Evidence on the prevalence and geographic distribution of major cardiovascular risk factors in Italy

Objective: To assess the prevalence and geographic distribution of major cardiovascular risk factors in a large community-wide sample of the Italian population. Design: A cross-sectional survey. Standardized methods were used to collect and measure cardiovascular risk factors. Data were adjusted for survey weightings. Qualitative and quantitative variables were compared with parametric and non-parametric tests, as appropriate. Setting: Towns (n 193) across different Italian regions. Subjects: Unselected adults (n 24 213; 12 626 men; 11 587 women) aged 18–98 years (mean age 56·9 (sd 15·3) years), who volunteered to participate in a community-wide screening programme over a 2 d period in 2007. Results: Overall, the prevalence of major cardiovascular risk factors was: obesity, 22·7 % (women 18·9 %, men 26·1 %); overweight, 44·7 % (women 31·6 %, men 56·7 %); hypertension, 59·6 % (women 48·3 %, men 70·0 %); dyslipidaemia, 59·1 % (women 57·7 %, men 60·3 %); diabetes, 15·3 % (women 11·2 %, men 19·0 %) and smoking, 19·8 % (women 14·0 %, men 25·2 %). We found a high prevalence of unhealthy eating habits; fruit and vegetable consumption was below the recommended range in 60 % of the study population. Ninety per cent of the study population had more than one cardiovascular risk factor and 84 % had between two and five cardiovascular risk factors. There were differences among Italian macro-areas mainly for obesity, hypertension, dyslipidaemia and diabetes. Conclusions: The study provides alarming evidence on current prevalence data for major cardiovascular risk factors in a large sample of the Italian population. Particularly, obesity and hypertension represent a relevant public health problem. There is a pressing need for effective preventive health measures which must also take into account the differences among Italian macro-areas

Evidence That p-Cresol and IL-6 Are Adsorbed by the HFR Cartridge: Towards a New Strategy to Decrease Systemic Inflammation in Dialyzed Patients?

Introduction Hemodialysis (HD) and hemodiafiltration clear only with a low efficiency the plasma from interleukin-6 and p-cresol, two protein-bound uremic toxins associated with high cardiovascular risk in end stage renal disease. HFR Supra is a double-chamber hemodiafiltration system in which the ultrafiltrate returns to the patient after its regeneration through a resin cartridge that binds hydrophobic and protein-bound solutes. In the present study, we evaluated whether the HFR cartridge can also bind total p-cresol and IL-6 and remove them from the ultrafiltrate. Methods We compared the levels of IL-6 and p-cresol in ultrafiltrate samples collected at the inlet (UFin) and at the outlet (UFout) of the cartridge at the start or at the end of a 240 min HFR session in 12 inflamed chronic HD patients. The pro-inflammatory activity of the ultrafiltrate samples was also determined by evaluating the changes that they induced in IL-6 mRNA expression and protein release in peripheral blood mononuclear cells from 12 healthy volunteers. IL-6 and p-cresol circulating levels were also assessed in peripheral plasma blood samples collected before and after HFR and, for comparison, a control HD. Results p-Cresol and IL-6 were lower in UFout than in UFin both at the start and at the end of the HFR session, suggesting that they were retained by the cartridge. IL-6 mRNA expression and release were lower in PBMC incubated with UFout collected at the end than with UFin collected at the start of HFR, suggesting that passage through the cartridge reduced UF pro-inflammatory activity. Plasma total p-cresol decreased by about 53% after HFR, and 37% after HD. IL-6 circulating values were unmodified by either these dialysis procedures. Conclusions This study shows that the HFR-Supra cartridge retains total p-cresol and IL-6 in the ultrafiltrate and lowers plasma total p cresol but not IL-6 levels. Trial Registration ClinicalTrials.gov NCT0186577

Dietary Intake as a Link between Obesity, Systemic Inflammation, and the Assumption of Multiple Cardiovascular and Antidiabetic Drugs in Renal Transplant Recipients.

