Aspirin for primary prevention of cardiovascular disease in diabetes mellitus

Aspirin is effective for the prevention of cardiovascular events in patients with a history of vascular disease, as so-called secondary prevention. In general populations with no history of previous myocardial infarction or stroke, aspirin also seems useful for primary prevention of cardiovascular events, although the absolute benefits are smaller than those seen in patients with previous cardiovascular disease. Patients with diabetes mellitus are at an increased risk of cardiovascular events, but new trials have raised questions about the benefit of aspirin for primary prevention in patients with this disorder. This Review comprehensively examines the basic pharmacology of aspirin and provides an overview of the randomized, controlled trials of aspirin therapy that have included patients with diabetes mellitus. On the basis of currently available evidence from primary prevention trials, aspirin is estimated to reduce the relative risk of myocardial infarction and stroke by about 10% in patients with diabetes mellitus; however, aspirin also increases the risk of gastrointestinal bleeding. As such, low-dose aspirin therapy (75–162 mg) is reasonable for patients with diabetes mellitus and a 10-year risk of cardiovascular events >10%. Results from upcoming large trials will help clarify the effects of aspirin with greater precision, including whether the benefits differ between men and women

Evidence based management of hypertension: Using cardiovascular risk profiles to individualise hypertensive treatment

This is the fourth in a series of five articles Individual risks must be assessed in order to for the best decision to be made as to which patients to treat and how. Assessment identifies important cardiovascular risk factors that may warrant treatment and helps to establish the absolute benefits that patients can expect from particular treatments. The benefits of treating hypertensive patients also vary, depending on each patient's competing risks of dying from other than cardiovascular causes. For example, patients with multiple serious conditions, such as end stage Alzheimer's disease, obstructive lung disease, frequent falls, gout, and urinary incontinence, have high competing risks that may minimise or negate the benefits of treating their hypertension. #### Summary points Several treatment options reduce risk of cardiovascular disease and improve outcomes in patients with hypertension Providers should consider the expected benefits and potential adverse effects of different treatment options and discuss them with patients The use of decision tools may help decision making about options for reducing cardiovascular risk Establishing treatment priorities for patients with multiple cardiovascular risk factors and multiple conditions is difficult. Factors such as those given in the box deserve consideration. Knowing and weighing up multiple risk factors, conditions, and treatments is difficult. Explaining them to patients is daunting and time consuming. Some patients prefer to be told what to do rather than to have to take in the diverse, complicated information necessary to make their

Rocket: a Mediterranean crop for the world: Report of a workshop,13-14 December 1996, Legnaro (Padova), Italy

This publication represents the outcome of the second meeting of the Rocket Genetic Resources Network, an initiative launched in 1994 in the framework of IPGRI's project on Underutilized Mediterranean Species (UMS). The proceedings contain scientific contributions related to genetic resources, breeding and cultivation aspects of rocket, representing an extremely useful tool for all those interested in the cultivation and improvement of this crop. In particular, the paper on cultivation in the Veneto region can well be considered the first thorough scientific presentation ever made of rocket cultivation techniques in greenhouse environments. Apart from this paper, other contributions from India, Israel, Portugal and Turkey provide an overview of the degree of cultivation, uses and popularity of the crop around the world. Chapter III on International Cooperation provides a useful insight into the activity of the Rocket Network and supplies information on the initiatives promoted by UMS for safeguarding the genetic resources of this multipurpose crop

Comparison of the Nutritional Quality of Branded and Private-Label Food Products Sold in Italy: Focus on the Cereal-Based Products Collected From the Food Labeling of Italian Products Study

