Preclinical atherosclerosis and metabolic syndrome increase cardio- and cerebrovascular events rate: a 20-year follow up

BACKGROUND: Intima-media thickness (IMT) is a validated marker of preclinical atherosclerosis and a predictor of cardiovascular events. PATIENTS: We studied a population of 529 asymptomatic patients (age 62\u2009\ub1\u200912.8 years), divided into two groups of subjects with and without Metabolic Syndrome (MetS). METHODS: All patients, at baseline, have had a carotid ultrasound evaluation and classified in two subgroups: the first one without atherosclerotic lesions and the second one with preclinical atherosclerosis (increased IMT or asymptomatic carotid plaque). Cardiovascular endpoints were investigated in a 20-years follow-up. RESULTS: There were 242 cardiovascular events: 144 among patients with MetS and 98 among in healthy controls (57.4% vs. 35.2%; P\u2009<\u20090.0001). 63 events occurred in patients with normal carotid arteries, while 179 events occurred in patients with preclinical atherosclerosis (31.8% vs. 54.1%; P\u2009<\u20090.0001). Of the 144 total events occurred in patients with MetS, 36 happened in the subgroup with normal carotid arteries and 108 in the subgroup with preclinical atherosclerosis (45% vs. 63.15%; P\u2009=\u20090.009). 98 events occurred in patients without MetS, of which 27 in the subgroup with normal carotid arteries and 71 in the subgroup with preclinical atherosclerosis (22.88% vs. 44.37%; P\u2009=\u20090.0003). In addition, considering the 63 total events occurred in patients without atherosclerotic lesions, 36 events were recorded in the subgroup with MetS and 27 events in the subgroup without MetS (45% vs. 22.88%; P\u2009=\u20090.0019). Finally, in 179 total events recorded in patients with preclinical carotid atherosclerosis, 108 happened in the subgroup with MetS and 71 happened in the subgroup without MetS (63.15% vs. 44.37%; P\u2009=\u20090.0009). The Kaplan-Meier function showed an improved survival in patients without atherosclerotic lesions compared with patients with carotid ultrasound alterations (P\u2009=\u20090.01, HR: 0.7366, CI: 0.5479 to 0.9904). CONCLUSIONS: Preclinical atherosclerosis leads to an increased risk of cardiovascular events, especially if it is associated with MetS

Early induction of bedside pneumoperitoneum in the management of residual pleural space and air leaks after pulmonary resection

Background: The pneumoperitoneum to treat prolonged air leaks or pleural space problems after pulmonary resection has been successfully used for decades. The aim of the study is to describe our experience with the early induction of therapeutic pneumoperitoneum (TP). Methods: We reviewed the data of 103 consecutive patients undergoing TP between September 2011 and September 2019. Patients were divided into two groups according to the time of the induction of TP: early application (≥72&nbsp;h) and standard application (&gt;72&nbsp;h). Results: In total, 52 early TP and 51 standard TP were analyzed. The median time of TP induction was 2 (1–3) versus 8 (5–11) postoperative days (POD) (p &lt; 0.001). The time for obliteration of the residual pleural space (7 vs.9&nbsp;days, p = 0.805) and the time of resolution of the air leaks (14 vs. 16&nbsp;days, p = 0.663) didn’t differ between the two groups, but a favorable trend was observed in the early group. The hospital stay was lower for patients undergoing early pneumoperitoneum: 9 versus 18&nbsp;days (p &lt; 0.001). The multivariate analysis showed that POD of induction of TP (p &lt; 0.001), time of resolution of the air leak (p &lt; 0.001) and Heimlich valve (p = 0.002) were independent variables associated with the hospital stay. Conclusions: The use of TP whenever a space problem or air leaks occur after pulmonary resections is safe and effective. Its early use (≤72&nbsp;h) accelerates the hospital stay, eventually reducing the time of resolution of the air leak and residual pleural space

Preclinical atherosclerosis, metabolic syndrome and risk of cardiovascular events

Atherosclerotic disease is a chronic disorder developing insidiously throughout the life and usually progressing to an advanced stage by the time symptoms occur. In order to realize cardiovascular (CV) prevention, the detection of asymptomatic but diseased patients is crucial for an early intervention, since in these subjects there are opportunities to alter the progression of disease and the outcome (1). However, the simply analysis of risk factors don’t permits to identify always these subjects since it doesn’t informs about the effect that risk factors (RF) had already provoked and may more provoke on the individual vasculature. Besides, the risk factors known predict can explain only the 90 percent of cardiovascular disease (CVD) and traditional algorithms for prediction of CV risk failed to predict a proportion of cardiovascular events (CVE), realizing a “risk factors prediction gap” (2). It may be explained by several reasons: the epidemiology-derived models, based on the prediction of long-term risk, may not accurately predict short-term events, they don’t take into consideration emerging and novel risk factors; risk algorithms don’t identify, among patients with neither a previous history of CVD nor an high risk for atherosclerotic disease, those who will develop acute myocardial infarction and/or sudden coronary death as first CVD manifestation, and this may be due to the fact that the factors responsible of plaque formation and growth are not necessarily the same responsible of its instability and rupture, being the latter related to inflammation, thrombosis and plaque morphology (3).So, a possible approach to evaluate the individual global cardiovascular risk with more accurateness is to identify risk factors combination that more easily produces vascular damage, or alternatively, to evaluate directly the arterial wall and its damage degree. The former approach is performed by the evaluation of metabolic syndrome, the latter by the non-invasive study of pre-ATS markers