AUMENTO DELLA PREVALENZA DI DIABETE IN ITALIA
Uno studio retrospettivo condotto dalla Società Italiana di Medicina Generale (SIMG) e dal suo centro di ricerca Health Search ha descritto la situazione italiana riguardo alla patologia diabetica, in termini di prevalenza, di approccio clinico e di raggiungimento dei target terapeutici.

[Adnkronos Salute. 30 ottobre 2007]

Ogni medico di famiglia italiano ha fra i suoi assistiti dagli 80 ai 100 diabetici (il 5,59% su un totale di oltre mille pazienti). Di questi più della metà non è ancora sufficientemente sotto controllo: il 53% non raggiunge gli obiettivi terapeutici consigliati dalle linee guida nazionali per raggiungere il cosiddetto 'buon compenso' del diabete, una pratica che mette i pazienti al riparo dalle complicanze che derivano dalla malattia, mantenendo i valori dell'emoglobina glicata sotto una soglia raccomandata del 7%. Ma non solo: meno del 10% fa ricorso all'insulina, mentre il 42% ha come unica terapia quella di stare a dieta. In pochi tengono a bada la pressione arteriosa e il colesterolo, amplificando i rischi di andare incontro a una patologia cardiovascolare. E' il quadro che emerge da un'indagine condotta dalla Società Italiana di Medicina Generale (SIMG) e dal suo centro di ricerca Health Search, su un campione di 602.670 assistiti, di cui 33.698 diabetici. Lo studio retrospettivo, svolto nel 2005 e presentato oggi a Milano, offre uno spaccato della realtà dei diabetici italiani, rivelando anche il modo in cui viene gestita nel Paese questa patologia cronica che colpisce più di tre milioni di persone, con una previsione di crescita che porterà i malati a quota 5 milioni nel 2025. Dall'osservatorio dei medici di famiglia emerge inoltre che le donne, nonostante siano più virtuose nei controlli e più costanti nelle visite, in realtà sortiscono risultati più bassi rispetto agli uomini. Anche se il più soggetto alle patologie cardiovascolari resta il sesso maschile. ''Nonostante l'Italia sia tra le più virtuose a livello internazionale e versi in una situazione più favorevole rispetto ad altre realtà, la strada da percorrere è ancora lunga'', osserva Paolo Cavallo-Perin, vicepresidente della Società Italiana di Diabetologia (SID). Primo passo da compiere: rafforzare l'alleanza fra diabetologi e medici di medicina generale, per creare una solida rete assistenziale al paziente e, aggiunge Raffaele Scalpone, presidente dell'Associazione italiana diabetici (Aid), ''aumentare la consapevolezza sull'importanza dell'obiettivo del buon compenso del diabete''. A questo fine punta la campagna istituzionale lanciata dall'International Diabetes Federation (IDF) insieme alle affiliate Associazione Medici Diabetologi (AMD) e Società Italiana di Diabetologia (SID). Un'iniziativa avviata in Italia nel corso del 2006 e del 2007, coinvolgendo diabetologi, medici di medicina generale e associazioni di volontariato. A una fase preliminare è seguita la pubblicazione di un libro bianco sul buon compenso del diabete e di un insieme di raccomandazioni per una comunicazione efficace medico-paziente. Secondo passo: coinvolgere la medicina generale con la pubblicazione di un terzo libro che sarà consegnato ai medici di famiglia entro la fine dell'anno. Il flusso di informazioni però non deve essere interrotto, spiegano gli esperti. L'ultima fase, la più importante, sarà quella di trasferire, nel 2008, le conoscenze ai diretti interessati: i pazienti, che devono essere in grado di collaborare consapevolmente con il medico di medicina generale, condividendo target terapeutici di cui riconoscono l'importanza per la salute. L'obiettivo è uno solo: diffondere la pratica del test dell'emoglobina glicata, importante cartina al tornasole delle terapie. Finora, secondo la ricerca solo il 30% ne effettua almeno due l'anno, come consigliato dalle linee guida nazionali (più di due). La maggioranza (44%) esegue una sola misurazione nel corso dei 12 mesi, il 26% neanche quella. Tra quanti si sono sottoposti al test almeno una volta, il 47% mostra valori entro il limite. In pochi però sono anche attenti agli altri due fattori di rischio cardiovascolare: solo il 34% dei pazienti ha valori a target (cioè sotto i 130-80 mmHg) mentre per il colesterolo LDL solo il 26,7% ha un valore sotto il limite previsto di 100 mg/dL. Per tutti gli altri il rischio di sviluppare patologie cardiovascolari aumenta. ''E si amplifica ancora di più per quel 18% di diabetici fumatori. Il messaggio da lanciare è uno solo: il compenso del diabete deve essere globale, non solo limitato alla glicemia, ma esteso anche alla correzione degli altri fattori di rischio cardiovascolare, come l'ipertensione e la dislipidemia'', conclude Cavallo-Perin.

