Search

AIM: The presence of the metabolic syndrome (MS) increases cardiovascular morbidity and mortality and we aimed to assess the outcome in subjects with the MS and subclinical atherosclerosis. METHODS: We followed-up for five years 339 Mediterranean subjects with asymptomatic carotid intima-media thickness >0.9 mm (men: 60%; age: 66±5 years), of whom 130 had the MS (men: 59%; age: 66±5 years), evaluating at baseline traditional cardiovascular risk factors (including male gender, older age, obesity, hypertension, diabetes, smoking, family history of cardiovascular diseases, dyslipidemia) and plasma levels of C-reactive protein and fibrinogen. RESULTS: Cardio- and cerebrovascular events were registered in the 29% of subjects with the MS and in the 20% of those without it and the presence of more criteria for the diagnosis of the MS was significantly associated with vascular morbidity and mortality. By multivariate analysis, including all baseline variables, independent predictive roles for the events were found for elevated markers of inflammation (OR 3.8), elevated fasting glucose (OR 2.1) and elevated triglycerides (OR 1.4). CONCLUSION: These findings confirm a worst vascular outcome in subjects with more criteria for the diagnosis of the MS and further suggest the need of future research to understand the combined role of inflammation and the MS in the progression from subclinical to clinical atherosclerosis.

Aortic stenosis (AS) is a common valvular heart disease in the Western populations, with an estimated overall prevalence of 3% in adults over 75 years. To understand its patho-biological processes represents a priority. In elderly patients, AS usually involves trileaflet valves and is referred to as degenerative calcific processes. Scientific evidence suggests the involvement of an active "atherosclerosis-like" pathogenesis in the initiation phase of degenerative AS. To the contrary, the progression could be driven by different forces (such as mechanical stress, genetic factors and interaction between inflammation and calcification). The improved understanding presents potentially new therapeutic targets for preventing and inhibiting the development and progression of the disease. Furthermore, in clinical practice the management of AS patients implies the evaluation of generalized atherosclerotic manifestations (i.e., in the coronary and carotid arteries) even for prognostic reasons. In counselling elderly patients, the risk stratification should address individual frailty beyond the generic risk scores. In these regard, the co-morbidities, and in particular those linked to the global atherosclerotic burden, should be carefully investigated in order to define the risk/benefit ratio for invasive treatment strategies. We present a detailed overview of insights in pathogenesis of AS with possible practical implications.

Aim To compare the incidence, and risk factors, in-hospital and at the 18-month prognosis of contrast-induced nephropathy (CIN) according to the definition utilized: as an increase in serum creatinine (Scr) ≥0.5 mg/dL (CIN 1) or as an increase in Scr ≥25% above baseline values (CIN 2). Methods and Results We prospectively evaluated CIN according to two different definitions in 150 patients who underwent percutaneous coronary intervention (PCI) in simple lesions employing a low-medium dose of contrast media. Incidence of CIN was higher using the CIN 2 definition than CIN 1 (9.3% vs. 4%; p=0.0133). Patients with CIN 1 had a higher incidence of chronic kidney disease (CKD) (66.7% vs. 13.9%; p=0.006), higher mean serum creatinine levels (1.35±0.42 vs. 0.98±0.35; p=0.001) and lower mean eGFR levels (58.3±19.6 vs. 84±25.9; p=0.002). Patients with CIN 2 had a higher incidence of anemia (57.1% vs. 30.9%; p=0.049) and a higher mean contrast media volume was used (142.6±62.2 mL vs. 110.6±57.2 mL; p=0.05). In the multivariate analysis the only significant variable associated with CIN (CIN 2) was a higher volume of contrast media (OR=1.01; p=0.04). There were no differences in the major in-hospital events, but patients with CIN (both definitions) had a longer in-hospital stay. A persistent rise in serum creatinine at discharge occurred in only one patient. There were no differences between patients with and without CIN in events at the follow-up, with the exception of an increased risk of new hospitalization in patients with CIN 2. Conclusion After PCI employing low-medium dose of contrast media the incidence of CIN varied according to the definition used. Neither of the two definitions offers additional information compared with the other. Chronic kidney disease and baseline parameters of renal function are the risk factors associated with CIN 1; anemia and higher volume of contrast media are associated with CIN 2.

The term metabolic syndrome defines a cluster of risk factors for cardiovascular diseases and diabetes. This syndrome is very frequent in general population. However, despite the efforts to define the diagnostic criteria, nowadays its clinical utility is object of a lively debate.