Gender-specific aspects in primary and secondary prevention of cardiovascular disease

Gender differences in biological substrates of disease determine different clinical manifestations of CV disease with importantimplications for prevention, diagnosis and therapy in the two sexes.In women, the activity of sex hormones reduces the influence of CV risk factors during the reproductive age, and delays the onset ofCHD of 2 decades compared to men. However, women as men suffer from CV events, and in women mortality from all CV causes andhave a greater than the sum of the others 7 causes of death together. Women are more likely than men to die of a first myocardial infarctiona probability of developing heart failure or a second infarction than their male counterparts. The levels of lipid components vary in different ages of life and in the two genders. TC and LDL increase in men between 35 and 50years of age. On the contrary LDL levels do not change significantly in fertile women in which they have a lower predictive value forCHD than in men, HDL levels are higher in premenopausal women than in men of the same all age and their role in predicting CHD isconsiderably higher in women. High triglycerides and Lp(a) are more important as a risk factor in women than in men.Because of the greater incidence of cardiovascular diseases in men until the early 80s, information about the importance of risk factorsassociated with an increased risk of cardiovascular events has been gathered mainly in men and transferred to women. Most studies onlipid-lowering therapy did not have the adequate statistical power to show significant reductions in CV events in women. Regarding theindications for use of statins in daily practice, current data suggest that in secondary prevention statins are equally effective in both genderswhile in primary prevention the CV benefits from lipid-lowering therapy in women are less clear than in men and therefore shouldbe used according to the degree of risk calculated from the available score systems

Analysis of patients with chronic cerebro-spinal venous insufficiency and multiple sclerosis: identification of parameters of clinical severity

The aims of this study were: i) analysis of clinical severity evolution in multiple sclerosis patients; ii) identification of temporal indicators for clinical worsening. We investigated by echo-color-Doppler (ECD) 789 patients (490 female plus 299 male), aged 45.4 years, with chronic cerebro-spinal venous insufficiency (CCSVI) and multiple sclerosis (MS). All patients tested positive for CCSVI by ECD assessment were divided into three groups, namely: type 1 CCSVI (371) presenting an endo-vascular obstacle to the venous drainage; type 2 CCSVI (40) presenting an extra-vascular obstacle to the venous drainage, for external compression of the vessel; type 3 CCSVI (315) presenting both venous endo-vascular and extra-vascular obstructed drains. We analyzed the morphological and hemodynamic data recorded on computerized map (MEM-net). All data were collected by respecting the Italian Privacy Laws and they are available on the National Epidemiological Observatory on CCSVI website (www.osservatorioccsvi.org). We focused in the three main parameters in all studied patients. First parameter was expanded disability status scale (EDSS) score; second parameter was illness duration; third parameter was CCSVI type. The MS duration values stratified by EDSS grouped values in CCSVItype- 1 and CCSVI-type-3 patients shows that the differences were statistical significant by Kruskal-Wallis test: H=44.2829; degree of freedom= 1 for CCSVI-type-1 (P<0.001); and H=37.3036; degree of freedom=1 for CCSVItype- 3 (P<0.001). The present study confirmed and completed scientific literature about relation between CCSVI and MS. On the same time, we found a strong correlation between MS illness duration and severity of EDSS score. In fact there is a clinical severity worsening after 11 years of illness in MS patients with CCSVI type-1 or type-3 (P<0.001). These data may suggest the influence of chronic vascular disease on MS. Further searches need in order to learn more about this new aspect in MS etiology

Italian Chronic Cerebrospinal Venous Insufficiency National Epidemiological Observatory methodology and preliminary data