CONSUMO DI FRUTTA, VERDURA ED ANTIOSSIDANTI E RISCHIO DI DIABETE DI TIPO 2
Una riduzione dello stress ossidativo e dell'infiammazione, contemporanea alla progressiva disabilità delle funzioni delle cellule beta-pancreatiche nello sviluppo del diabete, può costituire uno dei meccanismi alla base del benefico effetto di alimenti con proprietà antiossidanti; con questa metanalisi si è voluto indagare tale associazione attraverso l'analisi di dati ricavati da studi di coorte.

[INTAKE OF FRUIT, VEGETABLES, AND ANTIOXIDANTS AND RISK OF TYPE 2 DIABETES: SYSTEMATIC REVIEW AND META-ANALYSIS. Journal of Hypertension 2007; 25(12):2361-2369]

ABSTRACT
BACKGROUND The public health recommendation is to consume five or more servings of fruit and vegetables daily, but the association between the intake of fruit and vegetables and the risk of type 2 diabetes is unclear.
METHODS To examine the association between the intake of fruit, vegetables, and antioxidants and the risk of type 2 diabetes, prospective cohort studies were sought, with measures of intakes at baseline and incident diabetes at follow-up.
RESULTS Five cohort studies of fruit and vegetables intake and the risk of diabetes were included, incorporating 167 128 participants and 4858 incident cases of type 2 diabetes, with a mean follow-up of 13 years. The relative risk of type 2 diabetes for consuming five or more servings of fruit and vegetables daily was 0.96 (95% CI, 0.79-1.17, P = 0.96), 1.01 (0.88-1.15, P = 0.88) for three or more servings of fruit, and 0.97 (0.86-1.10, P = 0.59) for three or more servings of vegetables. Nine cohort studies of antioxidant intake and the risk of diabetes were also identified, incorporating 139 793 participants and 8813 incident cases of type 2 diabetes, with a mean follow-up of 13 years. The pooled relative risk was 0.87 (0.79-0.98, P = 0.02) for the highest compared with the lowest antioxidant intake.
CONCLUSIONS The consumption of three or more daily servings of fruit or vegetables was not associated with a substantial reduction in the risk of type 2 diabetes. The intake of antioxidants was associated with a 13% reduction in risk, mainly attributed to vitamin E. These results are not supported by randomized, controlled trials of vitamin supplements, therefore the findings might not be causal, and the discrepancy remains unclear.

APPORTO DIETETICO DI CARBOIDRATI E PROTEINA C REATTIVA IN UOMINI E DONNE AD ALTO RISCHIO CV
Dal momento che in questo ambito gli studi condotti fino ad oggi hanno incluso soggetti sani e prevalentemente di sesso femminile, lo scopo principale di questa indagine è stato di valutare la relazione tra l'apporto glicemico nella dieta e le concentrazioni di proteina C reattiva ad alta sensibilità in una popolazione di uomini e donne a rischio per CVD.

