Effect of ageing on carotid artery morphology, hemodynamics, and the development of atherosclerosis.

Cardiovascular diseases and ageing are two main challenges for health services. Cardiovascular disease is characterised by atherosclerosis, leading to heart attack and stroke. Atherosclerosis is a focal disease and occurs preferentially in regions of arterial bifurcation and curvature where complex flow features are observed. The carotid arteries represent a region of significant involvement in atherosclerosis. Previous studies have shown that haemodynamic factors are important determinants of the local distribution of atherosclerosis. However, longitudinal studies are lacking. The aim of this study was to investigate age-related changes in carotid artery morphology and haemodynamics based on longitudinal data acquired from a group of middle-aged subjects recruited to a cardiovascular disease prevention programme in Italy. The longitudinal study started in 1996 and participants were examined twice 12 years apart. All subjects underwent blood viscosity measurements and echo-Doppler examinations of the common carotid artery at baseline and follow-up. From the acquired ultrasound data, common carotid artery diameter, blood flow velocity, and intima-media thickness were measured, and wall shear stress, circumferential wall tension and Peterson elastic modulus were calculated. It was found that with ageing, blood viscosity increased, common carotid artery diameter increased, mean blood velocity and wall shear stress decreased, while intima-media thickness, circumferential wall tension and arterial stiffness increased. Interrelationships of the data were also examined: reductions in common carotid wall shear stress were independently associated with intima-media thickening. Furthermore, ageing-associated wall shear stress reduction predicted the development of atherosclerotic plaques, independently of known cardiovascular risk factors. In addition, in participants presenting shear stress reductions in only one side of the common carotid artery, development of atherosclerosis in the carotid tree was limited to the same body side. In conclusion, this longitudinal study confirms the role of arterial wall shear stress as a mediator of the effects of ageing on atherosclerosis.Open Acces

Markers of insulin resistance and carotid atherosclerosis. A comparison of the homeostasis model assessment and triglyceride glucose index.

Summary Aims The present investigation was designed to test the association between carotid atherosclerosis and two simple markers of insulin resistance, i.e. HOMA-Index and TyG-Index. Materials and methods The study was performed in two different cohorts. In the first cohort, 330 individuals were enrolled. Blood pressure, lipids, glucose, waist and cigarette smoking were evaluated. HOMA-IR and TyG-Index were calculated as markers of prevalent hepatic and muscular insulin resistance respectively. Carotid atherosclerosis was assessed by Doppler ultrasonography. The association between cardiovascular risk factors, markers of insulin resistance and carotid atherosclerosis was assessed by multiple logistic regression analyses. In the second cohort, limited to the evaluation of TyG-Index, 1432 subjects were studied. Results In the first cohort, TyG-Index was significantly associated with carotid atherosclerosis in a model including age, sex, diabetes, cigarette smoking and LDL cholesterol, while HOMA-IR was not. When components of metabolic syndrome were added to the model as dichotomous variables (absent/present), TyG-Index retained its predictive power. The same result was obtained when the metabolic syndrome was added to the model (absence/presence). The association between TyG-Index and carotid atherosclerosis was confirmed in the second cohort. Conclusions The present findings suggest that TyG-Index is better associated with carotid atherosclerosis than HOMA-IR

Sistema informativo integrato multipiattaforma per la promozione e l’esperienza consapevole del territorio laziale

Il progetto è finalizzato a promuovere, rafforzare ed arricchire l’esperienza consapevole del territorio laziale e il complesso dei beni territoriali e culturali che esso offre e a produrre valore aggiunto territoriale. Nell’ottica di perseguire un modello innovativo di Smart Tourism e al tempo stesso di Smart Environments, l’approccio utilizzato è stato di tipo bottom up volto a favorire processi di partecipazione, co-progettazione e consapevolezza tra la comunità locale in una logica di sistema, orientata a creare servizi turistici utili a migliorare la fruizione del patrimonio dei beni geografici e il legame delle popolazioni con il proprio territorio

Autoimmune thyroiditis and celiac disease do not worsen endothelial function in subjects with type 1 diabetes: an observational study

Abstract Background Type 1 diabetes (T1D) is frequently associated with autoimmune thyroiditis (AT) and coeliac disease (CD). Whether the coexistence of multiple autoimmune diseases increases cardiovascular risk is uncertain. We evaluated the effects of AT and CD on arterial wall thickening and endothelial function in patients with T1D. Methods This observational study analyzed data from T1D patients regularly followed by the Diabetes Care Centre. Clinical and biochemical characteristics and micro and macrovascular complications were collected from the electronic medical records. All subjects performed Echo-Doppler to evaluate Intima-Media Thickness (IMT) of the common carotid artery (CCA) and endothelial function by the flow-mediated dilation (FMD) technique. The statistical analyses were performed by SPSS for Macintosh. Comparison between means was performed using the t-test for unpaired data and the Mann–Whitney U test. The ANalysis Of VAriance and the Tukey posthoc test were applied to compare patients with and without other autoimmune diseases, and control subjects. The p-value for statistical significance was set at p < 0.05. Results A total of 110 patients were enrolled. Among these, 69 had T1D and 41 T1D and AT and or CD, of whom 33 AT, 7 CD, and 1 both AT and CD. The mean age was 35 years, mean HbA1c was 7.6%, and mean diabetes duration 18 years. The IMT of the CCA was not significantly different between T1D patients with and without concomitant autoimmune diseases (with AT and CD: right CCA 603 ± 186 µ, left 635 ± 175 µ; without AT and CD: right CCA 611 ± 176 µ, left CCA 631 ± 200 µ). FMD was also comparable between T1D groups, with AT and CD 7.9 ± 4.2%; without AT and CD 8.8 ± 4.4%. Conclusion Patients with T1D and concomitant AT and or CD show no worse morphological or functional vascular damage, evaluated by CCA IMT and brachial artery flow-mediated dilation, than patients with T1D alone

Management of Type 2 Diabetes Mellitus through Telemedicine.

Type 2 diabetes mellitus T2DM has a huge and growing burden on public health, whereas new care models are not implemented into clinical practice; in fact the purpose of this study was to test the effectiveness of a program of integrated care for T2DM, compared with ordinary diligence."Progetto Diabete Calabria" is a new organizational model for the management of patients with diabetes mellitus, based on General Practitioners (GPs) empowerment and the use of a web-based electronic health record, shared in remote consultations among GPs and Hospital Consultants. One-year change in glucose and main cardiovascular risk factors control in 104 patients (Cases) following this integrated care program has been evaluated and compared with that of 208 control patients (Controls) matched for age, gender, and cardiometabolic profile, and followed in an ordinary outpatient medical management by the Consultants only. Both patient groups had Day Hospitals before and after the study period.The mean number of accesses to the Consultants during the study was 0.6 ± 0.9 for Cases, and 1.3 ± 1.5 for Controls (p<0.0001). At follow-up, glycated hemoglobin (HbA1c) significantly decreased from 58 ± 6 to 54 ± 8 mmol/mol in Cases only (p=0.01); LDL cholesterol decreased in both groups; body mass index decreased in Cases only, from 31.0 ± 4.8 to 30.5 ± 4.6 kg/m(2) (p=0.03).The present study demonstrates that a health care program based on GPs empowerment and taking care plus remote consultation with Consultants is at least as effective as standard outpatient management, in order to improve the control of T2DM