The aim of our work is to describe the Memnet program’s use and potential and to show the data of Italian Chronic Cerebrospinal Venous Insufficiency (CCSVI)-National Epidemiological Observatory (NEO) activity in the first three years (http://www.osservatorioccsvi. org). From 2011 to 2014, all echo-color- Doppler (ECD) assessments were stored by Mem-net program into CCSVI-NEO web site (http://www.mem-net.it). Mem-net is a tool for multicenter data collection based on the International Society for Neurovascular Disease consensus and position statement, where we can insert patients (pts) history, neurological visits, ECD assessments, different examinations, therapies and surgical procedures. The website provides an epidemiological and statistical program for data analysis in real time. At present, 7 medical centers, affiliated to CCSVI-NEO, input their symptomatic and asymptomatic subjects with CCSVI. Data were storage using the Mem-net program. We analyzed data of only four centers on seven (Rome, Bari, Cagliari and Benevento). Total pts number with multiple sclerosis (MS) was 1109, mean age 46.0±13.4 [male 422 (38.05%); female 687 (61.95%)]. CCSVI positive pts were 937 (84.49%), CCSVI negative pts were 172 (15.51%). The CCSVI type 1 subjects were 530 (56.56%), CCSVI type 2 subjects were 20 (2.13%), CCSVI type 3 subjects were 387 (41.30%). We found 800 (85.38%) pts with criterion 1; 725 (77.37%) with criterion 2; 519 (55.39%) with criterion 3; 483 (51.55%) with criterion 4; 88 (9.39%) with criterion 5. The venous hemodynamic insufficiency severity score mean score was 3.8; the CCSVI mean score was 2.8; the MEM mean score was 34.7; the expanded disability status scale mean score was 4.5; the disease mean duration was 12.5±5.7 years. MS clinical types were divided as follows: relapsing-remitting pts were 449 (47.92%), Secondary progressive pts were 144 (15.37%), primary progressive pts were 72 (7.68%). The CCSVI-NEO database and Memnet software may be useful medical and researching tools for recording, storing, analyzing and studying ECD and vascular data. Preliminary data of NEO show an elevated prevalence of CCSVI in MS

The perilipin 2 (PLIN2) gene Ser251Pro missense mutation is associated with reduced insulin secretion and increased insulin sensitivity in Italian obese subjects

Background: Perilipin 2 (PLIN2), a member of the family of perilipin lipid droplets coating proteins, is very widely expressed. The Ser251Pro (rs35568725) missense mutation in exon 6 of PLIN2 gene was previously associated with increased lipid accumulation, decreased lipolysis and increased number of small lipid droplets per cell. Furthermore, the Pro251 mutation was associated with decreased plasma triglyceride and very low density lipoprotein concentrations in population studies. The aim of this study was to evaluate the effect of the Ser251Pro mutation of PLIN2 gene in a cohort with a higher predisposition to obesity-associated metabolic alterations, such as insulin resistance, decreased insulin-secretion, hyperglycaemia, and dyslipidaemia. Methods: A large cohort (N = 1692) of Italian obese subjects (mean body mass index = 41 kg/m2) was genotyped for the Ser251Pro mutation. All participants underwent oral glucose tolerance tests (OGTT), with measurement of glucose and insulin levels. Indices of insulin resistance and of insulin secretion were also calculated. Clinical and biochemical parameters were collected for all participants. Results: We observed that insulin concentration was significantly reduced at 120 min after the administration of glucose in Pro251 allele carriers, whereas glucose levels were similar in Pro251 allele carriers and non-carriers throughout the OGTT. Furthermore, the CIR120 index of insulin secretion was significantly lower (P < 0.035) and the ISI index of insulin-sensitivity was significantly higher (P < 0.031) in carriers of the Pro251 allele. When we analysed men and women separately to test for gender-specific associations, we observed that in women insulin levels were significantly lower in Pro251 allele carriers compared with wild-type subjects throughout the whole OGTT. In men, we confirmed a significant reduction in insulin concentration only at 120 min after the OGTT. No significant differences between genotype groups regarding triglyceride levels and anyother clinical and metabolic parameters were observed. Conclusion: We observed a strong significant association between the PLIN2 Pro251 mutation and lower insulin secretion associated with an increased insulin sensitivity

Positive effects of Nordic Walking on anthropometric and metabolic variables in women with type 2 diabetes mellitus

