rubrica

Cause ed epidemiologia analitica

  • Lorenzo Richiardi1

  1. Università di Torino

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Ricerca bibliografica periodo dal 16 settembre 2014 – 01 dicembre 2014

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("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2014/09/16"[PDat] : "2014/12/01"[PDat]) AND (“Case-Control” [All fields] OR “Cohort”[all fileds] OR “Cross-sectional”[All fields]) AND ("risk"[All Fields] OR "association"[all fields] OR "epidemiologic factors"[MeSH Terms]) and (“odds ratios”[all fields] OR “odds ratio”[all fields] OR “ORs”[all fields] OR “rate ratio”[all fileds] OR “rate ratios”[all fileds] OR “RR”[all fileds] OR “RRs” [all fileds] OR “risk ratio”[all fields] OR “risk ratios”[all fields] OR “prevalence ratio*” [all fields] OR “prevalence ratios” [all fields] OR “hazard ratio” [all fields] OR “hazard ratios” [all fields] OR “HR”[all fields] OR “HRs”[all fields]) NOT "Clinical Trials as Topic"[Mesh] NOT "Sensitivity and Specificity"[Mesh] NOT "Comorbidity"[Mesh] NOT "Predictive Value of Tests"[Mesh] NOT "Prognosis"[Mesh] NOT "Review"[publication type] NOT "Population Surveillance"[Mesh]

FOCUS: patologie cardiovascolari
AND ("cardiovascular diseases"[MeSH Terms] OR (cardiovascular*[title/abstract] AND diseas*[title/abstract]))

1. Borges ÁH(1), Lundgren JD, Ridolfo A, Katlama C, Antunes F, Grzeszczuk A, Blaxhult A, Mitsura VM, Doroana M, Battegay M, Gargalianos P, Mocroft A; EuroSIDA in EuroCOORD. Thrombocytopenia is associated with an increased risk of cancer during treated HIV disease. AIDS. 2014 Nov 13;28(17):2565-71. doi: 10.1097/QAD.0000000000000433.
Author information: (1)aCentre for Health & Infectious Diseases Research (CHIP), Department of Infectious Diseases and Rheumatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark bClinica delle Malattie Infettive, Ospedale L. Sacco, Milan, Italy cDept de Medicine Tropicale, Hopital de la Pitié-Salpêtriére, Paris, France dInstituto de Saúde Ambiental, Faculdade de Medicina de Lisboa eServiço de Doenças Infecciosas, Hospital de Santa Maria, Lisbon, Portugal fDepartment of Infectious Diseases, Wojewodzki Szpital Specjalistyczny, Bialystok, Poland gDepartment of Infectious Diseases, Södersjukhuset Venhälsan, Stockholm, Sweden hInfectious Diseases Department, Gomel State Medical University, Gomel, Belarus iDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland j1st Department of Internal Medicine, Athens General Hospital 'G. Gennimatas', Athens, Greece kDepartment of Infection and Population Health, University College London, London, UK. *Study group listed in the Acknowledgements section.

Abstract OBJECTIVE: To assess the relationship between platelet counts and risk of AIDS and non-AIDS-defining events. DESIGN: Prospective cohort. METHODS: EuroSIDA patients with at least one platelet count were followed from baseline (first platelet ≥ 1 January 2005) until last visit or death. Multivariate Poisson regression was used to assess the relationship between current platelet counts and the incidence of non-AIDS-defining (pancreatitis, end-stage liver/renal disease, cancer, cardiovascular disease) and AIDS-defining events. RESULTS: There were 62 898 person-years of follow-up (PYFU) among 12 279 patients, including 1168 non-AIDS-defining events [crude incidence 18.6/1000 PYFU, 95% confidence interval (CI) 17.5-19.6] and 735 AIDS-defining events (crude incidence 11.7/1000 PYFU, 95% CI 10.8-12.5). Patients with thrombocytopenia (platelet count ≤100 × 10/l) had a slightly increased incidence of AIDS-defining events [adjusted incidence rate ratio (aIRR) 1.42, 95% CI 1.07-1.86], when compared to those with platelet counts 101-200 × 10/l, whereas the incidence of non-AIDS-defining events was more than two-fold higher (aIRR 2.66, 95% CI 2.17-3.26). Among non-AIDS-defining events, the adjusted incidence of cancer (aIRR 2.20, 95% CI 1.61-3.01), but not cardiovascular disease (aIRR 0.66, 95% CI 0.32-1.34), was significantly higher in patients with thrombocytopenia. The association between thrombocytopenia and cancer remained unaltered in sensitivity analyses requiring repeated platelet counts to confirm thrombocytopenia and lagging platelets by 1 year prior to clinical events. CONCLUSION: Patients with thrombocytopenia had increased incidence of AIDS-defining and non-AIDS-defining events, but the association with the latter, in particular cancer, was stronger. Future studies should investigate whether the pathophysiological processes underlying thrombocytopenia are associated with the development of cancer during treated HIV disease.

