RICOVERI PER INFARTO MIOCARDICO DURANTE LA SETTIMANA O NEL WEEK-END E MORTALITÀ
Un nuovo studio ha mostrato che i pazienti con infarto miocardico che arrivano in ospedale nei fine settimana hanno tassi di sopravvivenza inferiori ai pazienti ricoverati durante la settimana.

WEEKEND VERSUS WEEKDAY ADMISSION AND MORTALITY FROM MYOCARDIAL INFARCTION
Kostis WJ, Demissie K, Marcella SW et al.
N Engl J Med 2007; 356:1099-1109

Abstract
BACKGROUND Management of acute myocardial infarction requires urgent diagnostic and therapeutic procedures, which may not be uniformly available throughout the week.
METHODS We examined differences in mortality between patients admitted on weekends and those admitted on weekdays for a first acute myocardial infarction, using the Myocardial Infarction Data Acquisition System. All such admissions in New Jersey from 1987 to 2002 (231,164) were included and grouped in 4-year intervals.
RESULTS There were no significant differences in demographic characteristics, coexisting conditions, or infarction site between patients admitted on weekends and those admitted on weekdays. However, patients admitted on weekends were less likely to undergo invasive cardiac procedures, especially on the first and second days of hospitalization (P<0.001). In the interval from 1999 to 2002 (59,786 admissions), mortality at 30 days was significantly higher for patients admitted on weekends (12.9% vs. 12.0%, P=0.006). The difference became significant the day after admission (3.3% vs. 2.7%, P<0.001) and persisted at 1 year (1% absolute difference in mortality). The difference in mortality at 30 days remained significant after adjustment for demographic characteristics, coexisting conditions, and site of infarction (hazard ratio, 1.048; 95% confidence interval [CI], 1.022 to 1.076; P<0.001), but it became nonsignificant after additional adjustment for invasive cardiac procedures (hazard ratio, 1.023; 95% CI, 0.997 to 1.049; P=0.09).
CONCLUSIONS For patients with myocardial infarction, admission on weekends is associated with higher mortality and lower use of invasive cardiac procedures. Our findings suggest that the higher mortality on weekends is mediated in part by the lower rate of invasive procedures, and we speculate that better access to care on weekends could improve the outcome for patients with acute myocardial infarction.

FATTORI DI RISCHIO PER L'INFARTO MIOCARDICO ACUTO IN AMERICA LATINA
Un'analisi dello studio INTERHEART indica che l'obesità addominale è il principale fattore di rischio per l'infarto miocardio acuto nella popolazione dell'America latina.

RISK FACTORS FOR ACUTE MYOCARDIAL INFARCTION IN LATIN AMERICA: THE INTERHEART LATIN AMERICAN STUDY
Lanas F, Avezum A, Bautista LE et al.
Circulation 2007; 115: 1067-1074

Abstract
BACKGROUND Current knowledge of the impact of cardiovascular risk factors in Latin America is limited.
METHODS AND RESULTS As part of the INTERHEART study, 1237 cases of first acute myocardial infarction and 1888 age-, sex-, and center-matched controls were enrolled from Argentina, Brazil, Colombia, Chile, Guatemala, and Mexico. History of smoking, hypertension, diabetes mellitus, diet, physical activity, alcohol consumption, psychosocial factors, anthropometry, and blood pressure were recorded. Nonfasting blood samples were analyzed for apolipoproteins A-1 and B-100. Logistic regression was used to estimate multivariate adjusted odds ratios (ORs) and their 95% confidence intervals (CIs). Persistent psychosocial stress (OR, 2.81; 95% CI, 2.07 to 3.82), history of hypertension (OR, 2.81; 95% CI, 2.39 to 3.31), diabetes mellitus (OR, 2.59; 95% CI, 2.09 to 3.22), current smoking (OR, 2.31; 95% CI, 1.97 to 2.71), increased waist-to-hip ratio (OR for first versus third tertile, 2.49; 95% CI, 1.97 to 3.14), and increased ratio of apolipoprotein B to A-1 (OR for first versus third tertile, 2.31; 95% CI, 1.83 to 2.94) were associated with higher risk of acute myocardial infarction. Daily consumption of fruits or vegetables (OR, 0.63; 95% CI, 0.51 to 0.78) and regular exercise (OR, 0.67; 95% CI, 0.55 to 0.82) reduced the risk of acute myocardial infarction. Abdominal obesity, abnormal lipids, and smoking were associated with high population-attributable risks of 48.5%, 40.8%, and 38.4%, respectively. Collectively, these risk factors accounted for 88% of the population-attributable risk.
CONCLUSIONS Interventions aimed at decreasing behavioral risk factors, lowering blood pressure, and modifying lipids could have a large impact on the risk of acute myocardial infarction among Latin Americans.

