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Giuseppe Cianciolo,
Gaetano La Manna,
Elena Della Bella,
Maria Laura Cappuccilli,
Maria Laura Angelini, Ada Dormi,
Irene Capelli,
Claudio Laterza,
Roberta Costa,
Francesco Alviano,
Gabriele Donati,
Claudio Ronco,
Sergio Stefoni
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ABSTRACT: Background: The effects of vitamin D receptor (VDR) and osteocalcin (OC) expression as well as VDR agonist (VDRA) therapy on circulating endothelial progenitor cells (EPCs) has not been elucidated yet. Methods: We therefore analyzed EPCs in 30 healthy controls and 82 patients undergoing dialysis (no VDRA therapy: 28; oral calcitriol: 30, and intravenous paricalcitol, PCTA: 24). The percentage of EPCs (CD34+/CD133-/KDR+/CD45-) expressing VDR or OC, and VDR and OC expression defined by mean fluorescence intensity (MFI) were analyzed using flow cytometry. The in vitro effect of VDRAs was evaluated in EPCs isolated from each patient group. Results: The percentage of VDR+ EPCs correlated positively with VDRA therapy and 25(OH)D, and negatively with diabetes, C-reactive protein, hemoglobin and osteopontin. VDR-MFI correlated positively with VDRA therapy, parathyroid hormone (PTH) and 25(OH)D, and negatively with diabetes and osteopontin. The percentage of OC+ EPCs correlated positively with the calcium score, PTH and phosphate, and negatively with 25(OH)D. OC-MFI correlated positively with calcium score, PTH, phosphate and hemoglobin, and negatively with albumin, 25(OH)D and osteopontin. Cell cultures from patients without VDRA therapy had the highest levels of calcium deposition and OC expression, which both significantly decreased following in vitro VDRA administration: in particular extracellular calcium deposition was only reduced by adding PCTA. Conclusions: Our data suggest that 25(OH)D serum levels and VDRA therapy influence VDR and OC expression on circulating EPCs. Since OC expression may contribute to vascular calcification, we hypothesize a putative protective role of VDRA therapy.
Blood Purification 03/2013; 35(1-3):187-195. · 2.10 Impact Factor
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ABSTRACT: AIMS: Atherosclerosis is the leading cause of cardiovascular morbidity and mortality in Italy. One of its principal risk factors is dyslipidemia. The aim of our study was to determine the accuracy of antihypercholesterolemic treatment in high-risk patients [low-density lipoprotein (LDL) > 100 mg/dl] discharged from hospital. METHODS: Among all the patients aged 40-70 years hospitalized at S. Orsola-Malpighi Hospital, Bologna, during 2008, we selected patients who had established arterial disease (coronary artery disease, cerebrovascular disease, peripheral arterial disease) or diabetes; excluding patients with creatine kinase or transaminase alterations, renal function impairment, diagnosis of hypercholesterolemia alone or incomplete lipid profile; the final population included 999 participants. Total cholesterol, high-density lipoprotein cholesterol and triglycerides were measured on blood samples. LDL-cholesterol was obtained by the Friedwald formula. Statin use was evaluated through medical records, comparing admission and discharge. The χ-test was used to compare the percentage of patients on lipid-lowering treatment at admission and discharge. RESULTS: Considering all 462 individuals with LDL-cholesterol levels more than 100 mg/dl, statin treatment increased from 25.5% at admission to 61.7% at discharge; however, more than 38% of patients who deserved a pharmacological therapy were not treated. In addition, we observed an improvement in lipid-lowering therapy only in 23 patients with LDL-cholesterol levels more than 100 mg/dl already under statin treatment. CONCLUSION: Our data show that dyslipidemia is generally undertreated in high-risk patients, despite the fact that hospitalization brings them in contact with specialized physicians.