2. de Moraes AC(1), Carvalho HB(2), Siani A(3), Barba G(3), Veidebaum T(4), Tornaritis M(5), Molnar D(6), Ahrens W(7), Wirsik N(7), De Henauw S(8), Mårild S(9), Lissner L(10), Konstabel K(4), Pitsiladis Y(11), Moreno LA(12); IDEFICS consortium. Incidence of high blood pressure in children - Effects of physical activity and sedentary behaviors: The IDEFICS study: High blood pressure, lifestyle and children. Int J Cardiol. 2015 Feb 1;180:165-70. doi: 10.1016/j.ijcard.2014.11.175. Epub 2014 Nov 26.
Author information: (1)School of Medicine of the University of São Paulo, FMUSP, São Paulo, Brazil; Universidad de Zaragoza, Facultad de Ciencias de la Salud, GENUD Research Group (Growth, Exercise, Nutrition and Development) Zaragoza, Spain; YCARE (Youth/Child and Cardiovascular Risk and Environmental) Research Group, FMUSP, Brazil. Electronic address: augustocesar.demoraes@usp.br. (2)School of Medicine of the University of São Paulo, FMUSP, São Paulo, Brazil; YCARE (Youth/Child and Cardiovascular Risk and Environmental) Research Group, FMUSP, Brazil. (3)Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy. (4)Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia. (5)Research and Education Foundation of Child Health, Strovolos, Cyprus. (6)Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary. (7)Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany. (8)Department of Public Health, Ghent University, Ghent, Belgium. (9)Department of Paediatrics, University of Gothenburg, Gothenburg, Sweden. (10)Department of Public Health and Community Medicine, University of Gothenburg, Sweden. (11)University of Glasgow, Faculty of Biomedical and Life Sciences, Glasgow, Scotland, United Kingdom. (12)Universidad de Zaragoza, Facultad de Ciencias de la Salud, GENUD Research Group (Growth, Exercise, Nutrition and Development) Zaragoza, Spain; School of Medicine of the University of São Paulo, Department of Preventive Medicine, São Paulo, Brazil.

Abstract BACKGROUND/OBJECTIVES: High blood pressure (HBP) is one of the most important risk factors for cardiovascular diseases and it has a high prevalence in pediatric populations. However, the determinants of the incidence of Pre-HBP and HBP in children are not well known. i) To describe the incidence of HBP in European children; and ii) to evaluate the effect of physical activity (PA) and sedentary behavior (SB) on the Pre-HBP and HBP. METHODS: The IDEFICS cohort study. A total of 16,228 children 2-9years at baseline were recruited by complex sampling population-based survey in eight European countries. At baseline (T0), 5221 children were selected for accelerometer measurements; 5061 children were re-examined 2years later (T1). We estimated the incidence of Pre-HBP and HBP and evaluate the effect of PA and SB on the Pre-HBP and HBP, by computing relative risks and the corresponding 95% confidence intervals (RR, 95% CI). RESULTS: Incidences of Pre-HBP and HBP per year were: 121/1000 children and 110/1000 children, respectively. We found that children maintaining SB>2h/d during the two year follow-up showed a RR of having HBP of 1.28 (1.03-1.60). Children in T1 not performing the recommended amount of PA (<60min/d) have a RR of HBP of 1.53 (1.12 to 2.09). We found no association between pre-HBP and the behaviors. CONCLUSION: The incidence of pre-HBP and HBP is high in European children. Maintaining sedentary behaviors during childhood increases the risk of developing HBP after two years of follow-up.

Lorenzo Richiardi
Lo studio IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) è uno studio multicentrico europeo finanziato dall comunità europea sui determinanti dell’obesità del bambino. Comprende in tutto più di 16.000 bambini reclutati tra i 2 e i 9 anni in diversi Paesi, tra cui l’Italia. I bambini sono stati visitati due volte: al reclutamento e dopo 2 anni di follow-up. Questo articolo si focalizza sull'attività fisica, misurata utilizzando accelerometri, e sulla sedentarietà (uso di schermi: TV, videogiochi eccetera) come fattori di rschio per l’ipertensione arteriosa. Sia un comportamento sedentario sia un'attività fisica ridotta erano associati all’ipertensione arteriosa alla visita di follow-up. Questo studio, come altri nel quadro della letteratura internazionale, sottolinea la possibile importanza per la salute a lungo termine di interventi in età infantile per stimolare l’attività fisica e contrastare la sedentarietà.

