Papers by Francesco Perticone
PLOS ONE, Aug 11, 2014
Evidence suggests that advanced fibrosis, as determined by the noninvasive NAFLD fibrosis score (... more Evidence suggests that advanced fibrosis, as determined by the noninvasive NAFLD fibrosis score (NFS), is a predictor of cardiovascular mortality in individuals with ultrasonography-diagnosed NAFLD. Whether the severity of histology (i.e., fibrosis stage) is associated with more pronounced cardiovascular organ damage is unsettled. In this study, we analyzed the clinical utility of NFS in assessing increased carotid intima-media thickness (cIMT), and left ventricular mass index (LVMI). In this cross-sectional study NFS, cIMT and LVMI were assessed in 400 individuals with ultrasonography-diagnosed steatosis. As compared with individuals at low probability of liver fibrosis, individuals both at high and at intermediate probability of fibrosis showed an unfavorable cardio-metabolic risk profile having significantly higher values of waist circumference, insulin resistance, high sensitivity C-reactive protein (hsCRP), fibrinogen, cIMT, and LVMI, and lower insulin-like growth factor-1 (IGF-1) levels. The differences in cIMT and LVMI remained significant after adjustment for smoking and metabolic syndrome. In a logistic regression model adjusted for age, gender, smoking, and diagnosis of metabolic syndrome, individuals at high probability of fibrosis had a 3.9-fold increased risk of vascular atherosclerosis, defined as cIMT.0.9 mm, (OR 3.95, 95% CI 1.12-13.87) as compared with individuals at low probability of fibrosis. Individuals at high probability of fibrosis had a 3.5-fold increased risk of left ventricular hypertrophy (LVH) (OR 3.55, 95% CI 1.22-10.34) as compared with individuals at low probability of fibrosis. In conclusion, advanced fibrosis, determined by noninvasive fibrosis markers, is associated with cardiovascular organ damage independent of other known factors.
The Journal of Clinical Endocrinology and Metabolism, Mar 8, 2019
Context: Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are highly pathophys... more Context: Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are highly pathophysiologic heterogeneous prediabetes conditions that can occur in all age groups, from youth to elderly people. Objective: We evaluated whether distinct age-related phenotypes exist among individuals with IFG or IGT. Research Design: 479 young (aged 18 to 35 years), 699 adult (45 to 55 years) and 240 older ($65 years) subjects underwent an oral glucose tolerance test (OGTT). From the OGTT results, the participants were grouped as follows: young age and normal glucose tolerance (NGT), adult age and NGT, older age and NGT, IFG young subjects, IFG adult subjects, IFG older subjects, IGT young (Y-IGT) subjects, IGT adult (A-IGT) subjects, and IGT older (O-IGT) subjects. Main Outcome Measures: Insulin sensitivity and secretion, insulin clearance, and b-cell function. Results: Peripheral insulin sensitivity assessed using the Matsuda index, basal and glucose-stimulated insulin secretion, and b-cell function estimated using the disposition index were decreased in IFG adult subjects and IFG older subjects compared with IFG young subjects. A-IGT and Y-IGT subjects exhibited a progressively greater degree of hepatic insulin resistance assessed using the liver insulin resistance index, and reduced insulin clearance compared with O-IGT subjects. In contrast, the Matsuda index did not differ among Y-IGT, A-IGT, and O-IGT subjects. Basal and glucose-stimulated insulin secretion and b-cell function were lower in A-IGT and O-IGT subjects compared with Y-IGT individuals. Conclusions: Subjects with IFG or IGT exhibited different age-related pathophysiologic characteristics. A more precise phenotyping of subjects with IGT or IFG could help to better design individualized preventive approaches to counteract diabetes progression.