Journal of Cardiovascular Medicine 06/2012; · 1.51 Impact Factor
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ABSTRACT: Hypertension and high serum cholesterol levels are two of the most relevant risk factors for cardiovascular diseases. A combined
increase in both risk factors has been reported in a significant proportion of patients with coronary artery disease. Statins
are the most widely used drugs to treat hypercholesterolemia, and they interact with blood pressure control in different populations
of hypertensive patients. A significant reduction in blood pressure associated with the use of statins has been described
in patients with untreated hypertension and in patients treated with antihypertensive drugs, particularly angiotensin converting
enzyme inhibitors and calcium channel blockers. The effect of statins on blood pressure control has also been reported in
diabetic patients. The mechanisms responsible for the hypotensive effect seem to be largely independent of the effect of statins
on lipid profile, and are probably related to their interaction with endothelial function or angiotensin II receptors. The
capacity of statins to improve blood pressure control could be a useful consideration for an integrated approach to better
prevention of cardiovascular diseases.
Current Hypertension Reports 04/2012; 3(4):281-288. · 2.50 Impact Factor
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ABSTRACT: The objective is to evaluate the relationship between cholesterolemia, serum apolipoprotein B (apoB) level and blood pressure in a large sample of general population.
The Brisighella Heart Study (BHS) is a prospective, population-based longitudinal epidemiological investigation. For this study, we analysed the data sampled in the 2008 BHS population survey, excluding those participants treated with antihypertensive and/or lipid lowering drugs (N: 2473).
In a sex, BMI, smoking habit, physical activity level and serum creatinine adjusted model, low-density lipoprotein-cholesterol (LDL-C) appears to be significantly related to SBP (P < 0.001), DBP (P = 0.026), and pulse pressure (PP) (P < 0.001). In individuals aged less than 52 years, LDL-C was significantly associated to SBP and DBP (P < 0.001), but not PP. In the same model, apoB appears to be mildly but significantly related to SBP (P < 0.001), DBP (P < 0.001), and PP (P < 0.001). In individuals aged less than 52 years, apoB was significantly associated to SBP (P < 0.001), DBP (P < 0.001), and PP (P < 0.001). In individuals aged 52 or more, nor LDL-C neither apoB were significantly associated to blood pressure. Including in the same model LDL-C and apoB, apoB excluded the predicting role of LDL-C as it regards the blood pressure either in the whole population sample and in the younger individuals.
On the basis of our observation, either serum LDL-C and apoB are significantly related to the blood pressure level in a large sample of individuals untreated with antihypertensive and lipid-lowering drugs. This association is stronger in younger individuals than in elderly. ApoB seems to be a stronger predictor of either SBP, DBP and PP than LDL-C.
Journal of hypertension 03/2012; 30(3):492-6. · 4.02 Impact Factor
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Giuseppe Cianciolo,
Gaetano La Manna,
Maria L Cappuccilli,
Nicole Lanci,
Elena Della Bella,
Vania Cuna, Ada Dormi,
Paola Todeschini,
Gabriele Donati,
Francesco Alviano,
Roberta Costa,
Gian Paolo Bagnara,
Sergio Stefoni
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ABSTRACT: Vitamin D deficiency is associated with endothelial dysfunction in uremic patients, possibly by the impairment in the number and function of endothelial progenitor cells (EPCs). In 89 hemodialysis patients, we investigated the factors associated with the number of circulating EPCs (CD34+/CD133+/KDR+ and CD34+/CD133-/KDR+ cells), the presence of VDR and the determinants of VDR expression on EPCs, in particular in calcitriol therapy.
EPC counts, percentages of VDR-positive EPCs and VDR expression were assessed by flow cytometry. Cells isolated from a subgroup of patients were cultured to analyze colony-forming units, specific markers expression and a capillary-like structure formation.
Our study demonstrates the presence of VDR on EPCs. In our dialysis patients, the parameters studied on both CD34+/CD133+/KDR+ and CD34+/CD133-/KDR+ cells, in particular VDR expression, seem to be influenced by uremia-related factors, including anemia, inflammation, diabetes, 25(OH)D serum levels and calcitriol therapy.
Blood Purification 07/2011; 32(3):161-73. · 2.10 Impact Factor
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ABSTRACT: The complex mechanism responsible for tinnitus, a symptom highly prevalent in elderly patients, could involve an impaired control of the microcirculation of the inner ear, particularly in patients with poor blood pressure control and impaired left ventricular (LV) function.
