How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction? Insights from the EYESHOT Post-MI Study

Background: Current guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI). Hypothesis: We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year. Methods: We analyzed data from the EYESHOT Post-MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. Results: Out of the 1633 post-MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit. Conclusions: Risk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Beni culturali e soggetti coinvolti in percorsi turistici: anelli di un itinerario adriatico di lunga percorrenza

Il contributo parte da una ricerca internazionale cui l'a. ha partecipato "Routes for tourism and culture" in cui erano coinvolte sette universit\ue0 (Italia, Germania, Gracia e Portogallo). Il lavoro ha avuto seguito con il rilevamento e lo studio paesaggistico, agrario e di beni culturali e con l'elaborazione un itinerario di lunga percorrenza adriatico (del vino e dell'olio), dal quale si staccano anelli di dettaglio anche con l'uso di tecniche e strumentazioni ICT. Questa ricerca ne fa la sintesi e tratta del coinvogimento di ulteriori stakeholders. Qui ci si sofferma su un anello tematico (Castelli scaligeri veronesi) e su uno integrale (la SP Cingolana delle Marche)

Maintaining the conservation value of shifting cultivation landscapes requires spatially Explicit Interventions

Fallow vegetation within landscapes dominated by shifting cultivation represents a woody species pool of critical importance with considerable potential for biodiversity conservation. Here, through the analysis of factors that influence the early stages of fallow vegetation regrowth in two contrasting forest margin landscapes in Southern Cameroon, we assessed the impact of current trends of land use intensification and expansion of the cultivated areas, upon the conservation potential of shifting cultivation landscapes. We combined the analysis of plot and landscape scale factors and identified a complex set of variables that influence fallow regrowth processes in particular the characteristics of the agricultural matrix and the distance from forest. Overall we observed a decline in the fallow species pool, with composition becoming increasingly dominated by species adapted to recurrent disturbance. It is clear that without intervention and if present intensification trends continue, the potential of fallow vegetation to contribute to biodiversity conservation declines because of a reduced capacity, (1) to recover forest vegetation with anything like its original species composition, (2) to connect less disturbed forest patches for forest dependent organisms. Strategies to combat biodiversity loss, including promotion of agroforestry practices and the increase of old secondary forest cover, will need not only to operate at a landscape scale but also to be spatially explicit, reflecting the spatial pattern of species reservoirs and dispersal strategies and human usage across landscapes

Religious tourism: an itinerary in the Veneto Region linked to the ancient Via Romea. From Lake Garda to the Adriatic coast

Analysis of cultural heritage in Veneto, looking at the creation of a religious tourism related to the ancient Via Rome