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Università Magna Græcia di Catanzaro Dipartimento di Medicina Sperimentale e Clinica Cattedra di Medicina Interna Scuola di Specializzazione in Geriatria.

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Presentazione sul tema: "Università Magna Græcia di Catanzaro Dipartimento di Medicina Sperimentale e Clinica Cattedra di Medicina Interna Scuola di Specializzazione in Geriatria."— Transcript della presentazione:

1 Università Magna Græcia di Catanzaro Dipartimento di Medicina Sperimentale e Clinica Cattedra di Medicina Interna Scuola di Specializzazione in Geriatria U.O. Malattie Cardiovascolari Geriatriche Prof. Francesco Perticone Cattedra di Medicina Interna Scuola di Specializzazione in Geriatria U.O. Malattie Cardiovascolari Geriatriche Prof. Francesco Perticone Sindrome Infiammatoria Sistemica e Rischio CV

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6 Association Between Airflow Obstruction, CRP and AMI Ukena C et al. Int J Cardiol 2010

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8 Inflammatory Events in Complex Comorbidities Ukena C et al. Int J Cardiol 2010

9 Cardiopulmonary Continuum Concept of systemic inflammatory processes as underlying pathophysiological relationship between COPD and CAD Ukena C et al. Int J Cardiol 2010

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12 Low-Dose Aspirin Reduces Thromboxane B 2 but not CRP Serum CRP (% of Baseline) 140 100 60 20 Placebo (n=11) Feldman M et al. J Am Coll Cardiol 2001;37:2036-2041 140 100 60 20 Serum Thromboxane (% of Baseline) ASA 81 mg qd (n=13) Placebo (n=11) ASA 81 mg qd (n=13) 28 Days 31 Days * p<0.001 *

13 0 1 2 3 Rischio relativo di un evento Infiammazione Assente Infiammazione Presente ( PCR e SAA) P trend=0.005 Ridker et al: Circulation 1998;98:839–844 P=0.007 CARE: La Pravastatina Riduce il Rischio Rappresentato dall ’ Infiammazione PravastatinaPlaceboPravastatinaPlacebo

14 Serum L-ascorbic acid,  mol/L Serum CRP, mg/L Tzoulaky I et al., Circulation 2005 Serum L-ascorbic acid,  ControlsPAD L-ascorbic Acid Depletion in Spiked Sera from Nonsmoking Men (10 control subjects, 15 PAD patients), Stratified for Serum CRP (5.0 mg/L) Correlation Between Serum L-ascorbic Acid and CRP Concentrations in PAD Patients r= -0.72 P<.001

15 Cangemi R et al, Eur Heart J 2008;29:54–62 Oxidative Stress and Atorvastatin

16 Perticone F et al, Clin J Am Soc Nephrol, accepted Vascular Function According to Median of Hb

17 Baseline 0 306090 120 SBP DBP HR Hemodynamics and Flow Before and After Smoking 60 80 100 120 140 HR (b/m) and BP (mmHg) FBF 100 120 140 160 180 FBF (ml/min) J Lekakis et al, Am J Cardiol 1998;81:1225-28 min

18 Flow-mediated Dilation of the Brachial Artery after Smoking, Sham Smoking and after Smoking a Second Cigarette 0 2 4 6 8 10 12 0306090120 Time, min J Lekakis et al, Am J Cardiol 1998 FMD (%) sham 1 st cigarette 2 nd cigarette

19 Relationship Between Smoking and Flow Mediated Dilation FMD % 10 5 0 Celermajer et al, N Engl J Med 1996 None1 - 45 - 910 - 19> 20 <.01 P <.01

20 P <.001 0 5 10 15 20 Controls Passive Active smokers smokers FMD % P <.001 P = NS Celermajer et al, N Engl J Med 1996 Relationship Between Passive Smoking and Flow Mediated Dilation

