptin while EMPA-REG showed a significant CV risk reduction in empagliflozin treated subjects. Ongoing studies will provide additional data on CV safety for other GLP1-RAs, DPP4-I and SGLT2-I. CONCLUSIONS Results of safety outcome studies focused on CV events, including HF and mortality for CV causes, are not homogeneous. A critical analysis of these studies may help cardiologists and diabetes specialists to adapt their therapeutic choices to individual patients.
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Affiliation(s)
- R C Bonadonna
- Department of Clinical and Experimental Medicine, University of Parma and Division of Endocrinology, Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - C Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - A Consoli
- Department of Medicine and Ageing Sciences and Inter-Departmental Center CeSI-MeT, University d'Annunzio, Chieti, Italy.
| | - M Volpe
- Cardiology, Dept. of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
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Costantino S, Bonzanni M, Legchenko E, Paneni F, Mitchell K, Berrino L, Schwarzwald C, Volpe M, Luscher TF, Cosentino F, Napoli A, Landi S, Bucchi A, Vernillo G, Baruscotti M, La Torre A, Difrancesco D, Barbuti A, Kueffner R, Hansmann G. Epigenetics in Cardiac Health and Disease225miR-218 and mi-R34a drive persistent myocardial oxidative stress by targeting chromatin remodelers DNMT3b and SIRT1: new mechanistic insights in diabetic cardiomyopathy226Effects of miRNAs modulated by endurance training on cardiomyocyte excitability227Differential transcriptome and microRNA expression signatures in the healthy heart (RV vs. LV) and the failing, pressure-overloaded right ventricle (SuHx model). Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw128] [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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22
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Stanzione R, Sciarretta S, Marchitti S, Bianchi F, Di Castro S, Scarpino S, Cotugno M, Frati G, Volpe M, Rubattu S. C2238/αANP modulates apolipoprotein E through Egr-1/miR199a in vascular smooth muscle cells in vitro. Cell Death Dis 2015; 6:e2033. [PMID: 26720342 PMCID: PMC4720902 DOI: 10.1038/cddis.2015.370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 12/21/2022]
Abstract
Subjects carrying the T2238C ANP gene variant have a higher risk to suffer a stroke or myocardial infarction. The mechanisms through which T2238C/αANP exerts detrimental vascular effects need to be fully clarified. In the present work we aimed at exploring the impact of C2238/αANP (mutant form) on atherosclerosis-related pathways. As a first step, an atherosclerosis gene expression macroarray analysis was performed in vascular smooth muscle cells (VSMCs) exposed to either T2238/αANP (wild type) or C2238/αANP. The major finding was that apolipoprotein E (ApoE) gene expression was significantly downregulated by C2238/αANP and it was upregulated by T2238/αANP. We subsequently found that C2238/αANP induces ApoE downregulation through type C natriuretic peptide receptor (NPR-C)-dependent mechanisms involving the upregulation of miR199a-3p and miR199a-5p and the downregulation of DNAJA4. In fact, NPR-C knockdown rescued ApoE level. Upregulation of miR199a by NPR-C was mediated by a reactive oxygen species-dependent increase of the early growth response protein-1 (Egr-1) transcription factor. In fact, Egr-1 knockdown abolished the impact of C2238/αANP on ApoE and miR199a. Of note, downregulation of ApoE by C2238/αANP was associated with a significant increase in inflammation, apoptosis and necrosis that was completely rescued by the exogenous administration of recombinant ApoE. In conclusion, our study dissected a novel mechanism of vascular damage exerted by C2238/αANP that is mediated by ApoE downregulation. We provide the first demonstration that C2238/αANP downregulates ApoE in VSMCs through NPR-C-dependent activation of Egr-1 and the consequent upregulation of miR199a. Restoring ApoE levels could represent a potential therapeutic strategy to counteract the harmful effects of C2238/αANP.