MALATTIA POLMONARE CRONICA OSTRUTTIVA E OUTCOMES DOPO INFARTO MIOCARDICO
Per chiarire la relazione tra malattia polmonare cronica ostruttiva e le condizioni successive ad un infarto miocardico sono stati esaminati i dati di pazienti da uno studio osservazionale su 19 centri e sono stati definiti la mortalità ad un anno, il tasso di ospedalizzazioni e lo stato di salute.

IMPACT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE ON POST-MYOCARDIAL INFARCTION OUTCOMES
Salisbury AC, Reid KJ, Spertus JA
The American Journal of Cardiology 2007; 99:636-641

Abstract
Although chronic obstructive pulmonary disease (COPD) is common in patients with myocardial infarction (MI), its association with long-term mortality after MI is controversial and little is known about its influence on patients' health status (symptoms, function, and quality of life). We prospectively enrolled 2,481 patients presenting with MI at 19 United States centers to examine the relations between COPD and patients' long-term mortality, rehospitalization rates, and health status after MI. Patients were administered the disease-specific Seattle Angina Questionnaire and the generic Short Form 12 at baseline and 1 year later. COPD was common (15.6% of patients) and was associated with a substantially greater risk of 1-year mortality (15.8% vs 5.7%, p <0.001) and rehospitalization (48.7% vs 38.6%, p <0.001). After extensive adjustment for baseline differences, patients with COPD had a twofold greater 1-year mortality rate (hazard ratio 2.00, 95% confidence interval [CI] 1.44 to 2.79) and higher rehospitalization rates (hazard ratio 1.22, 95% CI 1.01 to 1.48). Similarly, adjusted 1-year health status was worse in patients with COPD, with lower 1-year Seattle Angina Questionnaire quality-of-life score (?2.53 points, 95% CI ?0.25 to ?4.81) and Short Form 12 physical component score (?1.83 points, 95% CI ?0.43 to ?3.24). In addition, COPD was associated with a trend toward a greater prevalence of angina at 1 year (risk ratio 1.12, 95% CI 0.89 to 1.41). In conclusion, patients with COPD have greater mortality, higher rehospitalization rates, and poorer health status 1 year after a MI. Although additional research is needed, clinicians should recognize that patients with COPD are at high risk for poor outcomes after MI.

STORIA FAMILIARE DI INFARTO MIOCARDICO E CALCIO NELLE ARTERIE CORONARICHE
Data l'incertezza riguardo le implicazioni di una storia familiare di infarto miocardico in specifiche classi di età e in presenza di fattori di rischio, lo studio ha valutato se l'associazione tra storia familiare di IM e livelli di calcio nelle arterie coronariche è modificato dall'età e da un concomitante profilo di rischio CV.

RELATION OF FAMILY HISTORY OF MYOCARDIAL INFARCTION AND THE PRESENCE OF CORONARY ARTERIAL CALCIUM IN VARIOUS AGE AND RISK FACTOR GROUPS
Philips B, de Lemos JA, Patel MJ et al.
Am J Cardio 2007; 99:825-829

Abstract
Family history of myocardial infarction (FHMI) is an independent risk factor for cardiovascular (CV) events but may be more informative in certain subgroups. The association between FHMI and the presence of coronary artery calcium (CAC) was examined in various age and risk factor groups in the Dallas Heart Study (DHS), a population-based probability sample of subjects aged 30 to 65 years. Analyses were stratified by age (with the young group composed of men aged <45 years and women aged <55 years) and by the presence of 0, 1, 2, or >2 CV risk factors. In the overall cohort of 2,743 subjects, FHMI was an independent predictor of CAC (adjusted odds ratio 1.3, 95% confidence interval 1.1 to 1.7), attributable to an independent association between FHMI and CAC in the young group (adjusted odds ratio 1.5, 95% confidence interval 1.0 to 2.1) that was not evident in the older subset (adjusted odds ratio 1.2, 95% confidence interval 0.91 to 1.6, interaction p = 0.02). In the young cohort, the association between FHMI and CAC was particularly robust in those with ?2 risk factors (FHMI-by-risk factor interaction p = 0.04). In older subjects, FHMI was not associated with CAC for any risk factor category (p >0.05 for each). In conclusion, this study suggests that FHMI is a more important predictor of atherosclerosis in young compared with older adults and, among the young, in those with multiple CV risk factors.