3. Zaccardi F(1), Kurl S(2), Pitocco D(3), Ronkainen K(2), Laukkanen JA(4). Serum fructosamine and risk of cardiovascular and all-cause mortality: A 24-year prospective population-based study. Nutr Metab Cardiovasc Dis. 2014 Oct 5. pii: S0939-4753(14)00306-8. doi: 10.1016/j.numecd.2014.09.007. [Epub ahead of print]
Author information: (1)Internal Medicine and Diabetes Care Unit, Catholic University, Rome, Italy. Electronic address: frazac@fastwebnet.it. (2)Institute of Public Health, School of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland. (3)Internal Medicine and Diabetes Care Unit, Catholic University, Rome, Italy. (4)Institute of Public Health, School of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Lapland Central Hospital, Department of Internal Medicine, Rovaniemi, Finland.

Abstract BACKGROUND AND AIMS: The association between fructosamine and cardiovascular complications is not well established. We sought to evaluate whether serum fructosamine may be a risk factor for cardiovascular and all-cause mortality in nondiabetic subjects. METHODS AND RESULTS: Fructosamine and other cardiovascular risk factors were measured in a sample of 1909 nondiabetic middle-aged men without a known history of coronary heart disease (CHD) at baseline. Associations between baseline fructosamine levels and fatal CHD and cardiovascular disease (CVD) events, and all-cause mortality were estimated using a Cox regression analysis, progressively adjusted for potential confounders. Mean baseline age was 52 years and 30% were smokers. During a median follow-up of 24 years (interquartile range: 18-26 years), 177 (9%) fatal CHD, 289 (15%) fatal CVD, and 728 (38%) all-cause mortality events occurred. In analyses adjusted for several conventional risk factors (i.e., age, systolic blood pressure, smoking, LDL- and HDL-cholesterol), the hazard ratios (HRs) comparing top vs bottom quartile of serum fructosamine levels resulted: 1.33 (95% CI: 0.97, 1.82; p = 0.078) for CHD death and 0.93 (0.72, 1.19; p = 0.567) for CVD death, and 1.04 (0.89, 1.22; p = 0.617) for all-cause mortality. In similar comparisons, further adjustments for body mass index, alcohol consumption, C-reactive protein, and fasting plasma glucose did not materially change these estimates. The exclusion of participants with prevalent CVD at baseline yielded similar results. CONCLUSION: In our cohort of nondiabetic men without known CHD, baseline fructosamine levels were not independently associated with cardiovascular and all-cause mortality. Further studies are warranted to confirm these results in other populations.

4. Iannotti N(1), Gazzola L(1), Savoldi A(1), Suardi E(1), Cogliandro V(1), Bai F(1), Magenta A(2), Peri M(2), Bini T(1), Marchetti G(1), Monforte Ad(1). Association between abdominal aortic calcifications, bone mineral density and vertebral fractures in a cohort of HIV-positive patients. J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19715. doi: 10.7448/IAS.17.4.19715. eCollection 2014.
Author information: (1)San Paolo Hospital, Clinic of Infectious Diseases, Milan, Italy. (2)San Paolo Hospital, Department of Radiology, Milan, Italy.

Abstract INTRODUCTION: Evidence from HIV-negative cohorts suggests a link between osteoporosis and cardiovascular disease. We evaluated the presence and distribution of abdominal aortic calcifications (AAC) and its correlation with bone mineral density (BMD) and vertebral fractures (VF) in a cohort of HIV-positive patients. MATERIALS AND METHODS: In this cross-sectional study, 280 asymptomatic HIV-positive patients from the SPID ("San Paolo" Infectious Diseases) cohort were submitted to lateral spine X-ray and DXA. AAC was identified using the AAC-8 score, which estimates the total length of calcification of the anterior and posterior aortic walls in front of vertebrae L1-L4. Low BMD was defined by T-score or Z-score <-1 at lumbar spine or femoral neck. VF were identified by morph-metric analysis of X-ray and were defined by the "spine deformity index" (SDI) ≥1 according to semiquantitative method by Genant. Associations between AAC, BMD and SDI were evaluated by univariate and multivariate logistic regression models. The relationship between the grade of AAC and SDI was evaluated by Spearman's correlation. RESULTS: AAC≥1 was present in 65 patients (23.2%); of these 15 patients showed moderate/severe calcifications (AAC>2). Low BMD was found in 163 patients (58.2%) and VF (SDI≥1) in 47/274 patients (17.1%). By univariate analysis, factors associated with AAC>=1 were: age (for additional 10 years older HR 3.81 [IC95% 2.64-5.51], p<0.0001) lower CD4 nadir (for additional 50 CD4 HR 0.89 [IC95% 0.82-0.97], p=0.01) AIDS-diagnosis (HR 2.13 [IC95 % 1.11-4.08], p=0.02) and being on HAART (HR 2.75 [IC95% 1.28-5.90], p=0.009). In multivariate analysis, only age (OR 2.62, IC95% 1.72-3.99, p<0.0001) resulted significantly associated with AAC≥1. Patients with AAC≥1 had twofold increase in the risk of low BMD (HR 2.45 [IC95% 1.32-4.45], p=0.004) and VF (SDI>=1: HR 2.17 [IC95% 1.1-4.2], p=0.02) compared to patients without AAC. The grade of AAC was directly correlated with the grade of SDI (rho=0.16; p=0.008): AAC>2 determines a sixfold increase in the risk of VF (HR 6.44 [IC95% 2.21-18.79], p=0.0006). AAC≥1 predict VF independently from BMD, vitamin D status and bone turnover marker (Table 1). CONCLUSIONS: In our HIV population, AAC resulted a strong predictor of both low BMD and VF, irrespective of factors involved in bone formation. The grade of AAC was directly correlated with the grade of VF.

