The combination of Ezetimibe and Statin: a new treatment for hypercholesterolemia

The combination of Simvastatin and Ezetimibe allows dual inhibition of both cholesterol production and absorption. This treatment approach allows achieving same low serum cholesterol levels with the administration of much lower doses of statins. This should reduce side effects, compared to statin only therapy, enabling more patients to achieve their LDL cholesterol treatment goals. With ezetimibe/simvastatin therapy, reductions of about 60% from baseline in LDL cholesterol have been shown. Concomitant improvement in other lipid fractions have also been demonstrated. The ezetimibe/simvastatin combination has been well tolerated, with a safety profile similar to that of statin therapy. This article will review clinical experience with ezetimibe/simvastatin combination, commenting upon its place and potential value in the prevention of cardiovascular disease

Response to Letter Regarding Article, "Is Worsening Renal Function an Ominous Prognostic Sign in Patients With Acute Heart Failure? The Role of Congestion and Its Interaction With Renal Function"

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Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Geological monitoring networks for risk management close to large rock cliffs: the case history of Gallivaggio and Cataeggio in the italian Alps

Abstract. In areas located near large rock cliffs, risk reduction by early warning monitoring systems highligts potentiality but also critical issues and limits. The paper examines two rock slope failures that occurred in a short time from each other near inhabited areas in the Italian Alps. The viscous behavior of the rock mass was reconstructed through data processing from ground-based Synthetic Aperture Radar Interferometry (InSAR), and elaboration of acceleration and speed curves. Landslides types and underlying complexity associated with rock detachment mechanisms suggest the identification of precautionary alarm thresholds for collapse forecasting. The analysis of financial outlay, both for mitigation works and for monitoring activities, highlight the adequacy and the opportunity to combine passive systems, like embankments or rockfall drapery meshes, with a reliable monitoring network for early warning

Use of inotropic agents in patients with advanced heart failure: lessons from recent trials and hopes for new agents.

9Abnormalities of cardiac function, with high intraventricular filling pressure and low cardiac output, play a central role in patients with heart failure. Agents with inotropic properties are potentially useful to correct these abnormalities. However, with the exception of digoxin, no inotropic agent has been associated with favourable effects on outcomes. This is likely related to the mechanism of action of current agents, which is based on an increase in intracellular cyclic adenosine monophosphate and calcium concentrations. Novel agents acting through different mechanisms, such as sarcoplasmic reticulum calcium uptake, cardiac myosin and myocardial metabolism, have the potential to improve myocardial efficiency and lower myocardial oxygen consumption. These characteristics might allow a haemodynamic improvement in the absence of untoward effects on the clinical course and prognosis of the patients.openopenMetra M; Bettari L; Carubelli V; Bugatti S; Dei Cas A; Del Magro F; Lazzarini V; Lombardi C; Dei Cas L.Metra, Marco; Bettari, Luca; Carubelli, Valentina; Bugatti, Silvia; Dei Cas, A; Del Magro, F; Lazzarini, Valentina; Lombardi, Carlo Mario; DEI CAS, Livi

Serum levels of carbohydrate antigen 125 in patients with chronic heart failure

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Unraveling spatial and temporal heterogeneities of very slow rock-slope deformations with targeted DInSAR analyses

Spaceborne radar interferometry is a powerful tool to characterize landslides at local and regional scales. However, its application to very slow rock slope deformations in alpine environments (displacement rates < 5 cm/year) remains challenging, mainly due to low signal to noise ratio, atmospheric disturbances, snow cover effects, and complexities resulting from heterogeneous displacement in space and time. Here we combine SqueeSARTM data, targeted multi-temporal baseline DInSAR, GPS data, and detailed field morpho-structural mapping, to unravel the kinematics, internal segmentation, and style of activity of the Mt. Mater deep-seated gravitational slope deformation (DSGSD) in Valle Spluga (Italy). We retrieve slope kinematics by performing 2D decomposition (2D InSAR) of SqueeSARTM products derived from Sentinel-1 data acquired in ascending and descending orbits. To achieve a spatially-distributed characterization of DSGSD displacement patterns and activity, we process Sentinel-1 A/B images (2016-2019) with increasing temporal baselines (ranging from 24-days to 1-year) and generate several multi-temporal interferograms. Unwrapped displacement maps are validated using ground-based GPS data. Interferograms derived with different temporal baselines reveal a strong kinematic and morpho-structural heterogeneity and outline nested rockslides and active sectors, that arise from the background displacement signal of the main DSGSD. Seasonal interferograms, supported by GPS displacement measurements, reveal non-linear displacement trends suggesting a complex response of different slope sectors to rainfall and snowmelt. Our analyses clearly outline a composite slope instability with different nested sectors possibly undergoing different evolutionary trends towards failure. The results herein outline the potential of a targeted use of DInSAR for the detailed investigation of very slow rock slope deformations in different geological and geomorphological settings.ISSN:2072-429

The combination of Ezetimibe and Statin: a new treatment for hypercholesterolemia

The combination of Simvastatin and Ezetimibe allows dual inhibition of both cholesterol production and absorption. This treatment approach allows achieving same low serum cholesterol levels with the administration of much lower doses of statins. This should reduce side effects, compared to statin only therapy, enabling more patients to achieve their LDL cholesterol treatment goals. With ezetimibe/simvastatin therapy, reductions of about 60% from baseline in LDL cholesterol have been shown. Concomitant improvement in other lipid fractions have also been demonstrated. The ezetimibe/simvastatin combination has been well tolerated, with a safety profile similar to that of statin therapy. This article will review clinical experience with ezetimibe/simvastatin combination, commenting upon its place and potential value in the prevention of cardiovascular disease. (Heart International 2007; 3: 12-7