[DIETARY CARBOHYDRATE INTAKE AND HIGH-SENSITIVITY C-REACTIVE PROTEIN IN AT-RISK WOMEN AND MEN. American Heart Journal 2007; 154 (5):962-968]

ABSTRACT
BACKGROUND The quality and quantity of dietary carbohydrate intake, measured as dietary glycemic load (GL), are associated with a number of cardiovascular disease (CVD) risk factors and, in healthy young women, are related to increased high-sensitivity C-reactive protein (hsCRP) concentrations. Our objective was to determine if GL is related to hsCRP and other measures of CVD risk in a population of sedentary, overweight, dyslipidemic middle-aged women and men enrolled in an exercise intervention trial (STRRIDE).
METHODS This was a cross-sectional evaluation of the relationships between measures of dietary carbohydrate intake, calculated from food frequency questionnaire data, and CVD risk factors, including plasma hsCRP, measured in 171 subjects.
RESULTS After adjusting for energy intake, GL and other measures of carbohydrate intake were not independently related to hsCRP (P > .05 for all). In the analyses performed separately for each sex, only the quantity of carbohydrate intake was independently related to hsCRP (R2 = 0.28, P < .04), and this relationship was present for women but not for men. The strongest relationship identified between GL and any CVD risk factor was for cardiorespiratory fitness (R2 = 0.12, P < .02); an elevated GL was associated with a lower level of fitness in all subjects, and this relationship persisted even when the findings were adjusted for energy intake and sex (R2 = 0.48, P < .03).
CONCLUSIONS In middle-aged, sedentary, overweight to mildly obese, dyslipidemic individuals, consuming a diet with a low GL is associated with better cardiorespiratory fitness. Our findings suggest that the current literature relating carbohydrate intake and hsCRP should be viewed with skepticism, especially in the extension to at-risk populations that include men.

COLAZIONE A BASE DI CEREALI E INSUFFICIENZA CARDIACA
Principale obiettivo dello studio era di esaminare prospetticamente se un alto consumo di cereali a colazione fosse associato ad una riduzione del rischio di insufficienza cardiaca in medici americani.

[BREAKFAST CEREALS AND RISK OF HEART FAILURE IN THE PHYSICIANS' HEALTH STUDY I. Arch Intern Med. 2007; 167:2080-2085]

ABSTRACT
BACKGROUND Heart failure (HF) is the leading cause of hospitalization among the elderly population in the United States. Consumption of grain products and dietary fiber has been shown to reduce the risk of hypertension and myocardial infarction. However, it is not known whether a higher consumption of breakfast cereals is associated with risk of HF.
METHODS This study evaluated prospectively the association between breakfast cereal intake and incident HF among 21 376 participants of the Physicians' Health Study I. Cereal consumption was estimated using a semiquantitative food frequency questionnaire. Incident HF was ascertained through annual follow-up questionnaires and validated using Framingham criteria. We used Cox regression models to estimate adjusted relative risk of HF across categories of cereal intake.
RESULTS During an average follow-up of 19.6 years, 1018 incident cases of HF occurred. For average weekly cereal consumption of 0 servings, 1 or fewer, 2 to 6, and 7 or more, hazard ratios (95% confidence intervals) for HF were 1 (reference), 0.92 (0.78-1.09), 0.79 (0.67-0.93), and 0.71 (0.60-0.85), respectively (P<.001 for trend), adjusting for age, smoking, alcohol consumption, vegetable consumption, use of multivitamins, exercise, and history of atrial fibrillation, valvular heart disease, and left ventricular hypertrophy. However, the association was limited to the intake of whole grain cereals (P <.001 for trend) but not refined cereals (P = .70 for trend).
CONCLUSIONS Our data demonstrate that a higher intake of whole grain breakfast cereals is associated with a lower risk of HF. Additional studies are warranted to confirm these findings and determine specific nutrients that are responsible for such a protection.

DIETA E STILE DI VITA E INFARTO MIOCARDICO NELLE DONNE
Un nuovo studio svedese ha mostrato che una dieta salutare, il moderato consumo di alcolici, l'attività fisica, l'astensione dal fumo e un basso rapporto vita/fianchi possono prevenire la maggior parte degli attacchi cardiaci nelle donne.