5. Bruno G(1), Barutta F, Landi A, Pinach S, Caropreso P, Mengozzi G, Baldassarre S, Fragapani S, Civera S, Cavallo Perin P, Gruden G. Levels of N-terminal pro brain natriuretic peptide are enhanced in people with the uncomplicated metabolic syndrome: a case-cohort analysis of the population-based Casale Monferrato study. Diabetes Metab Res Rev. 2014 Nov 5. doi: 10.1002/dmrr.2616. [Epub ahead of print]
Author information: (1)Department of Medical Sciences, University of Turin, Turin, Italy.

Abstract BACKGROUND: Both metabolic syndrome (MetS) and N-amino terminal fragment of the prohormone B-type natriuretic peptide (NT-proBNP) confer increased risk of cardiovascular diseases (CVD). We assessed if NT-proBNP levels were greater in people with uncomplicated MetS, who had neither CVD/chronic kidney disease (CKD) nor diabetes, as compared with subjects who met none of the defining criteria of the MetS. METHODS: A case-cohort study from the non-diabetic population-based Casale Monferrato study was performed, after exclusion of all subjects with established CVD, CKD [estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) ], and CRP values ≥3 mg/L. Cases (n = 161) with MetS were compared with all subjects within the cohort (n = 124) who were completely free of any component of the MetS. Serum NT-proBNP was centrally measured by immunoenzymatic assay. RESULTS: NT-proBNP levels were significantly higher in cases than in control subjects [35.4 (15.5-98.2) vs 24.4 (11.7-49.6) pg/mL, p = 0.014]. In logistic regression analysis, compared with NT-proBNP values in the lower quartiles (≤49.64 pg/mL), higher values conferred odds ratio 4.17 (1.30-13.44) of having the MetS, independently of age, sex, microalbuminuria, CRP, eGFR, and central obesity. This association was evident even after the exclusion of hypertensive subjects. Further adjustment for log-HOMA and diastolic blood pressure did not modify the strength of the association, while central obesity was a negative confounder. CONCLUSIONS: Compared with people without any component of the MetS, those with uncomplicated MetS, who had neither CVD/CKD nor diabetes, had increased NT-proBNP values, even if they were normotensive and although absolute values were still in the low range. The insulin resistance state did not mediate this association, while central obesity was a negative confounder.