In order to define the relationship between the presence of tinnitus and the severity and clinical prognosis of mild-to-moderate chronic heart failure (CHF) in a large population of elderly patients (N = 958), a cross-sectional study was conducted with a long-term extension of the clinical follow-up. Blood pressure, echocardiographic parameters, brain natriuretic peptide (BNP), hospitalization, and mortality for CHF were measured. Multivariate logistic regression analysis was used to assess the association between the presence of tinnitus and some of the prognostic determinants of heart failure.
The presence of tinnitus was ascertained in 233 patients (24.3%; mean age 74.9 ± 6 years) and was associated with reduced systolic and diastolic blood pressure (123.1 ± 16/67.8 ± 9 vs 125.9 ± 15/69.7 ± 9; P = .027/P = .006), reduced LV ejection fraction (LVEF%; 43.6 ± 15 vs 47.9 ± 14%, P = .001), and increased BNP plasma levels (413.1 ± 480 vs 286.2 ± 357, P = .013) in comparison to patients without symptoms. The distribution of CHF functional class was shifted toward a greater severity of the disease in patients with tinnitus. Combined one-year mortality and hospitalization for CHF (events/year) was 1.43 ± 0.2 in patients with tinnitus and 0.83 ± 0.1 in patients without tinnitus, with an adjusted hazard ratio (HR) of 0.61 (95% confidence interval (CI): 0.37 to 0.93, P <.002).
Our preliminary data indirectly support the hypothesis that tinnitus is associated with a worse CHF control in elderly patients and can have some important clinical implications for the early identification of patients who deserve a more aggressive management of CHF.
BMC Medicine 06/2011; 9:80. · 6.03 Impact Factor
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ABSTRACT: This randomized crossover study investigated the effects of unfractioned heparin (UFH) and low-molecular-weight heparin (LMWH) on intra- and post-dialytic blood levels of osteoprotegerin (OPG), receptor activator of nuclear factor kappa B ligand (RANKL) and inflammatory cytokines.
Forty patients on haemodialysis for at least 12 months were selected. UFH or LMWH was randomly assigned and maintained for 1 month, and then, in the following month, each patient was switched to the other form of heparin. In the mid-week session, we determined the changes in anti-Xa activity, OPG, RANKL, IL-1β, IL-6 and TNF-α values before heparin administration and after 15 min, 4, 8 and 24 h (T0, T1, T2, T3 and T4 respectively). Since these parameters at the various experimental times showed a non-normal distribution, log transformation was applied in order to run parametric ANOVA, with Bonferroni correction for multiple comparisons.
The changes in anti-Xa activity over time were similar but not the same for the UFH and LMWH. A highly significant (P<0.001) increase in anti-Xa activity was detected at T1, regardless of the type of heparin, as confirmed in the comparison of T0 vs T1 using one-way ANOVA. Moreover, with both heparins, significant differences were found in the comparisons of anti-Xa activity at T1 vs T2 (both P<0.001) and at T2 vs T3 (P=0.0003 with UFH; P<0.001 with LMWH). Conversely, the difference in anti-Xa activity at T3 vs T4 was still significant with UFH (P=0.0186) but not significant with LMWH (P=0.728). When comparing anti-Xa activity at T4 vs T0, no significant differences were found either with UFH (P=0.1996) or with LMWH (P=0.7470), thus indicating that 24 h after heparin infusion, anti-Xa activity returned back to the pre-infusion values. When we analysed the changes in OPG levels over time, we found that the administration of heparin, regardless of the type, determined an increase in circulating OPG with a zenith at 15 min (T1), with a return back to the baseline levels within the 24th hour post-infusion. One-way ANOVA revealed significant differences in OPG blood levels at T0 vs T1 with both UFH (P=0.0112) and LMWH (P=0.0288), whereas no significant difference was observed in the comparisons of OPG levels at T1 vs T2, T2 vs T3, T3 vs T4 and T4 vs T0, either with UFH or with LMWH. The circulating levels of RANKL, IL-1β, IL-6 and TNF-α at the different intra- and post-dialytic times did not show significant variations following heparin administration, either with UFH or with LMWH. One-way ANOVA performed on the log-transformed values of RANKL, IL-1β, IL-6 and TNF-α at the various experimental times (T0 vs T1, T1 vs T2, T2 vs T2, T3 vs T4 and T4 vs T0) revealed no significant intra- and post-dialytic changes in their blood levels, thus confirming that heparin infusion did not affect their blood levels.
