1,721,005 research outputs found
Nutraceuticals and cholesterol-lowering action
No full textAbstractNutraceuticals play an important role in cardiovascular prevention in patients with dyslipidemia. Many scientific studies support the use of these substances alone or associated with other drugs in clinical practice. Specifically, monacolines, berberine, policosanol and gamma-oryzanol could significantly reduce cholesterolemia. However, there is still an insufficient number of studies demonstrating morbidity and mortality outcomes of nutraceuticals, nor are sufficient data regarding the use of nutraceuticals in different types of patients, on tolerability, safety, target population, modality and duration of use present in the literature
Additional therapy for cholesterol lowering in ezetimibe-treated, statin-intolerant patients in clinical practice: results from an internal audit of a university lipid clinic
No full textObjective: The aim of our study was to evaluate the tolerability and efficacy of alternative approaches to improve cholesterolemia control in patients with statin-related myalgia treated with ezetimibe. Research design and methods: We retrospectively evaluated 3534 Clinical Report Forms (CRFs) filled in the period June 2012–June 2015 for first visits to the lipid clinic of the University of Bologna. For this study, we selected 252 CRFs based on the following criteria: statin-related myalgia, previous failed treatment with at least two low-dosed statins, well tolerated treatment with ezetimibe. Then, the following lipid-lowering treatments were added in order to improve the ezetimibe low density lipoprotein cholesterol (LDL-C) lowering efficacy, based on clinical judgment: fenofibrate 145 mg, rosuvastatin 5 mg 1 tablet/week, rosuvastatin 5 mg 2 tablets/week, red yeast rice (standardized in monacolin K 3 mg) + berberine 500 mg, berberine 500 mg b.i.d., phytosterols 900 mg + psyllium fiber 3.5 g b.i.d. Patients continuing to claim a tolerable myalgia were then treated with coenzyme Q10 nanoemulsions 200 mg/day. Results: The treatment with standard lipid-lowering diet plus ezetimibe alone was associated with a mean LDL-C reduction of 17 ± 2%. The additive LDL-lowering effect with the various tested treatment was: −16 ± 2% with fenofibrate 145 mg/day, −13 ± 1% with rosuvastatin 5 mg 1 tablet/week, −17 ± 3% with rosuvastatin 5 mg 2 tablets/week, −19 ± 4% with red yeast rice + berberine, −17 ± 4% with berberine b.i.d. and −10 ± 3% with phytosterols + psyllium b.i.d.; 11% of the patients treated with fenofibrate required treatment modification because of myalgia recurrence, while the percentage was negligible for the other tested treatments. In patients with residual tolerable myalgia, treatment with coenzyme Q10 for 8 weeks was associated with a mean improvement of the graduated myalgia score from 4.8 ± 1.9 to 2.9 ± 1.3 (p = 0.013). Conclusions: Some alternative treatments seems to be effective and well tolerated, thus improving the ezetimibe effect on cholesterolemia
Serum uric acid predicts incident metabolic syndrome in the elderly in an analysis of the Brisighella Heart Study
Full text linkSeveral epidemiological studies report a positive correlation between hyperuricemia and metabolic syndrome (MetS) in adults, which hyperuricemic subjects seem to more easily develop. We aimed to verify if serum uric acid (SUA) concentrations were positively associated with MetS prevalence and middle-term (4-year) incidence in older overall healthy subjects. We also purposed to identify which SUA cut-off values could be functional in MetS diagnosis in addition to the traditionally used parameters. For this reason, we selected from the historical cohort of the Brisighella Heart Study 923 older healthy subjects repeatedly visited during the 2008 and 2012 population surveys. In our sample, MetS was more frequent for higher SUA concentrations rather than the population’s mean in both men [OR = 2.12, 95%C.I.(1.55, 2.90)] and women [OR = 2.69,95%C.I.(1.91, 3.78)]. ROC analysis showed SUA was predictive of MetS in the whole population [AUC = 0.647, 95%C.I.(0.609, 0.686), P = 0.000001] and in both sex subgroups [men: AUC = 0.592, 95%C.I.(0.529, 654); P = 0.004; women: AUC = 0.758, 95%C.I.(0.711, 0.806), P < 0.000001], even there were sex-related differences in the best cut-off values (5.5 mg/dL for men; 4.2 mg/dL for women). Prospectively, SUA appeared predictive of middle-term (4-year) MetS incidence in the whole population (AUC = 0.604, 95%C.I.[0.518, 0.690], P = 0.029, best cut-off value = 4.7 mg/dL) and in the female group (AUC = 0,641, 95%C.I.[0.519, 0.762], P = 0.039, best cut-off value = 3.9 mg/dL) though not in the male one (P > 0.05). In conclusion, in our cohort, SUA is a frequent component of MetS, other than a middle-term predictor of newly diagnosed MetS in older women
NoSAS score associated with arterial stiffness in a large cohort of healthy individuals.
