Prevalence and severity of airway obstruction in an Italian adult population

Background. This study sets out to estimate the prevalence and the degree of severity of bronchial obstruction in an adult population with three different diagnostic criteria: the European Respiratory Society (ERS), the American Thoracic Society (ATS), and the World Health Organization (WHO) defined as Global Obstructive Lung Disease (GOLD). Methods. 1514 subjects underwent complete medical evaluation and spirometry. Results. The prevalence of bronchial obstruction was respectively 27.5% (ERS), 33% (GOLD), and 47.3% (ATS). The prevalence of bronchial obstruction in the smoker group was 33.4% (ERS), 38.1% (GOLD), and 52.3% (ATS). The prevalence of obstruction in the ex-smoker group was 33% (ERS), 41.4% (GOLD), and 57.1% (ATS). The prevalence of obstruction in the non-smoker group was 21.1% (ERS), 24.9% (GOLD), and 38.6% (ATS). Conclusions. The results show that the prevalence of airway obstruction increases proportionally with age; the cigarette smoking represents an important conditioning factor. These observations warrant the necessity of a more complete and multi-parametric analysis in the evaluation of patients with airway obstruction using methodologies that explore the functional state and the risk factors that cause the airway obstruction

Prevalence and severity of airway obstruction in an Italian adult population

Background. This study sets out to estimate the prevalence and the degree of severity of bronchial obstruction in an adult population with three different diagnostic criteria: the European Respiratory Society (ERS), the American Thoracic Society (ATS), and the World Health Organization (WHO) defined as Global Obstructive Lung Disease (GOLD). Methods. 1514 subjects underwent complete medical evaluation and spirometry. Results. The prevalence of bronchial obstruction was respectively 27.5% (ERS), 33% (GOLD), and 47.3% (ATS). The prevalence of bronchial obstruction in the smoker group was 33.4% (ERS), 38.1% (GOLD), and 52.3% (ATS). The prevalence of obstruction in the ex-smoker group was 33% (ERS), 41.4% (GOLD), and 57.1% (ATS). The prevalence of obstruction in the non-smoker group was 21.1% (ERS), 24.9% (GOLD), and 38.6% (ATS). Conclusions. The results show that the prevalence of airway obstruction increases proportionally with age; the cigarette smoking represents an important conditioning factor. These observations warrant the necessity of a more complete and multi-parametric analysis in the evaluation of patients with airway obstruction using methodologies that explore the functional state and the risk factors that cause the airway obstruction

Leptin increase is associated with markers of the hemostatic system in obese healthy women

Background: Leptin, a hormone secreted by the adipose tissue, might be a link between obesity and increased morbidity for cardiovascular disease. Leptin exerts proinflammatory, pro-angiogenic actions by activating a specific receptor (Ob-Rb) which is expressed in human endothelial cells. Thus, a link may exist between leptin expression and endothelial dysfunction. Objectives: We sought to determine whether in obese women there is a correlation between leptin levels, endothelial perturbation and coagulative activation. Methods: Circulating levels of leptin, von Willebrand Factor (VWF), factor (F)VIIa, prothrombin fragment 1 + 2 (Fl+2), were measured in 51 non-diabetic, obese women and in 51 normal-weight subjects, using immunoenzymatic assays. Results: Obese women had significantly higher levels of leptin, VWF, FVIIa, Fl+2 compared with healthy women. Simple correlation coefficients showed significant correlation between leptin and either VWF, FVIIa, or Fl+2 concentrations. A multiple linear regression analysis, performed to quantify further the relationship between leptin levels and the above-mentioned variables as well as the inflammatory marker C-reactive protein (CRP) and including age, body mass index (BMI), waist-hip ratio (WHR) and lipid parameters as potential confounders, revealed that only FVIIa and VWF were independently related to leptin levels. Reduction in adipose tissue after weight loss resulted in a decrease in both circulating leptin and endothelial and coagulative activation markers. Conclusions: We suggest that leptin might have pro-atherogenic effects in vivo, with a mechanism involving endothelial cell activation. © 2003 International Society on Thrombosis and Haemostasis