Nutrition Metabolism and Cardiovascular Diseases, Jul 1, 2017
Background and aims: A link between increased blood viscosity and type 2 diabetes has been previo... more Background and aims: A link between increased blood viscosity and type 2 diabetes has been previously reported. Herein, we investigated the association of blood viscosity with prediabetes, identified by glycated hemoglobin A1c (HbA1c) according to the new American Diabetes Association criteria, and subclinical atherosclerosis. Methods and results: The study cohort includes 1136 non-diabetic adults submitted to anthropometrical evaluation, an oral glucose tolerance test and ultrasound measurement of carotid intima-media thickness (IMT). Whole blood viscosity was estimated using a validated formula based on hematocrit and total plasma proteins. After adjusting for age, and gender, individuals with HbA1c-defined prediabetes (HbA1c 5.7e6.4% [39e47 mmol/mol]) exhibited significantly higher values of hematocrit, and predicted blood viscosity as compared with controls. Increased levels of IMT were observed in subjects with HbA1c-defined prediabetes in comparison to controls. Predicted blood viscosity was positively correlated with age, waist circumference, blood pressure, cholesterol, triglycerides, fibrinogen, white blood cell, HbA1c, fasting and 2-h post-load glucose levels, fasting insulin, IMT and inversely correlated with HDL and Matsuda index of insulin sensitivity. Of the three glycemic parameters, i.e. HbA1c, fasting and 2h post-load glucose, only HbA1c showed a significant correlation with predicted blood viscosity (b Z 0.054, P Z 0.04) in a multivariate regression analysis model including multiple atherosclerosis risk factors. The study shows that individuals with HbA1c-defined prediabetes have increased predicted blood viscosity and IMT. The HbA1c criterion may be helpful to capture individuals with an increased risk of diabetes and cardiovascular disease who may benefit from an intensive lifestyle intervention.
Nutrition Metabolism and Cardiovascular Diseases, Aug 1, 2016
Background and aims: Recent data demonstrated that serum phosphorus, within the normal range, is ... more Background and aims: Recent data demonstrated that serum phosphorus, within the normal range, is an independent predictor of atherosclerotic cardiovascular disease, independently of renal function. Traditional cardiovascular risk factors are important mediators of endothelial dysfunction, the early step of atherosclerosis. We designed this study to evaluate a possible correlation between serum phosphorus and endothelium-dependent vasodilation, evaluated by the strain-gauge plethysmography, in naïve hypertensives. Methods and results: We investigated by strain-gauge plethysmography, the relationship between forearm blood flow (FBF) response to acetylcholine (ACh) and serum phosphorus in 500 patients with uncomplicated, never-treated, essential hypertension, divided by phosphorus tertiles. There were no significant differences among tertiles with the exclusion of forearm blood flow (FBF). Phosphorus (b Z À0.454; P Z 0.0001), estimated-glomerular filtration rate (e-GFR, by CKD-EPI formula) (b Z 0.261; P Z 0.0001), gender (b Z 0.215; P Z 0.0001), BMI (b Z À0.086; P Z 0.018), HDL-cholesterol (b Z 0.077; P Z 0.036) were significantly related to endothelium-dependent vasodilation. In an additional analysis including serum high sensitivity C-reactive protein (hs-CRP) (measured in 400 patients) in the same model, the link between serum phosphorus and ACh-stimulated FBF did not change (b Z À0.422; P Z 0.0001). Clinically relevant, 0.1 mg of phosphorus increase is associated with a reduction of 22% of ACh-stimulated FBF. On multiple logistic regression analysis, the risk of endothelial dysfunction was about twice higher in patients in the second (OR Z 1.754, 95% CI Z 1.055 e2.915; P Z 0.030) and three-fold higher in the third tertile (OR Z 2.939, 95% CI Z 1.598e5.408; P Z 0.0001) in comparison with those in the first tertile of phosphorus. Conclusion: An impaired ACh-stimulated FBF is associated with serum phosphorus levels, within the normal range, in hypertensives.