Abstract We evaluated dietary intake and nutritional-inflammation status in ninety-six renal transplant recipients, 7.2±5.0 years after transplantation. Patients were classified as normoweight (NW), overweight (OW), and obese (OB), if their body mass index was between 18.5 and 24.9, 25.0 and 29.9, and ≥30 kg/m2, respectively. Food composition tables were used to estimate nutrient intakes. The values obtained were compared with those recommended in current nutritional guidelines. 52% of the patients were NW, 29% were OW, and 19% were OB. Total energy, fat, and dietary n-6 PUFAs intake was higher in OB than in NW. IL-6 and hs-CRP were higher in OB than in NW. The prevalence of multidrug regimen was higher in OB. In all patients, total energy, protein, saturated fatty acids, and sodium intake were higher than guideline recommendations. On the contrary, the intake of unsaturated and n-6 and n-3 polyunsaturated fatty acids and fiber was lower than recommended. In conclusion, the prevalence of obesity was high in our patients, and it was associated with inflammation and the assumption of multiple cardiovascular and antidiabetic drugs. Dietary intake did not meet nutritional recommendations in all patients, especially in obese ones, highlighting the need of a long-term nutritional support in renal transplant recipients

Plasma p-Cresol Lowering Effect of Sevelamer in Peritoneal Dialysis Patients: Evidence from a Cross-Sectional Observational Study.

p-Cresol is a by-product of the metabolism of aromatic aminoacid operated by resident intestinal bacteria. In patients with chronic kidney disease, the accumulation of p-cresol and of its metabolite p-cresyl-sulphate, that represents more than 95% of circulating p-cresol, causes endothelial dysfunction and ultimately increases the cardiovascular risk of these patients. Therapeutic strategies able to reduce plasma p-cresol levels are highly demanded but unfortunately not available yet. Because it has been reported that the phosphate binder sevelamer also sequesters p-cresol in vitro we hypothesized that it could do so also in peritoneal dialysis patients. To explore this hypothesis we measured total cresol plasma concentrations in 57 patients with end-stage renal disease on peritoneal dialysis patients, 29 receiving sevelamer for the treatment of hyperphosphatemia and 28 patients not assuming this drug. Among the patients not assuming sevelamer, 16 were treated with lanthanum whereas the remaining 12 received no drug because they were not hyperphosphatemic. When we compared total p-cresol plasma concentrations in these different groups of patients, we, we found that plasma p-cresol levels were significantly lower in patients receiving sevelamer than in subjects receiving lanthanum or no drug. Patients assuming sevelamer had also lower high sensitivity C-reactive protein serum concentrations compared to patients not assuming this drug. Multiple linear regression analysis showed that Conversely, no difference either in residual glomerular filtration rate, total weekly dialysis dose or serum phosphate levels were observed among the different groups. These results suggest that sevelamer could be an effective strategy to lower p-cresol circulating levels in peritoneal dialysis patients in which it could also favorably affect the cardiovascular risk because of its anti-inflammatory effect

Human Mature Adipocytes Express Albumin and This Expression Is Not Regulated by Inflammation

Aims. Our group investigated albumin gene expression in human adipocytes, its regulation by inflammation and the possible contribution of adipose tissue to albumin circulating levels. Methods. Both inflamed and healthy subjects provided adipose tissue samples. RT-PCR, Real-Time PCR, and Western Blot analysis on homogenates of adipocytes and pre-adipocytes were performed. In sixty-three healthy subjects and fifty-four micro-inflamed end stage renal disease (ESRD) patients circulating levels of albumin were measured by nephelometry; all subjects were also evaluated for body composition, calculated from bioelectrical measurements and an thropometric data. Results. A clear gene expression of albumin was showed in pre-adipocytes and, for the first time, in mature adipocytes. Albumin gene expression resulted significantly higher in pre-adipocytes than in adipocytes. No significant difference in albumin gene expression was showed between healthy controls and inflamed patients. A significant negative correlation was observed between albumin levels and fat mass in both healthy subjects and inflamed ESRD patients. Conclusions. In the present study we found first time evidence that human adipocytes express albumin. Our results also showed that systemic inflammation does not modulate albumin gene expression. The negative correlation between albumin and fat mass seems to exclude a significant contributing role of adipocyte in plasma albumin