6. Elhai M(1), Avouac J(1), Walker UA(2), Matucci-Cerinic M(3), Riemekasten G(4), Airò P(5), Hachulla E(6), Valentini G(7), Carreira PE(8), Cozzi F(9), Balbir Gurman A(10), Braun-Moscovici Y(10), Damjanov N(11), Ananieva LP(12), Scorza R(13), Jimenez S(14), Busquets J(14), Li M(15), Müller-Ladner U(16), Kahan A(1), Distler O(17), Allanore Y(1); EUSTAR co-authors; EUSTAR co-authors. A gender gap in primary and secondary heart dysfunctions in systemic sclerosis: a EUSTAR prospective study. Ann Rheum Dis. 2014 Oct 23. pii: annrheumdis-2014-206386. doi: 10.1136/annrheumdis-2014-206386. [Epub ahead of print]
Collaborators: Guiducci S, Tyndall A, Lapadula G, Iannone F, Becvar R, Sierakowsky S, Bielecka OK, Cutolo M, Sulli A, Cuomo G, Vettori S, Rednic S, Nicoara I, Vlachoyiannopoulos P, Montecucco C, Caporali R, Novak S, Czirják L, Varju C, Chizzolini C, Kucharz EJ, Kotulska A, Kopec-Medrek M, Widuchowska M, Rozman B, Mallia C, Coleiro B, Gabrielli A, Farge D, Hij A, Hesselstrand R, Scheja A, Wollheim F, Martinovic D, Govoni M, Monaco AL, Hunzelmann N, Pellerito R, Bambara LM, Caramaschi P, Black C, Denton C, Henes J, Santamaria VO, Heitmann S, Krasowska D, Seidel M, Oleszowsky M, Burkhardt H, Himsel A, Salvador MJ, Stamenkovic B, Stankovic A, Tikly M, Starovoytova MN, Engelhart M, Strauss G, Nielsen H, Damgaard K, Szücs G, Zea Mendoza A, de la Puente Buijdos C, Sifuentes Giraldo WA, Midtvedt O, Garen T, Launay D, Valesini G, Riccieri V, Ionescu RM, Opris D, Groseanu L, Wigley FM, Mihai CM, Cornateanu RS, Ionitescu R, Gherghe AM, Gorga M, Dobrota R, Bojinca M, Schett G, Distler JH, Meroni P, Zeni S, Mouthon L, Keyser FD, Smith V, Cantatore FP, Corrado A, Ullman S, Iversen L, Pozzi MR, Eyerich K, Hein R, Knott E, Szechinski J, Wiland P, Szmyrka-Kaczmarek M, Sokolik R, Morgiel E, Krummel-Lorenz B, Saar P, Aringer M, Günther C, Anic B, Baresic M, Mayer M, Radominski SC, Müller CD, Azevedo VF, Agachi S, Groppa L, Chiaburu L, Russu E, Zenone T, Stebbings S, Highton J, Stamp L, Chapman P, Baron M, O'Donnell J, Solanki K, Doube A, Veale D, O'Rourke M, Loyo E, Rosato E, Pisarri S, Tanaseanu CM, Popescu M, Dumitrascu A, Tiglea I, Chirieac R, Ancuta C, Furst DE, Kafaja S, Lefebvre PG, Rubio SR, Exposito MV, Sibilia J, Chatelus E, Gottenberg JE, Chifflot H, Litinsky I, Venalis A, Butrimiene I, Venalis P, Rugiene R, Karpec D, Kerzberg E, Montoya F, Cosentino V. Author information: (1)Department of Rheumatology A, Paris Descartes University, Cochin Hospital, Paris, France. (2)Department of Rheumatology, Basel University, Unispital Basel, Basel, Switzerland. (3)Department of Experimental and Clinical Medicine, Section of Internal Medicine and Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi (AOUC), University of Florence, Florence, Italy. (4)Department of Rheumatology, Charitè University Hospital, Berlin, German Rheumatism Research Centre Berlin (DRFZ), a Leibniz institute, Berlin, Germany. (5)UO Reumatologia ed Immunologia Clinica Spedali Civili Brescia, Brescia, Italy. (6)Department of Internal Medicine, Hôpital Claude Huriez, University Lille Nord-de-France, Lille cedex, France. (7)Department of Clinical and Experimental Medicine "F-Magrassi" II, Naples, Italy. (8)Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain. (9)Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy. (10)B. Shine Department of Rheumatology, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel. (11)Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia. (12)Institute of Rheumatology, Russian Academy of Medical Science, Moscow, Russia. (13)U.O. Immunologia Clinica-Centro di Riferimento per le Malattie Autoimmuni Sistemiche, Milano, Italy. (14)Scleroderma Center of Thomas Jefferson University, Philadelphia, Pennsylvania, USA. (15)Department of Rheumatology, Peking Union Medical College Hospital (West Campus), Chinese Academy of Medical Sciences, Beijing, China. (16)Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic, Bad Nauheim, Germany. (17)Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland.

Abstract OBJECTIVES: In agreement with other autoimmune diseases, systemic sclerosis (SSc) is associated with a strong sex bias. However, unlike lupus, the effects of sex on disease phenotype and prognosis are poorly known. Therefore, we aimed to determine sex effects on outcomes. METHOD: We performed a prospective observational study using the latest 2013 data extract from the EULAR scleroderma trials and research (EUSTAR) cohort. We looked at (i) sex influence on disease characteristics at baseline and (ii) then focused on patients with at least 2 years of follow-up to estimate the effects of sex on disease progression and survival. RESULTS: 9182 patients with SSc were available (1321 men) for the baseline analyses. In multivariate analysis, male sex was independently associated with a higher risk of diffuse cutaneous subtype (OR: 1.68, (1.45 to 1.94); p<0.001), a higher frequency of digital ulcers (OR: 1.28 (1.11 to 1.47); p<0.001) and pulmonary hypertension (OR: 3.01 (1.47 to 6.20); p<0.003). In the longitudinal analysis (n=4499), after a mean follow-up of 4.9 (±2.7) years, male sex was predictive of new onset of pulmonary hypertension (HR: 2.66 (1.32 to 5.36); p=0.006) and heart failure (HR: 2.22 (1.06 to 4.63); p=0.035). 908 deaths were recorded, male sex predicted deaths of all origins (HR: 1.48 (1.19 to 1.84); p<0.001), but did not significantly account for SSc-related deaths. CONCLUSIONS: Although more common in women, SSc appears as strikingly more severe in men. Our results obtained through the largest worldwide database demonstrate a higher risk of severe cardiovascular involvement in men. These results raise the point of including sex in the management and the decision-making process.

