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Aims: To date, whether hyperuricemia may represent a marker or an independent risk factor for cardiovascular disease remains unclear. This study aimed at assessing the role of hyperuricemia in the onset of major cardiovascular events (MACE)., Methods: Baseline clinical data were collected through a 1998/1999 longitudinal survey as part of the larger Valle dell'Irno Prevenzione Project. Ten years later, MACE incidence was evaluated., Results: A total of 1175 patients (50% men, aged 25-74 years) completed the study. At least one MACE was reported by 135 patients, whose mean uric acid values were significantly higher compared with patients without events (6.0 ± 4.8 and 4.6 ± 4.0 mg/dl, respectively; P < 0.01). Patients with uric acid values of at least 6 mg/dl (prevalence of 14.6%) had significantly lower levels of high-density lipoprotein cholesterol and increased values of BMI, blood pressure (BP), cholesterol, triglycerides, white blood cells, complement component 3 (C3) and creatinine. After subgrouping patients in tertiles and considering the first one as reference [odds ratio (OR): 1], the OR (95% confidence interval) was 1.44 (0.7-2.9) in the second and 2.2 (1.3-3.5) in the third tertile, respectively. Confounder-adjusted stepwise linear regression revealed uric acid, age, creatinine, glucose and systolic BP as independent predictors of MACE. Diastolic BP and creatinine were independently correlated with uric acid in the entire population, diastolic BP only in men and BMI, creatinine, age and C3 in women., Conclusion: Hyperuricemia was shown to be a strong independent risk factor for MACE and should be included in cardiovascular prevention strategies. Whether hypouricemic drugs can decrease cardiovascular disease risk warrants further studies.

The aim of this study was to determine the trends of cardiovascular risk factor prevalence between 1988/9 and 2008/9 in the 25-74-year-old population in an area of Southern Italy. We compared three cross-sectional studies conducted in random population samples, in 1988/9, 1998/9, and 2008/9 in Salerno, Italy. The methodology of data collection (lipid profile, systolic and diastolic blood pressure, glycaemia, and smoking) and conducting tests which the population underwent during the three phases was standardized and comparable. Prevalence of diabetes, hypertension, hypercholesterolemia, and smoking was calculated and standardized for age. A total of 3491 subjects were included. From 1988/9 to 2008/9, in males, the prevalence of all four risk factors was reduced. In women, there was a clear reduction of hypertension, a similar prevalence of hypercholesterolemia, and an increase of smoking and diabetes. In the area of Salerno, our data confirm that the global prevalence of the major risk factors is decreasing in men, but their absolute values are still far from optimization. In women, diabetes and smoking showed a negative trend, therefore requiring targeted interventions. These data are now used as a base for executive targeted programs to improve prevention of cardiovascular disease in our community.

Background: Data relating to non-fatal cardiovascular events are poor but these data are essential to organize targeted interventions on the territory and to understand their effectiveness., Methods: We calculated the rates of morbidity from cardiovascular events covering the period 1998/99-2008/09, in a cohort of 1200 persons (600 men and 600 women) aged 25 to 74 years. Data were standardized using the European standard population., Results: The incidence of events to ten years of non-fatal myocardial infarc.ion was 2.2% in men and of 1.8% in women. PCI interventions to ten year have been 3.3% in men and 3.4% in women, the interventions of aorto-coronary bypass have been 2.4% and 0.5% for men and women respectively. While all major cardiovascular events have been more frequent in men, in women there was a higher incidence of stroke (1.6% vs 0.9%)., Conclusion: Although by comparison with other European countries Italy is among the countries considered at low-risk of coronary heart disease, in Campania cardiovascular diseases reach higher rates than the rest of the country. Our results are in keeping with the literature data and confirm that cardiovascular diseases are a major public health problem. Local analysis are useful in providing additional information for planning prevention interventions targeted to its own territory.