ANORMALITÀ DELL'ECG E RISCHIO DI EVENTI E DI MORTALITÀ CV IN DONNE ASINTOMATICHE
Le donne in post-menopausa, senza sintomi di malattie cardiovascolari e con anomalie dell'elettrocardiogramma, sono esposte ad un maggior rischio di futuri eventi o di morte CV e l'aumento del rischio è indipendente dai comuni fattori di rischio e dalla terapia ormonale.

MAJOR AND MINOR ECG ABNORMALITIES IN ASYMPTOMATIC WOMEN AND RISK OF CARDIOVASCULAR EVENTS AND MORTALITY
Denes P, Larson JC, Lloyd-Jones DM et al.
JAMA. 2007; 297:978-985

Abstract
CONTEXT Data are sparse regarding the prevalence, incidence, and independent prognostic value of minor and/or major electrocardiographic (ECG) abnormalities in asymptomatic postmenopausal women. There is no information on the effect, if any, of hormonal treatment on the prognostic value of the ECG.
OBJECTIVE To examine association of minor and major baseline and incident ECG abnormalities with long-term cardiovascular morbidity and mortality.
DESIGN, SETTING, AND PARTICIPANTS Post-hoc analysis of the estrogen plus progestin component of the Women's Health Initiative study, a randomized controlled primary prevention trial of 14 749 postmenopausal asymptomatic women with intact uterus who received 1 daily tablet containing 0.625 mg of oral conjugated equine estrogen and 2.5 mg of medroxyprogesterone acetate or a matching placebo. Participants were enrolled from 1993 to 1998, and the estrogen plus progestin trial was stopped on July 7, 2002.
MAIN OUTCOME MEASURES The Novacode criteria were used to define minor, major, and incident ECG abnormalities. Cardiovascular end points included incident coronary heart disease (CHD) and cardiovascular disease (CVD) events.
RESULTS Among women with absent (n = 9744), minor (n = 4095), and major (n = 910) ECG abnormalities, there were 118, 91, and 37 incident CHD events, respectively. The incident annual CHD event rates per 10 000 women with absent, minor, or major ECG abnormalities were 21 (95% confidence interval [CI], 18-26), 40 (95% CI, 32-49), and 75 (95% CI, 54-104), respectively. After 3 years of follow-up, 5% of women who had normal ECG at baseline developed new ECG abnormalities with an annual CHD event rate of 85 (95% CI, 44-164) per 10 000 women. The adjusted hazard ratios for CHD events were 1.55 (95% CI, 1.14-2.11) for minor baseline, 3.01 (95% CI, 2.03-4.46) for major baseline, and 2.60 (95% CI, 1.08-6.27) for incident ECG abnormalities. There were no significant interactions between hormone treatment assignment and ECG abnormalities for risk prediction of cardiovascular end points. For prediction of CHD events, the addition of ECG findings to the Framingham risk score increased from 0.69 to 0.74 the area under the receiver operating characteristic curve. Similar findings were found for incident CVD events.
CONCLUSIONS Among asymptomatic postmenopausal women, clinically relevant baseline and incident ECG abnormalities are independently associated with increased risk of cardiovascular events and mortality, and the information is incremental to the established method of risk stratification.

Koplik told heartwire that the mechanism behind this effect was not known, but it appears that smoking and coffee "may share a common pathway" in increasing heart-disease risk. This idea is also consistent with a previous study that suggested that coffee and smoking exerted a synergistic detrimental effect on aortic stiffness.
"It is also possible that heavy smokers and people who drink lots of coffee share other traits that could increase their risk of heart disease that we have not controlled for, but on the basis of these results l would advise that people who smoke or who have ever smoked should cut their coffee consumption," Koplik added.