7. Mazza A(1), Zamboni S, Ramazzina E, Schiavon L, Rempelou P, Zorzan S, Bascelli A, Segato R, Redi R, Pagnin E, Camerotto A, Zuin M, Rizzato E, Marcolongo A, Orsini A, Rubello D, Casiglia E. The ROVIGO Study (Risk of Vascular Complications: Impact of Genetics in Old people): Protocol, Study Design, and Preliminary Results of the Initial Survey : Cardiovascular epidemiology in the elderly. High Blood Press Cardiovasc Prev. 2014 Oct 23. [Epub ahead of print]
Author information: (1)Hypertension Centre Certified by the Italian Society of Hypertension, Santa Maria della Misericordia General Hospital, Rovigo, Italy, mazza.alberto@azisanrovigo.it.

Abstract BACKGROUND: The epidemiology of cardiovascular risk (CV) in the elderly is far from being defined, and the reasons why some subjects retain a healthy body while growing old while others are affected by different diseases or die prematurely are still unknown. AIMS: To compare the CV risk pattern in two elderly cohorts living in North-East Italy. MATERIALS AND METHODS: The Risk Of Vascular complications: Impact of Genetics in Old people (ROVIGO) study is a population-based study including 580 unrelated elderly subjects representative of general population living in Rovigo in the Veneto region. They were compared to a cohort of 580 age-gender-matched unrelated subjects from the CArdiovascular STudy in the Elderly (CASTEL) living in the same region in Castelfranco Veneto and Chioggia. RESULTS: Blood pressure (BP), heart rate (HR), low-density-lipoprotein cholesterol, and prevalence of coronary heart disease, heart failure and chronic pulmonary disease were lower in the ROVIGO than in the CASTEL cohort, while high-density-lipoprotein cholesterol and the prevalence of diabetes were higher in the former than in the latter. In the ROVIGO cohort, diabetes, left ventricular hypertrophy, coronary and cerebrovascular diseases were more represented in men. In the CASTEL cohort, systolic BP was higher in women. In both cohorts, the lipid pattern was less favourable and HR higher in women, chronic pulmonary disease more represented in men. CONCLUSIONS: People living in Rovigo were at lower CV risk than those in Castelfranco Veneto and Chioggia, mainly due to lower BP values, better lipid pattern and lower prevalence of CV and pulmonary disease.

8. Rubattu S(1), De Giusti M, Farcomeni A, Abbolito S, Comito F, Cangianiello S, Greco ES, Dito E, Pagliaro B, Cotugno M, Stanzione R, Marchitti S, Bianchi F, Di Castro S, Battistoni A, Burocchi S, Caprinozzi M, Pierelli G, Sciarretta S, Volpe M. T2238C ANP gene variant and risk of recurrent acute coronary syndromes in an Italian cohort of ischemic heart disease patients. J Cardiovasc Med (Hagerstown). 2014 Sep 23. [Epub ahead of print]
Author information: (1)aIRCCS Neuromed, Pozzilli bDept. of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Ospedale S. Andrea, Rome cDept. of Science of Public Health and Infectious Diseases, School of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy.

Abstract BACKGROUND: The role of C2238/atrial natriuretic peptide (ANP) minor allele, at the T2238C ANP gene variant, as a predisposing risk factor for acute cardiovascular events, has been previously reported. We aimed at evaluating, by a retrospective approach, the long-term impact of C2238/ANP-minor allele carrier status toward the risk of recurrent acute coronary syndromes (re-ACS) in an Italian cohort of ischemic heart disease patients. METHODS: A total of 379 patients (males = 80.5%; mean age = 62.5 ± 9.2 years) presenting with ACS were retrospectively analyzed. Mean follow-up was 5.1 ± 3.5 years (range 1-26 years). Occurrence of new episodes of unstable angina, non-ST-segment elevation myocardial infarction and STE myocardial infarction over the years was recorded and compared between subjects not carrying and carrying C2238/ANP-minor allele. RESULTS: At univariate analysis, C2238/ANP-minor allele carrier status and treatment with beta-blocker, aspirin and statin were associated with risk of re-ACS. Multivariate analysis confirmed that hypercholesterolemia (P < 0.0001) and C2238/ANP-minor allele carrier status (P < 0.05) were both significantly and independently associated with increased risk of re-ACS. Both treatments with beta-blocker and with statin were significantly associated with reduced risk of re-ACS (P = 0.01 and P < 0.01, respectively). Age above 55 years was associated with recurrence of ACS in C2238/ANP-minor allele carriers (hazard ratio 1.427, 95% confidence interval 1.066-1.911, P = 0.017). Kaplan-Meier curves confirmed highest risk of new events occurrence in C2238/ANP-minor allele carriers (P = 0.035). CONCLUSIONS: The present results demonstrate that C2238/ANP-minor allele carrier status is an independent risk factor for ACS recurrence in an Italian cohort of ischemic heart disease patients over the long term, and they support the role of C2238/ANP-minor allele as a negative prognostic factor in coronary artery disease patients.

