1,720,996 research outputs found
Non-alcoholic fatty liver disease and cardiovascular disease: Epidemiological, clinical and pathophysiological evidences
No full textNon-alcoholic fatty liver disease is recognized as the most common and emerging chronic liver disease in western countries. The disease has been traditionally interpreted as a possibly progressing condition to liver fibrosis and cirrhosis. However, recently, a large number of publications have demonstrated that people with non-alcoholic fatty liver have an increased chance of developing cardiovascular diseases, which represent the major causes of death in this setting. This association is mainly explained by the atherogenic profile of the metabolic syndrome a condition frequently associated with fatty liver, which may represent its hepatic component. Some studies have also shown an association independent of traditional risk factors or of the clinical features of the metabolic syndrome. In this setting, cardiovascular disease seems to be the consequence of low-grade chronic inflammation and increased oxidative stress. Most studies did not differentiate cardiovascular risk between simple steatosis and non-alcoholic steatohepatitis, although the latter seems to be at higher cardiovascular risk. Few studies have investigated the direct correlation between hepatic inflammation and atherosclerosis. Genetic studies will probably improve the interpretation of the increased cardiovascular risk in patients with fatty liver and no metabolic syndrome. © 2012 SIMI
The risk of myocardial infarction in patients with atrial fibrillation: an unresolved issue
No full text[No abstract available
Underuse of oral anticoagulants in patients with nonvalvular atrial fibrillation in Italy
No full textINTRODUCTION: Oral anticoagulants (OAs) are significantly more effective than Aspirin in the prevention of cerebrovascular accidents among patients with atrial fibrillation (AF). Several studies, however, showed OAs to be widely underused in these patients. OBJECTIVE: To assess the appropriateness of antithrombotic therapy in an Italian population of AF patients. METHODS: Two hundred and fifty-five consecutive patients affected by nonvalvular AF participated in the study. Data were collected on demographic characteristics, risk factors for stroke, current prophylactic therapy, and perceived or actual risk factors for bleeding. INR levels were measured. Patients were stratified by their risk for stroke (214 at high risk, 21 moderate, 20 low), and their prophylactic therapy was analysed in light of international antithrombotic therapy recommendations. After therapy adjustment, 203 of our patients were followed-up for the occurrence of cerebrovascular events for an average of 27 months. RESULTS: Upon admission, 35% (n=75) of patients in the high-risk category were either taking no antithrombotic prophylaxis or were being treated with Aspirin. In addition, 38 of 139 patients receiving OAs had an INR<2. Thus, a total of 113 (52.8%) high-risk subjects were not receiving adequate antithrombotic therapy. Of high-risk patients not treated with OAs, 46.7% reported no perceived or actual risk factors for bleeding. The annual incidence of cerebrovascular accidents was 3.8% among 163 high-risk patients assigned to OA treatment, and 4.5% among 39 patients given Aspirin treatment. Relative to expected annual incidence rates, cerebrovascular risk in anticoagulated patients was reduced by about 70%. CONCLUSIONS: Underuse of OAs is still common in Italy, and much of it cannot be explained by the concern for haemorrhage. Support and training in the complex task of anticoagulation management may help to extend this efficacious prophylactic therapy to all patients who may benefit from it
Ultrasonography (US) and non-invasive diagnostic methods for non-alcoholic fatty liver disease (NAFLD) and early vascular damage. Possible application in a population study on the metabolic syndrome (MS)
No full textSindrome delle apnee ostruttive del sonno e rischio cardiovascolare
No full textThe obstructive sleep apnoea syndrome (OSAS) is a very common condition characterized by repeated
alternation of episodes of apnoea and hypopnea during night, heavy snoring, sleep fragmentation and
increased daytime sleepiness. Patients with OSAS experience recurrent episodes of cessation of breathing
which expose the cardiovascular system to cycles of hypoxia, exaggerated negative intrathoracic
pressure and arousals. The diagnosis of OSAS has important clinical and social implications, as the result
of the impact on quality of life, the risk of traffic accidents and the strong association with cardiovascular
disease. In patients with OSAS there are often conditions of high cardiovascular risk, such as hypertension,
endothelial dysfunction, chronic low-grade inflammation, oxidative stress, dyslipidemia and
insulin resistance. The cardiovascular risk is even higher when OSAS is associated with the metabolic
syndrome.
In milder forms, the main therapeutic objective is the reduction of body weight, which is able to improve
the overall clinical picture. In more severe forms, there is an indication for positive airway pressure therapy
(CPAP) which is able to correct oxygen desaturation and, consequently, to control the clinical and
metabolic alterations and reduce cardiovascular risk.