FUMO IN GRAVIDANZA E DANNO VASCOLARE NEI FIGLI
Un nuovo studio ha mostrato per la prima volta che i figli di donne che avevano fumato durante la gravidanza sviluppano un quadro aterosclerotico più grave, determinato come ispessimento dell'intima-media carotidea, e sono quindi esposti ad un rischio maggiore di infarto miocardico e ictus.

SMOKING WHILE PREGNANT CAUSES PERMANENT VASCULAR DAMAGE IN OFFSPRING
Fonte: theheart.org. 8 Marzo 2007

Orlando, FL - Smoking during pregnancy not only slows intrauterine growth and lowers birth weight, but it has now been found that it can also cause permanent vascular damage in the offspring [1].
In a study presented last week at the American Heart Association 2007 Annual Conference on Cardiovascular Disease Epidemiology and Prevention, a Dutch group found that young adults who were exposed to smoke during gestation had a higher atherosclerosis burden as determined by increased carotid artery intima-media thickness (CIMT), putting them at higher risk of MI and stroke.
Lead author Dr Cuno Uiterwaal (University Medical Center, Utrecht, the Netherlands) said: "This is the first report to demonstrate this association. This is a preventable risk factor. Women need to stop smoking, especially in pregnancy, not only for their own health, but for their unborn child."
In the Netherlands Atherosclerosis Risk in Young Adults (ARYA) study, 732 participants who were born in 1970-1973 had vascular risk measurements performed in 1999-2000. Results showed that the adult offspring of the 215 mothers who smoked during pregnancy had an increase in CIMT of 13.4 µm compared with the offspring of mothers who did not smoke in pregnancy. A 9.4-µm difference remained after adjustment for other risk factors, including age, gender, body-mass index, pulse pressure, and cholesterol levels.
Adjustment for current smoking by both mothers and fathers or the number of cigarettes smoked by study participants also did not change this association. "While it is difficult to separate the problem of current smoking and smoking during pregnancy, this study indicates that smoking in pregnancy has an independent effect," Uiterwaal said.
If both parents smoked during pregnancy, the children as young adults had increased CIMT compared with other participants with either one smoking parent or parents who didn't smoke. Offspring of mothers who smoked the highest number of cigarettes during pregnancy had higher CIMT measurements than those born to mothers smoking less than the average or those who did not smoke. "Our findings suggest that both smoking by mothers themselves in pregnancy and exposure to passive smoking are important. More exposure leads to more vascular damage in the offspring," the researchers said.
They believe that pregnancy is a critical period for damage from smoke exposure. "There is the possibility that the compounds in tobacco smoke go through the placenta and directly damage the cardiovascular system of the fetus. The damage appears to be permanent and stays with the children," they noted.
When the people taking part in the study were born, about 30% of their mothers smoked during pregnancy. The current rate has dropped to around 5% to 7% due to health warnings, Uiterwaal et al reported. "But there are still a substantial number of women who smoke during pregnancy, and this is another reason for them to stop."

CRESCITA CORPOREA E LIVELLI LIPIDICI
Lo studio, il primo ad analizzare diverse misurazioni corporee nel corso della vita, ha trovato che i soggetti la cui crescita era limitata a due periodi fondamentali durante l'infanzia hanno poi sviluppato alti livelli di colesterolo.

LIFE COURSE BODY SIZE AND LIPID LEVELS AT 53 YEARS IN A BRITISH BIRTH COHORT
Skidmore PM, Hardy RJ, Kuh DJ, Langenberg C, Wadsworth ME
J Epidemiol Community Health. 2007; 61:215-20

Abstract
OBJECTIVES: To investigate the association between growth in height and change in body mass index (BMI) during the life course on lipid levels at 53 years.
METHODS: 2311 men and women from a British cohort study were included in analyses. Non-fasting total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels were measured at 53 years. Height and BMI at 2, 4, 7, 11, 15 and 36 years in relation to the lipid outcomes at 53 years were assessed using multiple regression models. The effects of z scores of height and BMI at 2 years and yearly rates of change (velocities) in height and BMI between 2-7, 7-15 and 15-36 years were also considered.
RESULTS: Total cholesterol level decreased by 0.119 mmol/l (95% CI -0.194 to -0.045) per SD increase in height at 2 years and by 0.073 mmol/l (95% CI -0.145 to -0.001) for every SD increase in height velocity between 15 years and adulthood. Similar, but weaker associations were seen for LDL cholesterol. The relationships between leg length and total and LDL cholesterol were stronger than the relationship with trunk length. Higher BMI at 36 and 53 years and greater BMI increases between 15-36 and 36-53 years were associated with higher total and LDL cholesterol and lower HDL cholesterol levels. The effects of growth could not be explained by birth weight or lifetime socioeconomic status.
CONCLUSIONS: Early life exposures, which restrict height growth in infancy, resulting in shorter adult leg length, may influence lipid levels in adult life.