9. Dongiovanni P(1), Petta S, Maglio C, Fracanzani AL, Pipitone R, Mozzi E, Motta BM, Kaminska D, Rametta R, Grimaudo S, Pelusi S, Montalcini T, Alisi A, Maggioni M, Kärjä V, Borén J, Käkelä P, Di Marco V, Xing C, Nobili V, Dallapiccola B, Craxi A, Pihlajamäki J, Fargion S, Sjöström L, Carlsson LM, Romeo S, Valenti L. TM6SF2 gene variant disentangles nonalcoholic steatohepatitis from cardiovascular disease. Hepatology. 2014 Sep 24. doi: 10.1002/hep.27490. [Epub ahead of print]
Author information: (1)Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milano, Milan, Italy.

Abstract Excess hepatic storage of triglycerides is considered a benign condition, but nonalcoholic steatohepatitis may progress to fibrosis and may promote atherosclerosis. Carriers of the TM6SF2 E167K variant have fatty liver due to reduced secretion of very low density lipoproteins. As a result, they have lower circulating lipids and reduced risk of myocardial infarction. In this study, we aimed to assess whether TM6SF2 E167K affects liver damage and cardiovascular outcomes in subjects at risk of nonalcoholic steatohepatitis. Liver damage was evaluated in 1201 patients who underwent liver biopsy for suspected nonalcoholic steatohepatitis; 427 were evaluated for carotid atherosclerosis. Cardiovascular outcomes were assessed in 1819 controls from the Swedish Obese Subjects cohort.Presence of the inherited TM6SF2 E167K variant was determined by Taqman assays. In the liver biopsy cohort, 188 subjects (13%) were carriers of the E167K variant. They had lower serum lipid levels than noncarriers (P<0.05), had more severe steatosis, necroinflammation, ballooning, and fibrosis (P<0.05), and were more likely to have nonalcoholic steatohepatitis (OR 1.84, 95% CI 1.23-2.79) and advanced fibrosis (OR 2.08, 95% CI 1.20-3.55), after adjustment for age, sex, body mass index, fasting hyperglycemia, and the I148M PNPLA3 risk variant. However, E167K carriers had lower risk of developing carotid plaques (OR 0.49, 95% CI 0.25-0.94). In the Swedish Obese Subjects cohort, E167K carriers had higher ALT and lower lipid levels (P<0.05), and a lower incidence of cardiovascular events (HR 0.61, 95% CI 0.39-0.95). Conclusions: Carriers of the TM6SF2 E167K variant are more susceptible to progressive nonalcoholic steatohepatitis, but are protected against cardiovascular disease. Our findings suggest that reduced ability to export very low density lipoproteins is deleterious for the liver. (Hepatology 2014;).

10. Vishram JK(1), Borglykke A(2), Andreasen AH(2), Jeppesen J(3), Ibsen H(4), Jørgensen T(2), Palmieri L(5), Giampaoli S(5), Donfrancesco C(5), Kee F(6), Mancia G(7), Cesana G(8), Kuulasmaa K(9), Salomaa V(9), Sans S(10), Ferrieres J(11), Dallongeville J(12), Söderberg S(13), Arveiler D(14), Wagner A(14), Tunstall-Pedoe H(15), Drygas W(16), Olsen MH(17); MORGAM Project. Impact of age and gender on the prevalence and prognostic importance of the metabolic syndrome and its components in Europeans. The MORGAM Prospective Cohort Project. PLoS One. 2014 Sep 22;9(9):e107294. doi: 10.1371/journal.pone.0107294. eCollection 2014.
Author information: (1)Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark; Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark. (2)Research Centre for Prevention and Health, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark. (3)Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark. (4)Division of Cardiology, Holbæk University Hospital, Holbæk, Denmark. (5)Cerebro and Cardiovascular Epidemiology Unit, National Centre of Epidemiology Surveillance and Health Promotion, National Institute of Health, Rome, Italy. (6)UKCRC Centre of Excellence for Public Health Research (NI), The Queen's University of Belfast, Belfast, Northern Ireland. (7)Clinica Medica e Istituto Auxologico Italiano, Monza, Milano, Italy. (8)Research Centre on Public Health, University of Milano Bicocca, Monza, Italy. (9)National Institute for Health and Welfare (THL), Helsinki, Finland. (10)Department of Health, Barcelona, Spain. (11)Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France. (12)Institut Pasteur de Lille, Lille, France. (13)Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Umeå, Sweden. (14)Department of Epidemiology and Public Health, University of Strasbourg, Faculty of Medicine, Strasbourg, France. (15)Cardiovascular Epidemiology Unit, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom. (16)Department of Epidemiology, CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland. (17)Department of Endocrinology, Center of Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark, and Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.