Diabetes-metabolism Research and Reviews, Feb 4, 2020
Experimental evidence indicate that high-density lipoprotein (HDL) may stimulate glucose uptake a... more Experimental evidence indicate that high-density lipoprotein (HDL) may stimulate glucose uptake and improve β-cell function. The aim of this study was to evaluate whether lower levels of HDL may affect the risk to develop type 2 diabetes. : Incident rate of type 2 diabetes and changes in insulin sensitivity and βcell function over 5.5 years follow-up were examined in 670 non-diabetic subjects stratified in tertiles according to basal HDL levels. Results: As compared to the highest tertile of HDL, individuals with lower levels of HDL have an increased risk to develop type 2 diabetes independently from several cardio-metabolic risk factors (OR: 2.88, 95%CI: 1.05-7.91), and exhibited a greater deterioration of β-cell function, estimated by the disposition index, over 5.5 years follow-up. Conversely, changes in Matsuda index of insulin sensitivity over the follow-up were not significantly different amongst the three HDL groups. In a multivariable regression analysis model including age, sex, waist circumference, triglycerides, total cholesterol, C reactive protein, fasting and 2-h post-load glucose, family history of type 2 diabetes and smoking habit, HDL concentration at baseline was an independent predictor of β-cell function decline over the followup (β=0.30, P=0.0001). Mediation analysis showed that the association between lower HDL levels at This article is protected by copyright. All rights reserved. baseline and increased risk of incident diabetes was mediated by β-cell function deterioration during the follow-up (t= -3.32, P=0.001). Conclusions: Subjects with lower levels of HDL have an increased risk to develop type 2 diabetes likely due to a greater β-cell function decline over time.
Nutrition Metabolism and Cardiovascular Diseases, May 1, 2015
Background and aims: To evaluate if complement C3 is associated with insulin secretion, as sugges... more Background and aims: To evaluate if complement C3 is associated with insulin secretion, as suggested by recent in vitro studies, independently of confounders including adiposity measures. Methods and results: 1010 nondiabetic subjects were stratified into quartiles according to complement C3 values. Insulin secretion was assessed using indexes derived from oral glucose tolerance test (OGTT) in the whole study group and from intravenous glucose tolerance test (IVGTT) in a subgroup (n Z 110). Significant differences between quartiles of C3 were observed in body mass index (BMI), waist, fat mass, blood pressure, total cholesterol, high density lipoprotein (HDL), triglycerides, fasting and 2-h post-load glucose, fasting insulin, C reactive protein (hsCRP), fibrinogen, aspartate aminotransferase (AST), alanine aminotransferase (ALT), complement C4, and insulin sensitivity with C3 quartiles exhibiting graded increases in cardio-metabolic risk factors. Differences in insulin secretion indexes between C3 quartiles remained significant after adjustment for age, gender, BMI, insulin sensitivity, blood pressure, total cholesterol, HDL, triglycerides, hsCRP, fibrinogen, and complement C4 levels (P < 0.0001). A multivariable regression analysis revealed that complement C3 is a contributor of insulin secretion, explaining 2.4% and 1.9% of variation of the Stumvoll index for first-phase and second-phase insulin secretion, respectively, and 2.1% of variation of the InsAUC30/GluAUC30 index, independently of gender, age, BMI, waist, fat mass, blood pressure, total cholesterol, HDL, triglycerides, hsCRP, fibrinogen, AST, ALT. Conclusions: Complement C3 concentrations are associated with insulin secretion independently of important determinants of glucose homeostasis such as gender, age, adiposity, subclinical inflammation, and insulin sensitivity.