PESO E DIMENSIONI ALLA NASCITA E PRESSIONE ARTERIOSA NELL'ADOLESCENZA
Lo studio ha esaminato l'associazione tra alcune misure antropometriche alla nascita, come peso, altezza, circonferenza cranica ed età gestazionale, e i valori di pressione arteriosa sviluppati in adolescenza.

SIZE AT BIRTH AND BLOOD PRESSURE IN EARLY ADOLESCENCE: A PROSPECTIVE BIRTH COHORT STUDY
Menezes AMB, Hallal PC, Horta BL et al.
Am. J. Epidemiol 2007. 165: 611-616

Abstract
Previous studies have suggested that birth size may influence blood pressure in later life. Most of these reported inverse associations only became evident after weight or body mass index at some later age was included in the regression model. In a prospective birth cohort study in Brazil, the effect of birth size on blood pressure at age 11 years was explored. Of the 5,249 cohort members, 4,452 were interviewed. Mean systolic and diastolic blood pressures were 101.9 mmHg (standard deviation, 12.3) and 63.4 mmHg (standard deviation, 9.9), respectively. Birth weight was positively associated with blood pressure in the crude analysis, but this effect was no longer significant after adjustment for confounders. When current body mass index-a possible mediating variable-was added to the model, the association between birth weight and blood pressure tended to become negative, though not quite significant. Birth length showed a positive effect on later blood pressure regardless of the adjustments made. Head circumference, gestational age, and ponderal index were not associated with blood pressure. Children born small for gestational age had lower blood pressure values. The postulated inverse association between birth weight and later blood pressure was not confirmed in this cohort. Instead, a positive effect of birth length was detected.

INQUINAMENTO AMBIENTALE E ACCESSI AL PRONTO SOCCORSO PER CAUSE CARDIOVASCOLARI
L'analisi ha esaminato l'associazione tra livelli di inquinanti ambientali e morbilità cardiovascolare in soggetti potenzialmente sensibili per la presenza concomitante di condizioni quali diabete, ipertensione, disritmia, insufficienza cardiaca, aterosclerosi, patologia polmonare cronica ostruttiva, infezioni delle vie respiratorie e asma.

AMBIENT AIR POLLUTION AND CARDIOVASCULAR EMERGENCY DEPARTMENT VISITS IN POTENTIALLY SENSITIVE GROUPS
Peel JL, Metzger KB, Klein M et al.
Am. J. Epidemiol 2007. 165: 625-633

Abstract
Limited evidence suggests that persons with conditions such as diabetes, hypertension, congestive heart failure, and respiratory conditions may be at increased risk of adverse cardiovascular morbidity and mortality associated with ambient air pollution. The authors collected data on over 4 million emergency department visits from 31 hospitals in Atlanta, Georgia, between January 1993 and August 2000. Visits for cardiovascular disease were examined in relation to levels of ambient pollutants by use of a case-crossover framework. Heterogeneity of risk was examined for several comorbid conditions. The results included evidence of stronger associations of dysrhythmia and congestive heart failure visits with comorbid hypertension in relation to increased air pollution levels compared with visits without comorbid hypertension; similar evidence of effect modification by diabetes and chronic obstructive pulmonary disease (COPD) was observed for dysrhythmia and peripheral and cerebrovascular disease visits, respectively. Evidence of effect modification by comorbid hypertension and diabetes was observed in relation to particulate matter less than 10 µm in aerodynamic diameter, nitrogen dioxide, and carbon monoxide, while evidence of effect modification by comorbid COPD was also observed in response to ozone levels. These findings provide further evidence of increased susceptibility to adverse cardiovascular events associated with ambient air pollution among persons with hypertension, diabetes, and COPD.

