1,219 research outputs found
Extremes of both weight gain and weight loss are associated with increased incidence of heart failure and cardiovascular death: evidence from the CANVAS Program and CREDENCE
No full textAbstract Background Obesity is an independent risk factor for cardiovascular disease (CVD) in patients with type 2 diabetes (T2D). However, it is not known to what extent weight fluctuations might be associated with adverse outcomes. We aimed at assessing the associations between extreme weight changes and cardiovascular outcomes in two large randomised controlled trials of canagliflozin in patients with T2D and high cardiovascular (CV) risk. Methods In the study populations of the CANVAS Program and CREDENCE trials, weight change was evaluated between randomization and week 52–78, defining subjects in the top 10% of the entire distribution of weight changes as gainers, subjects in the bottom 10% as losers and the remainder as stable. Univariate and multivariate Cox proportional hazards models were used to test the associations between weight changes categories, randomised treatment and covariates with heart failure hospitalisation (hHF) and the composite of hHF and CV death. Results Median weight gain was 4.5 kg in gainers and median weight loss was 8.5 kg in losers. The clinical phenotype of gainers as well as that of losers were similar to that of stable subjects. Weight change within each category was only slightly larger with canagliflozin than placebo. In both trials, gainers and losers had a higher risk of hHF and of hHF/CV death compared with stable at univariate analysis. In CANVAS, this association was still significant by multivariate analysis for hHF/CV death in both gainers and losers vs. stable (hazard ratio – HR 1.61 [95% confidence interval - CI: 1.20–2.16] and 1.53 [95% CI 1.14–2.03] respectively). Results were similar in CREDENCE for gainers vs. stable (adjusted HR for hHF/CV death 1.62 [95% CI 1.19–2.16]) Conclusions Extremes of weight gain or loss were independently associated with a higher risk of the composite of hHF and CV death. In patients with T2D and high CV risk, large changes in body weight should be carefully assessed in view of individualised management. Trials registration CANVAS ClinicalTrials.gov number: NCT01032629. CREDENCE ClinicalTrials.gov number: NCT0206579
Effects of gender and body composition on GH response to GHRH+Arg in HIV-lipodystrophic patients: higher rate of GH deficiency in men
No full textThe study investigated the gender difference in GH secretion after GHRH+Arg in patients with HIV-related lipodystrophy showing hoe men are at higher risk to fail to respond copmared to females. In this group of patients with HIV that are at higher risk of GH deficiency, men have higher risk of GH deficiency than women
Dysglycaemia and cardiovascular disease. Aspects on screening, management, and prognosis
No full textBackground: Dysglycaemia, in this thesis defined as impaired glucose tolerance (IGT) or type 2 diabetes (T2DM), is a major risk factor for cardiovascular disease (CVD). International guidelines recommend screening for dysglycaemia and target-driven lifestyle and pharmacological management in people with high cardiovascular (CV) risk or established CVD for both men and women. New glucose-lowering drugs with proven CV benefit are now available. Aims: The overall aim of this doctoral thesis was to investigate the screening and management of patients with CVD or at high CV risk including gender differences and implementation of new cardioprotective glucose-lowering drugs by studying: - the prevalence of dysglycaemia according to different screening tools in patients without known diabetes (Study I) and by gender (Study II); - the value of new screening methods for dysglycaemia in these patients (Study III and IV); - the management of such patients as regards lifestyle habits, use of cardioprotective drugs, and treatment target attainment (Study I) including possible gender disparities (Study II); - gender differences in prognosis (Study II); - whether cardioprotection of the glucagon-like peptide-1 receptor agonist dulaglutide is dependent on metformin (Study V). Methods: Studies I, II, III and IV were based on the population from the EUROASPIRE V cross-sectional survey; Study II included data from EUROASPIRE IV and V. Both surveys included patients with established coronary artery disease recruited across Europe at least six months prior to the investigation. Data on clinical history, life-style advice and pharmacological treatment was based on validated questionnaires and standardised blood tests at a study visit. Study V is based on patients with T2DM at high CV risk from the randomised controlled trial REWIND. Results: Prevalence and screening for dysglycaemia: In Study I, 29% of the study population had dysglycaemia detected by screening, with 70% of them being identified by a two-hour postload glucose value (2hPG) during an oral glucose tolerance test (OGTT). Study II found that more women than men had IGT and more men had T2DM. Study III validated a diagnostic algorithm for T2DM based on the assessment of a one-hour postload glucose value (1hPG) during the OGTT, shortening the time needed for glycaemic classification in 79% of them. In Study IV, the diagnostic performance of different insulin resistance indexes was unsatisfactory compared with the yield of an OGTT. Management: Study I showed that multifactorial management after the coronary event was unsatisfactory, with poor adherence to recommended treatment targets for blood