Internal and Emergency Medicine, May 5, 2015
No data exist concerning a possible association between CHADS 2 or CHA 2 DS 2 -VASc scores and at... more No data exist concerning a possible association between CHADS 2 or CHA 2 DS 2 -VASc scores and atrial fibrillation (AF). In this prospective observational study, we tested the hypothesis whether thromboembolic risk scores predict AF. We investigated 3549 subjects, 1829 men and 1720 women, aged 60.7 ± 10.6 years, without baseline AF. Patients with thyroid disorders were excluded. CHADS 2 and CHA 2 DS 2 -VASc scores were evaluated as categorical variables. To test the effect of some clinical confounders on incident AF, we constructed different models including clinical and laboratory parameters. During follow-up (53.3 ± 18.1 months), 546 subjects developed AF (4.5 events/100 patient-years). Progressors to AF are older, have a higher body mass index (BMI), blood pressure, LDL-cholesterol, and glucose. Hypertension, metabolic syndrome, diabetes and carotid wall thickening were more common among AF cases than among control subjects. In the final Cox-regression model, variables that remained significantly associated with incident AF were BMI (HR = 1.022, 95 % CI = 1.008-1.037), LDLcholesterol (HR = 1.032, 95 % CI = 1.008-1.056), CHA 2 DS 2 -VASc score (HR = 1.914, 95 % CI = 1.439-2.546), and CHADS 2 score (HR = 2.077, 95 % CI = 1.712-2.521). In conclusion, CHADS 2 and CHA 2 DS 2 -VASc scores are independent predictors of AF. Atrial fibrillation Á CHADS 2 score Á CHA 2 DS 2 -VASc score Á Cardiovascular risk factors A. Sciacqua and M. Perticone have equally contributed to the work.
Thrombosis and Haemostasis, 2016
Multiplicative effect of serum phosphorus levels and insulin resistance on hypertensive vascular ... more Multiplicative effect of serum phosphorus levels and insulin resistance on hypertensive vascular stiffness -
American Journal of Physiology-endocrinology and Metabolism, 2007
The aim of this study was to investigate whether insulin resistance is independently associated w... more The aim of this study was to investigate whether insulin resistance is independently associated with early manifestations of atherosclerosis. To this end, 176 normotensive offspring of type 2 diabetic patients were subjected to euglycemic hyperinsulinemic clamp to assess insulin sensitivity. Early atherosclerosis was studied by ultrasonography of the common carotid artery. Of the total 176 subjects, 145 were glucose tolerant, 18 had impaired fasting glucose, and 13 had impaired glucose tolerance. Univariate correlations showed that age, body mass index, waist, blood pressure, 2-h postchallenge glucose, fasting insulin, triglycerides, interleukin-6, fibrinogen, and white blood cell count were significantly correlated with carotid intimamedia thickness (IMT), whereas HDL cholesterol and glucose disposal showed a negative correlation. A stepwise multivariate regression analysis including sex, age, waist circumference, smoking status, systolic blood pressure, diastolic blood pressure, triglyceride, HDL cholesterol, 2-h postchallenge glucose, plasma IL-6, fibrinogen, white blood cell count, insulin-stimulated glucose disposal, and fasting insulin showed that the four variables that remained significantly associated with carotid IMT were waist circumference, insulin-stimulated glucose disposal, white blood cell count, and diastolic blood pressure, accounting for 33.7% of its variation. These findings support the concept that insulin sensitivity, rather than plasma insulin levels, is associated with early atherosclerosis in nondiabetic normotensive offspring of type 2 diabetic patients.