INQUINAMENTO ATMOSFERICO E MORTALITÀ PER ICTUS
Lo scopo dello studio era di indagare l'associazione tra il particolato fine e ultrafine e un aumento della mortalità per ictus in una popolazione anziana residente in un'area con livelli di inquinanti atmosferici relativamente bassi.

ASSOCIATIONS OF FINE AND ULTRAFINE PARTICULATE AIR POLLUTION WITH STROKE MORTALITY IN AN AREA OF LOW AIR POLLUTION LEVELS
Kettunen J, Lanki T, Tiittanen P et al.
Stroke, pubblicato on line il 23 febbraio 2007

Abstract
BACKGROUND AND PURPOSE Daily variation in outdoor concentrations of inhalable particles (PM10 <10 [mu]m in diameter) has been associated with fatal and nonfatal stroke. Toxicological and epidemiological studies suggest that smaller, combustion-related particles are especially harmful. We therefore evaluated the effects of several particle measures including, for the first time to our knowledge, ultrafine particles (<0.1 [mu]m) on stroke.
METHODS Levels of particulate and gaseous air pollution were measured in 1998 to 2004 at central outdoor monitoring sites in Helsinki. Associations between daily levels of air pollutants and deaths caused by stroke among persons aged 65 years or older were evaluated in warm and cold seasons using Poisson regression.
RESULTS There was a total of 1304 and 1961 deaths from stroke in warm and cold seasons, respectively. During the warm season, there were positive associations of stroke mortality with current- and previous-day levels of fine particles (<2.5 [mu]m, PM2.5) (6.9%; 95% CI, 0.8% to 13.8%; and 7.4%; 95% CI, 1.3% to 13.8% for an interquartile increase in PM2.5) and previous-day levels of ultrafine particles (8.5%; 95% CI, -1.2% to 19.1%) and carbon monoxide (8.3; 95% CI, 0.6 to 16.6). Associations for fine particles were mostly independent of other pollutants. There were no associations in the cold season.
CONCLUSIONS Our results suggest that especially PM2.5, but also ultrafine particles and carbon monoxide, are associated with increased risk of fatal stroke, but only during the warm season. The effect of season might be attributable to seasonal differences in exposure or air pollution mixture.

PRESSIONE ARTERIOSA E STIMA DEL RISCHIO DI ICTUS NELLA POPOLAZIONE ANZIANA DELLA SPAGNA
Il rischio stimato era maggiore tra gli individui con diagnosi di ipertensione rispetto ai normotesi o ai soggetti con pressione alta ma senza diagnosi della patologia, suggerendo un ruolo dell'ipertensione diagnosticata nell'aumento del rischio di ictus.

BLOOD PRESSURE AND ESTIMATED RISK OF STROKE IN THE ELDERLY POPULATION OF SPAIN: THE PREV-ICTUS STUDY
Redon J, Cea-Calvo L, Lozano JV et al.
Stroke, pubblicato on line il 22 febbraio 2007

Abstract
BACKGROUND AND PURPOSE The objective of this study was to estimate the high blood pressure values and the 10-year risk of stroke in the Spanish general population aged 60 years or older using the Framingham scale.
METHODS This was a multicenter, population-based, cross-sectional study performed in Spanish primary care centers. A randomized selection of centers and recruitment population was used. We collected clinical, biochemical, and electrocardiographic data.
RESULTS We analyzed 7343 subjects (mean age, 71.6 years; standard deviation, 7.0; 53.4% females, 34.4% obese subjects, and 27.1% diabetic subjects). Electrocardiographic-left ventricle hypertrophy was present in 12.9% of the subjects, atrial fibrillation in 8.4%, and established cardiovascular disease in 28.9%; 73.0% already had hypertension diagnosed, and 12.8% showed high blood pressure without a prior diagnosis of hypertension. Among hypertensive subjects, 29.1% had high blood pressure on therapeutic objective, and of the total population 35.7% had high blood pressure under control. Those with hypertension already diagnosed showed a higher prevalence of other stroke risk factors (left ventricle hypertrophy, atrial fibrillation, diabetes, or established cardiovascular disease). The estimated 10-year stroke risk was 19.6% (standard deviation, 17.3%), and was greater in hypertensive patients (23.7%; standard deviation, 18.5) than in patients with high blood pressure without known hypertension (12.4%; standard deviation, 9.2), or in normotensive subjects (5.3%; standard deviation, 0.2; P<0.001).
CONCLUSION The 10-year estimated stroke risk was 19.6%, and it was greater in hypertensive patients as compared with the remainder people at any blood pressure range. The concomitant stroke risk factors are more prevalent in patients with hypertension already diagnosed, which implies an important additional estimated risk of stroke.

