Prevalence and determinants of diabetes mellitus in a representative sample of Italian adults

Background: Diabetes mellitus is a dramatic epidemic worldwide. This study providea an updated estimate of itsprevalence and determinants among Italian adults. Methods: Data were derived from a face-to-face survey conducted in 2013 on 2901 individuals (1391 men, 1510 women) aged ≥18 years, representative of the general adult Italian population. Odds ratios (OR) for diabetes versus non diabetes in relation to selected risk factors were derived using multiple logistic regression models. Results: Overall, 135 out of 2901 adults (4.7%) reported a diagnosis of diabetes, with similar prevalence in men (4.8%) and in women (4.5%). Diabetes increased with age (0.6% at age 18-44, 5.1% at age 45-64, and 11.3% at age ≥65 years; p-trend <0.001) and decreased with increasing level of education (12.8% for low, 7.8% for middle, and 1.4% for high education; p-trend <0.001). Prevalence was higher among obese subjects (10.8%) compared to normal weight subjects (3.1%; OR=2.46; p-trend=0.001), among individuals reporting a physical activity <30 minutes of walk/day (5.6%) compared to those reporting >60 minutes of walk/day (3.8%; OR=1.43), and among ex-smokers (11.6%) compared to never smokers (4.2%; OR=2.51); moreover, it was lower among moderate drinkers (3.1%) than among abstainers (6.1%; OR=0.57; p-trend=0.016). Prevalence of diabetes was 16.1% in individuals with a diagnosis of hypertension (OR=4.66), 15.2% in those with high cholesterol (OR=3.84), and 21.6% among aspirin users (OR=4.46). Conclusion: Although diabetes prevalence in Italy is still comparatively low, effective clinical and preventive intervention strategies – focused on major risk behaviors – should be implemented to control the diffusion of this condition

Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose:analysis of individual patient data from randomised trials

Background A one-dose-fits-all approach to use of aspirin has yielded only modest benefits in long-term prevention of cardiovascular events, possibly due to underdosing in patients of large body size and excess dosing in patients of small body size, which might also affect other outcomes. Methods Using individual patient data, we analysed the modifying effects of bodyweight (10 kg bands) and height (10 cm bands) on the effects of low doses (≤100 mg) and higher doses (300–325 mg or ≥500 mg) of aspirin in randomised trials of aspirin in primary prevention of cardiovascular events. We stratified the findings by age, sex, and vascular risk factors, and validated them in trials of aspirin in secondary prevention of stroke. Additionally, we assessed whether any weight or height dependence was evident for the effect of aspirin on 20-year risk of colorectal cancer or any in-trial cancer. Results Among ten eligible trials of aspirin in primary prevention (including 117 279 participants), bodyweight varied four-fold and trial median weight ranged from 60·0 kg to 81·2 kg (pand#60;0·0001). The ability of 75–100 mg aspirin to reduce cardiovascular events decreased with increasing weight (pinteraction=0·0072), with benefit seen in people weighing 50–69 kg (hazard ratio [HR] 0·75 [95% CI 0·65–0·85]) but not in those weighing 70 kg or more (0·95 [0·86–1·04]; 1·09 [0·93–1·29] for vascular death). Furthermore, the case fatality of a first cardiovascular event was increased by low-dose aspirin in people weighing 70 kg or more (odds ratio 1·33 [95% CI 1·08–1·64], p=0·0082). Higher doses of aspirin (≥325 mg) had the opposite interaction with bodyweight (difference pinteraction=0·0013), reducing cardiovascular events only at higher weight (pinteraction=0·017). Findings were similar in men and women, in people with diabetes, in trials of aspirin in secondary prevention, and in relation to height (pinteraction=0·0025 for cardiovascular events). Aspirin-mediated reductions in long-term risk of colorectal cancer were also weight dependent (pinteraction=0·038). Stratification by body size also revealed harms due to excess dosing: risk of sudden death was increased by aspirin in people at low weight for dose (pinteraction=0·0018) and risk of all-cause death was increased in people weighing less than 50 kg who were receiving 75–100 mg aspirin (HR 1·52 [95% CI 1·04–2·21], p=0·031). In participants aged 70 years or older, the 3-year risk of cancer was also increased by aspirin (1·20 [1·03–1·47], p=0·02), particularly in those weighing less than 70 kg (1·31 [1·07–1·61], p=0·009) and consequently in women (1·44 [1·11–1·87], p=0·0069). Interpretation Low doses of aspirin (75–100 mg) were only effective in preventing vascular events in patients weighing less than 70 kg, and had no benefit in the 80% of men and nearly 50% of all women weighing 70 kg or more. By contrast, higher doses of aspirin were only effective in patients weighing 70 kg or more. Given that aspirin's effects on other outcomes, including cancer, also showed interactions with body size, a one-dose-fits-all approach to aspirin is unlikely to be optimal, and a more tailored strategy is required

Is global cardiovascular risk considered in current practice? Treatment and control of hypertension, hyperlipidemia, and diabetes according to patients’ risk level