The Journal of Clinical Endocrinology and Metabolism, 2009
The prevalence of type 2 diabetes (T2D), particularly among young adults, has been rising steadil... more The prevalence of type 2 diabetes (T2D), particularly among young adults, has been rising steadily during the past 2 decades. T2D, especially in its early-onset subtype, is under genetic control. TRIB3 inhibits insulin-stimulated Akt phosphorylation and subsequent insulin action. A TRIB3 gain-of-function polymorphism, Q84R (rs2295490), impairs insulin signaling. The objective of the study was to verify the association of TRIB3 Q84R with: 1) T2D, either subtyped or not according to age at diagnosis (early-onset, Ͻ45 yr, or Ն 45 yr); 2) insulin secretion and sensitivity in nondiabetic individuals; or 3) in vitro insulin secretion from isolated human islets. Design: Four different case-control samples comprising a total of 5469 whites were examined. Insulinogenic and insulin sensitivity indexes and their interplay (disposition index) were assessed in 645 nondiabetic individuals at oral glucose tolerance test, glucose (16.7 mmol/liter)-induced in vitro insulin secretion was assessed in islets isolated from 54 nondiabetic donors. In the whole sample, the R84 variant was nominally associated with T2D (odds ratio 1.17, 95% confidence interval 1.00 -1.36, P ϭ 0.04). When stratifying according to age of diabetes onset, R84 carriers had an increased risk of early-onset T2D (odds ratio 1.32, 95% confidence interval 1.10 -1.58, P ϭ 0.002). Among 645 nondiabetic subjects, R84 carriers had higher glucose levels (P ϭ 0.005) and lower insulinogenic (P ϭ 0.03) and disposition index (P ϭ 0.02) during the oral glucose tolerance test. R84 islets were more likely to display relatively low glucose-stimulated insulin release (P ϭ 0.04). The TRIB3 R84 variant is associated with early-onset T2D in whites. Alteration in the insulin secretion/insulin sensitivity interplay appears to underlie this association. (J Clin Endocrinol Metab 94: 190 -196, 2009) T ype 2 diabetes (T2D) is a typical complex disease that recog- nizes both genetic and environmental factors (1, 2). Its prevalence, especially among young adults, is dramatically increasing to the point of assuming the characteristics of an epidemic and therefore posing severe problems to health care systems (3-5). T2D, especially in its early-onset subtype, is under genetic control (6 -8).
Frontiers in Medicine, Aug 9, 2021
Background: Although sleep respiratory disorders are known as a relevant source of cardiovascular... more Background: Although sleep respiratory disorders are known as a relevant source of cardiovascular risk, there is a substantial lack of trials aimed to evaluate the eventual occurrence of associations between sleep apnea (SA) and valvular heart diseases (VHD). We recruited 411 patients referring to our sleep disorder unit, among which 371 had SA. Ninety-three subjects with SA also suffered from VHD. Physical examination, echocardiography, nocturnal cardio-respiratory monitoring, and laboratory tests were performed in each patient. Patient subgroups were comparatively evaluated through cross-sectional analysis. Results: A statistically significant increase in the prevalence of VHD was detected in relation to high apnea hypopnea index (AHI) values (p = 0.011). Obstructive sleep apnea occurrence was higher in SA patients without VHD (p < 0.0001). Conversely, central and mixed sleep apneas were more frequent among SA patients with VHD (p = 0.0003 and p = 0.002, respectively). We observed a direct correlation between AHI and BMI values (p < 0.0001), as well as between AHI and serum uric acid levels (p < 0.0001), high sensitivity C-reactive protein (p < 0.0001), and indexed left ventricular end-diastolic volume (p < 0.015), respectively. BMI and VHD resulted to be the main predictors of AHI values (p < 0.0001). Conclusions: Our study suggests that a significant association can occur between SA and VHD. It is clinically relevant that when compared to SA patients without VHD, higher frequencies of central and mixed apneas were found in subjects with SA and VHD. Moreover, after elevated BMI, VHD represented the second predictor of AHI values.
