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1.
Monaldi Arch Chest Dis ; 80(1): 27-30, 2013 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-23923587

RESUMO

Cardiovascular diseases represent the leading cause of morbidity and mortality worldwide, mostly contributing to hospitalizations and health care costs. Dyslipidemias represent one of the major cardiovascular risk factor and its management, throughout life-style modifications and pharmacological interventions, has shown to reduce cardiac events. The risk of adverse cardiovascular events is related not only to elevated LDL blood levels, but also to decreased HDL concentrations, that exhibit protective effects in the development of atherosclerotic process. Aim of this review is to summarize current evidences about defensing effects of such lipoproteins and to show the most recent pharmacological strategies to reduce cardiovascular risk through the increase of their circulating levels.


Assuntos
Doenças Cardiovasculares , Hipolipemiantes/uso terapêutico , Estilo de Vida , Lipoproteínas HDL/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Saúde Global , Humanos , Morbidade/tendências , Fatores de Risco , Taxa de Sobrevida/tendências
2.
Monaldi Arch Chest Dis ; 78(1): 34-9, 2012 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-22928402

RESUMO

AIM: to evaluate endothelial function (EF) in diabetic and non-diabetic patients without CAD by peripheral artery tonometry (PAT) technique. METHODS: a cohort of 94 patients (55 men and 39 postmenopausal women; mean age 63 +/- 9 years) undergoing coronary angiography was divided into 2 groups: 58 patients with DM and (group 1) and 36 patients without DM. Endothelial dysfunction (ED) was assessed by digital pulse amplitude, using a fingertip peripheral arterial tonometry (PAT). As a measure of ED, reactive hyperemia index (RHI) was calculated as the ratio of the digital pulse volume during reactive hyperemia following 5 min ischemia and its basal value. RESULTS: prevalence of cardiovascular risk factors was similar between the two groups. RHI values were significantly lower in diabetic patients compared to non-diabetics (1.72 +/- 0.34 vs 2.00 +/- 0.44; p < 0.005) and they correlated with levels of glycosylated hemoglobin (p = 0.05; r = -0.266). CONCLUSION: despite similar level of other risk factors, EF was much more impaired in diabetic patients than in non-diabetics. These evidences further support the impact of DM on cardiovascular risk.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Endotélio Vascular/fisiopatologia , Vasos Coronários , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade
3.
Monaldi Arch Chest Dis ; 76(3): 115-20, 2011 Sep.
Artigo em Italiano | MEDLINE | ID: mdl-22363969

RESUMO

Atherosclerotic coronary artery disease (CAD) is a major cause of morbidity and mortality. The majority of cardiovascular events, more than 50% of CAD deaths, occur in previously asymptomatic individuals at intermediate cardiovascular risk, highlighting the relevance of accurate individual risk assessment to decrease cardiovascular events through more appropriate targeting of preventive measures. In the last decades, the development of non-invasive imaging techniques have prompted interest in imaging of atherosclerosis. Coronary computed tomography provides the opportunity to assess the deposition of calcium in the coronary tree and to non-invasively image coronary vessels. Both information are useful for risk stratification of asymptomatic subjects or of subjects with suspected CAD.


Assuntos
Doença das Coronárias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Cálcio/metabolismo , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/metabolismo , Humanos , Medição de Risco
4.
Monaldi Arch Chest Dis ; 76(4): 175-82, 2011 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-22567733

RESUMO

In HIV infected patients an increased incidence of cardiac events has been reported since the introduction of highly active antiretroviral therapy (HAART). Antiretroviral drugs' regimens are, in fact, associated with several metabolic side effects, such as dyslipidemia, impaired glucose metabolism and abnormal body fat distribution, that increase cardiovascular risk of HIV subjects. In addition, HIV infection itself, the chronic inflammatory status and the frequent presence in this population of traditional risk factors contribute to an higher incidence of cardio and cerebrovascular events. In last years several studies showed the occurrence of carotid vascular impairment in patients treated with protease inhibitors (PI). Similarly the DAD Study reported an increase of 26% of the risk of myocardial infarction in patients on HAART and that this risk was independently associated with longer exposure to PI, after multivariate adjustments. A correct evaluation of the metabolic status before starting HAART and an adequate control of drugs-related metabolic abnormalities may reduce the incidence of cardiac events and still improve HIV patients prognosis. This review will focus on the metabolic effects of antiretroviral drugs and on the contribution of combination antiretroviral therapy on cardiovascular risk.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Dislipidemias/induzido quimicamente , Infecções por HIV/tratamento farmacológico , Síndrome Metabólica/induzido quimicamente , Inibidores de Proteases/efeitos adversos , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/virologia , Transtornos Cerebrovasculares/induzido quimicamente , Transtornos Cerebrovasculares/virologia , Dislipidemias/epidemiologia , Medicina Baseada em Evidências , Infecções por HIV/complicações , Humanos , Incidência , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/virologia , Medição de Risco , Fatores de Risco
5.
Expert Rev Cardiovasc Ther ; 14(2): 137-40, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26606394