Daria Roccatagliata1, Fausto Avanzini1, Lara Monesi1, Vittorio Caimi2, Davide Lauri1, Paolo Longoni3, Roberto Marchioli4, Massimo Tombesi2, Gianni Tognoni1, Maria Carla Roncaglioni1, on behalf of the Collaborative Group Risk and Prevention Study*1Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy; 2CSeRMEG Centro Studi e Ricerca in Medicina Generale, Monza, Italy; 3CoS Consorzio Sanità, Milano, Italy; 4Consorzio Mario Negri Sud, S. Maria Imbaro, Italy *A full list of investigators is reported in the AppendixObjectives: To assess the pharmacological treatment and the control of major modifiable cardiovascular risk factors in everyday practice according to the patients’ cardiovascular risk level.Methods: In a cross-sectional study general practitioners (GPs) had to identify a random sample of their patients with cardiovascular risk factors or diseases and collect essential data on the pharmacological treatment and control of hypertension, hyperlipidemia, and diabetes according to the patients’ cardiovascular risk level and history of cardiovascular disease. Participants were subjects of both sexes, aged 40–80 years, with at least one known cardiovascular risk factor or a history of cardiovascular diseases.Results: From June to December 2000, 162 Italian GPs enrolled 3120 of their patients (2470 hypertensives, 1373 hyperlipidemics, and 604 diabetics). Despite the positive association between the perceived level of global cardiovascular risk and lipid-lowering drug prescriptions in hyperlipidemic subjects (from 26% for lowest risk to 56% for highest risk p < 0.0001) or the prescription of combination therapy in hypertensives (from 41% to 70%, p < 0.0001) and diabetics (from 24% to 43%, p = 0.057), control was still inadequate in 48% of diabetics, 77% of hypertensives, and 85% of hyperlipidemics, with no increase in patients at highest risk. Trends for treatment and control were similar in patients with cardiovascular diseases.Conclusions: Even in high-risk patients, despite a tendency towards more intensive treatment, pharmacological therapy is still under used and the degree of control of blood pressure, cholesterol level and diabetes is largely unsatisfactory.Keywords: global cardiovascular risk, hypertension, hyperlipideamia, diabetes, general practice

Sex differences in stroke and major adverse clinical events in patients with atrial fibrillation::A systematic review and meta-analysis of 993,600 patients

Background: Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia, which is associated with an increased risk of stroke. Several studies have suggested that female AF patients could have a greater risk for stroke and thromboembolic events (TE). Methods: A systematic literature review update and meta-analysis was conducted using Pubmed. The search used the terms “atrial fibrillation”, “gender”, “sex”, “female”, “women”, “stroke”, “thromboembolism”. Main aim of the study was to compare and male AF patients for occurrence of stroke and TE. Secondary outcomes were: major bleeding, cardiovascular (CV) death and all-cause death. Results: Forty-four studies were included in the analysis including 993,603 patients (48.9% women). After pooling the data, there was a higher risk of stroke for women vs. male AF patients (hazard ratio [HR]: 1.24; 95% confidence intervals [CIs]: 1.14–1.36). Overall, TE risk was not different between female and male patients, despite sensitivity analysis left some uncertainties. No sex differences were found for major bleeding, CV death and all-cause death. A significant relationship between increasing age and the difference in stroke risk between female and male AF patients was found (Delta HR: 1.01; 95% CI: 1.00–1.03 for each year of age increase). Conclusions: Female patients with AF are at increased risk of stroke compared to men. A significant relationship between increasing age and stroke risk in women compared to men was found, most evident at age > 65 years. Female sex may act as a stroke risk modifier, particularly in elderly and very elderly AF subjects, conferring a significant increase in stroke risk

Diagnostic evaluation of people with hypertension in low income country: cohort study of “essential” method of risk stratification

Objectives To explore the predictive power of a risk stratification method for people with hypertension based on “essential” procedures (that is, available in economically less developed areas of the world), comparing it in the same population with the results given by the method suggested by the 1999 World Health Organization-International Society of Hypertension (WHO-ISH) guidelines

Long-Term Relationship Between Atrial Fibrillation, Multimorbidity and Oral Anticoagulant Drug Use

Objectives: To analyze the relationship between atrial fibrillation (AF) and Charlson comorbidity index (CCI) in a population-based cohort study over a long-term follow-up period, in relation to oral anticoagulant (OAC) prescriptions and outcomes. Patients and Methods: We used data from the administrative health databases of Lombardy. All patients with AF and age 40 years and older and who were admitted to the hospital in 2002 were considered for analysis and followed up to 2014. AF diagnosis and CCI were established according to codes from the International Classification of Diseases, Ninth Revision. Results: In 2002, 24,040 patients were admitted with a diagnosis of AF. CCI was higher in patients with AF than in those without AF (1.8\ub12.1 vs 0.2\ub10.9; P<.001). Over 12 years of follow-up, AF was associated with an increased risk of higher CCI (beta coefficient, 1.69; 95% CI, 1.67-1.70). In patients with AF, CCI was inversely associated with OAC prescription at baseline (P<.001) and at the end of the follow-up (P=.03). Patients with AF and a high CCI ( 654) had a higher cumulative incidence of stroke, major bleeding, and all-cause death (all P<.001), compared with those with low CCI (range, 0-3). Adjusted Cox regression analysis revealed that time-dependent continuous CCI was associated with an increased risk for stroke, major bleeding, and all-cause death (all P<.001). Conclusions: In hospitalized patients, AF is associated with an increase in CCI that is inversely associated with OAC prescriptions during follow-up. CCI is independently associated with an increased risk of stroke, major bleeding, and all-cause death