Major problems arise from the large number of undiagnosed OSA and low adherence to long term treatment
with the CPAP.The obstructive sleep apnoea syndrome (OSAS) is a very common condition characterized by repeated
alternation of episodes of apnoea and hypopnea during night, heavy snoring, sleep fragmentation and
increased daytime sleepiness. Patients with OSAS experience recurrent episodes of cessation of breathing
which expose the cardiovascular system to cycles of hypoxia, exaggerated negative intrathoracic
pressure and arousals. The diagnosis of OSAS has important clinical and social implications, as the result
of the impact on quality of life, the risk of traffic accidents and the strong association with cardiovascular
disease. In patients with OSAS there are often conditions of high cardiovascular risk, such as hypertension,
endothelial dysfunction, chronic low-grade inflammation, oxidative stress, dyslipidemia and
insulin resistance. The cardiovascular risk is even higher when OSAS is associated with the metabolic
syndrome.
In milder forms, the main therapeutic objective is the reduction of body weight, which is able to improve
the overall clinical picture. In more severe forms, there is an indication for positive airway pressure therapy
(CPAP) which is able to correct oxygen desaturation and, consequently, to control the clinical and
metabolic alterations and reduce cardiovascular risk.
Major problems arise from the large number of undiagnosed OSA and low adherence to long term treatment
with the CPAP
Modern approach to the clinical management of non-alcoholic fatty liver disease
No full textNon-alcoholic fatty liver disease (NAFLD) is the most common and emerging form of chronic liver disease worldwide. It includes a wide spectrum of liver diseases ranging from simple fatty liver to steatohepatitis, which may progress to cirrhosis, liver cancer, and liver mortality. Common metabolic diseases, which are well established cardiovascular risk factors, have been associated to NAFLD and cardiovascular disease is the single most important cause of morbidity and mortality in this patient population. The pathogenesis of NAFLD appears multifactorial and many mechanisms have been proposed as possible causes of fatty liver infiltration. Management of fatty liver has become a major challenge to healthcare systems as the consequence of the increasing rates of obesity worldwide. First-line management focuses on lifestyle modifications. Moderate weight reduction either by dietary restriction or by increased habitual physical activity is safe and highly recommended. Several therapeutic interventions have been proposed. These include insulin sensitizer agents, lipid lowering drugs, antioxidants such as vitamin E and supplementation of vitamin D3. However, therapeutic strategies have been largely empirical so far, and experimental trials have mostly been carried out in uncontrolled settings with small sample sizes. Metabolic conditions such as diabetes mellitus, obesity, hypertension and hyperlipidemia, should be strongly considered and a multidisciplinary approach should be personalized for individual patients. Treatment of co-morbidities should be regarded as of paramount importance in the management of these patients. The purpose of this review is to examine different approaches for the clinical management of non-alcoholic fatty liver disease.Nonalcoholic fatty liver disease (NAFLD) is the most common and emerging form of chronic liver disease worldwide. It includes a wide spectrum of liver diseases ranging from simple fatty liver to steatohepatitis, which may progress to cirrhosis, liver cancer, and liver mortality. Common metabolic diseases, which are well established cardiovascular risk factors, have been associated to NAFLD and cardiovascular disease is the single most important cause of morbidity and mortality in this patient population.
The pathogenesis of NAFLD appears multifactorial and many mechanisms have been proposed as possible causes of fatty liver infiltration.
Management of fatty liver has become a major challenge to healthcare systems as the consequence of the increasing rates of obesity worldwide. First- line management focuses on lifestyle modifications. Moderate weight reduction either by dietary restriction or by increased habitual physical activity is safe and highly recommended. Several therapeut
Soluble CD40 ligand predicts ischemic stroke and myocardial infarction in patients with nonvalvular atrial fibrillation
Full text linkOBJECTIVE - Atrial fibrillation (AF) is associated with a high incidence of vascular disease that may be related to a prothrombotic and inflammatory state. Soluble CD40 ligand (sCD40L), which stems essentially from platelet activation, possesses inflammatory and prothrombotic properties. The aim of the study was to assess whether sCD40L is a predictor of stroke or myocardial infarction (MI) in patients with nonvalvular AF. METHODS AND RESULTS - Plasma levels of sCD40L were measured in 231 patients (177 [77%] had permanent or persistent AF, and 54 [23%] had paroxysmal AF). Patients were followed for a mean period of 27.8±8.8 months, and cardiovascular events such as fatal and nonfatal stroke and MI were recorded. AF population was divided in 2 groups according to sCD40L level above or below the median (4.76 ng/mL). The 2 patients' groups had similar distribution of cardiovascular risk factors, age, gender, medications, or serum C-reactive protein levels. During the follow-up period, vascular events occurred in 6 (2 nonfatal MI and 4 nonfatal ischemic strokes) of 116 patients with low levels of sCD40L (5.1%) and in 29 (11 fatal and 3 nonfatal MI; 3 fatal and 12 nonfatal ischemic strokes) of 115 patients with high levels (25.2%) (log-rank test: P<0.001). Using the COX proportional Hazards model, patients with sCD40L above the median were 4.63 times more likely to experience a vascular event (95% C.I.: 1.92 to 11.20). CONCLUSIONS - This study shows that enhanced soluble CD40L level is a predictor of vascular events in patients with nonvalvular AF, thus suggesting that enhanced platelet activation may play a role in its clinical progression. © 2007 American Heart Association, Inc
The role of nutraceuticals for the treatment of non-alcoholic fatty liver disease
No full textNon-alcoholic fatty liver disease (NAFLD) represents the most common chronic liver disease. It is characterized by a wide spectrum of
hepatic changes, which may progress to liver fibrosis and to cirrhosis. NAFLD is considered as the hepatic component of the metabolic
syndrome but mechanisms underlying the onset and progression of NAFLD are still under investigation. The traditional ‘two hit
hypothesis’ has been developed within a more complex ‘multiple parallel hit hypothesis’ which comprises a wide spectrum of parallel
hits. Many therapeutic approaches have been proposed so far and several types of nutraceuticals have been suggested for the
treatment of NAFLD and non-alcoholic steatohepatitis (NASH), the most promising of which are those with antioxidant effects. In
particular, vitamin E appears to be effective for the treatment of nondiabetic subjects with more advanced NASH, although the high
suggested daily dosages are a matter of concern. Moreover, polyphenols reduce liver fat accumulation, mainly by inhibiting lipogenesis.
