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Microalbuminuria e aterosclerosi.
No full textarticolo in italiano rivolto ai medici di medicina general
Extreme but asymptomatic hypergastrinemia with gastroparesis in a young woman with insulin dependent diabetes mellitus.
No full text
Plasma homocysteine and cardiovascular risk in type 2 diabetes: Role of metabolic control and duration of disease.
No full textabstract - comunicatio
Relationships between fasting plasma insulin, anthropometrics, and metabolic parameters in a very old healthy population
No full textSeveral studies have shown that insulin resistance and hyperinsulinemia are associated with many metabolic disorders predisposing to coronary heart disease (CHD). This syndrome has been termed syndrome X. However, it is not completely known whether these relationships are still present in the elderly, or whether other factors such as age, gender, and body fat distribution modulate them. Therefore, we investigated the relationship between fasting plasma insulin, total and regional adiposity, fasting plasma glucose and lipids, plasma plasminogen activator inhibitor-1 (PAI-1), fibrinogen, and coagulation factor VII in a sample of 100 healthy free-living octogenarians-nonagenarians (52 men and 48 women) who were disability-free according to the Katz index. By univariate analysis, fasting insulin correlated positively with all anthropometric measures except the waist to hip ratio (WHR) in women. There was a positive correlation between fasting insulin and fasting glucose (r=.40, P < .01), plasma triglycerides ([TGs] r=.21, P < .05), and PAI-1 levels (r=.33, P < .01), whereas a negative relation was found with high-density lipoprotein cholesterol (HDL-C) and apolipoprotein, A-I (apo A-I) levels (r=-.22 and =-.24, respectively, P < .05). These relationships were weaker and less significant in women. In pooled data, stepwise multiple regression analysis showed an independent relationship of both the body mass index (BMI) and fasting insulin level with TGs (R2=.14), while gender and fasting insulin were the best predictors of HDL-C variance (R2=.17). Furthermore, fasting insulin was the only variable independently related to PAI-1 (R2=.12). Our findings support the existence of a metabolic syndrome even in very old age by showing that high insulin levels are related to various metabolic and hemostatic disorders
Alzheimer disease and vascular dementia: Relationships with fasting glucose and insulin levels
No full textCerebrovascular disease and Alzheimer disease are the leading causes of dementia in elderly subjects. In spite of it, relatively little is known about the pathogenesis and risk factors for dementia. We evaluated fasting plasma glucose and insulin, albumin, lipids, Lp(a) and uric acid levels in nondiabetic patients of both sexes affected by vascular dementia (VD) and senile dementia of the Alzheimer type (SDAT) as well as in a control group of age-matched nondemented subjects. Following a covariance analysis by gender, body mass index, albumin levels and prevalence of arterial hypertension, total and LDL cholesterol as well as HDL cholesterol levels were not significantly different among the three groups. Fasting glucose (p < 0.001 and p < 0.005, respectively) and insulin levels (p < 0.05 for both differences) were higher in patients with VD and SDAT than in control subjects. Our data show that nondiabetic patients with VD or SDAT have higher fasting glucose and insulin levels than healthy control subjects. These metabolic characteristics were not influenced by differences in gender, adiposity, nutritional status, lipids or presence of arterial hypertension. Copyright 2000 S. Karger AG, Base
Fibrinolytic and coagulation factors in very old subjects: Association with lipoprotein profile and anthropometric variables
