Cardiovascular effects of arsenic: clinical and epidemiological findings

Several population studies relate exposure to high levels of arsenic with an increased incidence of ischemic heart disease and cardiovascular mortality. An association has been shown between exposure to high levels of arsenic and cardiovascular risk factors such as hypertension and diabetes mellitus, and vascular damage such as subclinical carotid atherosclerosis. The mechanisms underlying these phenomena are currently being studied and appear to indicate an alteration of vascular function. However, the effects of low levels of exposure to arsenic and their potential detrimental cardiovascular effect are less explored. The article provides an overview of the pathophysiologic mechanisms linking lowlevel arsenic exposure to the occurrence of cardiovascular disease and its complications, and some potential preventive strategies to implement.

Bioactive and Antioxidant Activity from Citrus bergamia Risso (Bergamot) Juice Collected in Different Areas of Reggio Calabria Province, Italy

The chemical composition and antioxidant activity of juice extracted from seven samples of bergamot (Citrus bergamia Risso) collected in different areas of Reggio Calabria Province were investigated. The ascorbic acid, total polyphenol, and flavonoid contents were determined. Total flavonoids and polyphenols were analyzed by ultraviolet spectra, while flavanone content was analyzed by high-performance liquid chromatography. The antioxidant activity of the fractions was assessed using three representative assays: 2,2′-azinobis(3-ethylbenzothiazoline 6-sulfonic acid), 1,1-Diphenyl-2-picryl-hydrazyl radical quenching and β-carotene bleaching test. The main flavanones were naringin, neohesperedin, and neoeriocitrin, and their average content 242.4 ± 1.8, 183.0 ± 0.6, and 247.0 ± 1.4 mg mL–1, respectively. The results showed that bergamot juice possessed a good quality and a valuable source of health promoting constituents. In fact it contained eriocitrin, naringin, neoeriocitrin, and neohesperedin, which may ..

Stress echocardiography for risk stratification of patients following percutaneous coronary intervention

Objectives: To assess the prognostic value of stress echocardiography following percutaneous coronary intervention. Materials and methods: The study group was made by 904 patients (682 men; age 64?10 years) who underwent stress echocardiography with exercise (n=66), dipyridamole (n=677) or dobutamine (n=161) after a median of 7 months from percutaneous coronary intervention. Patients were followed-up for the occurence of hard (death, infarction) and major events [death, infarction, late (>3 months) revascularization]. Results: Ischemia at stress echo was assessed in 272 (30 %) patients. During a median follow-up of 18 months, there were 182 events (43 deaths, 51 myocardial infarctions, and 88 late revascularizations). Additionally 131 patients underwent early (<3 months) revascularization and were censored. Independent predictors of hard events were ischemia at stress echo (HR=2.55; 95 % CI=1.68-3.87; p<0.0001), rest wall motion score index (HR=2.83; 95 % CI=1.66-4.82; p<0.0001), and age (HR=1.02; 95 % CI=1.00-1.04; p=0.04). 4-year hard event rate was 34 % in patients with and 10 % in those without ischemia (p<0.0001) (Figure). Independent predictors of major events were ischemia at stress echo (HR=2.82; 95 % CI=2.10-3.81; p<0.0001), diabetes (HR=1.87; 95 % CI=1.35-2.59; p<0.0001), rest wall motion score index (HR=1.93; 95 % CI=1.27-2.93; p=0.002), and antianginal therapy at the time of test (HR=1.44; 95 % CI=1.07-1.93; p=0.02). 4-year major event rate was 53 % in patients with and 21 % in those without ischemia (p<0.0001) (Figure). Conclusion: Stress echocardiography is effective for risk stratification of patients following percutaneous coronary intervention. In particular, inducible ischemia is a strong and independent predictor of both hard and major events

Stress echocardiography for the risk stratification of patients following coronary bypass surgery

Objectives: The aim of the study was to assess the prognostic value of stress echocardiography after surgical revascularization. Methods: We evaluated 500 (100 women) patients who had undergone exercise or pharmacological SE after a median of 69 months after coronary artery by-pass grafting (CABG). Of these, 351 (70%) complained of symptoms suggestive of ischemic origin while 149 (30%) were tested for asymptomatic progression of the disease. Results: SE was positive for ischemia in 196 (39%) patients. During a median follow-up of 25 months, 61 patients died, 33 had a nonfatal myocardial infarction, and 112 underwent late (N3 months) revascularization. Multivariable Cox\u27 regression analysis indicated age (HR=1.04; 95% CI 1.01-1.06; pb0.003), and peak WMSI (HR=3.07; 95% CI 1.96-4.81; p=0.0001) as independent predictors of hard (total mortality and myocardial infarction) events. SE information provided a significant improvement in predictive power of the statistical model (chi-square increase 34%, pb0.0001 for hard and 91%, pb0.0001 for major events, respectively). Survival analysis showed ischemia at SE to be associated with significantly higher hard and major event rate in both symptomatic and asymptomatic patients. Discussion: SE represents an effective tool for the risk stratification of patients with previous CABG independently of the presence of symptoms suggestive of ischemic origin

Additive Prognostic Value of Coronary Flow Reserve in Patients With Chest Pain Syndrome and Normal or Near-Normal Coronary Arteries