These results suggest that heparin-regulated cyclic increases of OPG might play a role in the vascular pathology of haemodialysis patients.
Nephrology Dialysis Transplantation 02/2011; 26(2):646-52. · 3.40 Impact Factor
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ABSTRACT: To evaluate whether a nutritional education intervention on a general population cohort is able to balance the metabolic effects of incident menopause in a large sample of perimenopausal women.
We measured body mass index (BMI), blood pressure, plasma lipids, fasting plasma glucose, and prevalence of metabolic syndrome in two groups of perimenopausal nondiabetic women involved in the Brisighella Heart Study, a longitudinal epidemiological study, before (sample size 301) and after (sample size 262) a nutritional education program aimed at improving the cardiovascular disease (CVD) risk profile in a whole village population.
Before the interventional period, women undergoing menopause experienced a significant increase in BMI, systolic blood pressure, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (LDL-C), and triglycerides (all parameters exhibited p < 0.01). After the nutritional intervention, women undergoing menopause experienced a significant reduction only in triglyceride plasma level (p < 0.001). Metabolic syndrome prevalence was 73 in 301 and 99 in 301 (p = 0.018), respectively, before and after menopause in the preintervention group, and it was 66 in 262 and 68 in 262 (p = 0.871), respectively, in the postintervention group.
In our study, a nutritional education program aimed at improving the CVD risk profile of a whole village population is associated with the prevention of increase in systolic blood pressure, BMI, cholesterolemia, and metabolic syndrome prevalence linked to menopause.
Journal of Women s Health 01/2010; 19(1):133-7. · 1.57 Impact Factor
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ABSTRACT: Abstract Objective: Our objective was to contribute to drawing a haemodynamic profile of healthy subjects prone to labyrinthine disorders of functional origin. The aim was to determine if some haemodynamic aspects could characterize young people with a history of transient tinnitus, considered as an early symptom of cochlear damage possibly derived from hypoperfusion. In one year we studied 60 consecutive subjects (28 ± 5.2, range 18–40 years): 24 who experienced transient tinnitus, and 36 without tinnitus. Exclusion criteria were a history of audiological and otological impairment, ear surgery, and known cardiac abnormalities. A clinical and echographic cardiac evaluation was performed, with assessment of blood pressure, heart rate, and left ventricular structure and function. Results: All results were within the normal range in both groups. The tinnitus group had a slightly lower body mass index (BMI) (p = 0.05) and body surface area (BSA) (p <0.05), while age, blood pressure and heart rate were similar in the two groups. Tinnitus subjects showed reduced diastolic and systolic left ventricular internal dimensions (p = 0.01 and 0.02, respectively) and left ventricular end-diastolic volume (p = 0.02). Left ventricular mass (LVM) related to height 2.7 and observed LVM were reduced in tinnitus subjects (both p = 0.02), while LVM related to BSA had a less marked reduction (p = 0.04), and predicted LVM and appropriate LVM showed only a borderline statistically significant reduction (p = 0.05). Functional systolic left ventricular aspects were similar in the two groups apart from a lower stroke volume in tinnitus subjects compared with the no-tinnitus group (p = 0.03), and no differences were observed in diastolic function indexes between the two groups. Conclusion: Subjects with a history of transient tinnitus, although presenting normal echocardiographic parameters, seem to have smaller somatic and cardiac structural characteristics, which could be less adequate in maintaining peripheral perfusion. In particular, a terminal circle district such as the cochlear one could thus show its stress through tinnitus. This observation indirectly supports the theory of a cochlear origin of tinnitus in a number of cases and is reminiscent of what happens in hypertension and heart failure.