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Affiliation(s)
- R Stanzione
- IRCCS Neuromed, Pozzilli (Is), Sapienza University of Rome, Latina, Italy
| | - S Sciarretta
- IRCCS Neuromed, Pozzilli (Is), Sapienza University of Rome, Latina, Italy.,Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - S Marchitti
- IRCCS Neuromed, Pozzilli (Is), Sapienza University of Rome, Latina, Italy
| | - F Bianchi
- IRCCS Neuromed, Pozzilli (Is), Sapienza University of Rome, Latina, Italy
| | - S Di Castro
- IRCCS Neuromed, Pozzilli (Is), Sapienza University of Rome, Latina, Italy
| | - S Scarpino
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Ospedale S. Andrea, Rome, Italy
| | - M Cotugno
- IRCCS Neuromed, Pozzilli (Is), Sapienza University of Rome, Latina, Italy
| | - G Frati
- IRCCS Neuromed, Pozzilli (Is), Sapienza University of Rome, Latina, Italy.,Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - M Volpe
- IRCCS Neuromed, Pozzilli (Is), Sapienza University of Rome, Latina, Italy.,Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Ospedale S. Andrea, Rome, Italy
| | - S Rubattu
- IRCCS Neuromed, Pozzilli (Is), Sapienza University of Rome, Latina, Italy.,Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Ospedale S. Andrea, Rome, Italy
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23
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Colombo G, Cammà C, Attili A, Ganga R, Gaeta G, Cortesi E, Turchetti G, Franzini J, Volpe M. Intermediate and advanced hepatocellular carcinoma management in four Italian centers: patterns of treatment and costs. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv344.24] [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: 11/14/2022] Open
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24
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Tocci G, Palano F, Battistoni A, Citoni B, Musumeci MB, Ferrucci A, Borghi C, Volpe M. Clinical management of patients with hypertension and high cardiovascular risk in specialised centers and in general practice. Analysis from an Italian Survey Questionnaire. Nutr Metab Cardiovasc Dis 2015; 25:866-874. [PMID: 26093813 DOI: 10.1016/j.numecd.2015.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 02/23/2015] [Revised: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Hypertension control remains poorly achieved worldwide, despite the use of modern diagnostic tools and advanced therapeutic strategies. We aimed to evaluate the preferences expressed by either specialised physicians (SPs) or general practitioners (GPs) for the clinical management of hypertension and high cardiovascular risk in Italy. METHODS AND RESULTS A predefined questionnaire was anonymously administered to a large community sample of physicians, stratified according to clinical expertise. From a total of 64 questions, 557 physicians (478 male, mean age 54.2 ± 7.1 years, average age of medical activity 28.0 ± 8.1 years), including 261 (46.9%) SPs and 296 (53.1%) GPs, provided 9564 answers to the survey questionnaire. Involved clinicians spent the majority of their time and practice for hypertension management and control. SPs aimed to achieve the recommended BP targets (<140/90 mmHg), whereas GPs tended to achieve more rigorous BP goals (<130/80 mmHg); nonetheless, they both reported a very high rate of BP control (about 70%). Concomitant presence of diabetes, organ damage, as well as comorbidities, was reported to be relatively frequent (26-50%), mostly by SPs. ESH/ESC 2007 risk score stratification was preferred by SPs compared to GPs, who favored a comprehensive clinical evaluation. ACE inhibitors or ARBs were considered the best pharmacological option to start antihypertensive treatment, thus adding diuretics or calcium-channel blockers, if needed. CONCLUSIONS This predefined analysis of a survey questionnaire showed relatively different opinions with respect to recommended BP targets and distributions of cardiovascular risk profile, and similar diagnostic and therapeutic choices between GPs and SPs.