Aim: To examine trends of uncontrolled total serum cholesterol, treatment and control in a Mediterranean region (Campania)., Methods: We considered and compared the data collected as part of "Montecorvino Rovella Project" 1988-1989 and cross-sectional data from the two phases of the "VIP Project-Valle dell'Irno Prevenzione": 1998-1999 (1(st) phase) and 2008-2009 (2(nd) phase), in the 35-74-year-old-population., Results: Data show a reduction of mean cholesterolemia in the last twenty years of 7.3 mg/dL for men and unchanged values for women. In the three surveys the mean values for serum cholesterol are in men: 205.2 ± 47.1 mg/dL (1988/89), 200 ± 38.9 mg/dL (1998/99) and 197.9 ± 40.2 mg/dL (2008/09); in the women: 203.1 ± 42.5 mg/dL (1988/89), 198.9 ± 37.9 mg/dL (1998/99) and 203.3 ± 39.3 mg/dL (2008/09). Prevalence of uncontrolled high cholesterol ≥ 240 mg/dL for men decreased from 20.8% (1988/89) to 14.3% (1998/99) and 13.9% (2008/9), P = 0.002; for women the values decreased from 19.9% (1988/89), to 18.2% (1998/99) and 18.1% (2008/09), P = 0.007. Is statistically increased the number of patients treated and those treated to target., Conclusion: Encouraging increases in awareness, treatment, and control of hypercholesterolemia occurred from 1988 through 2008. Nevertheless, control of hypercholesterolemia remains poor.

Unlabelled: Current American Academy of Pediatrics Guidelines recommended that statins should be considered as a first-line agent in children as early as 8 years of age. The aim of our work is to assess the safety of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors in children with hypercholesterolaemia., Conclusion: Controlled studies in children show that statin monotherapy is efficacious, well tolerated and safe in the short-time. Unfortunately, these studies have relatively short-term follow-up periods, and therefore, long-term safety remains unclear., (©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Rationale: In Italy the mortality data were obtained almost exclusively from the data RENCAM (Name Causes of Death Register), while there are few prospective surveys. In order to assess whether there are particular epidemiological conditions in the geographical area of Mercato S. Severino, in Southern Italy, we have studied, and reassessed at ten years (1998/99 - 2008/09), a cohort of adult general population in a project of cardiovascular epidemiology and prevention., Materials and Methods: We calculated the rates of mortality and morbidity from cardiovascular events covering the period 1998/99 - 2008/09, in a cohort of 1200 persons (600 men and 600 women) aged 25 to 74 years. Data were standardized using the European standard population., Results: Mortality from cardiovascular causes was 46.5% in men and 48.7% in women; it was mainly concentrated in the age group 65-74 years where it occurred on 62.9% of deaths in men and 66.7% in women. Regarding morbidity, the incidence of events to ten years of non-fatal myocardial infarction was 2.2% in men and of 1.8% in women. PTCA interventions to ten year have been 3.3% in men and 3.4% in women, the interventions of aorto-coronary bypass have been 2.4% and 0.5% for men and women respectively. While all major cardiovascular events have been more frequent in men, in women there was a higher incidence of stroke (1.6% vs 0.9%)., Conclusions: Although by comparison with other European countries Italy is among the countries considered at low-risk of coronary heart disease, in Campania cardiovascular diseases reach higher rates than the rest of the country. Our results are in line with the literature data and confirm that cardiovascular diseases are a major public health problem. Local analysis to propose means to provide useful information for planning prevention interventions targeted to their own territory.