11/2009; 7(4):200-204.
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Giuseppe Cianciolo,
Gaetano La Manna,
Gabriele Donati,
Elisa Persici, Ada Dormi,
Maria Laura Cappuccilli,
Serena Corsini,
Rossella Fattori,
Vincenzo Russo,
Valentina Nastasi,
Luigi Colì,
Marylou Wratten,
Sergio Stefoni
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ABSTRACT: The aim of the study was to assess the factors potentially involved in coronary artery calcifications (CAC) in end-stage renal disease patients. 253 hemodialysis (HD) patients (92 females, 161 males), aged 62.5 +/- 13.5, who had been on HD treatment for at least 6 months, were enrolled in a cross-sectional study. Calcium-phosphate product (Ca x P), body mass index (BMI), fetuin-A, osteoprotegerin (OPG), osteopontin, transforming growth factor-beta1 (TGF-beta1), fibroblast growth factor-23 (FGF-23) and matrix Gla protein (MGP) were considered. CAC was assessed using multislice spiral computed tomography and calcium score was quantified by means of the Agatston score. The median calcium score was 364 Agatston (range 0-7,336). CAC was detected in 228/253 patients (90.1%). Multivariate regression analysis, adjusted for age and for dialysis vintage, showed that TGF-beta1, OPG and days with Ca x P >55 mg/dl are independent predictors of CAC, while MGP was shown to be a protective factor. Surprisingly, results showed that BMI was a protective factor too: the interpolation with cubic spline function revealed a significant reduction in calcium score in patients with a high BMI (>28). However, when diabetes was considered in the regression analysis, only OPG emerged as a predictor of a high CAC score. The interpolation with spline function continued to show a significant reduction in CAC score in nondiabetic and in diabetic patients with the highest BMI quartile. The protective effect of a high BMI on CAC might represent another example of inverse biology in dialysis patients but it needs to be further addressed in larger longitudinal studies.
Blood Purification 10/2009; 29(1):13-22. · 2.10 Impact Factor
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ABSTRACT: We enrolled 347 hypertensive patients, randomly allocated them to different first-line treatments, and followed-up for 24 months. Persistence on treatment was significantly higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs. CCBs (51.6%), β-blockers (44.8%), and diuretics (34.4%). No ARB, ACE inhibitor, β-blocker, or diuretic was associated with a greater persistence in therapy as compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs. other CCBs (59.3% vs. 46.6%). Systolic and diastolic BP decreased more in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) when compared to ß-blockers (-4.0/-2.3 mmHg) and diuretics (-2.3/-2.1 mmHg).
07/2009; 29(8):553-562.
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Davide Festi, Ada Dormi,
Simona Capodicasa,
Tommaso Staniscia,
Adolfo-F Attili,
Paola Loria,
Paolo Pazzi,
Giuseppe Mazzella,
Claudia Sama,
Enrico Roda,
Antonio Colecchia
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ABSTRACT: To evaluate gallstone incidence and risk factors in a large population-based study.
Gallstone incidence and risk factors, were evaluated by structured questionnaire and physical examination, respectively, in 9611 of 11 109 (86.5%) subjects who were gallstone-free at the cross-sectional study.
Six centers throughout Italy enrolled 9611 subjects (5477 males, 4134 females, aged 30-79 years), 9517 of whom were included into analysis: 424 subjects (4.4%) had gallstones and 61 (0.6%) had been cholecystectomized yielding a cumulative incidence of 0.67% per year (0.66% in males, 0.81% in females). Increasing age, a high body mass index (BMI), a history of diabetes, peptic ulcer and angina, and low cholesterol and high triglyceride levels were identified as risk factors in men while, in females, the only risk factors were increasing age and a high BMI. Increasing age and pain in the right hypocondrium in men and increasing age in females were identified as predictors of gallstones. Pain in the epigastrium/right hypocondrium was the only symptom related to gallstones; furthermore, some characteristics of pain (forcing to rest, not relieved by bowel movements) were significantly associated with gallstones. No correlation was found between gallstone characteristics and clinical manifestations, while increasing age in men and increasing age and BMI in females were predictors of pain.