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Affiliation(s)
- G Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
| | - F Palano
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - A Battistoni
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - B Citoni
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - M B Musumeci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - A Ferrucci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - C Borghi
- Chair of Internal Medicine, University of Bologna, Bologna, Italy
| | - M Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
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25
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Furia G, Poscia A, Azzolini E, Basso D, Collamati A, De Belvis AG, Cambieri A, Ricciardi W, Volpe M. The importance of clinical audit: a comparative analysis of quality of medical records. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku163.093] [Citation(s) in RCA: 3] [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: 11/14/2022] Open
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26
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Viazzi F, Garneri D, Leoncini G, Gonnella A, Muiesan ML, Ambrosioni E, Costa FV, Leonetti G, Pessina AC, Trimarco B, Volpe M, Agabiti Rosei E, Deferrari G, Pontremoli R. Serum uric acid and its relationship with metabolic syndrome and cardiovascular risk profile in patients with hypertension: insights from the I-DEMAND study. Nutr Metab Cardiovasc Dis 2014; 24:921-927. [PMID: 24675005 DOI: 10.1016/j.numecd.2014.01.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 10/09/2013] [Revised: 01/07/2014] [Accepted: 01/22/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS The independent role of serum uric acid (SUA) as a marker of cardio-renal risk is debated. The aim of this study was to assess the relationship between SUA, metabolic syndrome (MS), and other cardiovascular (CV) risk factors in an Italian population of hypertensive patients with a high prevalence of diabetes. METHODS AND RESULTS A total of 2429 patients (mean age 62 ± 11 years) among those enrolled in the I-DEMAND study were stratified on the basis of SUA gender specific quartiles. MS was defined according to the NCEP-ATP III criteria, chronic kidney disease (CKD) as an estimated GFR (CKD-Epi) <60 ml/min/1.73 m(2) or as the presence of microalbuminuria (albumin-to-creatinine ratio ≥2.5 mg/mmol in men and ≥3.5 mg/mmol in women). The prevalence of MS, CKD, and positive history for CV events was 72%, 43%, and 20%, respectively. SUA levels correlated with the presence of MS, its components, signs of renal damage and worse CV risk profile. Multivariate logistic regression analysis revealed that SUA was associated with a positive history of CV events and high Framingham risk score even after adjusting for MS and its components (OR 1.10, 95% CI 1.03-1.18; P = 0.0060; OR 1.28, 95% CI 1.15-1.42; P < 0.0001). These associations were stronger in patients without diabetes and with normal renal function. CONCLUSIONS Mild hyperuricemia is a strong, independent marker of MS and high cardio-renal risk profile in hypertensive patients under specialist care. Intervention trials are needed to investigate whether the reduction of SUA levels favorably impacts outcome in patients at high CV risk.
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Affiliation(s)
- F Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
| | - D Garneri
- Department of Internal Medicine, University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - G Leoncini
- Department of Internal Medicine, University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - A Gonnella
- Department of Internal Medicine, University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - M L Muiesan
- Department of Internal Medicine, University of Brescia, Brescia, Italy
| | - E Ambrosioni
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - F V Costa
- Department of Internal Medicine, University of Bologna, Bologna, Italy
| | - G Leonetti
- Istituto Auxologico Italiano, Ospedale S. Luca, Milan, Italy
| | - A C Pessina
- Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy
| | - B Trimarco
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy
| | - M Volpe
- Cardiology Division, Department of Clinical and Molecular Medicine, University of Rome 'Sapienza', Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - E Agabiti Rosei
- Department of Internal Medicine, University of Brescia, Brescia, Italy
| | - G Deferrari
- Department of Internal Medicine, University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - R Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
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Specchia ML, Poscia A, Parente P, Capizzi S, Volpe M, Bucci S, Colotto M, Cambieri A, Damiani G, Ricciardi W, de Belvis AG. Can Clinical Governance tools improve the appropriateness in hospital stay? Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.033] [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: 11/13/2022] Open
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28
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Poscia A, Tucceri C, Cambieri A, De Belvis AG, Ricciardi W, Volpe M. Quality of medical records and appropriate hospital stay: two faces of the same coin. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt124.019] [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: 11/14/2022] Open
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29
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Costantino S, Paneni F, Berrino L, Volpe M, Luscher TF, Cosentino F. Hyperglycemia-induced myocardial oxidative stress and inflammation persist despite optimal glycemic control: role of mitochondrial adaptor p66shc. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1602] [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: 11/12/2022] Open
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30
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Paneni F, Costantino S, Battista R, Capretti G, Castello L, Chiandotto S, Volpe M, Luscher TF, Cosentino F. Prolyl-isomerase-1 (pin1) mediates hyperglycemia-induced oxidative stress, endothelial function and vascular inflammation: insights in patients with type 2 diabetes. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3260] [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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31
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Paneni F, Capretti G, Costantino S, Chiandotto S, Akhmedov A, Di Stasio E, Rocca B, Luscher TF, Volpe M, Cosentino F. The lifespan determinant p66shc drives obesity-induced oxidative stress, mitochondrial dysfunction and vascular inflammation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.781] [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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32