[COMBINED EFFECT OF LOW-RISK DIETARY AND LIFESTYLE BEHAVIORS IN PRIMARY PREVENTION OF MYOCARDIAL INFARCTION IN WOMEN. Arch Intern Med. 2007; 167:2122-2127]

ABSTRACT
BACKGROUND Limited data are available on the benefit of combining healthy dietary and lifestyle behaviors in the prevention of myocardial infarction (MI) in women.
METHODS We used factor analysis to identify a low-risk behavior-based dietary pattern in 24 444 postmenopausal women from the population-based prospective Swedish Mammography Cohort who were free of diagnosed cancer, cardiovascular disease, and diabetes mellitus at baseline (September 15, 1997). We also defined 3 low-risk lifestyle factors: nonsmoking, waist-hip ratio less than the 75th percentile (< 0.85), and being physically active (at least 40 minutes of daily walking or bicycling and 1 hour of weekly exercise).
RESULTS During 6.2 years (151 434 person-years) of follow-up, we ascertained 308 cases of primary MI. Two major identified dietary patterns, "healthy" and "alcohol," were significantly associated with decreased risk of MI. The low-risk diet (high scores for the healthy dietary pattern) characterized by a high intake of vegetables, fruit, whole grains, fish, and legumes, in combination with moderate alcohol consumption ( 5 g of alcohol per day), along with the 3 low-risk lifestyle behaviors, was associated with 92% decreased risk (95% confidence interval, 72%-98%) compared with findings in women without any low-risk diet and lifestyle factors. This combination of healthy behaviors, present in 5%, may prevent 77% of MIs in the study population.
CONCLUSION Most MIs in women may be preventable by consuming a healthy diet and moderate amounts of alcohol, being physically active, not smoking, and maintaining a healthy weight.

According to Horne, 70% of the population of Utah is LDS, making this a "sizable" group in whom to study the effects of fasting: LDS Mormons fast once a month for 24 hours. While the study does not conclusively link fasting to cardioprotection, there are a number of possible hypotheses that might explain the effect.
The most plausible, he said, is that recurring, temporary food deprivation might have an effect on body metabolism, serving as a reminder to the body to delve into its stores for nutrients, rather than relying on food intake. "Fasting could have some effect on resensitizing the body to glucose and insulin," Horne said, citing an animal study published in Nature earlier this year that suggested that animals subjected to periods of fasting lived longer than animals eating a normal diet and that certain genes upregulated during the fasting period seemed to have some benefit on glycogen, the molecule that stores glucose.
Another possible explanation is that people who fast may also have better awareness and control over their diet generally, enabling them to exercise better restraint in their day-to-day lives. Horne pointed out that other recent studies have also shown that people who practice "caloric restriction"-eating 20% to 30% less than the general population-also seem to have greater longevity.
"Obviously we need to follow up on several different questions raised by these data," Horne said. "The implication is that people could fast periodically and potentially receive some cardiac benefit, even if they're not fasting for religious purposes. There could be some interaction with diet that could have positive coronary artery disease-reducing benefits. . . . There are more questions than answers, but it's a very interesting concept that I think people could adopt in their lifestyle and have some coronary benefit."
Diabetics, however, should not try fasting to improve their CVD risk profile, he added.

SIESTA E MORTALITÀ CORONARICA
È stata valutata l'associazione tra un breve sonno pomeridiano e la mortalità coronarica in una coorte di adulti greci nei quali erano stati determinati in modo dettagliato i fattori di rischio tradizionali per la mortalità da CHD.

