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

Gender-related issues in the pharmacology of new anti-obesity drugs

Four new medicines-liraglutide, lorcaserin, bupropion/naltrexone, and phentermine/topiramate-have been recently added to the pharmacological arsenal for obesity treatment and could represent important tools to manage this epidemic disease. To achieve satisfactory anti-obesity goals, the use of these new medicines should be optimized and tailored to specific patient subpopulations also by applying dose adjustments if needed. In the present review, we posit that gender could be among the factors influencing the activity of the new obesity drugs both because of pharmacokinetic and pharmacodynamic factors. Although evidence from premarketing clinical studies suggested that no dose adjustment by gender is necessary for any of these new medicines, these studies were not specifically designed to identify gender-related differences. This observation, together with the strong theoretical background supporting the hypothesis of a gender-dimorphic response, strongly call upon an urgent need of new real-life data on gender-related difference in the pharmacology of these new obesity drugs

Body composition and cardiovascular risk factors in pretransplant hemodialysis patients

BACKGROUND: Obesity, hyperlipemia and cardiovascular complications contribute to a significant proportion of morbidity and mortality of renal transplant patients and have negative effects on renal survival. Aim of the present study was to evaluate the main abnormalities in body composition and the prevalence of some cardiovascular risk factors in a population of hemodialyzed (HD) patients awaiting renal transplantation. METHODS: We studied 151 HD patients, all included in a waiting list for renal transplantation, 97 males and 54 females, with mean age 47.4+/-12 years. Patients were divided into three groups according to their body mass index (BMI) (kg/m2): 18.5 to 24.9 (normoweight, NW); 25.0 to 29.9 (overweight, OW); > or =30 (obese, OB). The body composition measurements were obtained the day after the mid-week HD session using bioelectrical impedance analysis (BIA). RESULTS: We found that 47 patients were NW (31%), while 56 were OW (37%), and 48 were OB (32%). BIA-measured body cell mass was (BCM) significantly increased in the OW as compared with the NW group (P<0.001), but, of note, no significant difference was found in OB group in comparison with the OW. Total cholesterol and triglycerides plasma levels were significantly elevated in OW and OB patients with respect to NW (P<0.05) and an increased prevalence of diabetes was seen in OB patients (NW: 6%, OW: 5%, OB: 12%). CONCLUSIONS: These data show that a large proportion of patients awaiting renal transplant are overweight or obese and a consistent part of them have other cardiovascular risk factors associated. Furthermore, obese HD patients have a BCM lower than predicted on the basis of BMI and show an altered metabolic profile. A better understanding of the characteristics of patients included in the renal transplant waiting list is crucial in order to design prospective studies that aim to define the proper risk profile for the selection of patients

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

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

BEYOND WAIST CIRCUMFERENCE IN AN ADULT MALE POPULATION OF SOUTHERN ITALY: IS THERE ANY ROLE FOR SUBSCAPULAR SKINFOLD THICKNESS IN THE RELATIONSHIP BETWEEN INSULIN-LIKE GROWTH FACTOR-1 SYSTEM AND METABOLIC PARAMETERS ?

ABSTRACT Background: Apart from waist circumference, other adiposity measures, such as subscapular skin fold (SST), arouse growing interest due to their relationship to metabolic complications and cardiovascular risk. The Insulin-like Growth Factor (IGF)-1 system is deregulated in obese subjects in proportion to their degree of visceral adiposity. Aim : To examine the association among IGF-1, IGF-Binding Protein (BP)1 and 3 levels and different measures of adiposity in a sample of adult male population in Southern Italy. Materials and Methods: A complete database for this analysis was available for 229 (age range 50–82 years) participating at 2002-2004 Olivetti Heart Study follow-up. Results: After adjustment for age, IGF-1 was inversely associated with BMI and waist circumference (p<0.05). IGFBP1 was inversely associated with BMI, waist circumference, SST, Homeostasis Model Assessment (HOMA) index, Fat Mass (FM). HOMA index, age and SST significantly predicted the IGFBP1 plasma levels, with 24% of IGFPB-1 variability explained at a linear regression analysis. Conclusions: IGFBP1 inversely correlated to adiposity and HOMA index. Among adiposity indexes, SST was the best predictor of IGFPB-1 levels. The evaluation of some components of the IGFs system, and simple measures of body adiposity, such as SST, may represent a further tool to better evidence phenotype profiles associated to the pathogenetic mechanism of cardiovascular risk factor clustering in male adults

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

Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis

BACKGROUND: Left ventricular (LV) diastolic dysfunction is linked to myocardial collagen content in many cardiac diseases. There are no data regarding such relationship in patients with end-stage renal disease (ESRD) undergoing haemodialysis. METHODS: Twenty-five patients with ESRD undergoing haemodialysis were studied by echocardiography. LV diastolic function was investigated by Doppler echocardiography, by analysing LV filling velocities at rest and during loading manoeuvres, which represent an estimate of LV filling pressure. According to the Doppler pattern, LV filling pressure in a given patient was judged to be normal or slightly increased or to be moderately or severely increased. The presence of myocardial fibrosis was estimated by ultrasound tissue characterization with integrated backscatter, which in diastole correlates with the collagen content of the myocardium. RESULTS: Integrated backscatter was higher in patients with moderate or severely increased than in patients with normal or slightly increased LV filling pressure (integrated backscatter: 51.0 +/- 9.8 vs 41.6 +/- 5.6%; P = 0.008). Integrated backscatter was a strong and independent determinant of diastolic dysfunction (odds ratio = 1.212; P = 0.040). CONCLUSION: Our data support the hypothesis that, in a selected population of patients with ESRD undergoing haemodialysis, myocardial fibrosis is associated with LV diastolic myocardial propertie

A fúria poética de Antígona González: o que pode um corpo esgotado?

Pretendemos, a partir da leitura de Antígona González, obra dramática da poetisa mexicana Sara Uribe, discutir a potência de resistência de corpos femininos, corpos que se encontram em estado de esgotamento e é justamente a partir desse corpo que não aguenta mais é que se produz a potência da fúria do corpo poético da personagem Antígona González, bem como de outros corpos literários ou não. Assim, nossa leitura será conduzida, prioritariamente, pela ideia de corpo esgotado defendida pelo filósofo David Lapoujade