Acta Diabetologica, Sep 23, 2014
Aims We aimed to evaluate the inflammatory profile of individuals with prediabetes defined by HbA... more Aims We aimed to evaluate the inflammatory profile of individuals with prediabetes defined by HbA1c levels, according to the new American Diabetes Association criteria, and to determine the ability of HbA1c to identify individuals with subclinical inflammation independently of the contribution of other metabolic parameters such as fasting, 1-or 2-h post-load glucose (PG) levels. Methods High sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), fibrinogen, white blood cells (WBC) count and complement C3 (C3) were assessed, and oral glucose tolerance test (OGTT) was performed in 711 adults. Results Subjects were stratified into three groups according to their HbA1c levels. Poor agreement existed between HbA1c and 2-h PG criteria for identification of individuals with prediabetes (j coefficient = 0.300). As compared with subjects having HbA1c \5.7 % (39 mmol/ mol), individuals with prediabetes (HbA1c 5.7-6.4 %, [39-46 mmol/mol]) exhibited a significant increase of the concentration of five inflammatory markers (hsCRP, ESR, fibrinogen, WBC count, C3) as well as of a cluster of inflammatory markers, as measured by an inflammatory score after adjusting for sex, age, smoking, fasting, 1-and 2-h PG levels. In multiple regression models including sex, age, body mass index, smoking habit, fasting, 1-and 2-h PG levels, and HOMA index, HbA1c levels were significant independent contributors to each of the five inflammatory markers examined. Conclusions These data suggest that HbA1c is a reliable marker of glucose homeostasis, and may identify individuals at increased risk of diabetes with unfavorable inflammatory profile independently from fasting and 2-h PG levels.
Nutrients, Jan 31, 2020
Type 2 diabetes mellitus (T2DM) is a risk factor for cognitive impairment. Ranolazine, an anti-is... more Type 2 diabetes mellitus (T2DM) is a risk factor for cognitive impairment. Ranolazine, an anti-ischemic drug used in the treatment of angina pectoris, has been shown to possess hypoglycemic properties in pre-clinical and clinical studies. The aim of this study was to evaluate the effects of ranolazine on glucose metabolism and cognitive function in a T2DM model of Wistar rats. Diabetes was induced by a high fat diet (HFD) and streptozotocin (STZ). The control group received a normal caloric diet (NCD) and sodium citrate buffer. Metformin, an effective hypoglycemic drug, was employed as a positive control. Animals were divided into the following groups: HFD/STZ + Ranolazine, HFD/STZ + Metformin, HFD/STZ + Vehicle, NCD + Vehicle, NCD + Ranolazine, and NCD + Metformin. Rats received ranolazine (20 mg/kg), metformin (300 mg/kg), or water, for 8 weeks. At the end of the treatments, all animals underwent to an intraperitoneal glucose tolerance test (IPGTT) and behavioral tests, including passive avoidance, novel object recognition, forced swimming, and elevate plus maze tests. Interleukin-6 plasma levels in the six treatment groups were assessed by Elisa assay. Body mass composition was estimated by nuclear magnetic resonance (NMR). Glucose responsiveness significantly improved in the HFD/STZ + Ranolazine (p < 0.0001) and HFD/STZ + Metformin (p = 0.003) groups. There was a moderate effect on blood glucose levels in the NCD + Ranolazine and NCD + Metformin groups. Lean body mass was significantly increased in the HFD/STZ + Ranolazine and HFD/STZ + Metformin animals, compared to HFD/STZ + Vehicle animals. Ranolazine improved learning and long-term memory in HFD/STZ + Ranolazine compared to HFD/STZ + Vehicle (p < 0.001) and ameliorated the pro-inflammatory profile of diabetic mice. These results support the hypothesis of a protective effect of ranolazine against cognitive decline caused by T2DM.