No full textWe read with interest Helena Marti-Soler and colleagues' Article1 in the Lancet Respiratory Medicine on their proposed clinical algorithm (NoSAS), which showed good sensitivity for detecting individuals at risk of sleep-disordered breathing with greater accuracy than other validated questionnaires. This algorithm could be potentially useful for screening purposes in large cohorts for whom polysomnography is too expensive and time consuming
Subjective effects of a combined lipid-lowering nutraceutical or ezetimibe on well-being and sexual performance in patients with perceived worsening of erectile function during statin treatment: a randomised clinical trial
No full textBackground
Beyond clinical trial evidence, the perceived association of statin use and impotence in general practice is not infrequent and the most common associated consequence is the discontinuation of the statin treatment.
Aim of the study
To carry out a randomised clinical trial on Caucasian men refusing to continue statin therapy because of perceived worsening of erectile function in order to test the tolerability of alternative lipid-lowering strategies.
Methods
This is a single-blind, randomised clinical trial carried out on 50 moderately hypercholesterolaemic subjects (mean age: 54±6 years old) who voluntarily interrupted statin treatment because of self-reported erectile dysfunction (ED) during statin treatment, randomised to treatment with ezetimibe 10 mg or a combined lipid-lowering nutraceutical containing red yeast rice and berberine (3 mg monacolins and 500 mg per dose, respectively), to be taken as one dose per evening for 12 weeks. The effects of both treatments on ED and subjective well-being was tested by administrating, before and after 12 weeks of treatment, the International Index of Erectile Function (IIEF-5) and the Satisfaction Profile (SAT-P), and comparing the baseline hormonal level with the final one.
Results
After 12 weeks of treatment, both ezetimibe- and nutraceutical-treated patients experienced a significant improvement in low-density lipoprotein cholesterolaemia and triglyceridaemia (both p<0.05) and a significant increase in IIEF-5 score (p<0.05 for both). However, patients taking the nutraceutical experienced a more significant increase than the group taking ezetimibe (1.2±0.7 vs. 0.7±0.3, p=0.04). Both ezetimibe- and nutraceutical-treated subjects experienced a significant improvement in psychological performance-related SAT-P score, but the nutraceutical-treated group’s improvement was larger than that of the ezetimibe-treated group (+8±4 vs. +6±3, p<0.05). Moreover, only the nutraceutical-treated patients experienced a significant improvement in physical and social performance related SAT-P score compared to the baseline (+7±5 and 6±3, both p<0.05).
Conclusion
Our data support the use of alternative lipid-lowering strategies in patients refusing to continue statin consumption because of perceived worsening of erectile function
High serum uric acid is associated to poorly controlled blood pressure and higher arterial stiffness in hypertensive subjects
No full textIntroduction Serum uric acid (SUA) has been associated to incident hypertension and increased risk of cardiovascular diseases. Materials and methods Among the 2191 subjects enrolled during the last population survey of the Brisighella Heart Study, we identified 146 new cases of arterial hypertension and 394 treated but uncontrolled hypertensive patients with different levels of SUA. Their hemodynamic characteristics have been compared with those of age- and sex-matched normotensive (N. 324) and controlled hypertensive (N. 470) subjects. Then, by logistic regression analysis, we evaluated which factors were associated with a worse BP control under pharmacological treatment. Results SUA levels were significantly higher in untreated hypertensive and uncontrolled hypertensive patients when compared to normotensives and controlled hypertensive patients. Pulse wave velocity (PWV) was significantly higher (p 
Serum uric acid and impaired cognitive function in a cohort of healthy young elderly: data from the Brisighella Study
No full textContrasting evidence shows a possible association between serum uric acid (SUA) and cognitive function in elderly subjects. We aimed at evaluating the impact of circulating SUA levels on cognitive function in a cohort of pharmacologically untreated young elderly subjects. For this study, we selected 288 healthy young elderly participants from the historical cohort of the Brisighella Heart Study (M: 108, F: 180; mean age: 69 ± 6 years old). Exclusion criteria were limitation of activities of daily living, depression, chronic pharmacological treatment, patients in secondary prevention for cardiovascular disease, known neurodegenerative disorders, confirmed diabetes or gout, and ultrasonic evaluated carotid atherosclerosis. Cognitive functions were assessed by scholarship-adjusted mini-mental state examination (MMSE). A stepwise multiple regression analysis was carried out including a large set of clinical and laboratory parameters, carotid intima-media thickness, and the Beck Depression scale score. The analysis was then repeated by gender. In the multiple regression analysis, the only factors associated with the MMSE score were: age (B = −0.058, 95 % CI −0.108, −0.009, p = 0.022), LDL-C (B = −0.639, 95 % CI −0.912, −0.411, p = 0.034) and SUA (B = −0.527, 95 % CI −0.709, −0.344, p = 0.022). Repeating the analysis by low or high SUA level (based on the gender specific SUA distribution 50th percentile), it appears that in subjects with a low SUA, cognitive decline is only associated with age, while in those with high SUA it is associated with LDL-C (OR 1.18, 95 % CI 1.07–1.33, p = 0.019) and SBP (OR 1.02, 95 % CI 1.001–1.048, p = 0.039). Our data demonstrate a positive association between circulating levels of uric acid and cognitive dysfunction in a sample of pharmacologically untreated young elderly subjects