[SIESTA IN HEALTHY ADULTS AND CORONARY MORTALITY IN THE GENERAL POPULATION. Arch Intern Med. 2007; 167:296-301]

ABSTRACT
BACKGROUND Midday napping (siesta) is common in populations with low coronary mortality, but epidemiological studies have generated conflicting results. We have undertaken an analysis based on a sizable cohort with a high frequency of napping and information on potentially confounding variables including reported comorbidity, physical activity, and diet.
METHODS Among participants in a general population cohort (the Greek European Prospective Investigation into Cancer and Nutrition [EPIC] cohort), 23 681 individuals who at enrollment had no history of coronary heart disease, stroke, or cancer and had complete information on frequency and duration of midday napping, as well as on potentially confounding variables, were followed up for a mean of 6.32 years. Data were modeled through Cox regression, using time to coronary death and treating deaths from other causes as censoring events as outcomes.
RESULTS Among men and women, when controlling for potential confounders and using those not taking siesta as a referent category, those taking a siesta of any frequency or duration had a coronary mortality ratio (MR) of 0.66 (95% confidence interval [CI], 0.45-0.97). Specifically, those occasionally napping had a 12% lower coronary mortality (MR, 0.88; 95% CI, 0.48-1.60), whereas those systematically napping had a 37% lower coronary mortality (MR, 0.63; 95% CI, 0.42-0.93). Among men, the inverse association was stronger when the analysis was restricted to those who were currently working at enrollment, whereas among women, a similar analysis was not possible because of the small number of deaths.
CONCLUSION After controlling for potential confounders, siesta in apparently healthy individuals is inversely associated with coronary mortality, and the association was particularly evident among working men.

SOVRAPPESO E RISCHIO DI MALATTIA CORONARICA
Una condizione di sovrappeso, anche moderato, si è dimostrata significativamente correlata ad un aumento del rischio di malattia coronarica, indipendentemente dalla presenza di altri fattori di rischio.

[ASSOCIATION OF OVERWEIGHT WITH INCREASED RISK OF CORONARY HEART DISEASE PARTLY INDEPENDENT OF BLOOD PRESSURE AND CHOLESTEROL LEVELS. Arch Intern Med. 2007;167(16):1720-1728]

ABSTRACT
BACKGROUND The extent to which moderate overweight (body mass index [BMI], 25.0-29.9 [calculated as weight in kilograms divided by height in meters squared]) and obesity (BMI, >= 30.0) are associated with increased risk of coronary heart disease (CHD) through adverse effects on blood pressure and cholesterol levels is unclear, as is the risk of CHD that remains after these mediating effects are considered.
METHODS Relative risks (RRs) of CHD associated with moderate overweight and obesity with and without adjustment for blood pressure and cholesterol concentrations were calculated by the members of a collaboration of prospective cohort studies of healthy, mainly white persons and pooled by means of random-effects models (RRs for categories of BMI in 14 cohorts and for continuous BMI in 21 cohorts; total N = 302 296).
RESULTS A total of 18 000 CHD events occurred during follow-up. The age-, sex-, physical activity-, and smoking-adjusted RRs (95% confidence intervals) for moderate overweight and obesity compared with normal weight were 1.32 (1.24-1.40) and 1.81 (1.56-2.10), respectively. Additional adjustment for blood pressure and cholesterol levels reduced the RR to 1.17 (1.11-1.23) for moderate overweight and to 1.49 (1.32-1.67) for obesity. The RR associated with a 5-unit BMI increment was 1.29 (1.22-1.35) before and 1.16 (1.11-1.21) after adjustment for blood pressure and cholesterol levels.
CONCLUSIONS Adverse effects of overweight on blood pressure and cholesterol levels could account for about 45% of the increased risk of CHD. Even for moderate overweight, there is a significant increased risk of CHD independent of these traditional risk factors, although confounding (eg, by dietary factors) cannot be completely ruled out.

CONSUMO DI OPPIO E PATOLOGIA CORONARICA
Dal momento che l'esatta azione dell'oppio non è ben chiara e ci sono pareri discordanti tra i medici riguardo i suoi effetti sul sistema cardiovascolare, è stato condotto uno studio per indagare la relazione tra l'assunzione di oppio e le patologie coronariche.