The Journal of Clinical Endocrinology and Metabolism, Nov 1, 2016
Individuals with glycated hemoglobin (HbA1c)-defined prediabetes (HbA1c value of 5.7-6.4%) and 1-... more Individuals with glycated hemoglobin (HbA1c)-defined prediabetes (HbA1c value of 5.7-6.4%) and 1-hour plasma glucose Ն155 mg/dL during an oral glucose tolerance test have an increased risk of developing type 2 diabetes. Objective: To evaluate the degree to which HbA1c-defined prediabetes and 1-hour postload glucose Ն155 mg/dL individually and jointly associate with hepatic steatosis and related biomarkers. A cross-sectional analysis was performed on 1108 White individuals. Setting: Ambulatory care. Results: Compared with the normal group (HbA1c Ͻ5.7%), HbA1c-defined prediabetic and diabetic individuals exhibit higher values of fasting, 1-hour, and 2-hour postload glucose; fasting and 2-hour postload insulin; triglycerides; uric acid; homeostasis model of assessment for insulin resistance; liver insulin resistance index; liver enzymes; and inflammatory biomarkers; and lower levels of high-density lipoprotein cholesterol and IGF-1. Prediabetic and diabetic subjects have increased risk of hepatic steatosis (1.5-and 2.46-fold, respectively). Stratifying participants according to HbA1c and 1-hour postload glucose, we found that individuals with HbA1c-defined prediabetes and 1-hour postload glucose Ն155 mg/dL have significantly higher risk of hepatic steatosis as compared with individuals with HbA1c-defined prediabetes but 1-hour postload glucose Ͻ155 mg/dL. Individuals with HbA1c-defined prediabetes and 1-hour postload glucose Ն155 mg/dL exhibit higher values of liver enzymes; fasting, 1-hour, and 2-hour postload glucose; insulin; triglycerides; uric acid; and inflammatory biomarkers; and lower levels of high-density lipoprotein and IGF-1. Conclusions: These data suggest that a value of 1-hour postload glucose Ն155 mg/dL may be helpful to identify a subset of individuals within HbA1c-defined glycemic categories at higher risk of hepatic steatosis. (J Clin Endocrinol Metab 101: 4030 -4038, 2016) T ype 2 diabetes mellitus and prediabetic dysglycemic conditions are reaching alarming proportions worldwide owing to the rapid rise in the prevalence of obesity in both adults and adolescents (1). The epidemic proportion of type 2 diabetes puts a tremendous burden on healthcare systems because it increases the risk of premature compli-
Frontiers in Cardiovascular Medicine
BackgroundHeart failure with reduced ejection fraction (HFrEF) is a clinical condition frequently... more BackgroundHeart failure with reduced ejection fraction (HFrEF) is a clinical condition frequently diagnosed in clinical practice. In patients affected by HFrEF, sleep apnea (SA) can be detected among the most frequent comorbidities. Sacubitril–valsartan (sac/val) association has been proven to be effective in reducing disease progression and all-cause mortality in HFrEF patients. Sac/val treatment can potentially attenuate SA development via several pathophysiologic mechanisms, including improvement of global hemodynamics, reduction of extracellular fluid overload, and decrease of sympathetic neural activity.MethodsWe recruited 132 patients affected by HFrEF and SA, already under treatment with continuous positive airway pressure (CPAP), which was discontinued 24 h before the scheduled study timepoints. Physical examination, echocardiography, nocturnal cardio-respiratory monitoring, and laboratory tests were performed in each patient at baseline and after a 6-month treatment with sa...
Background. Endothelial dysfunction, induced by some cardiovascular risk factors, is the early de... more Background. Endothelial dysfunction, induced by some cardiovascular risk factors, is the early determinant of atherosclerotic cardiovascular disease. Moreover, it predicts incident type-2 diabetes that is associated with an increased risk of fatal and nonfatal cardiovascular events; however, no data demonstrating a possible interaction between them in predicting cardiovascular outcomes are available. Thus, we designed present study to evaluate the prognostic significance of the joint effect of endothelial dysfunction and new-onset type-2 diabetes in hypertensives.Methods. We enrolled 653 white never-treated hypertensive outpatients free of cardiovascular events from the CATanzaro Metabolic Risk factors (CATAMERI) study. All subjects were without type-2 diabetes, heart failure and chronic kidney disease. Endothelium-dependent vasodilation was investigated by intra-arterial infusion of acetylcholine, and laboratory determinations were obtained by standard procedures. Follow-up include...