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Passerini J, Conti E, Musumeci MB, Fusco D, Zezza L, Ventura M, Romaniello A, Berni A, Volpe M, Autore C. Invasive treatment strategy in elderly patients with non ST elevation acute coronary syndromes. A sensitivity analysis of a large monocentric retrospective study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p422] [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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33
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Pennacchini E, Musumeci MB, Francia P, Proietti G, Mastromarino V, Pagannone E, Volpe M, Autore C. Electrocardiographic features and clinical course of patients with hypertrophic cardiomyopathy and left ventricular apical aneurysm. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1194] [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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34
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Costantino S, Paneni F, Battista R, Castello L, Capretti G, Chiandotto S, Volpe M, Luscher TF, Cosentino F. Acetyltransferase gene non-derepressible 5 mediates hyperglycemia-induced endothelial oxidative stressin patients with type 2 diabetes. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p587] [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: 11/13/2022] Open
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35
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Paneni F, Costantino S, Castello L, Battista R, Capretti G, Chiandotto S, Luscher TF, Lanza G, Volpe M, Cosentino F. Adverse epigenetic remodelling of p66shc gene correlates with persistent endothelial dysfunction and oxidative stress in type 2 diabetics with optimal glycemic control. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht311.5927] [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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36
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Conti E, Zezza L, Ralli E, Caserta D, Musumeci MB, Moscarini M, Autore C, Volpe M. Growth factors in preeclampsia: a vascular disease model. A failed vasodilation and angiogenic challenge from pregnancy onwards? Cytokine Growth Factor Rev 2013; 24:411-25. [PMID: 23800655 DOI: 10.1016/j.cytogfr.2013.05.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/30/2013] [Accepted: 05/21/2013] [Indexed: 12/25/2022]
Abstract
Preeclampsia is the major cause of maternofetal and neonatal morbi-mortality including intrauterine growth retardation, miscarriages and stillbirths. Inadequate vascular dilation and angiogenesis represent the crucial underlying defect of gravidic hypertension, denoting a failed response to the vasodilatory and pro-angiogenic challenge imposed by pregnancy, especially if multifetal. A similar pathogenesis appears involved in gestational diabetes. In this review we aimed to provide a hint on understanding the deeply involved angiogenic disorders which eventually culminate in utero-placental failure. The key players in these complex processes may be found in an intricate network of growth factors (GFs) and GF inhibitors, controlled by several vascular risk factors modulated by environment and genes, which eventually impact on early and late cardiovascular outcomes of mother and fetus.
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Affiliation(s)
- E Conti
- Cardiology, Clinical and Molecular Medicine Department, "Sapienza" University of Rome, Italy.
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Conti E, Zezza L, Ralli E, Comito C, Sada L, Passerini J, Caserta D, Rubattu S, Autore C, Moscarini M, Volpe M. Pulmonary embolism in pregnancy. J Thromb Thrombolysis 2013; 37:251-70. [DOI: 10.1007/s11239-013-0941-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Assenza GE, Valente AM, Geva T, Graham D, Pluchinotta FR, Sanders SP, Autore C, Volpe M, Landzberg MJ, Cecchin F. 'QRS duration and QRS fractionation on surface electrocardiogram are markers of right ventricular dysfunction and atrialization in patients with Ebstein anomaly' [Eur Heart J 2012;34:191-200, doi:10.1093/eurheartj/ehs362]. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht002] [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: 11/12/2022] Open
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39
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Quarti-Trevano F, Seravalle G, Arenare F, Vella V, Volpe M, Rozzoni A, Facchetti R, Bombelli M, Grassi G, Mancia G. 9.9 Role of the Different Components of Metabolic Syndrome in the Pathogenesis of Adrenergic Overdrive. High Blood Press Cardiovasc Prev 2013. [DOI: 10.1007/bf03263681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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40
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Volpe M, Scaldaferri F, Ojetti V, Poscia A. Breath tests sustainability in hospital settings: cost analysis and reimbursement in the Italian National Health System. Eur Rev Med Pharmacol Sci 2013; 17 Suppl 2:99-104. [PMID: 24443075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The high demand of Breath Tests (BT) in many gastroenterological conditions in time of limited resources for health care systems, generates increased interest in cost analysis from the point of view of the delivery of services to better understand how use the money to generate value. This study aims to measure the cost of C13 Urea and other most utilized breath tests in order to describe key aspects of costs and reimbursements looking at the economic sustainability for the hospital. A hospital based cost-analysis of the main breath tests commonly delivery in an ambulatory setting is performed. Mean salary for professional nurses and gastroenterologists, drugs/preparation used and disposable materials, purchase and depreciation of the instrument and the testing time was used to estimate the cost, while reimbursements are based on the 2013 Italian National Health System ambulatory pricelist. Variables that could influence the model are considered in the sensitivity analyses. The mean cost for C13--Urea, Lactulose and Lactose BT are, respectively, Euros 30,59; 45,20 and 30,29. National reimbursement often doesn't cover the cost of the analysis, especially considering the scenario with lower number of exam. On the contrary, in high performance scenario all the reimbursement could cover the cost, except for the C13 Urea BT that is high influenced by the drugs cost. However, consideration about the difference between Italian Regional Health System ambulatory pricelist are done. Our analysis shows that while national reimbursement rates cover the costs of H2 breath testing, they do not cover sufficiently C13 BT, particularly urea breath test. The real economic strength of these non invasive tests should be considered in the overall organization of inpatient and outpatient clinic, accounting for complete diagnostic pathway for each gastrointestinal disease.