pressure, lipids and glycaemic control and a high prevalence of obesity, persistent smoking and limited physical activity. Study II highlighted how this management was particularly inadequate in women, possibly contributing to a worse prognosis compared with men in those with known T2DM. Study V found that CV protection with dulaglutide seems to be present irrespective of metformin treatment at baseline. Conclusions: There is a compelling need for implementation of screening for dysglycaemia in patients with CAD, and the OGTT should be the preferred method because it identifies more patients with dysglycaemia, which otherwise would be missed. Time might be mature to introduce an algorithm based on the 1hPG value to identify T2DM. Its prognostic implications should however be further investigated. Multifactorial management of these patients is in demand of a substantial improvement, especially in women, where deficient care may be associated with worse prognosis. The use of new glucose-lowering agents with cardiovascular efficacy should be prioritised regardless of background glucose-lowering therapy.List of scientific papersI. Ferrannini G, de Bacquer D, De Backer G, Kotseva K, Mellbin L, Wood D, Rydén L. On behalf of the EUROASPIRE V collaborators. Screening for glucose perturbations and risk factor management in dysglycaemic patients with coronary artery disease - a persistent challenge in need of substantial improvement. A report from EUROASPIRE V. Diabetes Care. 2020 Apr; 43(4):726-733. https://doi.org/10.2337/dc19-2165 II. Ferrannini G, De Bacquer D, Vynckier P, De Backer G, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Tuomilehto J, Wood D, Rydén L; EUROASPIRE IV & V Investigators. Gender differences in screening for glucose perturbations, cardiovascular risk factor management and prognosis in patients with dysglycaemia and coronary artery disease: results from the ESC‑EORP EUROASPIRE surveys. Cardiovascular Diabetology. 2021 Feb; 20(1):38. https://doi.org/10.1186/s12933-021-01233-6 III. Ferrannini G, De Bacquer D, Gyberg V, De Backer G, Kotseva K, Mellbin LG, Risebrink R, Tuomilehto J, Wood D, Rydén L. Saving time by replacing the standardised two-hour oral glucose tolerance test with a one-hour test. Validation of a new screening algorithm in patients with coronary artery disease from the ESC-EORP EUROASPIRE V registry. Diabetes Research and Clinical Practice. 2022 Jan; 183:109156. https://doi.org/10.1016/j.diabres.2021.109156 IV. Ferrannini G, De Bacquer D, Erlund I, Gyberg V, Kotseva K, Mellbin L, Norhammar A, Schnell O, Tuomilehto J, Vihervaara T, Wood D, Rydén L. Measures of insulin resistance as a screening tool for dysglycaemia in patients with coronary artery disease. A report from EUROASPIRE V. Diabetes Care. 2022; 45: 2111-2117. https://doi.org/10.2337/dc22-0272 V. Ferrannini G, Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Dyal L, Lakshmanan M, Mellbin L, Probstfield J, Riddle MC, Shaw JE, Avezum A, Basile JN, Cushman WC, Jansky P, Keltai M, Lanas F, Leiter LA, Lopez-Jaramillo P, Pais P, Pīrāgs V, Pogosova N, Raubenheimer PJ, Sheu WH-H, Rydén L. Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin. A subgroup analysis of the REWIND Trial. European Heart Journal. 2021; 42: 2565-2573. https://doi.org/10.1093/eurheartj/ehaa777 </p
Giulia Veronica Varisco
No full textThe headword explains the biography and the contribution of the author Giulia Varisco to the children's literatur
Plasma mannose as a novel marker of myocardial infarction across different glycaemic states: a case control study
No full textBACKGROUND: Plasma mannose, an emerging novel biomarker of insulin resistance, is associated with both diabetes mellitus and coronary atherosclerosis, but the relationship between mannose concentrations and myocardial infarction (MI) across different glycaemic states remains to be elucidated. The aim of this study was to investigate the independent association between mannose and a first MI in a group of subjects characterized according to their glycaemic state. METHODS: Fasting plasma mannose concentrations were analysed in 777 patients 6–10 weeks after a first myocardial infarction and in 770 matched controls by means of high-performance liquid chromatography coupled to tandem mass spectrometry. Participants without known diabetes mellitus were categorized by an oral glucose tolerance test (OGTT) as having normal glucose tolerance (NGT, n = 1045), impaired glucose tolerance (IGT, n = 246) or newly detected type 2 diabetes (T2DM, n = 112). The association between mannose and MI was investigated across these glycaemic states by logistic regression. RESULTS: Mannose levels increased across the glycaemic states (p < 0.0001) and were significantly associated with a first MI in the whole study population (odds ratio, OR: 2.2; 95% CI 1.4 to − 3.5). Considering the different subgroups separately, the association persisted only in subjects with NGT (adjusted OR: 2.0; 95% CI 1.2–3.6), but not in subgroups with glucose perturbations (adjusted OR: 1.8, 95% CI 0.8–3.7). CONCLUSIONS: Mannose concentrations increased across worsening levels of glucose perturbations but were independently associated with a first MI only in NGT individuals. Thus, mannose might be a novel, independent risk marker for MI, possibly targeted for the early management of previously unidentified patients at high cardiovascular risk. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12933-022-01630-5
Effects of treatment for acromegaly on bone mineral density: is pegvisomant protective on lumbar BMD?