Lack of physical activity predisposes people to chronic diseases including diabetes mellitus, obesity, and coronary artery diseases. Identifying forms of physical activity is warranted for prevention of these chronic diseases. Daily exercise has also been considered a significant contributing factor in the management of type 2 diabetes. Nordic Walking is shown to be easy to teach and learn, simple and adaptable to subjects with diabetes and metabolic syndrome. Nordic Walking allows training of about 90% of body muscles in the active propulsion phase, thus increasing energy expenditure by 30 to 50%. Aim of our study was to evaluate the effects of Nordic Walking structured training in a group of female patients with type 2 diabetes, looking at changes in anthropometric, metabolic and bioelectrical variables pre- and post-activities. A follow-up of 6 months after the end of the program was also performed. Equipment and methods: Twenty women with type 2 diabetes, aged 40-65years, were enrolled. The participants were randomized in two groups: (1) 10women in the Nordic Walking active group, (2) 10women receiving counseling alone to perform physical activity (control group). Results: Results show that diabetic women involved in a 12-week structured Nordic Walking program obtain a significant reduction in HbA1c (-0.7%), BMI (-0.8kg·m-2) and body weight (-2.4kg), and a significant increase in HDL cholesterol (+5.8mg·dL-1). Also Handgrip strength was significantly improved (+4.3kg). At follow-up all changes returned to baseline values. Conclusions: Our study shows that a supervised Nordic Walking program determines a significant improvement in metabolic and anthropometric parameters in women with type 2 diabetes

C1-C2 X-Ray assessment of misalignment parameters in patients with chronic cerebra-spinal venous Insufficiency and multiple sclerosis versus patients with other pathologies

PURPOSE: The complete compression of the internal jugular veins, in front position, shows a prevalence of 48% and it is equally distributed in the various segments of these veins in patients with Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) and Multiple Sclerosis (MS). The aim of this search is to identify radiological dislocation of C1-C2 as specific markers in patients with CCSVI and Multiple Sclerosis (MS). METHOD: We investigated 386 patients suffering from CCSVI and Multiple Sclerosis and a control group of 156 patients without MS. RESULTS: The assessment of Anterior Intrusion shows the following average values: in the group with CCSVI and MS: 4.29 ±1.48 mm while in the control group: 3.78 ±1.45 mm (p = 0.0008).The evaluation of the Right Laterality shows the following average values: in group with CCSVI and MS: 2.31±1.41 mm, in control group: 1.97 ±1.28 mm (p = 0.0426). We found also that a longer duration of the disease corresponds to a higher severity of the pathological condition (p <0.0001). CONCLUSION: Data analysis of C1-C2 X-Ray parameters shows statistical significance of severe anterior intrusion and right laterality misalignment in the people with CCSVI and MS, that are two to three times more frequent as compared to controls. Considering the novelty of this work and the total absence of scientific similar works able to confirm this data, it is necessary to continue these studies in order to improve the clinical management of these patients and to perform therapeutic strategies based on venous decompressive treatments both surgical that manipulatives

Search for Genetic Variant in the Apelin (APLN) Gene by Resequencing and Association Study in European Subjects

Aims: Apelin is a peptide produced and secreted by white adipose tissue. It is synthesized as preproapelin, a protein containing 77 aminoacids which is then cleaved to shorter active fragments. As an adipokine, apelin plays a role in the regulation of many biological functions, including body energy homeostasis and glucose metabolism, water balance, and immunity. We have recently demonstrated that subjects with type 2 diabetes (T2D) have significantly higher serum apelin levels compared with controls, and that these levels associate with fasting glucose, basal disposition index, age, and diagnosis of T2D. The first aim of this study was to search for sequence variants in the APLN gene, located on chromosome Xq25-q26.1 that may associate with serum levels of apelin. The second aim was to analyze the possible association between diabetes and diabetes-related traits and APLN variants. Methods: We designed a two-step genetic association study. Step one consisted of an initial screen of 100 individuals selected from the extremes of the apelin distribution levels wherein we sequenced the APLN gene to identify common variants. In step two, the rs181301686 with a minor allele frequency &gt;0.2 was genotyped in 917 individuals to explore its association with T2D and diabetes-related traits. Results: Five sequence variations were found across the APLN gene. To test for association with apelin levels, the rs181301686 and rs2281069 single-nucleotide polymorphisms were genotyped in 256 subjects for whom serum apelin levels were available. No significant differences were observed in apelin levels between genotypes. Association analysis in 917 individuals did not show significant differences between APLN genotypes and diabetes and diabetes-related traits. Conclusions: Resequencing of the apelin gene in subjects stratified by low or high apelin levels identified five APLN variants in an European population. No association was found between the most frequent variant, diabetes, and metabolic parameters