[THE ASSOCIATION OF OPIUM WITH CORONARY ARTERY DISEASE. Eur J Cardiovasc Prev Rehabil 2007;14(5):715-717]

ABSTRACT
BACKGROUND The effects of opium consumption on coronary artery disease are still unknown.
METHODS A cross-sectional study was conducted on 2405 patients admitted to the Angiographic Ward at Tehran Heart Center from 7 May 2005 to 13 August 2005.
RESULTS After adjusting for conventional cardiovascular risk factors, opium consumption was a significant risk factor for coronary artery disease (P=0.01 and odds ratio=1.8). Moreover, the amount of opium consumption was associated significantly with the severity of coronary atherosclerosis, as measured by clinical vessel score (r=0.2, P=0.002).
CONCLUSIONS To our knowledge, this is the first time that the adverse effects of opium consumption on coronary arteries was defined.

FATTORE DI VON WILLEBRAND, D-DIMERO DELLA FIBRINA, ATTIVATORE TISSUTALE DEL PLASMINOGENO E INCIDENZA DI PATOLOGIE CORONARICHE
Sono stati esaminati alcuni marker per cercare un'associazione con CHD indipendentemente dai fattori confondenti socio-economici relativi allo stile di vita, nella popolazione generale e in modo specifico tra le donne anziane ad alto rischio.

[ASSOCIATIONS OF VON WILLEBRAND FACTOR, FIBRIN D-DIMER AND TISSUE PLASMINOGEN ACTIVATOR WITH INCIDENT CORONARY HEART DISEASE: BRITISH WOMEN'S HEART AND HEALTH COHORT STUDY. Eur J Cardiovasc Prev Rehabil 2007;14(5): 638-645]

ABSTRACT
BACKGROUND Associations of three markers of thrombotic tendency, von Willebrand factor, tissue plasminogen activator antigen and fibrin D-dimer, with coronary heart disease have been reported in meta-analyses. It is not known, however, whether findings are generalizable to older women.
DESIGN Prospective cohort of 3582 women aged 60-79 years randomly selected from 23 towns without evidence of cardiovascular disease at entry into the British Women's Heart and Health Study.
METHODS Women were followed for 4.7 years for incident coronary heart disease. Cox proportional hazard models were used to compare the hazard ratio of coronary heart disease per doubling for each thrombotic factor.
RESULTS In models adjusting for age and town only there was no association between von Willebrand factor or D-dimer and incidence of coronary heart disease, but there was a positive association of tissue plasminogen activator: coronary heart disease hazard ratio per doubling was 1.37 (95% confidence interval: 1.08-1.75). Adjustment for potential confounders (socio-economic position, smoking, lung function, physical activity, alcohol consumption, body mass index, waist-to-hip ratio) attenuated association to 1.20 (0.92-1.58). Further adjustment for risk factors that may be part of the same pathophysiological process linking tissue plasminogen activator to coronary heart disease (high density lipoprotein cholesterol, triglycerides, blood pressure, fasting glucose, insulin, C-reactive protein, fibrinogen) attenuated the hazard ratio to 1.05 (0.79-1.40).
CONCLUSION In older women, tissue plasminogen activator was associated with incident coronary heart disease, but does not appear to be an independent risk factor for coronary heart disease as the association was attenuated by adjustment for confounding and other metabolic and vascular risk factors.

ATEROSCLEROSI CAROTIDEA E RISCHIO DI INFARTO MIOCARDICO
A conferma di dati precedenti, questo studio mostra come l'estensione dell'aterosclerosi nell'arteria carotidea, misurato sia come spessore dell'intima-media che come area totale di placca, sia un predittore indipendente di infarto miocardico.

[CAROTID ATHEROSCLEROSIS IS A STRONGER PREDICTOR OF MYOCARDIAL INFARCTION IN WOMEN THAN IN MEN: A 6-YEAR FOLLOW-UP STUDY OF 6226 PERSONS: THE TROMSO STUDY. Stroke3 2007; 8(11): 2873-2880]

