Risultati per: FANS e Rischio Cardiovascolare (Rischio CV)

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Presidente SID: “Non aspettare a vaccinarsi”

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.

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 A15244-A15244, November 6, 2023. Background:The care model for type 2 diabetes (T2D) and its main complications is thought to be “asynchronous” and associated with delays in care and low use of guideline-directed medical therapies (GDMT).Hypothesis:A synchronous care clinic for T2D patients, including a simultaneous evaluation by cardiology/endocrinology and nephrology, will enhance the rate of GDMT use and improve biomarkers of interest.Methods:Retrospectively analysis from patients evaluated in the DECIDE-CV clinic, a cardiometabolic clinic for T2D patients with either atherosclerotic cardiovascular disease, heart fialure (HF) or chronic kidney disease (CKD). Baseline data was compared to the data obtained in the last available visit. For patients with only one visit, the treatment prescribed at the end of the first visit was considered in the last visit group. Categorical data is presented as frequencies (proportions) and was analyzed using McNemar test. Continuous data is presented as mean±SD or median (IQR) as appropriate and was compared using the t-test for paired data or Wilcoxon test.Results:150 patients, 72% male with a mean age of 67±12 years. 115 (78%) had atherosclerotic cardiovascular disease, 98 (65%) had HF and 77 (51%) CKD. Comparing baseline to last visit data, there was a statistically significant increase in GDMT and de-escalation of insulin, sulfonylureas and DPP4i (Table). For patients with two sets of available laboratory data, there was a significant decrease in N-terminal pro B-type natriuretic peptide (504 [155-1160] pg/mLvs335 [150-1031] pg/mL, p=0.03) and albuminuria (57 [19-259] mg/gvs57 [9-155] mg/g, p

Gli indicatori di salute mostrano lo svantaggio rispetto ai coetanei

Introduction
Improving physical activity (PA) and healthy eating is critical for primary and secondary prevention of cardiovascular disease (CVD). Behaviour change programmes delivered in sporting clubs can engage men in health behaviour change, but are rarely sustained or scaled-up post trial. Following the success of pilot studies of the Australian Fans in Training (Aussie-FIT) programme, a hybrid effectiveness–implementation trial protocol was developed. This protocol outlines methods to: (1) establish if Aussie-FIT is effective at supporting men with or at risk of CVD to sustain improvements in moderate-to-vigorous PA (primary outcome), diet and physical and psychological health and (2) examine the feasibility and utility of implementation strategies to support programme adoption, implementation and sustainment.

Methods and analysis
A pragmatic multistate/territory hybrid type 2 effectiveness–implementation parallel group randomised controlled trial with a 6-month wait list control arm in Australia. 320 men aged 35–75 years with or at risk of CVD will be recruited. Aussie-FIT involves 12 weekly face-to-face sessions including coach-led interactive education workshops and PA delivered in Australian Football League (Western Australia, Northern Territory) and rugby (Queensland) sports club settings. Follow-up measures will be at 3 and 6 months (both groups) and at 12 months to assess maintenance (intervention group only). Implementation outcomes will be reported using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework.

Ethics and dissemination
This multisite study has been approved by the lead ethics committees in the lead site’s jurisdiction, the South Metropolitan Health Service Human Research Ethics Committee (Reference RGS4254) and the West Australian Aboriginal Health Ethics Committee (HREC1221). Findings will be disseminated at academic conferences, peer-reviewed journals and via presentations and reports to stakeholders, including consumers. Findings will inform a blueprint to support the sustainment and scale-up of Aussie-FIT across diverse Australian settings and populations to benefit men’s health.

Trial registration number
This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12623000437662).

Immunoterapia con chemioterapia.In forme avanzate o metastatiche

Prima e dopo intervento chirurgico.Più possibilità di guarigione 

Con l’esposizione a particelle fini +28% casi. “Ridurre limiti”

Studio su Jama, su 900 pazienti dal 2015 in Piemonte e Vda

Problema comune in reumatologia, pazienti ricorrono al fai-da-te

Presidente Falabella: ‘aumenterebbe costo del lavoro domestico’