At present, there are insufficient data to support the use of vitamin C supplements in patients with NAFLD. Data on polyunsaturated
fatty acid (PUFA) supplementation are heterogeneous, and no well-designed randomized controlled studies (RCTs) of adequate
size, with histological assessment of steatosis, have been conducted. Based on the available data, silymarin supplementation for the
treatment of NAFLD seems to have a favourable effect. The results with anti-inflammatory agents, such as vitamin D and carnitine are
uncertain. In conclusion, there are insufficient data either to support or refute the use of nutraceuticals for subjects with NAFLD. Further
RTCs, with histological changes as an outcome measure, are needed
Ridotta attività della lipasi acida lisosomiale: un possibile ruolo patogenetico nella nafld?
No full textLysosomal Acid Lipase (LAL) is a hydrolase that plays a key role in intra-cellular cholesterol trafficking.
A reduced LAL activity promotes an increased lysosomal cholesterol esters storage, as observed in two
recessive autosomal genetic diseases. Wolman disease is characterized by total LAL deficiency and has
an early onset phenotype with rapid multi-organ failure. Cholesterol ester storage disease (CESD) may
develop during childhood and adulthood and has a less severe phenotype characterized by accelerated
atherosclerosis, dyslipidemia and fatty liver rapidly progressing to fibrosis and cirrhosis.
The natural history of LAL deficiency in adults is not well defined and the diagnosis is often incidental.
LAL deficiency has been suggested as a possible unrecognized cause of dyslipidemia and fatty liver.
Therefore, non-obese patients with unexplained persistent elevation of serum liver enzymes and LDL
cholesterol should be tested for LAL deficiency.
Recently, a reduced LAL activity was reported in adult subjects with non-alcoholic fatty liver disease
(NAFLD) suggesting a possible role of LAL in the pathogenesis and progression of the disease.
However, whether low LAL activity contributes to liver damage progression, or is itself a consequence
of liver failure is still unknown. A better knowledge of the role of LAL may provide new insights in the
pathogenesis and progression of NAFLD
Oxidative stress: new insights on the association of nonalcoholic fatty liver disease and atherosclerosis
Full text linkNon-alcoholic fatty liver disease (NAFLD) represents the most common and emerging chronic liver disease worldwide. It includes a wide spectrum of liver diseases ranging from simple fatty liver to non-alcoholic steatohepatitis (NASH), which may progress to fibrosis and more severe liver complications such as cirrhosis, hepatocellular carcinoma and liver mortality. NAFLD is strongly associated with obesity, insulin resistance, hypertension, and dyslipidaemia, and is now regarded as the liver manifestation of the metabolic syndrome. The increased mortality of patients with NAFLD is primarily a result of cardiovascular disease and, to a lesser extent, to liver related diseases. Increased oxidative stress has been reported in both patients with NAFLD and patient with cardiovascular risk factors. Thus, oxidative stress represents a shared pathophysiological disorder between the two conditions. Several therapeutic strategies targeting oxidative stress reduction in patients with NAFLD have been proposed, with conflicting results. In particular, vitamin E supplementation has been suggested for the treatment of non-diabetic, non-cirrhotic adults with active NASH, although this recommendation is based only on the results of a single randomized controlled trial. Other antioxidant treatments suggested are resveratrol, silybin, L-carnitine and pentoxiphylline. No trial so far, has evaluated the cardiovascular effects of antioxidant treatment in patients with NAFLD. New, large-scale studies including as end-point also the assessment of the atherosclerosis markers are needed
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