semi quantitative ultrasound assessment of nonalcoholic fatty liver disease highlightens early subclinical atherosclerotic vascular damage from risk factors to vascular damage

Introduction Nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for coronary artery disease; moreover, it increases systemic atherosclerotic burden by inducing the overexpression of inflammatory mediators, promoting endothelial damage, and impairing blood pressure regulation. Aim Aim of this work was to evaluate whether a standardized evaluation of NAFLD improves cardiovascular risk assessment recognizing subclinical atherosclerosis in lower cardiovascular risk. Material and methods We investigated NAFLD occurrence and severity, carotid and femoral intima-media-thickness (IMT) and vascular stiffness by ultrasound technique, endothelial function by peripheral-arterial-tonometry, lipid profile and inflammatory markers in 220 subjects (100 men, 120 women; 45.42 ± 13.22 years old), without history of cardiovascular event, diabetes, liver infection, alcohol consumption, systemic diseases, and the use of drugs causing liver damage. NAFLD was evaluated, graded according to an eight-point scoring semi-quantitative severity score. Results and discussion At univariate logistic analysis, NAFLD ≥ 3 score was significantly associated with pathological IMT, augmentation index, pulsewave-velocity at carotids and femoral arteries, and endothelial dysfunction, and this association was confirmed after adjustment for European Society of Cardiology Systematic Coronary Risk Evaluation (ESC SCORE) at multivariate analyses. Moreover, high sensitivity C-reactive protein levels were significantly higher in patients with at least 3 point steatosis, in comparison to the others. Receiver operating characteristic (ROC) curve analysis for NAFLD showed a significant higher area under curve for the detection of both early atherosclerotic burden and vascular stiffness, in comparison to ROC curve of ESC SCORE. Conclusions According to our findings a NAFLD ≥ 3 score was able to screen a subgroup with widespread morphological vascular damage and endothelial dysfunction in a primary prevention population

What is the gender of thrombosis? A natural model of precision medicine

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Endothelial progenitor cells and vascular health: effects of lifestyle's modifications

During the last years increasing evidence showed that bone marrow-derived cells with angiogenic capability, named endothelial progenitor cells (EPCs), possess the capacity to home to sites of vascular injury, so contributing to the neoangiogenesis in vivo and to the maintenance of the homeostasis of vascular endothelium. Currently, potent triggers for the mobilisation of EPCs from bone-marrow are known. In addition to some pharmacological treatment such as statins, erythropoietin, PPAR-gamma agonists and angiotensin-II receptor antagonists, the effects of healthy lifestyle, via mobilization and functional improvement of EPC, is increasingly recognized. In this review we analyze, the effects of lifestyle interventions on EPCs. In particular we will focus on physical activity and cardiac rehabilitation protocols, weight reduction, and smoking cessation. Moreover, the negative effects of depression, mood disturbances and type D-personality on EPCs are also considered

Platelet Function tests: A Comparative Review

In physiological hemostasis a prompt recruitment of platelets on the vessel damage prevents the bleeding by the rapid formation of a platelet plug. Qualitative and/or quantitative platelet defects promote bleeding, whereas the high residual reactivity of platelets in patients on antiplatelet therapies moves forward thromboembolic complications. The biochemical mechanisms of the different phases of platelet activation – adhesion, shape change, release reaction, and aggregation – have been well delineated, whereas their complete translation into laboratory assays has not been so fulfilled. Laboratory tests of platelet function, such as bleeding time, light transmission platelet aggregation, lumiaggregometry, impedance aggregometry on whole blood, and platelet activation investigated by flow cytometry, are traditionally utilized for diagnosing hemostatic disorders and managing patients with platelet and hemostatic defects, but their use is still limited to specialized laboratories. To date, a point-of-care testing (POCT) dedicated to platelet function, using pertinent devices much simpler to use, has now become available (ie, PFA-100, VerifyNow System, Multiplate Electrode Aggregometry [MEA]). POCT includes new methodologies which may be used in critical clinical settings and also in general laboratories because they are rapid and easy to use, employing whole blood without the necessity of sample processing. Actually, these different platelet methodologies for the evaluation of inherited and acquired bleeding disorders and/or for monitoring antiplatelet therapies are spreading and the study of platelet function is strengthening. In this review, well-tried and innovative platelet function tests and their methodological features and clinical applications are considered