Chronic kidney disease (CKD) is a common disorder whose prevalence is increasing worldwide. In Italy the prevalence of CKD, especially the early stages, is still not exactly known. Our study examines the prevalence and trends in ten years (1200 subjects in 1998-1999 and 1200 subjects in 2008-2009) of the estimated glomerular filtration rate (eGFR) in a population of southern Italy. We analyzed, within the VIP project, the prevalence of CKD (eGFR <60) in our area and its relationship to diabetes and hypertension as well as the trend between the years 1998-1999 and 2008-2009. The estimate of the GFR was obtained with the Cockcroft-Gault formula corrected for body surface area. The prevalence of CKD, stratified by the population of Campania, was about 5.9% in males and 3.9% in females in the years 1998-1999; ten years later (2008-2009) it had increased to 6.2% in males and 4.5% in females. The differences between males and females and between the two decades are not statistically significant although the trend shows a clear increase in subjects affected by CKD among both sexes. Among the male population the prevalence of CKD in persons with hypertension or diabetes, in those with both diseases, and in those free from these diseases was 11.2%, 12%, 13.8% and 6.3% (p=0.018), respectively. The same groups among females showed a CKD prevalence of 8%, 9.2%, 9.7% and 4.4%, respectively (p=0.042). Our work provides a picture of the prevalence of CKD in an area of southern Italy. It highlights the increase in CKD and calls upon a greater use of renal function tests in clinical practice, so that individuals at increased risk of developing cardiovascular complications may be detected as early as possible.

The relationship between genetic polymorphisms and migraine as a cause of an increased risk of thrombotic disorders development is still debated In this respect, factor V Leiden, factor V (H1299R), prothrombin G20210A, factor XIII (V34L), β-fibrinogen, MTHFR (C677T), MTHFR (A1298C), APO E, PAI-1, HPA-1 and ACE I/D seem to play a determinant role in vascular diseases related to migraine. The present review analyzes both the incidence of the above genetic vascular mutations in migraineurs and the most re-cent developments related to genetic polymorphisms and migraine.

In childhood, cholesterol values are closely related to the genetic heritage of the young patient. Among familial hypercholesterolemia, it is essential to identify the monogenic and multigenic forms. In monogenic forms, heterozygotes respond poorly or partially to changes in diet and lifestyle, making pharmacological therapy necessary; in homozygote patients plasmapheresis is required, and liver transplantation is the only intervention that can impact permanently on the development of cardiovascular lesions in adulthood. Conversely, multigenic forms or familial hypercholesterolemia secondary to other diseases respond to changes in diet and lifestyle as well as to pharmacological treatment. It remains unclear how early pharmacological intervention should be implemented. In particular, the presence in children of typical histological lesions of athero- sclerosis and their interaction with cardiovascular disease in adulthood justify a prompt, although cautious, intervention. In fact, cholesterol is necessary for normal development of the organism, provided that percentile values are in the normal range according to age and sex. Two methods of intervention are identified: a population strategy that should be implemented on a large scale for advice about diet and optimal level of physical activity; and an individual strategy, in which diet advice should be followed by pharmacological treatment. Pharmacological therapy may be administered even in children over the age of 8-10 years, if necessary. In younger patients, therapeutic interventions should be restricted to children with LDL cholesterol levels >500 mg/dl. Although statins have only been studied in populations affected by severe familial hypercholesterolemia in the short term, they seem to be the most effective agents in children owing to their efficacy and limited side effects.

Background: Several epidemiological studies have shown a relation between white blood cell (WBC) count in peripheral blood samples and other cardiovascular risk factors. Such associations have also been described in patients affected by dyslipidemia. On the other hand, no data are available in patients with systemic hypertension., Aim: In a southern Italian population of hypertensive patients, in order to assess the relation between WBC count and other risk factors for coronary artery disease; in addition, to evaluate if a high WBC count can identify subgroups of hypertensives with a higher risk profile for atherosclerosis., Population and Methods: We evaluated 147 consecutive patients (44 males, mean age 49 +/- 11 years) with a minimum 2-year history of systemic hypertension in the absence of ischemic heart disease and cerebrovascular disease. Among risk factors, we considered: hypercholesterolemia, hypertriglyceridemia, hyperglycemia and obesity., Results: WBC count was significantly higher in patients with 2 or more risk factors (7.092 +/- 1034 cells/dl than in hypertensives without risk factors (5.902 +/- 1167, p < 0.0001). WBC count was significantly associated with hyperglycemia (p < 0.001), number of cigarettes smoked daily (p < 0.004), fibrinogen plasma levels (p < 0.008) and azotemia (p < 0.009). Multivariate analysis has shown a positive significant and independent relation between WBC count and both hyperglycemia and number of cigarettes., Conclusions: These results emphasize that, among hypertensives, subgroups with a higher WBC count also have a higher risk profile for atherogenesis. The relation between WBC and some risk factors is confirmed by our data in a population of patients affected with systemic hypertension.