Increasing age and BMI represent true risk factors for gallstone disease (GD); pain in the right hypocondrium and/or epigastrium is confirmed as the only symptom related to gallstones.
World Journal of Gastroenterology 10/2008; 14(34):5282-9. · 2.47 Impact Factor
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Giuseppe Cianciolo,
Gaetano La Manna,
Luigi Colì,
Gabriele Donati,
Francesca D'Addio,
Elisa Persici,
Giorgia Comai,
Marylou Wratten, Ada Dormi,
Vilma Mantovani,
Gabriele Grossi,
Sergio Stefoni
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ABSTRACT: Hemodialysis (HD) patients have a greatly increased risk of cardiovascular morbidity and mortality. For this reason, attempts are often made to normalize hyperhomocysteinemia. This randomized prospective study sought to determine which risk factors are predictors of mortality and whether high doses of folates or 5-methyltetrahydrofolate (5-MTHF) could improve hyperhomocysteinemia and survival in HD patients.
341 patients were divided into two groups: group A was treated with 50 mg i.v. 5-MTHF, and group B was treated with 5 mg/day oral folic acid. Both groups received i.v. vitamin B(6) and B(12). By dividing patients into C-reactive protein (CRP) quartiles, group A had the highest survival for CRP <12 mg/l, whereas no survival difference was found for group B. CRP was the only predictive risk factor for death (RR 1.17, range 1.04-1.30, p = 0.02). Dialysis age, hyperhomocysteinemia, methylenetetrahydrofolate reductase polymorphism, albumin, lipoprotein (a) and folate did not influence mortality risk. Survival in group A was higher than that in group B, namely 36.2 +/- 20.9 vs. 26.1 +/- 22.2 months (p = 0.003).
Our results suggest that CRP, but not hyperhomocysteinemia, is the main risk factor for mortality in HD patients receiving vitamin supplements. Intravenous 5-MTHF seems to improve survival in HD patients independent from homocysteine lowering.
American Journal of Nephrology 06/2008; 28(6):941-8. · 2.54 Impact Factor
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ABSTRACT: We enrolled 347 hypertensive patients, randomly allocated them to different first-line treatments, and followed-up for 24 months. Persistence on treatment was significantly higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs. CCBs (51.6%), beta-blockers (44.8%), and diuretics (34.4%). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a greater persistence in therapy as compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs. other CCBs (59.3% vs. 46.6%). Systolic and diastolic BP decreased more in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) when compared to beta-blockers (-4.0/-2.3 mmHg) and diuretics (-2.3/-2.1 mmHg).
Clinical and Experimental Hypertension 12/2007; 29(8):553-62. · 1.07 Impact Factor
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ABSTRACT: To investigate the possible interactions between serum cholesterol levels and the renin-angiotensin system on the development of stable hypertension in subjects with high-normal blood pressure (BP).
Hypercholesterolemia increases angiotensin-II type 1 (AT1) receptor density and pressor responsiveness to angiotensin II, and has been reported to contribute to the development of hypertension. The effects of elevated serum cholesterol levels on BP control might be exaggerated by concomitant activation of the renin-angiotensin system, and their combination might contribute to the development of stable hypertension.
We investigated the relationship between serum cholesterol levels, plasma renin activity (PRA) and the long-term development of hypertension in 66 young (age < 45 years) patients with high-normal BP and elevated (> 200 mg/dl, n = 46: HC) or normal (</=200 mg/dl, n = 20: NC) serum cholesterol levels and in 20 normotensive, normocholesterolemic controls (C). The main outcome measure was the prospective evaluation of the 15-year incidence of stable hypertension in the different populations.