21 O2O2 O-2O-2 e-e- NADH/NA DPH Oxidase NO OONO - L-arginina NO - citrullina e-NOS

22 Maximal vasodilatory response to ACh (%) 5.6-years estimated probability of diabetes (%) 10008006004002000 80 60 40 20 0 Exponential fitting r=0.85 P<0.001 Endothelial Dysfunction and C-Reactive Protein Are Risk Factors for Diabetes in Essential Hypertension Perticone F et al, Diabetes 2008

23 012345 0 2 4 6 8 C-reactive Protein (mg/L) Number of Components of the Metabolic Syndrome Ridker PM, et al. Circulation. 2003;107:391-397. Sindrome Metabolica e Livelli di PCR

24 Coronary Heart Disease Mortality 0 2 4 6 81012 0 5 10 15 20 RR (95% CI), 3.77 (1.74-8.17) Follow-up, Y Cumulative Hazard (%) Yes No 866 288 852 279 834 234 292 100 Unadjusted Kaplan-Meier Curves No. at Risk Metabolic Syndrome Yes Metabolic Syndrome: 0 2 4 6 81012 0 5 10 15 20 RR (95% CI), 3.55 (1.96-6.43) Follow-up, Y 866 288 852 279 834 234 292 100 0 2 4 6 81012 0 5 10 15 20 RR (95% CI), 2.43 (1.64-3.61) Follow-up, Y 866 288 852 279 834 234 292 100 Cardiovascular Disease Mortality All Cause Mortality Lakka H-M, et al. JAMA. 2002;288:2709-2716. No

25 Relationship between metabolic syndrome, lung dysfunction and CV disease

26 IL-6 TNF- α IL-1 β un solido indicatore di rischio CV CRP 1rst 2nd 3rd 4th CRP quartiles PREVEND study, Kidney Int 63:654, 2003 Creatinine Cl (ml/min/1.73m 2 ) 100 95 90 The 3 years risk for CV events in the women health study Ridker NEJM 2000; 342:836 8642086420 4.4

27 FBF, % increase 0 400 800 0,40,60,81 r = 0.587 P < 0.0001 ADMA  mol/L Perticone F et al, J Am Coll Cardiol, 2005;46:518-23 ADMA and Endothelial Vasodilation in Hypertension -30 0 30 60 min SVR (change) 400 200 0 -200 MBP (change) 5 0 -5 ADMA Achan V & Vallance P. ATVB 2003 Perticone F et al, Int J Cardiol 2009

28 Sciacqua A et al, NMCD 2010

29 Fasting Insulin and Left Ventricular Mass G Sesti, F Perticone et al, J Hypertens 2007 LVMI, g/m 2 70 120 170 220 0102030 Insulin,  U/mL r = 0.636 p< 0.0001 F Perticone et al, J Clin Endocrinol Metab 2001

30 Signaling Pathways Used by Bone Morphometric Proteins in Osteoblasts Signaling Determining Mesenchimal-Cell Differentiation toward Osteoblasts and Signals Acting on Mature Osteoblasts to Enhance Bone Formation

31 Takimoto E, Kass DA, Hypertension 2007 Molecular signaling pathways linking ROS to cardiac hypertrophy and remodeling Perticone F et al, J Am Coll Cardiol 1997;29:365-9 Deletion Polymorphism of ACE-Gene and Left Ventricular Hypertrophy

32 Scieffer B et al, Circulation, 2000;101:1372-78

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34 Effect of Fructose on Various Organ Systems Johnson RJ et al, Endocrine Reviews 2009;30:96–116

35 0.001 0.012 0.340 0.799 0.355 0.192 0.124 0.090 0.071 HR (plus uric acid 1 g/dL increase) ACh % of increase Acido Urico, Funzione Endoteliale e Diabete Perticone F et al, submitted

36 Perticone F et al, Circulation 2010 Endothelial Dysfunction and e-GFR Decline

37 Effects of LDL Particles on the Wessel Wall Rocha VZ and Libby P, Nat Rev Cardiol 2009;6:399-409 Effects of FFA on Various Organs

38 INSULIN RESISTANCE ENDOTHELIAL DYSFUNCTIONHYPERTENSIONDIABETES TARGET ORGAN DAMAGE AMISTROKE HEART FAILURE SUDDEN DEATH INFLAMMATION

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