RESUMO

Dilated cardiomyopathy (DCM) is a primary heart muscle disease characterized by a progressive dilation and dysfunction of either the left or both ventricles. The management of DCM is currently challenging for clinicians. The persistent lack of knowledge about the etiology and pathophysiology of this disease continues to determine important fields of uncertainty in managing this condition. Molecular cardiology and genetics currently represent the most crucial horizon of increasing knowledge. Understanding the mechanisms underlying the disease allows clinicians to treat this disease more effectively and to further improve outcomes of DCM patients through advancements in etiologic characterization, prognostic stratification and individualized therapy. Left ventricular reverse remodeling predicts a lower rate of major cardiac adverse events independently from other factors. Optimized medical treatment and device implantation are pivotal in inducing left ventricular reverse remodeling. Newly identified targets, such as angiotensin-neprilysin inhibition, phosphodiesterase inhibition and calcium sensitizing are important in improving prognosis in patients affected by DCM.


Assuntos
Cardiomiopatia Dilatada/terapia , Ventrículos do Coração/fisiopatologia , Remodelação Ventricular , Cardiomiopatia Dilatada/fisiopatologia , Humanos , Prognóstico
6.
J Cardiovasc Med (Hagerstown) ; 14(12): 862-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23756415

RESUMO

Cardiac magnetic resonance (CMR) is commonly applied for the assessment of myocardial viability in patients with ischemic ventricular dysfunction, and it holds potential advantages over more traditional imaging modalities, including single-photon emission computed tomography (SPECT) and dobutamine stress echocardiography (DSE). CMR-based techniques for viability assessment include the evaluation of transmural extent of the scar using late gadolinium enhancement (LGE) images, the evaluation of end-diastolic wall thickness from resting cine images and the study of inotropic reserve during low-dose dobutamine infusion. During the past decade, the diffusion of the use of CMR for viability assessment confirmed the clinical strengths of this modality and, at the same time, helped to use old techniques with an increased level of awareness. With LGE CMR, both viable and nonviable dysfunctional myocardium can be visualized in a single image, allowing a direct quantification of the amount of regional viability, with a significant impact on the estimation of chance for recovery. As well, studies with CMR applied in the setting of ischemic heart disease allowed a better understanding of the best way to apply and interpret other tests for viability evaluation. For instance, it has been demonstrated that the transmural extension of the scar may influence the level of concordance between SPECT and DSE in assessing myocardial viability. The transmural extent of scar on LGE CMR also correlates with the timing of postrevascularization recovery of systolic function, with significant impact on the diagnostic accuracy of any applied imaging modality.


Assuntos
Imageamento por Ressonância Magnética/métodos , Isquemia Miocárdica/diagnóstico , Miocárdio/patologia , Meios de Contraste , Gadolínio , Humanos , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Revascularização Miocárdica
7.
G Ital Cardiol (Rome) ; 14(7-8): 517-25, 2013.
Artigo em Italiano | MEDLINE | ID: mdl-23877549

RESUMO

Systemic inflammatory diseases are associated with increased cardiovascular morbidity and mortality. The link between inflammatory and cardiovascular diseases can be attributed to the coexistence of classical risk factors and inflammatory mechanisms activated during systemic inflammatory diseases involving the immune system. Unfavorable metabolic effects of anti-inflammatory drugs can also contribute to increase cardiovascular risk. Yet, clinical implications of these findings are not entirely clear, and deeper knowledge and awareness of cardiac involvement in inflammatory diseases are necessary. The aim of this review is to summarize cardiac involvement in systemic inflammatory diseases and to identify aspects where evidence is currently lacking that would deserve further investigation in the future.


Assuntos
Doenças Cardiovasculares/etiologia , Inflamação/complicações , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Doença das Coronárias/epidemiologia , Doença das Coronárias/etiologia , Humanos , Inflamação/tratamento farmacológico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Psoríase/complicações , Psoríase/tratamento farmacológico , Fatores de Risco , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores
8.
Int J Cardiol ; 169(4): 262-70, 2013 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-24063912