Metabolic Modifications in HIV-Infected Women

To assess metabolic alterations and/or abnormal fat distribution in Human Immunodeficiency Virus (HIV)-infected women undergoing Highly Active Antiretroviral Therapy (HAART), a case-control study was carried out in a population of twenty-two HIV-infected, normal weight, non-diabetic, normotensive women. Twenty-five healthy non infected subjects matched for sex, age and Body Mass Index (BMI) were also included as a control group. Blood samples were collected for leptin and insulin measurements. Fasting glucose, triglycerides, total cholesterol and HDL-cholesterol were also measured. Insulin resistance was determined using the homeostasis model assessment index (HOMA-IR). Body fat distribution was evaluated using waist-to-hip ratio (WHR), Bioelectric Impedance Analysis (BIA) and abdominal CT-scan. Immunologic and virologic parameters included CD4- and CD8-T cell counts and HIV-RNA levels. HIV-infected patients showed higher levels of total cholesterol, LDL-cholesterol and triglycerides (P<0.05), higher fasting insulin and HOMA-IR (P<0.001), lower levels of HDL-cholesterol (P<0.001) and serum leptin (P<0.001) than the control group. With regard to body fat distribution, no statistically significant difference between cases and controls was found. Among the control women leptin levels were positively correlated with body fat distribution parameters (P<0.001)

Gout, allopurinol intake and clinical outcomes in the hospitalized multimorbid elderly.

Increased serum uric acid has been considered a cardiovascular risk factor but no study has assessed its relation with hospital mortality or length of stay. On the basis of data obtained from a prospective registry, the prevalence of gout/hyperuricemia and its association with these and other clinical parameters was evaluated in an Italian cohort of elderly patients acutely admitted to internal medicine or geriatric wards

Adherence to antithrombotic therapy guidelines improves mortality among elderly patients with atrial fibrillation: insights from the REPOSI study

Background: Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and mortality, significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths. Methods: Our objective was to evaluate if antithrombotic prophylaxis according to the 2012 European Society of Cardiology (ESC) guidelines is associated to a lower rate of adverse outcomes. Data were obtained from REPOSI; a prospective observational study enrolling inpatients aged 6565&nbsp;years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed. Results: Among 2535 patients, 558 (22.0&nbsp;%) were discharged with a diagnosis of AF. Based on ESC guidelines, 40.9&nbsp;% of patients were on guideline-adherent thromboprophylaxis, 6.8&nbsp;% were overtreated, and 52.3&nbsp;% were undertreated. Logistic analysis showed that increasing age (p&nbsp;=&nbsp;0.01), heart failure (p&nbsp;=&nbsp;0.04), coronary artery disease (p&nbsp;=&nbsp;0.013), peripheral arterial disease (p&nbsp;=&nbsp;0.03) and concomitant cancer (p&nbsp;=&nbsp;0.003) were associated with non-adherence to guidelines. Specifically, undertreatment was significantly associated with increasing age (p&nbsp;=&nbsp;0.001) and cancer (p&nbsp;&lt;&nbsp;0.001), and inversely associated with HF (p&nbsp;=&nbsp;0.023). AF patients who were guideline adherent had a lower rate of both all-cause death (p&nbsp;=&nbsp;0.007) and CV death (p&nbsp;=&nbsp;0.024) compared to those non-adherent. Kaplan\u2013Meier analysis showed that guideline-adherent patients had a lower cumulative risk for both all-cause (p&nbsp;=&nbsp;0.002) and CV deaths (p&nbsp;=&nbsp;0.011). On Cox regression analysis, guideline adherence was independently associated with a lower risk of all-cause and CV deaths (p&nbsp;=&nbsp;0.019 and p&nbsp;=&nbsp;0.006). Conclusions: Non-adherence to guidelines is highly prevalent among elderly AF patients, despite guideline-adherent treatment being independently associated with lower risk of all-cause and CV deaths. Efforts to improve guideline adherence would lead to better outcomes for elderly AF patients