Background: The purpose of this paper is to evaluate cholesterolemia and triglyceridemia in relation to BMI, alimentary habits and physical activity., Design: We compare our epidemiological data with those obtained in other studies previously carried out in Campania: "CNR-ATS-RF2-OB43"., Setting: Campania (Italy)., Results: Data show an increase of these risk factors in Southern Italy from 1978 to 1989. In males, between 20 and 59 years the prevalence of hypercholesterolemia increases from 15.9% in 1978-1979 (CNR-RF2) to 17.8% in 1983-1984 (ATS-OB43), and 20.6% in our own data (1988-1990). The pattern is similar for females: 14.4% (1978-79), 16.7% (1983-1984), and 18.6% (1988-1990). In males hypertriglyceridemia increases from 17% in 1978-1979, to 21.3% in 1983-1984 and 36.2% in 1988-1990. In females from 9.8% to 12.4% and 18% respectively., Conclusions: This reality can be explained through the gradual changing of alimentary habits (high consumption of saturated fats and very little intake of vegetal fibres) and by reduced physical activity that contributes to the progressive BMI increase.

The ischemic stroke syndrome is very broad and encompasses a wide range of underlying conditions. Its identification is of great importance in clinical routine, in particular in the management of young patients who have acute neurologic deficits. The introduction of CT, MR and ultra-sound demonstrating lesions of the brain and in certain degree of the cerebral arteries has in general eliminated the need for angiography as a first examination. The most common underlying anomaly found with thrombotic or embolic stroke is congenital or acquired heart disease. Thus, it is essential that patients with cerebral ischemia be submitted to a complete cardiac examination. Children tend to show more recovery after a stroke than adults do.

Background: Epidemiologic studies have shown a correlation between white blood cell (WBC) count and risk of developing myocardial infarction. Aim of this study is to assess the association between WBC and the other risk factors of coronary heart disease in a southern Italian population., Methods: Baseline data for the 1091 subjects (522 males and 569 females) enrolled in the "Montecorvino Rovella Project" were used to study factors associated with leukocytes., Results: WBC count was significantly higher in smokers (8711.1 +/- 1892 cells/dl) than in ex-smokers (6720 +/- 1608 cells/dl) and in those who never smoked (6674 +/- 1608 cells/dl). By multiple linear regression analysis, WBC count showed a positive association with triglycerides (p < 0.01), cholesterol (p < 0.05) fasting glucose levels (p < 0.01) and diastolic blood pressure (p < 0.05)., Conclusions: In this southern Italian population, elevated WBC count has been associated with other risk factors of coronary artery disease, particularly smoking, and has identified a high risk atherogenic profile. Even if the independency of the role of WBC is still under investigation, WBC count should be taken into account in establishing the coronary risk of apparently healthy people.

The prevention of sudden cardiac death remains one of the greatest challenges in the field of cardiovascular medicine today. Despite the difficulty in predicting which individuals are going to die suddenly, much knowledge has accumulated in recent years in regard to independent risk factors for SCD and moreover, different pharmacological interventions have been evaluated for the prevention of sudden coronary death. Currently, the beta-blockers are the only pharmacological agents that have been shown to reduce sudden cardiac deaths in clinical trials. The reduction in sudden death may involve several mechanisms that include antiatherosclerotic effects, antithrombotic effects, cardiac anti-ischemic effects and antifibrillatory effects.