The packaged foods sold in food stores may be \u201cprivate-label\u201d products (PL), when branded by the supermarket, and \u201cbranded\u201d products (BR). PL products are generally cheaper than the BR counterparts, and this can be perceived as a sign of general low quality by consumers, when items are compared with their branded counterparts. Thus, the aim of the present study was to compare the nutrient content of BR and PL cereal-based foods, by evaluating the nutritional declaration reported on the food pack of products on the home-shopping website of major retailers present on the Italian market. A total of 3,775 items (~58% BR and ~42% PL), collected in the period from July 2018 to March 2019 and updated in March 2020, were included in the final analysis. Data were analyzed by means of the Mann\u2013Whitney nonparametric test for two independent samples for differences between BR and PL categories and types. Overall, BR products showed higher contents of total and saturates than PL items. When products were grouped for categories and types, items only differed for the content of total fats, saturates, total carbohydrates, proteins, and salt. No differences were instead found for energy and sugar contents among any of the categories. However, we did not find any consistency in the direction of results. These results could be useful for future education activities aimed to help consumers in making informed food choices

Oral lactobacillus species in systemic sclerosis

In systemic sclerosis (SSc), the gastrointestinal tract (GIT) plays a central role in the patient’s quality of life. The microbiome populates the GIT, where a relationship between the Lactobacillus and gastrointestinal motility has been suggested. In this study, the analysis of oral Lactobacillus species in SSc patients and healthy subjects using culture-independent molecular techniques, together with a review of the literature on microbiota and lactobacilli in SSc, has been carried out. Twenty-nine SSc female patients (mean age 62) and twenty-three female healthy subjects (HS, mean age 57.6) were enrolled and underwent tongue and gum swab sampling. Quantitative PCR was conducted in triplicate using Lactobacillus specific primers rpoB1, rpoB1o and rpoB2 for the RNA-polymerase β subunit gene. Our data show significantly (p = 0.0211) lower LactobacillusspprpoB sequences on the tongue of patients with SSc compared to HS. The mean value of the amount of Lactobacillus ssprpoB gene on the gumsofSSc patients was minor compared to HS. A significant difference between tongue and gums (p = 0.0421) was found in HS but not in SSc patients. In conclusion, our results show a lower presence of Lactobacillus in the oral cavity of SSc patients. This strengthens the hypothesis that Lactobacillus may have both a protective and therapeutic role in SSc patients

Aspirin for Primary Prevention of Cardiovascular Events in People With Diabetes: A position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation

The burden of cardiovascular disease (CVD) among patients with diabetes is substantial. Individuals with diabetes are at two- to fourfold increased risk of cardiovascular events compared with age- and sex-matched individuals without diabetes. In diabetic patients over the age of 65 years, 68% of deaths are from coronary heart disease (CHD) and 16% are from stroke (1). A number of mechanisms for the increased cardiovascular risk with diabetes have been proposed, including increased tendency toward intracoronary thrombus formation (2), increased platelet reactivity (3), and worsened endothelial dysfunction (4). The increased risk for cardiovascular events and mortality in patients with diabetes has led to considerable interest in identifying effective means for cardiovascular risk reduction. Aspirin has been shown to be effective in reducing cardiovascular morbidity and mortality in high-risk patients with myocardial infarction (MI) or stroke (secondary prevention) (5). The Food and Drug Administration has not approved aspirin for use in primary prevention, and its net benefit among patients with no previous cardiovascular events is more controversial, for both patients with and without a history of diabetes (5). The U.S. Preventive Services Task Force recently updated its recommendation about aspirin use for primary prevention. The Task Force recommended encouraging aspirin use in men age 45–79 years and women age 55–79 years and not encouraging aspirin use in younger adults. They did not differentiate their recommendations based on the presence or absence of diabetes (6,7). In 2007, the American Diabetes Association (ADA) and the American Heart Association (AHA) jointly recommended that aspirin therapy (75–162 mg/day) be used as a primary prevention strategy in those with diabetes at increased cardiovascular risk, including those who are over 40 years of age or who have additional risk factors (family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria) (8). These recommendations were

The Impact of Prevention on Reducing the Burden of Cardiovascular Disease

OBJECTIVE—Cardiovascular disease (CVD) is prevalent and expensive. While many interventions are recommended to prevent CVD, the potential effects of a comprehensive set of prevention activities on CVD morbidity, mortality, and costs have never been evaluated. We therefore determined the effects of 11 nationally recommended prevention activities on CVD-related morbidity, mortality, and costs in the U.S