High Risk of Secondary Infections Following Thrombotic Complications in Patients With COVID-19

Background. This study’s primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications. Methods. This was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray’s method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections. Results. Overall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8–11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7–21.0) and 9.3 (95% CI, 7.9–11.0) per 1000-PDFU, respectively (P = .017). At multivariable analysis, thrombotic complications were associated with the development of secondary infections (subdistribution hazard ratio, 1.788; 95% CI, 1.018–3.140; P = .043). The etiology of secondary infections was similar in patients with and without thrombotic complications. Conclusions. In patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

Memorie del vuoto apparente. Ambiance sguardi e percezioni dal carcere di Buoncammino a Cagliari

La città narra sé stessa attraverso la sua costituzione fisica, la sua immagine spaziale e le sue ambiances, atmosfere sensibili e sintesi delle percezioni multiple che l’esperienza urbana produce. E, d’altra parte, l’urbano trova la sua identità significante attraverso l’uso e le pratiche, le memorie stratificate, individuali e collettive e in costante divenire. Da questo ancestrale rapporto dialettico e rappresentazionale tra società umane e spazi urbani, emergono configurazioni spaziali “generative”[1] legate agli intensi effetti determinati dall’interazione tra spazi, percezioni, luoghi, memorie, pratiche. Il vuoto (di senso più che nella trama costruita) assume, in questa visione, una doppia chiave interpretativa: da un lato è ciò che permette di cingere con i sensi la materia sedimentata, dall’altro si interpreta come mancanza, assenza di vita e di attività. Ma questo è solo apparente. La memoria resiste nel vuoto, custodisce e rinvia, si svela allo sguardo attento e si mostra capace di indurre rinnovate significazioni. Le grandi fabbriche urbane dismesse, e tra esse le carceri, racchiudono un patrimonio ricco di storie; possiedono una memoria, legata alle esperienze, ai fatti, ai racconti, alle suggestioni. Indotta dall’evocazione di alcune esperienze sensibili, ciò che segue è una narrazione multifocale del carcere cagliaritano di Buoncammino e del suo intorno, oggi grande vuoto apparente in attesa di nuovi (o vecchi) significati.The city tells of itself through its form, its spatial image and its ambiances, sensitive atmospheres and synthesis of the multiple perceptions produced by urban experience. And, on the other hand, the urban finds its significant identity through use and practices, stratified memories, individual and collective and in constant evolution. From this ancestral dialectical and representational relationship between human societies and urban spaces, emerge generative spatial configurations linked to the intense effects caused by the interaction between spaces, perceptions, places, memories, practices. The void (of meaning rather than in the plot) assumes, in this vision, a double interpretative key: on one side it is what allows us to embrace the sedimented matter with the senses, on the other it is interpreted as lack, absence of life and activities. But this is only apparent. Memory resists in the void, guards and resends, reveals itself to the watchful eye and it is capable of inducing renewed significations. The large abandoned urban complexes, and among them the prisons, contain a rich heritage of stories; they possess a memory, linked to experiences, facts, tales, suggestions. Induced by the evocation of some sensitive experiences, what follows is a multifocal narration of the Buoncammino prison in Cagliari and its surroundings, today a large apparent void waiting for new (or old) meanings

Memorie del vuoto apparente. Ambiance, sguardi e percezioni dal carcere di Buoncammino a Cagliari