RESUMO

BACKGROUND: Ranolazine (R), as add-on therapy in symptomatic patients with chronic stable coronary artery disease (CAD), has been tested in randomized clinical studies. Aim of the study was to assess in a meta-analysis the effects of R on angina, nitroglycerin consumption, functional capacity, electrocardiographic signs of ischemia and hemodynamic parameters in patients with chronic CAD. METHODS: Randomized trials assessing the effects of R compared to control on exercise duration, time to onset of angina, time to 1mm ST-segment depression, weekly nitroglycerin consumption and weekly angina frequency were included in the analysis. The effects of R compared to control on heart rate and blood pressure were also analyzed. RESULTS: Six trials enrolling 9223 patients were included in the analysis. At trough and peak levels, R compared to control significantly improved exercise duration, time to onset of angina and time to 1mm ST-segment depression. Additionally, R compared to control significantly reduced weekly angina frequency and weekly nitroglycerin consumption. Finally, R compared to control did not significantly reduce supine systolic and diastolic blood pressure as well as heart rate, standing heart rate and diastolic blood pressure, whereas it modestly reduced standing systolic blood pressure. At sensitivity analysis, results were not influenced by concomitant background therapy. CONCLUSIONS: In symptomatic patients with chronic CAD, R, added to conventional therapy, effectively reduces angina frequency and sublingual nitroglycerin consumption while prolonging exercise duration as well as time to onset of ischemia and to onset of angina with no substantial effects on blood pressure and heart rate.


Assuntos
Acetanilidas/uso terapêutico , Angina Pectoris/tratamento farmacológico , Doença da Artéria Coronariana/tratamento farmacológico , Piperazinas/uso terapêutico , Acetanilidas/farmacologia , Angina Pectoris/diagnóstico , Angina Pectoris/fisiopatologia , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Piperazinas/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Ranolazina
9.
G Ital Cardiol (Rome) ; 13(4): 254-62, 2012 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-22495642

RESUMO

Despite significant advances in pharmacological and clinical treatment, heart failure remains a leading cause of morbidity and mortality worldwide. G-protein coupled receptors are a wide superfamily of plasma membrane receptors which represent an important target of heart failure drug therapy. Since heart failure is characterized by the overactivity of different neurohormones, such as catecholamines and angiotensin II, responsible for several detrimental effects on the cardiovascular system, over the last decade therapeutic strategies targeting beta-adrenergic and angiotensin receptors have been developed. Despite the introduction of successful drug classes, such as beta-adrenergic receptor blockers, angiotensin-converting enzyme inhibitors and sartans, heart failure still poses an enormous challenge, thus indicating the urgent need to develop innovative treatments that might counteract mechanisms involved in heart failure onset and progression. It is now established that a single receptor, activated by the same agonist, can elicit several different signaling pathways often resulting in opposite cellular responses, some beneficial and some detrimental. However, drugs currently used in heart failure target receptors on their extracellular domain by competing with the endogenous agonists. Thus, they can inhibit non-specifically all the receptor-related signaling pathways including those with beneficial activity whose blockade would not be desirable in heart failure. These observations stress the need for the generation of new therapeutic molecules able to target specific signaling pathways which might result in innovative therapies for cardiovascular disease.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/mortalidade , Humanos , Receptores de Angiotensina/efeitos dos fármacos , Receptores Acoplados a Proteínas G/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos , Resultado do Tratamento
10.
Expert Opin Pharmacother ; 10(2): 173-89, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19236192

RESUMO

Angiotensin II receptor blockers (ARBs) are widely used in patients with hypertension, heart failure and type 2 diabetes mellitus (T2DM). Several large clinical trials have demonstrated that these agents are effective in reducing cardiovascular mortality and morbidity. These benefits are partly independent of the degree of blood pressure reduction and most likely related to ARBs' anti-inflammatory, metabolic and vascular effects. Clinical studies showed that the anti-inflammatory effect of ARBs could be related to the dosage and/or the length of the treatment. In large clinical trials, ARBs have inconsistently reduced the risk of new-onset T2DM. Among ARBs, only losartan significantly reduced serum uric acid levels. Moreover, it has been demonstrated that ARBs improve endothelial dysfunction in patients with hypertension and/or coronary artery disease (CAD), while all but one of the studies proved that these agents could usually, after 6-12 months of therapy, induce regression of vascular hypertrophy in hypertensive patients. These positive effects could be relevant to vascular protection and, together with the blood pressure reduction, constitute the background of the improved outcome observed in clinical studies on mortality and/or morbidity in hypertensive, high-risk and CAD patients. The clinical significance of the different potency of ARBs needs to be investigated further in specific and adequately powered trials.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II , Doenças Cardiovasculares/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Doenças Cardiovasculares/metabolismo , Estenose das Carótidas/tratamento farmacológico , Estenose das Carótidas/metabolismo , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/prevenção & controle , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiopatologia , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/metabolismo , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/metabolismo , Inflamação/metabolismo , Inflamação/prevenção & controle
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