CONTROLLO DELLA PRESSIONE ARTERIOSA E MORTALITÀ PER ICTUS IN SPAGNA
Lo studio, che ha stimato il rischio di ictus in soggetti appartenenti ad alcune comunità spagnole, ha chiarito le ragioni dei differenti tassi di mortalità registrati, correlandoli al grado di controllo della pressione arteriosa e alla presenza di ipertrofia ventricolare sinistra.

DIFFERENCES IN BLOOD PRESSURE CONTROL AND STROKE MORTALITY ACROSS SPAIN: THE PREVENCION DE RIESGO DE ICTUS (PREV-ICTUS) STUDY
Redon J, Cea-Calvo L, Lozano JV et al.
Hypertension, pubblicato on line il 23 febbraio 2007

Abstract
The objective was to assess the stroke risk and prevalence of the cardiovascular risk factors and to analyze their relationship with the specific stroke rates of mortality in each of the autonomic communities of Spain. We conducted a multicenter, cross-sectional study of population >60 years old in Spanish primary care centers. In all of the subjects, clinical, biochemical, and electrocardiographic data were obtained, and the 10-year stroke risk was calculated using the Framingham score. Mortality rates of stroke, age and sex adjusted, were obtained for each of the autonomic communities from the Ministry of Health. A total of 7343 subjects (mean age: 71.6 years, 53.4% women, 34.4% obese, and 27.1% diabetic subjects) were analyzed. A total of 73% were already diagnosed with hypertension. Among hypertensive subjects, 29.1% had blood pressure on therapeutic objective, and, of the total population, 35.7% had blood pressure under control. ECG-left ventricular hypertrophy was present in 12.9% of the subjects. The estimated stroke risk was 19.6%. Stroke mortality rates were significantly related to the estimated 10-year stroke risk (r=0.41; P<0.05) in each autonomic community. Poor hypertension control (P=-0.42; P<0.05) and prevalence of ECG-left ventricular hypertrophy (P=0.52; P<0.05) were the main factors related to the stroke mortality rates after controlling by age, sex, obesity, diabetes, and urban setting. Differences in stroke mortality throughout the autonomic communities of Spain were associated with indexes of worse blood pressure handling, low control rates, and high left-ventricular hypertrophy.

INCIDENZA E FATTORI DI RISCHIO DI ICTUS IN PAZIENTI DIABETICI
L'obiettivo dello studio era descrivere l'incidenza e i fattori di rischio dell'ictus in soggetti affetti da diabete di tipo 2, compresi pazienti anziani, nella popolazione italiana.

INCIDENCE AND RISK FACTORS FOR STROKE IN TYPE 2 DIABETIC PATIENTS: THE DAI STUDY
Giorda CB, Avogaro A, Maggini M et al.
Stroke, pubblicato on line il 2 marzo 2007

Abstract
BACKGROUND AND PURPOSE Type 2 diabetes mellitus is a strong predictor of cerebrovascular disease, yet few studies have assessed the incidence of stroke and the role of other risk factors in unselected type 2 diabetes mellitus populations.
METHODS We prospectively followed-up 14 432 type 2 diabetes mellitus patients, aged 40 to 97 years, with and without a history of cardiovascular disease at enrollment, and we estimated the incidence of stroke and the hazards ratios with respect to clinical variables.
RESULTS During a 4-year follow-up, 296 incident stroke events were recorded. In persons with no history of cardiovascular disease, the age-standardized incidence of stroke (per 1000 person-years) was 5.5 (95% confidence interval, 4.2 to 6.8) in men and 6.3 (95% confidence interval, 4.5 to 8.2) in women. In persons with a history of cardiovascular disease, it was 13.7 (95% confidence interval, 7.5 to 19.8) in men and 10.8 (95% confidence interval, 7.3 to 14.4) in women. The hazards ratios of stroke incidence varied according to age, sex, and history of cardiovascular disease. Among men with no history, HbA1c and smoking were predictors of stroke. Among patients with a history, the risk factors were, in men, therapy with insulin plus oral agents, treated high total cholesterol and low HDL cholesterol, whereas in women microvascular complications were a risk factor. Previous stroke was a strong predictor of stroke in both sexes.
CONCLUSIONS Age and previous stroke are the main predictors of stroke in diabetes. The combined role of Hba1c, microvascular complications, low HDL cholesterol, and treatment with insulin plus oral agents highlights the importance of diabetic history and clinical background in the development of stroke.

