[Cardiovascular risk and cardiometabolic risk: an epidemiological evaluation]
ABSTRACT On the basis of a critical literature review, this article deals with the concepts of global cardiovascular risk and cardiometabolic risk, pointing out their links but also their unresolved issues and discussing their usefulness in clinical practice. The global cardiovascular risk is the probability of suffering from a coronary event or stroke in a given period of time and in this sense it is an absolute risk, generally reported as percentage at 10 years. Usually risk functions are used, derived from longitudinal studies of healthy people at baseline. They consider some factors that are coherently linked with events in population analyses: among these there are some metabolic factors (total cholesterol, HDL cholesterol, fasting blood glucose), some biological factors (blood pressure) and some lifestyle factors (tobacco smoking), all modifiable beyond those non-modifiable like age and gender. The chosen factors must be independent at multivariate analysis, simple and standardized to measure, and contribute to significantly increase the risk-function predictivity. To be reliable, these risk functions must be derived from the same population where they will be later administered. For this reason the Italian Progetto CUORE, in the longitudinal study section, built a database of risk factors from longitudinal comparable studies started between the mid '80s and '90s and followed up the participants for cardiovascular mortality and morbidity to estimate the Italian global cardiovascular risk (first coronary or cerebrovascular event) for men and women. Two tools have been produced, the risk charts and a score software (see www.cuore.iss.it). The ongoing epidemics of obesity and diabetes and the fact that diabetes is associated with classical risk factors like hypertension and dyslipidemia induced the American Diabetes Association and the American Heart Association to launch a "call to action" to prevent both cardiovascular disease and diabetes. In this paper, as cardiometabolic risk factors were considered those "closely related to diabetes and cardiovascular disease: fasting/postprandial hyperglycemia, overweight/obesity, elevated systolic and diastolic blood pressure, and dyslipidemia". The association among the cardiometabolic risk factors has been known for a long time, and much of their etiology has been ascribed to insulin resistance. Also, the fact that these "metabolic" abnormalities can cluster in many individuals gave rise to the term "metabolic syndrome", a construct embraced by many organizations but questioned by other authors. From an epidemiological point of view the metabolic syndrome seems to increase modestly the cardiovascular risk, whereas in non-diabetic individuals it predicts diabetes much more efficiently. Many studies have compared the performance of the classical cardiovascular evaluation tools (the Framingham risk score, the SCORE charts, the Progetto CUORE score) and metabolic syndrome in cardiovascular disease prediction. Usually in people at high risk the presence of the metabolic syndrome does not improve the risk, whereas in people at lower risk its presence increases significantly the chances of cardiovascular disease. Many studies have shown that positive lifestyle interventions markedly reduce the rate of progression of type 2 diabetes. Also some drugs were tested for diabetes prevention, usually in people with impaired glucose tolerance. Oral diabetes drugs considered together (acarbose, metformin, flumamine, glipizide, phenformin) were less effective than lifestyle interventions, with different results among the drugs; the antiobesity drug orlistat gave similar results to lifestyle interventions. In Italy an appropriate approach to cardiovascular disease and diabetes prevention may be that of first evaluating the global cardiovascular risk using the charts or the score software of the Progetto CUORE, because high-risk subjects (> or =20%) must be treated aggressively independently of the presence of the metabolic syndrome; as a second step the metabolic syndrome may be sought, because it increases the risk; finally some attention should be paid to non-diabetic hyperglycemic individuals.