New-onset hypertension was higher in patients with high-normal BP and HC when compared to NC patients [relative risk (RR) = 1.9; 95% confidence interval (CI), 1.1-4.3, P < 0.001] and control subjects (RR = 3.1; 95% CI = 1.4-5.3, P < 0.001). High PRA increased the overall rate of hypertension in both HC and NC. The interaction between HC and PRA was more evident in patients with borderline high cholesterol levels (200-240 mg/dl) where the adjusted relative risk of new onset of hypertension was 2.17 (95% CI 1.2-3.74; P < 0.05) in high PRA subjects and 1.17 (95% CI 0.67-2.23; P = 0.87) in subjects with normal PRA.
We support the hypothesis that the presence of hypercholesterolemia can promote the development of stable hypertension through its interaction with the circulating renin-angiotensin system in patients with high-normal blood pressure.
Journal of Hypertension 10/2007; 25(10):2051-7. · 4.02 Impact Factor
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ABSTRACT: Objective: Familial Combined Hyperlipoproteinemic (FCH) is a disorder of lipid metabolism characterized by an increased risk of premature coronary heart disease. Our aim is to estimate the prevalence of FCH subjects in a large North-Italian rural population monitored for 32 years (1972-2004). Methods: In the 2004 Brisighella Heart Study (BHS) survey, 1303 subjects were tested in five or more four-yearly surveys (mean age: 63.7±14.9 years). The individual plasma lipid phenotype by Fredrickson classification was attributed for each survey on the basis of low density lipoprotein (LDL)-cholesterol and triglycerides. A primary dyslipoproteinemia was suspected on the basis of personal and family history, body mass index and dietary habits. Results: At the end of the longitudinal study, the subjects with variable phenotype in the studied population were 17.2% and among primary hyperlipoproteinemics 36.3%. Mean IIb phenotype prevalence was 12.3 ± 6.3% in all hyperlipoproteinemics, while it was 33.4 ± 11.9% in potential FCH subjects. Only 7 subjects were constantly IIb during the observation time and four of them are certainly secondary hyperlipoproteinemics. The Ilb phenotype prevalence was significantly more variable than the Ila phenotypes. The 3.1% of the studied subjects have been selected as candidates for a FCH diagnosis without significant differences between sexes. Conclusion: Our data suggest the existence of a long-term primary variability of the individual plasma lipid phenotype. The prevalence of FCH in the general population appears to be near 2%.
Vascular Disease Prevention 04/2007; 4(2):185-189.
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ABSTRACT: Persistence on treatment affects the efficacy of antihypertensive treatment. We prospectively investigated the persistence on therapy and the extent of blood pressure (BP) control in 347 hypertensive patients (age 59.4 +/- 6 years) randomly allocated to a first-line treatment with: angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers (CCBs), beta-blockers, angiotensin-II receptor blockers (ARBs), or diuretics and followed-up for 24-months. Persistence on treatment was higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs CCBs (51.6%; p < 0.05), beta-blockers (44.8%, p < 0.05), and diuretics (34.4%, p < 0.01). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher persistence in therapy compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs others CCBs (59.3% vs 46.6%, p < 0.05). Systolic and diastolic BP was decreased more successfully in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) compared with beta-blockers (-4.0/-2.3 mmHg p < 0.05) and diuretics (-2.3/-2.1 mmHg, p < 0.05). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher BP control compared with the other molecules used in each therapeutic class. A trend toward a better BP control was observed in response to lercanidipine vs other CCBs (p = 0.059). The present results confirm the importance of persistence on treatment for the management of hypertension in clinical practice.
Vascular Health and Risk Management 01/2007; 3(6):999-1005.
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Alessandro Menotti,
Mariapaola Lanti,
Enrico Agabiti-Rosei,
Luigi Carratelli,
Giovanni Cavera, Ada Dormi,
Antonio Gaddi,
Mario Mancini,
Mario Motolese,
Maria Lorenza Muiesan,
Sandro Muntoni,
Sergio Muntoni,
Alberto Notarbartolo,
Pierluigi Prati,
Stefano Remiddi,
Alberto Zanchetti
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ABSTRACT: The need to update tools for the estimate of cardiovascular risk prompted the "Gruppo di Ricerca per la Stima del Rischio Cardiovascolare in Italia" to produce a new chart and new software called Riskard 2005.