Background: The "Montecorvino-Rovella Project" is a clinical epidemiological study, whose aim is to ascertain the distribution of the coronary risk factors and to treat the high risk people in a southern Italian community (21,328 inhabitants) with a reference area., Methods: The project consists of three phases: 1) identification and classification of high risk subjects among people aged 25-74 years at Montecorvino Rovella and Bellizzi (intervention area) and in a significant sample at Battipaglia (reference area); 2) treatment of high risk people at Montecorvino Rovella and Bellizzi; 3) periodic rescreening (after 5 and 10 years) of the enrolled cohorts and monitoring of morbidity and fatal cardiovascular events. In the first phase (1988-1990) 569 females and 522 males were examined. The participation response was high: 72.7% (75.9% females and 69.6% males)., Results: In this paper were described the main risk factors prevalence. The mean values (age-standardized) of total serum cholesterol (tc), triglycerides (tg) and fasting blood sugar (gl), for all males were of 204.8 mg/dl (tc), 159.4 mg/dl (tg), and 93.5 mg/dl (gl). In the females the mean values were lower: 202.9 mg/dl (tc), 134.2 mg/dl (tg), and 87.8 mg/dl (gl). The prevalences of this risk factors are the following hypercholesterolemia (serum cholesterol = > 240 mg/dl): males 20.7%, females 19.8%; hypertriglyceridemia (serum triglycerides = > 170 mg/dl): males 38.3%, females 23.1%; hyperglycemia (blood glucose = > 120 mg/dl: males 8.8%, females 6.6%. The mean levels of systolic blood pressure were: males 130.3 mm Hg and females 129.2 mm Hg; diastolic blood pressure: males 80.5 mm Hg and females 78.6 mm Hg. The male subjects with hypertension (B.P. = > 160/95 mm Hg) were 16.3% while female subjects were 26.1%. Hypertension control level in the examined sample was quite low. The prevalence of smokers was: 46% males and 17.3% females. Smokers were more frequently observed in young people (men > 50%), than in the oldest groups.

It is well known that rapid myocardial reperfusion, obtained using thrombolysis and/or PTCA, continues to be the best treatment for evolving myocardial infarction. However, a number of experimental studies have drawn attention to the fact that myocardial recovery following reperfusion may be limited by the onset of numerous deleterious biochemical events which occur during reperfusion. Studies carried out after thrombolysis have shown that the perviousness of the vessel and the existence of flow at the level of the epicardial vessels do not necessarily correspond to the recovery of tissue perfusion since a perfusion defect may persist in the presence of angiographically documented anterograde flow. This discrepancy, which occurs during reperfusion, has been attributed to marked cellular enlargement caused by ischaemia both in irreversibly damaged areas and in those which may potentially recover. In basal conditions, endothelial-neutrophil interaction is inhibited by negatively charged molecules present on endothelial cell membranes and by the production of numerous anti-inflammatory substances. During ischemia, on the other hand, anti-inflammatory and endogenous vasodilating substances are depleted in association with the appearance, on the surface of endothelial cells, of molecules favouring leukocyte adhesion. Of these the glycoprotein which has been characterized in greatest detail is the endothelial leukocyte adhesion molecule (ELAM 1) whose production and appearance on the endothelial surface is linked to cytokine-dependent endothelium activation. Ischemia may also stimulate the activation of neutrophils secreting chemiotactical and vasoconstricting factors, and cytotoxic compounds (reactive oxygen metabolites and proteolyte enzymes).(ABSTRACT TRUNCATED AT 250 WORDS)

A two years follow up on 105 diabetic patients and 50 normal subjects was carried out by high resolution real time echotomography, aiming to evaluate the prevalence and the evolutionary trends of carotid atherosclerotic plaques. The prevalence of atherosclerotic lesions was higher in diabetic patients than in normal subjects, and the most part of them showed an "intermediate" echographic pattern, minimal stenosis and regular surface. The results of the two years follow up indicate that the "soft" and the "hard" plaque types were those showing a more significant progression toward to the "mixed" type. "Hard" and "mixed" plaques, particularly those showing irregular surface, resulted most associated with higher degree of vessel stenosis. Four diabetic patients experienced three minor and one major ischemic events during the follow up; however all the patients had shown plaques with "intermediate" pattern, regular surface, and no signs of vessel stenosis progression. Further studies, performed for longer period of time with a higher number of patients are needed to evaluate the evolutionary trends of carotid plaques in diabetic patients and their relationship with clinical ischemic events.