ABSTRACT
BACKGROUND AND PURPOSE Ultrasound of carotid arteries provides measures of intima media thickness (IMT) and plaque, both widely used as surrogate measures of cardiovascular disease. Although IMT and plaques are highly intercorrelated, the relationship between carotid plaque and IMT and cardiovascular disease has been conflicting. In this prospective, population-based study, we measured carotid IMT, total plaque area, and plaque echogenicity as predictors for first-ever myocardial infarction (MI).
METHODS IMT, total plaque area, and plaque echogenicity were measured in 6226 men and women aged 25 to 84 years with no previous MI. The subjects were followed for 6 years and incident MI was registered.
RESULTS During follow-up, MI occurred in 6.6% of men and 3.0% of women. The adjusted relative risk (RR; 95% CI) between the highest plaque area tertile versus no plaque was 1.56 (1.04 to 2.36) in men and 3.95 (2.16 to 7.19) in women. In women, there was a significant trend toward a higher MI risk with more echolucent plaque. The adjusted RR (95% CI) in the highest versus lowest IMT quartile was 1.73 (0.98 to 3.06) in men and 2.86 (1.07 to 7.65) in women. When we excluded bulb IMT from analyses, IMT did not predict MI in either sex.
CONCLUSIONS In a general population, carotid plaque area was a stronger predictor of first-ever MI than was IMT. Carotid atherosclerosis was a stronger risk factor for MI in women than in men. In women, the risk of MI increased with plaque echolucency.

VALUTAZIONE E CONSAPEVOLEZZA DEL RISCHIO DI ICTUS
Ai medici di medicina generale partecipanti allo studio ForLife Study è stato chiesto di raccogliere i dati dei soggetti ipertesi allo scopo di valutare l'impatto della stima del rischio di ictus sul rischio effettivo di sviluppo della patologia.

[REDUCTION IN ESTIMATED STROKE RISK ASSOCIATED WITH PRACTICE-BASED STROKE-RISK ASSESSMENT AND AWARENESS IN A LARGE, REPRESENTATIVE POPULATION OF HYPERTENSIVE PATIENTS: RESULTS FROM THE FORLIFE STUDY IN ITALY. Journal of Hypertension 2007; 25(12): 2390-2397]

ABSTRACT
OBJECTIVE A previous analysis of the ForLife Study demonstrated a high estimated risk of stroke, poor blood pressure control and higher cardiovascular risk. Data from a subsequent visit within 6 months, to evaluate the impact of systematic stroke risk assessment, are reported.
METHODS Between February and July 2003, 1800 general practitioners (GPs) recruited a total of 12 792 (7512 untreated and 5280 treated) patients with hypertension. Blood pressure values were assessed in the whole study population, and for different demographic and clinical features in two visits within 6 months. The data were recorded into a Framingham-based stroke risk score and computed using a risk calculator.
RESULTS Between the two visits the percentage of patients with controlled blood pressure (< 140/90 mmHg) increased substantially in all subgroups, being greater in patients who were not treated at baseline. Among initially treated patients, the greater control of blood pressure involved both diastolic and systolic values. The percentage of patients with diabetes whose blood pressure levels were less than 130/80 mmHg also increased at the second visit. Between the two visits the estimated stroke risk score showed a reduction, with a significant shift of patients from high to intermediate and low-risk categories. This reduction involved all subgroups, including patients with diabetes and left ventricular hypertrophy.
CONCLUSION The present large-scale observational study demonstrates that the assessment of stroke risk and increased awareness of stroke risk factors by GPs is associated with improved blood pressure control, reduced cardiovascular risk profile and a prompt reduction in the 10-year estimated risk of stroke.

FUMO E RISCHIO DI PSORIASI NELLE DONNE
Il fumo di sigaretta aumenta il rischio di sviluppare psoriasi e, in chi già ne soffre il rischio di veder peggiorare il disturbo è maggiore e cresce con il numero di sigarette consumate.

