Risk factors among coronary heart disease patients in the context of the Albanian paradox

Several years ago, the finding that the adult life expectancy in Albania was high, despite the fact that this is a poor country and would thus be expected to have high mortality rates, began to be referred to as the “Albanian paradox”. Moreover, it has been reported that infant mortality, as indicator of poverty is also high, yet according to WHO, the age-standardized coronary heart disease (CHD) mortality in Albania is very similar to that in Italy; it is less than half of that in the United Kingdom and is much lower than that in Central and other Eastern European countries (1, 2). Few studies have been performed on CHD risk factors in Albania (3). In order to evaluate the prevalence of CHD risk factors, we analyzed data from 809 patients (mean age: 61 years, range: 32-85 years; 76% of them were men), consecutively admitted with a first diagnosis of acute coronary heart syndrome during 2009 to the Intensive Coronary Unit of the University Hospital Centre of Tirana, (the country’s largest centre for CHD diagnosis and treatment). All patients had at least two CHD risk factors. Current smoking and hypertension were the most prevalent risk factors reported respectively, for 510 (63%) and 469 (58%) patients, followed by family history of CHD (n=267, 33%) and overweight/obesity (n=242, 30%). These data are consistent with those from cross-sectional studies conducted in groups of Albanian population, in which hypertension and smoking prevalence is comparable to that in other Western industrialized countries (4). The diabetes prevalence in Albania has, in recent years, increased rapidly, and excess weight and obesity have been reported as a leading public-health problem in the adult population (5). The median cholesterol level was 182 mg/dl (range 170-304 mg/dl). Total cholesterol levels were higher than 200 mg/dl in 168 (21%) patients, though for 46 (6%) of patients, the level was lower than 240 mg/dl. None of the patients with cholesterol levels below 200 mg/dl, used cholesterol-lowering drugs. In 639 (79%) patients, the HDL level was below 40 mg/dl of whom 479 (75%) had a total cholesterol level below 200 mg/dl. Although a high total cholesterol level is considered a leading risk factor for CHD, in our study, only 21% of the patients with a first episode of CHD had high levels. The Mediterranean diet (which typically consists of a low consumption of meat and dairy products and a high consumption of fruits, vegetables) has been prevalent in Albania, which could have contributed to maintaining the cholesterol levels low (1, 2). Another plausible explanation is the hypothesis that Mediterranean populations genetically have lower cholesterol levels. Cholesterol levels seem to play an insignificant role in the etiology of CHD in Albania, which could in part explain the “Albanian paradox”. These results could serve as a baseline for detecting signs of whether or not the low cholesterol levels will be maintained in a country which is currently developing and in which nutrition patterns are thus expected to change

Gender Differences in the Pathogenesis and Risk Factors of Hepatocellular Carcinoma

Simple Summary Significant gender disparities have been highlighted in the incidence, aggressiveness, and prognosis of HCC. A different epidemiological distribution of the risk factors of liver damage and, above all, the actions of sex hormones are at the basis of these differences. Accurate knowledge of gender disparities in HCC would lead to adequate surveillance strategies and the potential implementation of current treatment schemes. Several chronic liver diseases are characterized by a clear gender disparity. Among them, hepatocellular carcinoma (HCC) shows significantly higher incidence rates in men than in women. The different epidemiological distribution of risk factors for liver disease and HCC only partially accounts for these gender differences. In fact, the liver is an organ with recognized sexual dysmorphism and is extremely sensitive to the action of androgens and estrogens. Sex hormones act by modulating the risk of developing HCC and influencing its aggressiveness, response to treatments, and prognosis. Furthermore, androgens and estrogens are able to modulate the action of other factors and cofactors of liver damage (e.g., chronic HBV infection, obesity), significantly influencing their carcinogenic power. The purpose of this review is to examine the factors related to the different gender distribution in the incidence of HCC as well as the pathophysiological mechanisms involved, with particular reference to the central role played by sex hormones

Neoadjuvant and Adjuvant Systemic Therapies in Loco-Regional Treatments for Hepatocellular Carcinoma: Are We at the Dawn of a New Era?

: Despite maximizing techniques and patient selection, liver resection and ablation for HCC are still associated with high rates of recurrence. To date, HCC is the only cancer with no proven adjuvant or neoadjuvant therapy used in association to potentially curative treatment. Perioperative combination treatments are urgently needed to reduce recurrence rates and improve overall survival. Immunotherapy has demonstrated encouraging results in the setting of adjuvant and neoadjuvant treatments for non-hepatic malignancies. Conclusive data are not yet available in the context of liver neoplasms. However, growing evidence suggests that immunotherapy, and in particular immune checkpoint inhibitors, could represent the cornerstone of an epochal change in the treatment of HCC, improving recurrence rates and overall survival through combination treatments. Furthermore, the identification of predictive biomarkers of treatment response could drive the management of HCC into the era of a precision medicine. The purpose of this review is to analyze the state of the art in the setting of adjuvant and neoadjuvant therapies for HCC in association with loco-regional treatments in patients not eligible for liver transplantation and to hypothesize future scenarios