Long-Term Outcomes of a Cohort of Hypertensive Subjects in Rural Ecuador

Background: In contrast with the abundance of global epidemiological descriptive data on cardiovascular diseases and their risk factors, information on the outcomes of real populations prospectively followed up in their life and care settings is much rarer, especially in low-income countries.Objectives: This study sought to evaluate the feasibility and the overall results of a hypertension control program, based mainly on a network of community nonprofessional health promoters, in the poor rural region of Borbon (Ecuador).Methods: This is a prospective cohort study describing the results of a program of hypertension diagnosis, treatment and follow-up from 2004 to 2015 in the area, carried out mainly by the health promoters.Results: The number of hypertensive patients identified and followed over the years increased from 1,024 in 2004 to 1,733 in 2015. The percentage of patients with no visits during a year was reduced to <10%, whereas the proportion of hypertensive subjects attending all 4 scheduled annual checks approached and, in some years, exceeded 50%. From 2004 to 2015, the proportion of patients at high or very high cardiovascular risk progressively decreased from 26.6% in 2004 to 17.5% in 2015 (p for trend <0.01), whereas the proportion of hypertensive patients at low or very low risk increased from 30.4% in 2004 to 45.0% in 2015 (p for trend <0.01).Conclusions: In a poor, disadvantaged area, a strategy of control mainly based on the involvement and responsibility of community health promoters (with health professionals as supporters more than direct actors) can achieve adequate follow-up of the population of hypertensive patients and improve their global cardiovascular risk level.HighlightsHypertension is increasingly recognized as a major cause of cardiovascular mortality and morbidity also in low-income countries, but little is known about how to face this common risk factor with limited economic and professional resources, particularly in remote rural areas.In a poor disadvantaged area of the equatorial forest, hypertension diagnosis and control, mainly by nonprofessional local health promoters, can ensure adequate follow-up of the hypertensive population.Over more than 10 years, the global cardiovascular risk has progressively declined.Noncommunicable chronic diseases such as hypertension can be managed by giving local health promoters a pivotal role

Measurements on hydrophobic and hydrophilic surfaces using a porous gamma alumina nanoparticle aggregate mounted on Atomic Force Microscopy cantilevers

Atomic Force Microscopy (AFM) measurements are extensively used for a detailed understanding ofmolecular and surface forces. In this study, we present a technique for measuring such forces, using an AFM cantilever attached with a porous gamma alumina nanoparticle aggregate. The modified cantilever was used to measure the forces of interaction of the aggregate with hydrophilic and hydrophobic surfaces. A strong force of attraction was observed between the aggregate and hydrophilic surfaces when the aggregate was kept dry. However, the force of interaction on the aggregate in wet form (water filled in pores) was larger when the adjoining surface had hydrophobic characteristics. The results presented in this study show the versatility of the current technique and indicate its usefulness in directly characterizing hydrophilic/ hydrophobic properties of nano-scale surfaces and patterns

Long-term vitamin E supplementation fails to reduce lipid peroxidation in people at cardiovascular risk: analysis of underlying factors

BACKGROUND: Antioxidant supplementation with vitamin E had no effect in the prevention of cardiovascular diseases (CVD) in three recent large, randomized clinical trials. In order to reassess critically the role of vitamin E in CVD prevention, it is important to establish whether these results are related to a lack of antioxidant action. METHODS: We examined the in vivo antioxidant effect of vitamin E (300 mg/day for about three years) in 144 participants in the Primary Prevention Project (females and males, aged ≥ 50 y, with at least one major CV risk factor, but no history of CVD). Urinary 8-epi-PGF(2α) (isoprostane F(2α)-III or 15-F(2t)-isoP), a validated biomarker of lipid peroxidation, was measured by mass spectrometry. RESULTS: Urinary excretion of 8-epi-PGF(2α) [pg/mg creatinine, median (range)] was 141 (67–498) in treated and 148 (76–561) in untreated subjects (p = 0.10). Taking into account possible confounding variables, multiple regression analysis confirmed that vitamin E had no significant effect on this biomarker. Levels of 8-epi-PGF(2α) were in the normal range for most subjects, except smokers and those with uncontrolled blood pressure or hyperglycemia. CONCLUSIONS: Prolonged vitamin E supplementation did not reduce lipid peroxidation in subjects with major cardiovascular risk factors. The observation that the rate of lipid peroxidation was near normal in a large proportion of subjects may help explain why vitamin E was not effective as an antioxidant in the PPP study and was ineffective for CVD prevention in large scale trials