Abstract OBJECTIVE: To investigate the influence of age and gender on the prevalence and cardiovascular disease (CVD) risk in Europeans presenting with the Metabolic Syndrome (MetS). METHODS: Using 36 cohorts from the MORGAM-Project with baseline between 1982-1997, 69094 men and women aged 19-78 years, without known CVD, were included. During 12.2 years of follow-up, 3.7%/2.1% of men/women died due to CVD. The corresponding percentages for fatal and nonfatal coronary heart disease (CHD) and stroke were 8.3/3.8 and 3.1/2.5. RESULTS: The prevalence of MetS, according to modified definitions of the International Diabetes Federation (IDF) and the revised National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII), increased across age groups for both genders (P<0.0001); with a 5-fold increase in women from ages 19-39 years to 60-78 years (7.4%/7.6% to 35.4%/37.6% for IDF/NCEP-ATPIII) and a 2-fold increase in men (5.3%/10.5% to 11.5%/21.8%). Using multivariate-adjusted Cox regressions, the associations between MetS and all three CVD events were significant (P<0.0001). For IDF/NCEP-ATPIII in men and women, hazard ratio (HR) for CHD was 1.60/1.62 and 1.93/2.03, for CVD mortality 1.73/1.65 and 1.77/2.06, and for stroke 1.51/1.53 and 1.58/1.77. Whereas in men the HRs for CVD events were independent of age (MetS*age, P>0.05), in women the HRs for CHD declined with age (HRs 3.23/3.98 to 1.55/1.56; MetS*age, P=0.01/P=0.001 for IDF/NCEP-ATPIII) while the HRs for stroke tended to increase (HRs 1.31/1.25 to 1.55/1.83; MetS*age, P>0.05). CONCLUSION: In Europeans, both age and gender influenced the prevalence of MetS and its prognostic significance. The present results emphasise the importance of being critical of MetS in its current form as a marker of CVD especially in women, and advocate for a redefinition of MetS taking into account age especially in women.

11. Corrao G(1), Soranna D, Merlino L, Mancia G. Similarity between generic and brand-name antihypertensive drugs for primary prevention of cardiovascular disease: evidence from a large population-based study. Eur J Clin Invest. 2014 Oct;44(10):933-9. doi: 10.1111/eci.12326.
Author information: (1)Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.

Abstract BACKGROUND: Although generic and earlier brand-name counterparts are bioequivalent, their equivalence in preventing relevant clinical outcomes is of concern. OBJECTIVE: To compare effectiveness of generic and brand-name antihypertensive drugs for preventing the onset of cardiovascular (CV) outcomes. DESIGN AND SUBJECTS: A population-based, nested case-control study was carried out by including the cohort of 78 520 patients from Lombardy (Italy) aged 18 years or older who were newly treated with antihypertensive drugs during 2005. Cases were the 2206 patients who experienced a hospitalization for CV disease from initial prescription until 2011. One control for each case was randomly selected from the same cohort that generated cases. Logistic regression was used to model the CV risk associated with starting on and/or continuing with generic or brand-name agents. RESULTS: There was no evidence that patients who started on generics experienced different CV risk than those on brand-name product (OR 0•86; 95% CI 0•63-1•17). Patients at whom generics were main dispensed had not significantly difference in CV outcomes than those mainly on brand-name agents (OR 1•19; 95% CI 0•86-1•63). Compared with patients who kept initial brand-name therapy, those who experienced brand-to-generic or generic-to-brand switches, and those always on generics, did not show differential CV risks, being the corresponding ORs (and 95% CIs), 1•18 (0•96-1•47), 0•87 (0•63-1•21) and 1•08 (0•80-1•46). CONCLUSIONS: Our findings do not support the notion that brand-name antihypertensive agents are superior to generics for preventing CV outcomes in the real-world clinical practice.

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