Risultati per: Colesterolo e rischio cardiovascolare (CV): percorso diagnostico-terapeutico

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Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

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Circulation, Volume 148, Issue Suppl_1, Page A13105-A13105, November 6, 2023. Background:The interdependence of cardiovascular and kidney health in T2D requires understanding the combination of disease risk. Proteomic surrogate models for cardiovascular risk and kidney prognosis have been developed and validated, but not in a combined manner in T2D patients.Hypothesis:Combining the results of independent proteomic risk models for 4-year cardiovascular risk and kidney prognosis will identify patients at highest risk for MACE, better than eGFR.Methods:Plasma from 1,220 participants with T2D from the Atherosclerosis Risk in Communities (ARIC) study visit 5 were assayed for >5,000 proteins using the SomaScan® assay; 34.2% had incident MACE (MI, stroke, HF hospitalization, or death). Predictions from a validated proteomic CV risk model were calculated, as well as a de novo kidney prognosis model developed and validated in the Chronic Renal Insufficiency Cohort and Fenland cohort. Patients were stratified by predefined CV risk bins and sub-stratified by 2x kidney prognosis risk, and compared to eGFR stratification. Log-odds of Kaplan-Meier (KM) event rates were compared between strata.Results:Proteomic kidney risk predictions did not sub-stratify patients at low/medium CV risk (p > 0.05), but did stratify high-risk CV patients, with highest CV and kidney risk patients (5.6% of patients; p < 0.05) having a KM-estimated 63.4% 4-year MACE rate, more than 8 times the low CV risk group. Conversely, stratification using a corresponding eGFR threshold did not significantly stratify high-risk CV patients. High CV risk MACE types were different depending on proteomic kidney risk sub-stratification (chi-square p < 0.015), and participants with increased kidney risk had more HF hospitalizations (39.7% of MACE).Conclusions:Among patients with T2D and elevated proteomic markers for CV risk, an independent proteomic risk model for kidney prognosis can be applied to identify a significantly larger proportion of patients at risk for MACE.

Circulation, Volume 148, Issue Suppl_1, Page A13915-A13915, November 6, 2023. Introduction:The ASCVD pooled cohort equation (PCE) is well-established for CV risk assessment. Decision points for determining treatment plans are low, intermediate and high risk over 10 years, however this approach over and underestimates risk in certain subgroups. The validated CV Risk SomaSignal® Test (SST) provides 4-year risk probability of MACE allowing for timely assessment of risk, but the shorter timescale makes comparison to 10-year PCE risk less intuitive.Hypothesis:Using a previously described metacohort (n=5,575) of patients with increased CV risk, we hypothesized that PCE would stratify patients differently than the CV Risk SST, and that CV Risk score scaled to 10 years would yield an improved net reclassification index (NRI).Methods:CV Risk SST and PCE scores were calculated on metacohort plasma samples. CV risk score was scaled to 10 years by parameterizing the model for a 10-year score, and then calculating a quadratic equation for the conversion. CV risk score was stratified by four established risk bins, whereas the PCE was stratified similarly using 20% risks based on literature and practice-derived cutoffs. Event rates were compared between scores, and NRI was calculated.Results:We observed total NRI of 11.4% for the 10-year CV Risk SST vs. PCE, with up-classification (positive NRI=83.7%) mitigating down-classification (negative NRI=-0.723). Event rates for the high-risk group in the CV Risk test were higher than the PCE, and lower in the low-risk group (p < 0.05).Conclusions:The CV Risk SST stratifies patients by identifying low- and high-risk groups using thresholds that are more discriminatory than low-risk and high-risk thresholds in the PCE. For comparison, the CV risk SST can be scaled to 10-year risk, with CV risk SST having a positive NRI for identifying MACE. This reclassification can allow targeted therapies in patients at greater risk and use of non-pharmacological therapies in the low-risk patients.