Effect of Lactotripeptides (Isoleucine-Proline-Proline/Valine-Proline-Proline) on Blood Pressure and Arterial Stiffness Changes in Subjects with Suboptimal Blood Pressure Control and Metabolic Syndrome: A Double-Blind, Randomized, Crossover Clinical Trial
No full textBackground: Lactotripeptides (LTPs) have a mild antihypertensive effect in hypertensive subjects. The main aim of our clinical trial was to test if LTPs could have some influence on blood pressure (BP) and related hemodynamic parameters in a sample of outpatients affected by metabolic syndrome. Methods: A randomized, double-blind, placebo-controlled, crossover clinical trial was conducted in a group of 40 nonsmoking volunteers with metabolic syndrome. The treatment periods were 4 weeks long and were separated by a 4-week washout period. The dietary supplementation was made by daily administration of LTPs from casein, 10.2 mg/day, and compared with placebo. Results: During the LTP treatment, patients experienced a significant mean decrease in systolic BP (SBP; -3.4 ± 4.4 mmHg, P = 0.041), diastolic BP (DBP; -3.1 ± 3.2 mmHg, P = 0.049), and pulse wave velocity (PWV; -0.7 ± 0.3 m/sec, P = 0.001). After LTP treatment, delta SBP, DBP, and PP were all significantly improved (P < 0.01 for all) compared with placebo. PWV also improved significantly after LTP treatment with respect to the end of the treatment with placebo (-0.8 ± 0.4 vs. -0.1 ± 0.3 m/sec, P = 0.009). The square root of the ratio of peak:baseline pulse volume during hyperemia (V2/V1) improved after LTP treatment only (1.2 ± 0.4 vs. 1.4 ± 0.5, P = 0.04). Through the evaluation of the hemodynamic parameters that were measured by the 24-hr ambulatory monitoring, we observed that SBP, MBP, and the percentage of time with SBP over the normal were significantly reduced only after the LTP treatment (P < 0.05). These parameters were also significantly improved when compared with the ones measured after the placebo treatment (P < 0.05). Conclusion: In our trial, during LTP treatment, patients affected by metabolic syndrome experienced a mild but significant improvement in office and 24-hr BP, PWV, and endothelial function compared with placebo treatment
Relationship Between Serum Uric Acid and Electrocardiographic Alterations in a Large Sample of General Population: Data From the Brisighella Heart Study
No full textIntroduction: Serum uric acid (SUA) may contribute to the increased cardiovascular damage through direct injury to the endothelium and alteration of cardiovascular function. Aim: To evaluate the association of SUA with the presence of the most recurrent electrographic alterations and with the length of the main ECG intervals in a large sample of general population. Methods: For this study, on the database of the Brisighella Heart Study, we evaluated the available data of 790 men and 849 women, excluding subjects affected by gout or taking antihyperuricemic agents, those taking drug increasing the QT interval and those using beta-blockers or non-dihydropyridine calcium channel blockers at the moment of the ECG registration. Multiple ascending stepwise regression analyses were carried out to determine the independent predictors of the predefined ECG alterations. Results: The prevalence of predefined ECG alterations was comparable between genders, with the exception of sinus bradicardia, left-anterior fascicular block, atrio-ventricular blocks and left ventricular hypertrophy (LVH), which appeared to be more frequent in men. The multivariate analysis revealed that SUA was associated to ischaemic alterations, LVH, sinus tachycardia and tachyarrhytmias. Age was associated to all evaluated ECG alterations beyond sinus tachycardia and LVH. Male sex was associated to sinus bradicardia, atrio-ventricular blocks, anterior-left fascicular block and LVH. Blood pressure was associated to different ECG alterations, but with clinically relevant OR with ischaemic alterations and LVH. Conclusion: SUA level is related the prevalence of both organic and rhythm ECG alterations in a wide sample of general population
The possible role of Vicorder® apparatus in the diagnostic protocol of inner ear diseases
No full textObjective: Cardiovascular risk factors are widely reputed to be a possible cause for hearing impairment, and the role of arterial stiffness as a cardiovascular risk predictor has been recently emphasized. For these reasons pulse wave velocity (PWV) could represent a useful parameter in order to rapidly assess or rule out the existence of an underlying overall deteriorating circulatory condition in cases of inner ear impairment. Method: In order to assess the real significance of PWV for audiological purposes, a study was carried out comparing this parameter in subjects with normal hearing and those with symmetrical sensorineural hearing loss. Results: The results suggested an apparent lack of correlation between arterial stiffness and hearing deterioration. Conclusion: The findings appear to indicate that the relationship between systemic circulation and inner ear function, when excluding acute and/or well identifiable impairment factors, is not as linear as expected
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