Sex-difference of multifactorial intervention on cardiovascular and mortality risk in DKD: post-hoc analysis of a randomised clinical trial.

OBJECTIVE: Women with type 2 diabetes experience higher cardiovascular and mortality risk than men possibly because of a sub-optimal cardio-protective treatment. We evaluated whether an intensive multifactorial therapy (MT) produces similar protective effect on development of adverse outcomes in women and men. RESEARCH DESIGN AND METHODS: Nephropathy in Diabetes type 2 study is an open-label cluster randomized trial comparing the effect of Usual Care (UC) or MT of main cardiovascular risk factors (blood pressure < 130/80 mmHg, HbA1c < 7%, LDL < 100 mg/dL, and total cholesterol < 175 mg/dL) on cardiovascular and mortality risk in patients with type 2 diabetes. In this post-hoc analysis, we stratified patients by sex to compare the occurrence of MACEs (primary endpoint) and all-cause death (secondary endpoint) between women (104 MT and 105 UC) and men (103 MT and 83 UC). RESULTS: Achievement of therapeutic goals was similar by sex, with 44% and 47% of women and men in MT achieving at least 3 targets vs. 16% and 20% of women and men in UC. During a median follow-up of 13.0 years, we recorded 262 MACE (48.5% in women) and 189 deaths (53.6% in women). Compared to the UC group, the risk of MACE in the MT group was reduced by 52% in women and by 44% in men (P = 0.11). Conversely, the reduction in mortality risk by MT was greater in women (44% versus 12%, P = 0.019). CONCLUSIONS: MT similarly reduces the risk of MACEs in either sex. This therapeutic approach is associated with a survival advantage in women as compared with men and it may represent an important rationale to motivate physicians in overcoming their therapeutic inertia often encountered in female patients as well as to encourage patients of both sexes at improving their adherence to multidrug therapy.

[Synchronous adenomas of the stomach and rectum with severe protein-losing syndrome]. / Adenomi sincroni dello stomaco e del retto con grave sindrome da proteinodispersione.

The authors report a case of generalized edema with low colloidal osmotic pressure of plasma in an elderly man. After the exclusion of malnutrition and any myocadic, renal or hepatic involvement it has been shown that the physiopathogenetic mechanism is based on protein-losing enteropathy. Upper and lower endoscopy of the gastrointestinal tract reveals double synchronous villous adenomas of the rectum and stomach (the latter rare but often associated with the former). It is likely that these two lesions may play an important role in the development of "anasarca" but only complete reversal of symptoms after surgical excision of tumors would demonstrate the causative relationship. The study confirms two findings already observed in the literature. The first is the increased risk of villous adenoma malignant transformation, especially where rarely located, such as in the gastric site. The other depends upon the variety of villous adenoma symptomatology. The effects of low plasmatic protein levels are prominent in this case, but clinical manifestations range form insidious signs of occult bleeding, to frank diarrhea and/or rectal bleeding, up to unusual cases of secretory diarrhea with profound dehydration and hypokalemia or malabsorption.