Relation between white blood cell count and several risk factors for coronary heart disease in patients with systemic hypertension.

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.

The increased frequency of hypercholesterolemia in southern Italy is induced only by changing diet quality?

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.

Ischemic stroke syndromes in childhood.

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.

Association between white blood cell count and risk factors of coronary artery disease.

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.

Possible role of beta-blockers in the prevention of sudden cardiac death (SCD) in patients with coronary heart disease (CHD).

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.

[The Montecorvino Rovella Project: prevalence of coronary disease risk factors in an area of Campania]. / Il "Progetto Montecorvino Rovella": prevalenza dei fattori di rischio della cardiopatia ischemica in un'area della Campania.

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.

[Damage from reperfusion: no-reflow phenomenon]. / Danno da riperfusione: no-reflow phenomenon.

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)

[Diabetes and atherosclerosis: a follow-up echographic study of atherosclerotic carotid lesions]. / Diabete ed aterosclerosi: studio ecografico evolutivo delle lesioni aterosclerotiche carotidee.

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.