MENOPAUSA E SINDROME METABOLICA
Uno studio svolto su donne coreane ha mostrato un'associazione tra stato menopausale e rischio di sviluppo di sindrome metabolica indipendente dall'età.

THE EFFECT OF MENOPAUSE ON THE METABOLIC SYNDROME AMONG KOREAN WOMEN: THE KOREAN NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY, 2001
Kim HM, Park J, Ryu SYeon, Kim J
Diabetes Care 2007. 30:701-706

Abstract
OBJECTIVE This study examined the effect of menopausal status on the risk of the metabolic syndrome in Korean women.
RESEARCH DESIGN AND METHODS Data were obtained from the Korean National Health and Nutrition Examination Survey of 2001. A total of 2,671 women who did not receive hormone replacement therapy (1,893 premenopausal women and 778 postmenopausal women) were included in the analysis. The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III.
RESULTS Postmenopausal women had significantly higher mean waist circumference, systolic blood pressure, pulse pressure, total cholesterol, LDL cholesterol, and triglyceride levels than premenopausal women after adjusting for age (P = 0.018, P = 0.001, P < 0.0001, P < 0.0001, P < 0.0001, and P = 0.006, respectively). Among postmenopausal women, the age-adjusted odds ratio was 1.61 (95% CI 1.15-2.25) for abdominal obesity, 1.11 (0.76-1.61) for elevated blood pressure, 1.24 (0.90-1.72) for low HDL cholesterol, 1.28 (0.89-1.83) for high triglycerides, and 1.07 (0.69-1.65) for high fasting glucose compared with premenopausal women. The multivariate-adjusted odds ratio for the metabolic syndrome was 1.60 (95% CI 1.04-2.46) among postmenopausal women compared with premenopausal women.
CONCLUSIONS Postmenopausal status is associated with an increased risk of the metabolic syndrome independent of normal aging in Korean women.

DISTURBI DEL SONNO E INSUFFICIENZA CARDIACA
Questo studio ha mostrato che i disturbi del sonno possono essere considerati fattori di rischio per l'insufficienza cardiaca in uomini di mezza età e che l'associazione è presente solo nei soggetti in sovrappeso.

SLEEP DISTURBANCES INDEPENDENTLY PREDICT HEART FAILURE IN OVERWEIGHT MIDDLE-AGED MEN
Ingelsson E,Lind L,Ärnlöv J, Sundström J
European Journal of Heart Failure 2007; 9:184-190

Abstract
BACKGROUND Sleep disturbances are associated with manifest heart failure (HF). However, the relationship between sleep disturbances and incident HF has been less studied.
AIMS To investigate self-reported sleep disturbances as predictors of HF in a longitudinal, community-based cohort of 2314 middle-aged men.
METHODS AND RESULTS Data on self-reported sleep disturbances, as well as established risk factors for HF were collected and analyzed using Cox proportional hazards analyses. In multivariable Cox proportional hazards models adjusted for established risk factors for HF, the presence at baseline of sleep disturbances (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.16-1.99; p = 0.002) was an independent risk factor for HF. There was evidence of effect modification between BMI and sleep disturbances. In multivariable-adjusted models, sleep disturbance (HR, 1.58; 95% CI, 1.13-2.21; p = 0.008) was an independent risk factor for HF in overweight participants (BMI > 25), but not in normal-weight participants (BMI ? 25). All results remained similar in a sub-sample excluding all participants suffering from a myocardial infarction during follow-up.
CONCLUSIONS Self-reported sleep disturbances imply an increased risk of subsequent HF in overweight middle-aged men, via mechanisms largely independent of established risk factors for HF, including an interim myocardial infarction.