Antonio Pacilli

Publications (4)21.82 Total impact

• Article: Development and Validation of a Predicting Model of All-Cause Mortality in Patients With Type 2 Diabetes Mellitus.

  Salvatore De Cosmo, Massimiliano Copetti, Olga Lamacchia, Andrea Fontana, Michela Massa, Eleonora Morini, Antonio Pacilli, Stefania Fariello, Antonio Palena, Anna Rauseo, Rafaella Viti, Rosa Di Paola, Claudia Menzaghi, Mauro Cignarelli, Fabio Pellegrini, Vincenzo Trischitta
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  ABSTRACT: OBJECTIVE To develop and validate a parsimonious model for predicting short-term all-cause mortality in patients with type 2 diabetes mellitus (T2DM).RESEARCH DESIGN AND METHODS Two cohorts of patients with T2DM were investigated. The Gargano Mortality Study (GMS, n = 679 patients) was the training set and the Foggia Mortality Study (FMS, n = 936 patients) represented the validation sample. GMS and FMS cohorts were prospectively followed-up for 7.40 ± 2.15 and 4.51 ± 1.69 years, respectively, and all-cause mortality was registered. A new forward variable selection within a multivariate Cox regression was implemented. Starting from the empty model, each step selected the predictor that, once included into the multivariate Cox model, yielded the maximum continuous net reclassification improvement (cNRI). The selection procedure stopped when no further statistically significant cNRI increase was detected.RESULTSNine variables (age, BMI, diastolic blood pressure, LDL cholesterol, triglycerides, HDL cholesterol, urine albumin-to-creatinine ratio, and antihypertensive and insulin therapy) were included in the final predictive model with a C statistic of 0.88 (95% CI 0.82-0.94) in the GMS and 0.82 (0.76-0.87) in the FMS. Finally, we used a recursive partition and amalgamation algorithm to identify patients at intermediate and high mortality risk (hazard ratio 7.0 and 24.4, respectively, as compared with those at low risk). A web-based risk calculator was also developed.CONCLUSIONS We developed and validated a parsimonious all-cause mortality equation in T2DM, providing also a user-friendly web-based risk calculator. Our model may help prioritize the use of available resources for targeting aggressive preventive and treatment strategies in a subset of very high-risk individuals.
  Diabetes care 05/2013; · 8.09 Impact Factor
• Article: Role of relationship between HbA1c, fibrinogen and HDL-cholesterol on cardiovascular disease in patients with type 2 diabetes mellitus.

  Antonio Pacilli, Salvatore De Cosmo, Vincenzo Trischitta, Simonetta Bacci
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  ABSTRACT: OBJECTIVE: To assess the impact of relationship between glycated hemoglobin (HbA1c), fibrinogen and HDL-cholesterol (HDL-c) on cardiovascular disease in type 2 diabetes. METHODS: We investigated i) the relationship of HbA1c, fibrinogen and HDL-c in 375 coronary artery disease (CAD)-negative and 320 CAD-positive diabetic patients and ii) the association between clustering of these three factors and incident major cardiovascular events in 317/320 CAD-positive patients. RESULTS: i) The relationships between HbA1c and both fibrinogen and HDL-c and between HDL-c and fibrinogen were significant only in CAD-positive patients (β = 10.655, p = 0.002; β = -1.056, p = 0.013; β = -1.751, p = 0.000008, respectively); ii) patients with worse-than-median levels of the three factors showed higher risk for major cardiovascular events than others (HR: 2.22, 95%CI = 1.23-4.02, p = 0.008). Both findings were independent of LDL-c, blood pressure or ongoing therapies. CONCLUSION: Our findings suggest interwoven actions of poor glycemic control, low grade inflammation and low HDL-c on atherosclerotic processes in type 2 diabetes.
  Atherosclerosis 02/2013; · 3.79 Impact Factor
• Source

  Available from: Alessandra Testa

  Article: The ENPP1 Q121 variant predicts major cardiovascular events in high-risk individuals: evidence for interaction with obesity in diabetic patients.

  Simonetta Bacci, Stefano Rizza, Sabrina Prudente, Belinda Spoto, Christine Powers, Antonio Facciorusso, Antonio Pacilli, Davide Lauro, Alessandra Testa, Yuan-Yuan Zhang, [......], Renato Lauro, Ernest V Gervino, Thomas H Hauser, Massimiliano Copetti, Salvatore De Cosmo, Fabio Pellegrini, Carmine Zoccali, Massimo Federici, Alessandro Doria, Vincenzo Trischitta
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  ABSTRACT: Insulin resistance (IR) and cardiovascular disease may share a common genetic background. We investigated the role of IR-associated ENPP1 K121Q polymorphism (rs1044498) on cardiovascular disease in high-risk individuals. A prospective study (average follow-up, 37 months) was conducted for major cardiovascular events (myocardial infarction [MI], stroke, cardiovascular death) from the Gargano Heart Study (GHS; n = 330 with type 2 diabetes and coronary artery disease), the Tor Vergata Atherosclerosis Study (TVAS; n = 141 who had MI), and the Cardiovascular Risk Extended Evaluation in Dialysis (CREED) database (n = 266 with end-stage renal disease). Age at MI was investigated in cross-sectional studies of 339 type 2 diabetic patients (n = 169 from Italy, n = 170 from the U.S.). Incidence of cardiovascular events per 100 person--years was 4.2 in GHS, 10.8 in TVAS, and 11.7 in CREED. Hazard ratios (HRs) for KQ+QQ versus individuals carrying the K121/K121 genotype (KK) individuals were 1.47 (95% CI 0.80-2.70) in GHS, 2.31 (95% CI 1.22-4.34) in TVAS, and 1.36 (95% CI 0.88-2.10) in CREED, and 1.56 (95% CI 1.15-2.12) in the three cohorts combined. In the 395 diabetic patients, the Q121 variant predicted cardiovascular events among obese but not among nonobese individuals (HR 5.94 vs. 0.62, P = 0.003 for interaction). A similar synergism was observed in cross-sectional studies, with age at MI being 3 years younger in Q121 carriers than in KK homozygotes among obese but not among nonobese patients (P = 0.035 for interaction). The ENPP1 K121Q polymorphism is an independent predictor of major cardiovascular events in high-risk individuals. In type 2 diabetes, this effect is exacerbated by obesity. Future larger studies are needed to confirm our finding.
  Diabetes 01/2011; 60(3):1000-7. · 8.29 Impact Factor
• Article: Management of type 2 diabetes in geriatric patients.

  Anna Rauseo, Antonio Pacilli, Antonio Palena, Salvatore A De Cosmo
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  ABSTRACT: The International Diabetes Federation (IDF) indicates age above 45 years as a major risk factor for diabetes and predicts that the number of persons with the disease, which currently stands at 190 million, will double by the year 2025. Several recent trials suggest that tighter glucose control reduces long-term complications in diabetic patients; however, outcomes of tight blood sugar control in the elderly are not known. Nevertheless, the principles of management of type 2 diabetes in the elderly are not different from those in middle-aged patients. There are several reasons to keep glucose control on target, also in the elderly; nonetheless, it should be considered that the risk of hypoglycemia is more deleterious in the elderly and should be avoided. The old and more recent oral glucose-lowering agents, along with the newer types of insulin, will be discussed in this review.
  Journal of nephrology 23 Suppl 15:S72-9. · 1.65 Impact Factor