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ABSTRACT: Im Rahmen der vorliegenden Studie sollte geklärt werden, ob sich ein Zusammenhang zwischen Wundheilungsstörungen und speziellen chirurgischen Krankheitsbildern, wie z.B. Hernien, oder zwischen Wundheilungsstörungen und speziellen internistischen Komorbiditäten, wie z.B. Diabetes oder Niereninsuffizienz darstellen lässt. Insgesamt wurden im Rahmen der prospektiven Studie innerhalb des Erfassungszeitraumes von 9 Monaten (November 2006 bis einschließlich Juni 2007) 267 Patienten erfasst. Von diesen wurden 232 telefonisch 1-4 Monate später kontaktiert und zu Wundheilungs- assoziierten Ereignissen im weiteren Verlauf nach der Entlassung aus dem Krankenhaus befragt. Die Ergebnisse zeigen, dass zahlreiche Operations-assoziierte, wie auch Patienten-assoziierte Faktoren einen Einfluss auf das Auftreten von Wundheilungsstörungen haben und miteinander interagieren können. In der vorliegenden Studie haben wir gezeigt, dass Wundheilungsstörungen bei bestimmten Risikofaktoren für Operationen und bei einem Risikoprofil des Patienten häufiger auftreten. Besonders riskant in Bezug auf Wundheilungsstörungen ist demnach eine Hernien- oder kontaminierte Operation mit Narbenausschneidung, langer Narbe, Klammernaht und Redondrainage. Der typische Patient mit Risikoprofil für Wundheilungsstörungen ist männlich, >45 Jahre alt, BMI >24,9, mit positiver Anamnese für Diabetes, KHK, Hypertonie, Varizen, positiver Eigen- und Familienanamnese für Hernienerkrankungen und Aortenaneurysma und präoperativem Hb <100 g/l. Darüber hinaus zeigten sich zahlreiche Korrelationen der Parameter untereinander. Hier waren die Einflüsse von Alter und Hypertonie am auffälligsten. The present study has been conducted in order to find out whether wound healing and specific surgical or medical diseases are connected. A total of 267 patients was included during the acquisition period of the prospective study (November 2006 until June 2007). Of these patients, 232 were questioned after 1-4 months by telephone for events related to their wound healing. The results show, that many surgery- related, as well as patient- related factors can influence wound healing and that they just as well interact with each other. In the present study we demonstrate that wound healing is more often delayed when specific risk factors related to surgery and/ or the patient are present. Eminent risk factors for delay of wound healing are hernia- or contaminated surgeries with excision of scars, long scars, staple-stitch seam and use of Redon- drain. The typical patient to have a delay of wound healing is male, age >45 years, BMI >24,9, with positive medical history of diabetes mellitus, coronary heart disease, high blood pressure, varicosis, positive medical (family-) history of hernias and aortic aneurysm and preoperative haemoglobin <100 g/l. Furthermore, numerous correlations between the investigated parameters could be found. Of these, the influence of age and high blood pressure were the most outstanding.
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ABSTRACT: Lupin protein had hypocholesterolemic effects in laboratory animals. However, the effect in humans has not been elucidated till now. To investigate the effect of lupin protein on circulating cholesterol in plasma and lipoproteins of hypercholesterolemic subjects. A randomised, double-blind, placebo-controlled, parallel trial (23 females and 20 males completed the trial) was conducted to compare the effects of lupin protein versus casein as control protein on plasma lipids and amino acids. Thirty-five grams of the test protein were consumed daily for 6 weeks. Both lupin protein and casein resulted in a reduction of circulating plasma cholesterol (-0.50 +/- 0.64 and -0.47 +/- 0.79 mM; P < 0.05) from baseline to week 6. The reduction of plasma cholesterol was mainly caused by a reduction of LDL cholesterol in the lupin protein group (-0.31 +/- 0.46 mM; P < 0.05), while in the casein group HDL cholesterol significantly declined (-0.17 +/- 0.15 mM; P < 0.05). Comparing the lupin protein group with the casein group yielded a difference in the net changes from baseline to week 6 in the LDL:HDL cholesterol-ratio of -0.24 (95% CI: -0.007, -0.479; P < 0.05). No significant differences in net changes were observed for plasma concentrations of triglycerides, glucose, homocysteine, taurine and most of the amino acids. Lupin protein compared to casein slightly lowered the concentration of LDL cholesterol in hypercholesterolemic subjects, without altering HDL cholesterol. No or minor effects of lupin protein were observed on circulating glucose, homocysteine and plasma amino acids.European Journal of Nutrition 09/2009; 49(2):65-71. DOI:10.1007/s00394-009-0049-3 · 3.47 Impact Factor