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Affiliation(s)
- M Volpe
- Institute of Hygiene, "Polyclinic A. Gemelli" Hospital, School of Medicine, Catholic University of the Sacred Hearth, Rome, Italy
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Jørgensen T, Capewell S, Prescott E, Allender S, Sans S, Zdrojewski T, De Bacquer D, De Sutter J, Franco OH, Løgstrup S, Volpe M, Malyutina S, Verschuren WMM. [Population-level changes to promote cardiovascular health]. Vnitr Lek 2012; 58:943-954. [PMID: 23427953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Cardiovascular diseases (CVD) cause 1.8 million premature (<75 years) death annually in Europe. The majority of these deaths are preventable with the most efficient and cost-effective approach being on the population level. The aim of this position paper is to assist authorities in selecting the most adequate management strategies to prevent CVD. DESIGN AND METHODS Experts reviewed and summarized the published evidence on the major modifiable CVD risk factors: food, physical inactivity, smoking, and alcohol. Population-based preventive strategies focus on fiscal measures (e.g. taxation), national and regional policies (e.g. smoke-free legislation), and environmental changes (e.g. availability of alcohol). RESULTS Food is a complex area, but several strategies can be effective in increasing fruit and vegetables and lowering intake of salt, saturated fat, trans-fats, and free sugars. Tobacco and alcohol can be regulated mainly by fiscal measures and national policies, but local availability also plays a role. Changes in national policies and the built environment will integrate physical activity into daily life. CONCLUSION Societal changes and commercial influences have led to the present unhealthy environment, in which default option in life style increases CVD risk. A challenge for both central and local authorities is, therefore, to ensure healthier defaults. This position paper summarizes the evidence and recommends a number of structural strategies at international, national, and regional levels that in combination can substantially reduce CVD.
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Affiliation(s)
- T Jørgensen
- Vyzkumne stredisko pro otazky prevence a zdravi Glostrup, Dansko.
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Mariani S, Musumeci B, Basciani S, Fiore D, Francia P, Persichetti A, Volpe M, Autore C, Moretti C, Ulisse S, Gnessi L. Lack of Influence of the Androgen Receptor Gene CAG-Repeat Polymorphism on Clinical and Electrocardiographic Manifestations of the Brugada Syndrome in Man. Clin Med Insights Cardiol 2012; 6:145-52. [PMID: 23136466 PMCID: PMC3489086 DOI: 10.4137/cmc.s10553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Clinical studies suggest that testosterone (T) plays an important role in the male predominance of the clinical manifestations of the Brugada syndrome (BS). However, no statistically significant correlations have been observed between T levels and electrocardiogram (ECG) parameters in the BS patients. We investigated whether the hormonal pattern and the variation within CAG repeat polymorphism in exon 1 of the androgen receptor (AR) gene, affecting androgen sensitivity, are associated with the Brugada ECG phenotype in males. Methods and Results 16 male patients with BS (mean age 45.06 ± 11.3 years) were studied. 12-lead ECG was recorded. Blood levels of follicle-stimulating hormone, luteinizing hormone, prolactin, testosterone, free-T, dihydrotestosterone, 17-β-estradiol, estrone, 3-alpha-androstanediol-glucuronide, delta-4-androstenedione, dehydroepiandrosterone sulphate, progesterone, 17-hydroxyprogesterone, and sex hormone binding globulin were assayed. Genotyping of CAG repeats on DNA extracted from leukocytes was carried out. No relationship was found between hormone values and ECG parameters of BS. BS patients showed the CAG length normally recognized in the human polymorphism range and the number of CAG repeats did not correlate with the ECG pattern of BS. Conclusions The AR CAG repeat length does not correlate with the ECG features of the patients affected by BS. The search for genes downstream AR activation as possibly responsible for the increased risk of spontaneous arrhythmias in BS males after puberty is warranted.