[SMOKING AND THE RISK OF PSORIASIS IN WOMEN: NURSES' HEALTH STUDY IITHE AMERICAN. Journal of Medicine, 2007; 120 (11):953-959]

ABSTRACT
BACKGROUND Psoriasis is a common, chronic, inflammatory skin disorder. Smoking may increase the risk of psoriasis, but no prospective data are available on this relation.
METHODS We prospectively examined over a 14-year time period (1991-2005) the relation between smoking status, duration, intensity, cessation, and exposure to secondhand smoke, and incident psoriasis in 78,532 women from the Nurses Health Study II. The primary outcome was incident, self-reported, physician-diagnosed psoriasis.
RESULTS We documented 887 incident cases of psoriasis. Compared with those who had never smoked, the multivariate relative risk (RR) of psoriasis was 1.78 (95% confidence interval [CI], 1.46 to 2.16) for current smokers and 1.37 (95% CI, 1.17 to 1.59) for past smokers. Compared with nonsmokers, the multivariate RR of psoriasis was 1.60 (95% CI, 1.31 to 1.97) for those who had smoked 11-20 pack-years and 2.05 (95% CI, 1.66 to 2.53) for those who had smoked ?21 pack-years. Compared with never smokers, the multivariate RR of psoriasis was 1.61 (95% CI, 1.30 to 2.00) for those who quit smoking <10 years ago, 1.31 (95% CI, 1.05 to 1.64) for 10-19 years ago, and 1.15 (95% CI, 0.88 to 1.51) for ?20 years ago. Prenatal and childhood exposure to passive smoke was associated with an increased risk of psoriasis.
CONCLUSIONS In this prospective analysis, current and past smoking, and cumulative measures of smoking were associated with the incidence of psoriasis. The risk of incident psoriasis among former smokers decreases nearly to that of never smokers 20 years after cessation.

TREND DI PREVALENZA DEI FATTORI DI RISCHIO CARDIOVASCOLARI IN SPAGNA
Lo studio ha analizzato i trend di prevalenza e la distribuzione dei fattori di rischio cardiovascolari negli anni 1995, 2000 e 2005 nella popolazione spagnola: la conoscenza di questi dati e l'impatto dei fattori di rischio sull'incidenza e sulla mortalità CHD sono essenziali per disegnare degli efficaci interventi correttivi.

[TRENDS IN CARDIOVASCULAR RISK FACTOR PREVALENCE (1995-2000-2005) IN NORTHEASTERN SPAIN. Eur J Cardiovasc Prev Rehabil 2007;14(5): 653-659]

ABSTRACT
BACKGROUND High prevalence of cardiovascular risk factors has been observed in Spain along with low incidence of acute myocardial infarction. Our objective was to determine the trends of cardiovascular risk factor prevalence between 1995 and 2005 in the 35-74-year-old population of Gerona, Spain.
DESIGN Comparison of cross-sectional studies were conducted in random population samples in 1995, 2000, and 2005 at Gerona, Spain.
METHODS An electrocardiogram was obtained, along with standardized measurements of body mass index, lipid profile, systolic and diastolic blood pressure, glycaemia, energy expenditure in physical activity, smoking, use of lipid-lowering and antihypertensive medications, and cardiovascular risk. Prevalence of diabetes, hypertension, and obesity was calculated and standardized for age.
RESULTS A total of 7571 individuals (52.0% women) were included (response rate 72%). Low-density lipoprotein cholesterol >3.4 mmol/l (130 mg/dl) (49.7%) and hypertension (39.1%) were the most prevalent cardiovascular risk factors. In 1995, 2000 and 2005, low-density lipoprotein cholesterol decreased in both men and women: 4.05-3.91-3.55 mmol/l (156-151-137 mg/dl) and 3.84-3.81-3.40 mmol/l (148-147-131 mg/dl), respectively. Increases were observed in lipid-lowering drug use (5.7-6.3-9.6% in men and 4.0-5.8-8.0% in women), controlled hypertension (14.8-35.4-37.7% in men and 21.3-36.9-45.0% in women); (all P-trends <0.01), and obesity (greatest for men: 17.5-26.0-22.7%, P-trends=0.020). Prevalence of myocardial infarction or possibly abnormal Q waves in electrocardiogram also increased significantly (3.9-4.7-6.4%, P-trends=0.018).
CONCLUSIONS The cardiovascular risk factor prevalence change in Gerona was marked in this decade by a shift of total cholesterol and low-density lipoprotein cholesterol distributions to the left, independent of the increase in lipid-lowering drug use, and better hypertension control with increased use of antihypertensive drugs.