Data from 9 population studies in 8 Italian regions, for a grand total of 17,153 subjects (12,045 men and 5,108 women) aged 35-74 and for a total exposure of about 194,000 person/years were available. A chart for the estimate of cardiovascular risk (major coronary, cerebrovascular and peripheral artery disease events) in 10 years was produced for men and women aged 45-74 free from cardiovascular diseases. Risk factors employed in the estimate were sex, age (6 classes), systolic blood pressure (4 classes), serum cholesterol (5 classes), diabetes, and cigarette smoking (4 classes). Estimates were produced for absolute risk and for relative risk, the latter against levels expected in the general population that produced the risk functions. Software was produced for the separate estimate of major coronary, cerebrovascular and cardiovascular events (the latter made by coronary, cerebrovascular and peripheral artery disease of atherosclerotic origin) for follow-up at 5, 10 or 15 years, in men a women aged 35-74 years at entry and free from cardiovascular diseases. Risk factors employed here were sex, age, body mass index, mean physiological blood pressure, HDL cholesterol, non-HDL cholesterol, cigarette smoking, diabetes and heart rate. The output is based on several indicators: absolute risk, relative risk (as defined above), ideal risk (for a very favourable risk profile), biological age of risk, comparisons among the above indicators, the percent contribution of risk factors to the excess of estimated risk above the level of the ideal risk, and the description of trends in risk estimate in relation to repeated measurements.
These tools represent progress compared to similar tools produced some years ago by the same Research Group.
Nutrition Metabolism and Cardiovascular Diseases 01/2006; 15(6):426-40. · 3.73 Impact Factor
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ABSTRACT: Am J Hypertens (2005) 18, 153A–153A; doi:10.1016/j.amjhyper.2005.03.425
P-407: Left ventricular structure and function and development of pregnancy-related hypertensive disorders in pregnant women with altered utero-placental flow
Daniela Degli Esposti1, Vincenzo Immordino1, Angela Carletti1, Tullio Ghi1, Ada Dormi1, Maddalena Veronesi1, Stefano Bacchelli1, Maria Grazia Prandin1, Claudio Borghi1 and Ettore Ambrosioni11
Internal Medicine, S.Orsola Hospital-University of Bologna, Bologna, Italy; Obstetric and Ginaecology, S.Orsola Hospital-University of Bologna, Bologna, Italy.
American Journal of Hypertension 04/2005; · 3.18 Impact Factor
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ABSTRACT: To assess trends in blood pressure (BP) awareness, control, treatment and use of different antihypertensive medications in a cohort of hypertensive patients.
This study summarizes the results of a 12-year observation (1984-1996) of a cohort of 940 hypertensive patients from the population of 2329 participants to the Brisighella Heart Study (BHS). Primary outcome measures were the extent of BP control (systolic/diastolic BP < 140/90 mmHg) and prevalence of the use of various antihypertensive medications.
From 1984 to 1996 the proportion of patients aware of elevated BP and treated for hypertension rose from 73 to 88% and from 43.8 to 50.3% in men, and from 77 to 87% and from 50 to 56.6% in women (P < 0.001 for all). The rate of BP control increased from 7.5 to 17.4% in men (P < 0.001) and from 7.3 to 18.5% in women (P < 0.001). This occurred with increased use of combination therapy (+0.2 drugs/person) and with a decline in the use of diuretics (-38.2% men and -28% women; P < 0.001) and an increase in use of calcium-channel blockers (CCBs) (24.2% in men and 12.2% in women; P < 0.001) and angiotensin-converting enzyme (ACE) inhibitors (30.7% in men and 30.8% in women; P < 0.001) as first-line drugs. The improved BP control was associated with a lower rate of fatal and non-fatal cardiovascular (CV) events.
The results of this observational study confirm that the rate of BP control can be improved in daily clinical practice by increasing the use of drug combinations, as well as by the first-line prescription of ACE inhibitors and CCBs [and probably angiotensin II receptor inhibitors (ARBs)].
Journal of Hypertension 10/2004; 22(9):1707-16. · 4.02 Impact Factor