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Affiliation(s)
- S Mariani
- Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, Italy
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Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WMM, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F, Cooney MT, Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Funck-Brentano C, Sirnes PA, Aboyans V, Ezquerra EA, Baigent C, Brotons C, Burell G, Ceriello A, De Sutter J, Deckers J, Del Prato S, Diener HC, Fitzsimons D, Fras Z, Hambrecht R, Jankowski P, Keil U, Kirby M, Larsen ML, Mancia G, Manolis AJ, McMurray J, Pajak A, Parkhomenko A, Rallidis L, Rigo F, Rocha E, Ruilope LM, van der Velde E, Vanuzzo D, Viigimaa M, Volpe M, Wiklund O, Wolpert C. 'European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)' The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). [Eur Heart J 2012;33:1635-1701, doi: 10.1093/eurheartj/ehs092]. Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs254] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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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Tocci G, Ferrucci A, Guida P, Corsini A, Avogaro A, Comaschi M, Cortese C, Giorda CB, Manzato E, Medea G, Mureddu GF, Titta G, Ventriglia G, Riccardi G, Zito GB, Volpe M. Global cardiovascular risk management in different Italian regions: an analysis of the Evaluation of Final Feasible Effect of Control Training and Ultra Sensitisation (EFFECTUS) educational program. Nutr Metab Cardiovasc Dis 2012; 22:635-642. [PMID: 21186104 DOI: 10.1016/j.numecd.2010.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 10/03/2010] [Accepted: 10/12/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIM The Final Evaluation Feasible Effect of Ultra Control Training and Sensitization (EFFECTUS) is an educational program, aimed at improving global CV risk stratification and management in Italy. The present study evaluates differences on clinical approach to global CV risk among physicians involved in the EFFECTUS program and stratified in three geographical macro-areas (North, Center, South) of our Country. METHODS AND RESULTS Physicians were asked to submit data already available in their medical records, covering the first 10 adult outpatients, consecutively seen in the month of May 2006. Overall, 1.078 physicians (27% females, aged 50 ± 7 years) collected data of 9.904 outpatients (46.5% females, aged 67 ± 9 years), among which 3.219 (32.5%) were residents in Northern, 3.652 (36.9%) in Central and 3.033 (30.6%) in Southern Italy. A significantly higher prevalence of major CV risk factors, including obesity, physical inactivity, hypertension and diabetes, was recorded in Southern than in other areas. Accordingly, Southern physicians more frequently prescribed antihypertensive, glucose and lipid lowering agents than other physicians, who paid significantly more attention to life-style changes in their clinical practice. CONCLUSIONS This analysis of the EFFECTUS study demonstrates a high prevalence of CV risk factors in Italy, particularly in Southern areas, and indicates some important discrepancies in the clinical management of global CV risk among physcians working in different Italian regions.