No full textBACKGROUND: We evaluated plasminogen activator inhibitor-1 (PAI-1), factor VII activity (FVII), and fibrinogen in a sample of octo-nonagenarians. Furthermore, we investigated the relationship of these fibrinolytic and coagulation parameters with lipoprotein profile and anthropometric variables in the absence or presence of disability. METHODS: We enrolled a population of 162 octo-nonagenarians, divided in two groups on the basis of presence or absence of disability in the activity of daily living (ADL). All the anthropometric determinations were carried out according to standardized methods. Blood samples for hemostatic and lipid determinations were collected after overnight fasting and resting. RESULTS: PAI-1 activity and fibrinogen levels were significantly higher in disabled (DIS) compared to free-living (FL) adults, whereas FVII did not show differences in the two groups. PAI-1 activity and FVII positively correlated to anthropometric parameters (body mass index, subscapular and tricipital skinfold thickness) in both DIS and FL. No correlations were found between fibrinogen and other variables in FL, whereas a negative relation with high density lipoprotein-cholesterol levels emerged in DIS. FVII was positively related with total cholesterol low density lipoprotein-cholesterol, and apolipoprotein B in both FL and DIS. CONCLUSIONS: In a sample of octo-nonagenarians, PAI-1 activity and FVII show a significant correlation with several anthropometric and lipoprotein parameters, suggesting that these variables are strongly associated with body composition and lipid metabolism independent from age and disability. DIS presented higher PAI-1 and fibrinogen levels; this observation may take in account the high prevalence of vascular diseases and also occult inflammation, which are known to affect these parameters
MTHFR mutation and carotid wall thickness in aging non diabetic women
No full textA mild hyperhomocysteinemia (Hey) has been recognized as cardiovascular
risk factor in the general population. It may be due either to genetic or environmental
factors. The genetic defect responsible for HCy has been identified
in a mutation of the gene encoding for methylenetetrahydrofolate reductase
(MTHFR). Several authors have observed an increased atherothrombotic risk
in subjects homozygotes for the mutation. Few data are available concerning
the relation between MTHFR gene mutation and the degree of involvement
of carotid arteries.
The aim of our study was to evaluate ifhomozygosis for MTHFR mutation
was associated to an increased arterial wall thickness in a group of postmenopausal
women without clinical history of CHD. We studied 99 non
smokers women with a normal glucose tolerance after an OGGT. None
of the women had any emodinamically significant carotid stenosis on the
basis of a Duplex examination performed within the six months preeceding
the enrollment. We evaluated BMI, lipid profile, plasma vitamine BI2
and folate levels, homocysteinemia, systolic and diastolic blood pressure
values. A blood sample was collected for DNA extraction and MTHFR
polymorphism determination by PCR technique. Moreover, all women underwent
a Duplex color scanning with evaluation of the wall thickness.
Mean BMI was 27.8+5.2 kg/m2. Plasma total cholesterol was 241.6+47.7
mg/dl, HDL-cholesterol was 52.3+10.6 mg/dl, LDL-cholesterol 152.2+62.4
mg/dl; plasma triglycerides was 103+40.2 mg/dL Plasma B12 median value
was 268-I-89.5 pg/ml and plasma folate was 4.5+2.0 ng/ml. Mean plasma
homoeysteine was 10.8+1.9 nmol/ml. Hypertension was present in 48%
of the study group; all the hypertensive patients were on pharmacologic
treatment. Systolic blood pressure was 134+16 mm Hg and diastolic was
81 +5 mm Hg.
21.21% of the population resulted homozygous for normal MTHFR gene
polymorphism; 65.65% was heterozygous for the mutation and 13.13%
was homozygous for the mutation. Dividing the population in two groups(homozygous for the mutation vs other people), there were no differences in
anthropometric and biochemical parameters between the two groups. Median
value of carotid wall thickness in the whole population was 0.11 mm (0.07-
0.6). By ANCOVA after correction for age, BMI, plasma lipid values, arterial
hypertension, duration of hypertension, plasma B12 and folate, mean wall
thickness was significantly higher in the subgroup of subjects homozygotes
for mutation (0.26+0.042 vs 0.15 5: 0.015; p < 0.03).
These data show that in postmenopausal non diabetic women a condition
of homozygosis for the mutation of MTHFR gene, even in absence of significant
stenosis, is associated to an increased carotid thickness, suggesting
that MTHFR mutation could be a useful indicator of early atherosclerotic
damage even in the general population
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