No full textThe type of pharmacological treatment used for the control of acromegaly might have different effect in the prevention of bone loss
Ytterbium Disilicate/Monosilicate Multilayer Environmental Barrier Coatings: Influence of Atmospheric Plasma Spray Parameters on Composition and Microstructure
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Ytterbium Disilicate/Monosilicate Multilayer Environmental Barrier Coatings: Influence of Atmospheric Plasma Spray Parameters on Composition and Microstructure
by Giulia Di Iorio,Laura Paglia *ORCID,Giulia PedrizzettiORCID,Virgilio GenovaORCID,Francesco MarraORCID,Cecilia BartuliORCID andGiovanni PulciORCID
INSTM Reference Laboratory for Materials and Surface Engineering, Sapienza University of Rome, Eudossiana 18, 00184 Rome, Italy
*
Author to whom correspondence should be addressed.
Coatings 2023, 13(9), 1602; https://doi.org/10.3390/coatings13091602
Original submission received: 10 August 2023 / Revised: 31 August 2023 / Accepted: 11 September 2023 / Published: 13 September 2023
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Abstract
SiC/SiC ceramic matrix composites (SiCf/SiC CMCs) are regarded as the new materials for the hot-section components of aircraft gas turbine engines, since they have one-third of the density of metallic superalloys, a higher temperature capability, good mechanical strength, and excellent thermal shock resistance. However, high-temperature water-vapor-rich combustion gases can induce severe surface recession phenomena in SiC/SiC leading to component failure. For this reason, it is necessary to design protective coatings, i.e., environmental barrier coatings (EBCs), able to protect the SiC/SiC surface in combustion environments. In the present work, ytterbium monosilicate (Yb2SiO5), stable when exposed to water vapor at high temperatures, and ytterbium disilicate (Yb2Si2O7), characterized by a thermal expansion coefficient closer to that of the substrate, were selected for a multilayer EBC system. EBCs were processed using the atmospheric plasma spray (APS) technique. A set of deposition parameters were tested, varying the power of the torch, and the composition and microstructure of the deposited coatings were studied in terms of porosity, crack density, and post-deposition phase retention by performing SEM, EDS, and XRD analysis. The results allow for the definition of the influence of deposition parameters on the final properties of multilayer EBC coatings
I pazienti con infezione da HIV hanno un reale deficit di GH (GHD) ? Confronto tra pazienti HIV positivi con documentato GHD biochimico e pazienti ipopituitarici HIV negativi con GHD
No full textThe response to GHRH+Arginine is higher in HIV-infected patients with GHD when compared to patients with GHD and hypopituitaris
Correction to: Safety and Psychological Outcomes of Tandem t:Slim X2 Insulin Pump with Control-IQ Technology in Children, Adolescents, and Young Adults with Type 1 Diabetes: A Systematic Review
No full textThe second author name was incorrectly published as Giula Maria Smylie. The correct name is Giulia Marie Smylie. The original article has been corrected
GH deficiency in HIV-infected patients compared to hypoopituitary patients
No full textThe difference between HIV-infected patients with growth hormone deficiency (GHD) and GHD patients with hypopituitarism is in higher values go GH peak after GHRH+Arginine and IGF-1 in men with HIV
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