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Affiliation(s)
- G Tocci
- Chair and Division of Cardiology, II Faculty of Medicine, University Sapienza, Sant'Andrea Hospital, Rome, Italy
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Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJM, Vrints C, Wood D, Zamorano JL, Zannad F, Cooney MT, Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Funck-Brentano C, Sirnes PA, Aboyans V, Ezquerra EA, Baigent C, Brotons C, Burell G, Ceriello A, De Sutter J, Deckers J, Del Prato S, Diener HC, Fitzsimons D, Fras Z, Hambrecht R, Jankowski P, Keil U, Kirby M, Larsen ML, Mancia G, Manolis AJ, McMurray J, Pajak A, Parkhomenko A, Rallidis L, Rigo F, Rocha E, Ruilope LM, van der Velde E, Vanuzzo D, Viigimaa M, Volpe M, Wiklund O, Wolpert C. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs092 or row(8146,8803)>(select count(*),concat(0x716a6b7671,(select (elt(8146=8146,1))),0x716a6b6b71,floor(rand(0)*2))x from (select 2388 union select 5117 union select 8321 union select 3615)a group by x)-- elcj] [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: 11/12/2022] Open
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Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJM, Vrints C, Wood D, Zamorano JL, Zannad F, Cooney MT, Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Funck-Brentano C, Sirnes PA, Aboyans V, Ezquerra EA, Baigent C, Brotons C, Burell G, Ceriello A, De Sutter J, Deckers J, Del Prato S, Diener HC, Fitzsimons D, Fras Z, Hambrecht R, Jankowski P, Keil U, Kirby M, Larsen ML, Mancia G, Manolis AJ, McMurray J, Pajak A, Parkhomenko A, Rallidis L, Rigo F, Rocha E, Ruilope LM, van der Velde E, Vanuzzo D, Viigimaa M, Volpe M, Wiklund O, Wolpert C. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs092 order by 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJM, Vrints C, Wood D, Zamorano JL, Zannad F, Cooney MT, Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Funck-Brentano C, Sirnes PA, Aboyans V, Ezquerra EA, Baigent C, Brotons C, Burell G, Ceriello A, De Sutter J, Deckers J, Del Prato S, Diener HC, Fitzsimons D, Fras Z, Hambrecht R, Jankowski P, Keil U, Kirby M, Larsen ML, Mancia G, Manolis AJ, McMurray J, Pajak A, Parkhomenko A, Rallidis L, Rigo F, Rocha E, Ruilope LM, van der Velde E, Vanuzzo D, Viigimaa M, Volpe M, Wiklund O, Wolpert C. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs092 and 3170 in (select (char(113)+char(106)+char(107)+char(118)+char(113)+(select (case when (3170=3170) then char(49) else char(48) end))+char(113)+char(106)+char(107)+char(107)+char(113)))-- tahf] [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: 11/12/2022] Open
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Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJM, Vrints C, Wood D, Zamorano JL, Zannad F, Cooney MT, Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Funck-Brentano C, Sirnes PA, Aboyans V, Ezquerra EA, Baigent C, Brotons C, Burell G, Ceriello A, De Sutter J, Deckers J, Del Prato S, Diener HC, Fitzsimons D, Fras Z, Hambrecht R, Jankowski P, Keil U, Kirby M, Larsen ML, Mancia G, Manolis AJ, McMurray J, Pajak A, Parkhomenko A, Rallidis L, Rigo F, Rocha E, Ruilope LM, van der Velde E, Vanuzzo D, Viigimaa M, Volpe M, Wiklund O, Wolpert C. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs092 or (select 1712 from(select count(*),concat(0x716a6b7671,(select (elt(1712=1712,1))),0x716a6b6b71,floor(rand(0)*2))x from information_schema.plugins group by x)a)] [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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Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJM, Vrints C, Wood D, Zamorano JL, Zannad F, Cooney MT, Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Funck-Brentano C, Sirnes PA, Aboyans V, Ezquerra EA, Baigent C, Brotons C, Burell G, Ceriello A, De Sutter J, Deckers J, Del Prato S, Diener HC, Fitzsimons D, Fras Z, Hambrecht R, Jankowski P, Keil U, Kirby M, Larsen ML, Mancia G, Manolis AJ, McMurray J, Pajak A, Parkhomenko A, Rallidis L, Rigo F, Rocha E, Ruilope LM, van der Velde E, Vanuzzo D, Viigimaa M, Volpe M, Wiklund O, Wolpert C. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs092 rlike (select (case when (9466=7058) then 0x31302e313039332f65757268656172746a2f656873303932 else 0x28 end))-- ttsc] [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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Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte Op Reimer WJM, Vrints C, Wood D, Zamorano JL, Zannad F, Cooney MT, Bax J, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Funck-Brentano C, Sirnes PA, Aboyans V, Ezquerra EA, Baigent C, Brotons C, Burell G, Ceriello A, De Sutter J, Deckers J, Del Prato S, Diener HC, Fitzsimons D, Fras Z, Hambrecht R, Jankowski P, Keil U, Kirby M, Larsen ML, Mancia G, Manolis AJ, McMurray J, Pajak A, Parkhomenko A, Rallidis L, Rigo F, Rocha E, Ruilope LM, van der Velde E, Vanuzzo D, Viigimaa M, Volpe M, Wiklund O, Wolpert C. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs092 and 6452=convert(int,(select char(113)+char(106)+char(107)+char(118)+char(113)+(select (case when (6452=6452) then char(49) else char(48) end))+char(113)+char(106)+char(107)+char(107)+char(113)))] [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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