The city tells of itself through its form, its spatial image and its ambiances, sensitive atmospheres and synthesis of the multiple perceptions produced by urban experience. And, on the other hand, the urban finds its significant identity through use and practices, stratified memories, individual and collective and in constant evolution. From this ancestral dialectical and representational relationship between human societies and urban spaces, emerge generative spatial configurations linked to the intense effects caused by the interaction between spaces, perceptions, places, memories, practices. The void (of meaning rather than in the plot) assumes, in this vision, a double interpretative key: on one side it is what allows us to embrace the sedimented matter with the senses, on the other it is interpreted as lack, absence of life and activities. But this is only apparent. Memory resists in the void, guards and resends, reveals itself to the watchful eye and it is capable of inducing renewed significations.The large abandoned urban complexes, and among them the prisons, contain a rich heritage of stories; they possess a memory, linked to experiences, facts, tales, suggestions. Induced by the evocation of some sensitive experiences, what follows is a multifocal narration of the Buoncammino prison in Cagliari and its surroundings, today a large apparent void waiting for new (or old) meanings.La città narra sé stessa attraverso la sua costituzione fisica, la sua immagine spaziale e le sue ambiances, atmosfere sensibili e sintesi delle percezioni multiple che l’esperienza urbana produce. E, d’altra parte, l’urbano trova la sua identità significante attraverso l’uso e le pratiche, le memorie stratificate, individuali e collettive e in costante divenire. Da questo ancestrale rapporto dialettico e rappresentazionale tra società umane e spazi urbani, emergono configurazioni spaziali “generative”[1] legate agli intensi effetti determinati dall’interazione tra spazi, percezioni, luoghi, memorie, pratiche. Il vuoto (di senso più che nella trama costruita) assume, in questa visione, una doppia chiave interpretativa: da un lato è ciò che permette di cingere con i sensi la materia sedimentata, dall’altro si interpreta come mancanza, assenza di vita e di attività. Ma questo è solo apparente. La memoria resiste nel vuoto, custodisce e rinvia, si svela allo sguardo attento e si mostra capace di indurre rinnovate significazioni. Le grandi fabbriche urbane dismesse, e tra esse le carceri, racchiudono un patrimonio ricco di storie; possiedono una memoria, legata alle esperienze, ai fatti, ai racconti, alle suggestioni. Indotta dall’evocazione di alcune esperienze sensibili, ciò che segue è una narrazione multifocale del carcere cagliaritano di Buoncammino e del suo intorno, oggi grande vuoto apparente in attesa di nuovi (o vecchi) significati. [1] Massey 199

Plasma p-cresol lowering effect of sevelamer in peritoneal dialysis patients: evidence from a Cross-Sectional Observational Study.

p-Cresol is a by-product of the metabolism of aromatic aminoacid operated by resident intestinal bacteria. In patients with chronic kidney disease, the accumulation of p-cresol and of its metabolite p-cresyl-sulphate causes endothelial dysfunction and ultimately increases the cardiovascular risk of these patients. Therapeutic strategies to reduce plasma p-cresol levels are highly demanded but not available yet. Because it has been reported that the phosphate binder sevelamer sequesters p-cresol in vitro we hypothesized that it could do so also in peritoneal dialysis patients. To explore this hypothesis we measured total cresol plasma concentrations in 57 patients with end-stage renal disease on peritoneal dialysis, 29 receiving sevelamer for the treatment of hyperphosphatemia and 28 patients not assuming this drug. Among the patients not assuming sevelamer, 16 were treated with lanthanum whereas the remaining 12 received no drug because they were not hyperphosphatemic. Patients receiving sevelamer had plasma p-cresol and serum high sensitivity C-reactive protein concentrations significantly lower than those receiving lanthanum or no drug. Conversely, no difference was observed among the different groups either in residual glomerular filtration rate, total weekly dialysis dose, total clearance, urine volume, protein catabolic rate, serum albumin or serum phosphate levels. Multiple linear regression analysis showed that none of these variables predicted plasma p-cresol concentrations that, instead, negatively correlated with the use of sevelamer. These results suggest that sevelamer could be an effective strategy to lower p-cresol circulating levels in peritoneal dialysis patients in which it could also favorably affect cardiovascular risk because of its anti-inflammatory effect