In patients with angiographically normal coronary arteries and chest pain, pharmacologic stress echocardiography can identify a subgroup of patients with a less benign prognosis. Coronary flow reserve (CFR) in the left anterior descending artery (LAD) can currently be combined with wall motion analysis during vasodilator stress echocardiography. The aim of this study was to assess the prognostic value of CFR response in patients with normal coronary arteries and normal wall motion during stress. We selected 394 patients (171 men, 61 11 years of age) who underwent dipyridamole stress echocardiography (0.84 mg/kg over 6 minutes) with 2-dimensional echocardiography and CFR evaluation of the LAD by Doppler. All had angiographically nonsignificant (<50% quantitatively assessed) stenosis in any major vessel, normal left ventricular function (wall motion score index 1), and test negativity for conventional wall motion criteria. Images were independently read by a core laboratory for wall motion and a core laboratory for CFR. Mean CFR was 2.5 0.6 and 87 patients (22%) had an abnormal CFR <2. During a median follow-up of 51 months, 31 events occurred, namely 4 deaths and 27 nonfatal myocardial infarctions (3 ST-elevated myocardial infarctions and 24 non-ST-elevated myocardial infarctions). Kaplan-Meier survival estimates for hard events showed a better outcome for those patients with a normal CFR compared with those with an abnormal CFR (96% vs 55%, p 0.001, at 48 months of follow-up). In conclusion, in patients with angiographically normal or near-normal coronary arteries and preserved at-rest regional and global left ventricular function at baseline and during stress, CFR adds incremental value to the prognostic stratification achieved with clinical and angiographic data

Aspetti patogenetici comuni tra stenosi aortica calcifica e aterosclerosi: ruolo del recettore dei prodotti di glicosilazione avanzata

Clinical and experimental studies identified several similarities between calcific aortic stenosis and atherosclerosis, suggesting the involvement of similar pathogenic pathways in both conditions.There are severalmolecules involved in regulating the development, progression and calcification of the valve sclerosis and in growth and complications of atherosclerotic plaque. Among these molecules, the receptor of advanced glycation end-products , a multi-ligand receptor involved in the pathogenesis of several degenerative, inflammatory and immune diseases, could have an important regulatory role in both diseases and therefore worthy of study as a potential target therapeutic for both conditions.Studi sperimentali e clinici hanno individuato molte analogie fra la stenosi aortica calcifica e l\u27aterosclerosi,suggerendo una via patogenetica comune. Esistono diverse molecole coinvolte nella regolazione dello sviluppo, progressione della sclerosi e calcificazione della valvola,cos? come nella crescita e complicanze della placca aterosclerotica. Tra queste molecole, il recettore per i prodotti di glicosilazione avanzata, un recettoremulti-ligando che ? coinvolto nella patogenesi di diversemalattie degenerative infiammatorie e immunitarie, potrebbe avere un ruolo regolatore importante in entrambe le malattie, rappresentando un potenziale bersaglio terapeutico in ambedue le condizioni

Enrichment of Bread with Lycium barbarum (Goji) Puree

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Citrus species: Modern functional food and nutraceutical-based product ingredient

Citrus is the most cultivated fruit crop in the world and occupies a place of considerable importance in the country's economy. Almost 33% of the citrus fruits are processed for juice production; however, a great amount of wastes, including peels, segment membranes, and seeds are also produced. Indeed, citrus fruits consist of 45% juice, 26% pulp, 27% peels, and 2% seeds. Pruning, a cultural practice involving the removal of tree branches and limbs, was applied to improve fruit's quality. A large amount of leaves are produced through pruning. These agri-food matrices contain a wide range of bioactive phytochemicals compared to fruits. The present review covers the past 5 years of research carried out in chemistry, health properties, and applications in food and nutraceutical industries of all portions of citrus fruit and its major bioactive compounds. Additionally, patents are also included

Prognostic value of pharmacologic stress echocardiography in diabetic and nondiabetic chest pain patients with intermediate-to-high threshold positive exercise electrocardiography

Aims: To compare the prognostic value of pharmacologic stress echocardiography in diabetic and nondiabetic patients with chest pain and intermediate-to-high threshold positive exercise electrocardiography. Materials and methods: 935 chest pain patients (131 diabetics) with ST-segment depression &#8805;1 mm on exercise electrocardiography at >75 watt workload underwent dipyridamole (n=786) or dobutamine (n=149) stress echocardiography and were followed-up for the occurence of hard (death, infarction) and major events (death, infarction, late revascularization). Results: During a median follow-up of 26 months, 158 events (51 deaths, 28 myocardial infarctions, and 79 late revascularizations) occurred: 34 in diabetics and 124 in nondiabetics (see Figure). Independent predictors of hard events were age, diabetes, and ischemia at stress echo. 5-year hard event rate was 24 % in patients with and 4 % in those without ischemia (p<0.0001). Independent predictors of major events were age, diabetes, hypercholesterolemia, smoking habit, antianginal therapy at the time of testing, and ischemia at stress echo. 5-year major event rate was 46 % in patients with and 7 % in those without ischemia (p<0.0001). Conclusions: Stress echocardiography is effective in risk stratifying diabetics and nondiabetics with intermediate-to-high threshold ischemic exercise electrocardiography. However, major event rate associated with a non ischemic test is similar in diabetics and nondiabetics during the first year of follow-up, and markedly increased in the former thereafter