Nutrients, 2021
Background. Chronic obstructive pulmonary disease (COPD) patients have multiple comorbidities whi... more Background. Chronic obstructive pulmonary disease (COPD) patients have multiple comorbidities which may affect renal function. Chronic kidney disease (CKD) is a risk factor for adverse outcomes in COPD patients. The predictors of CKD in COPD are not well investigated. Methods. A multicenter observational cohort study including patients affected by COPD (GOLD stages 1 and 2) was carried out. Principal endpoints were the incidence of CKD, as defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, and the rapid decline of eGFR >5 mL/min/1.73 m2/year. Results. We enrolled 707 outpatients. Overall, 157 (22.2%) patients had CKD at baseline. Patients with CKD were older, with higher serum uric acid (UA) levels, and lower FEV1. During a mean follow-up of 52.3 ± 30.2 months, 100 patients developed CKD, and 200 patients showed a rapid reduction of eGFR. Multivariable Cox regression analysis displayed that UA (hazard ratio (HR) 1.148, p < 0.0001) and diabetes (HR...
Hypertension Research, 2021
Low levels of endothelial progenitor cells (EPCs) are associated with cardiovascular (CV) morbidi... more Low levels of endothelial progenitor cells (EPCs) are associated with cardiovascular (CV) morbidity and mortality. Early indicators of vascular damage represent independent predictors of CV prognosis. The aim of this study was to evaluate the possible association of EPCs and circulating cytokine levels with vascular damage markers in naive hypertensive patients according to sex and to evaluate the role of EPCs in vascular damage progression. We enrolled 60 subjects; circulating EPCs were determined by cytometric analysis, and serum cytokines were determined by chemiluminescence microarray technology. Endothelial function was estimated with the measurement of the reactive hyperemia index (RHI), arterial stiffness (AS) was evaluated with the measurement of carotid-femoral pulse wave velocity (PWV) and carotid intima-media thickness (IMT) was determined by a high-resolution ultrasound B-mode system. Patients were evaluated at baseline and after an average follow-up of 3.0 ± 0.6 years. RHI was correlated with EPCs and inversely related to HOMA, TNF-α, IL-6, hs-CRP, and IL-1β. PWV was positively correlated with HOMA, TNF-α, IL-6, IL-1β, and hs-CRP, and it was inversely related to EPCs. An inverse relationship was observed between c-IMT and EPCs and e-GFR. EPCs were the major predictor of the RHI and PWV. After adjustment for vascular index basal values and the other covariates, EPCs explained 17.0%, 27.7%, and 10.6% of the variability in ΔRHI, ΔPWV, and Δc-IMT at follow-up, respectively. Our study results support the hypothesis of an etiological link between circulating EPCs and morphofunctional vascular parameters in hypertensive subjects. Of interest, circulating EPCs, after adjusting for possible confounding factors, may indicate vascular damage progression. Low levels of endothelial progenitor cells (EPCs) are associated with cardiovascular (CV) diseases. Our results demonstrated an etiological link between EPCs and morpho-functional vascular parameters in hypertensive subjects, justifying vascular damage progression.
Backgroud: Ferritin, a crucial element for iron homeostasis, is associated with chronic diseases ... more Backgroud: Ferritin, a crucial element for iron homeostasis, is associated with chronic diseases characterized by subclinical inflammation such as essential arterial hypertension and type 2 diabetes mellitus (T2DM), showing a prognostic value in different clinical settings. We investigated whether ferritin is associated with arterial stiffness (AS), an early indicator of atherosclerosis, and if it could act as effect modifier on the relationship between inflammation and AS in hypertensive patients with different glucose tolerance.Methods: We enrolled 462 newly diagnosed untreated hypertensive (HT) patients. All subjects underwent an oral glucose tolerance test. Insulin sensitivity was assessed by MATSUDA index and ferritin levels were estimated by immunoradiometric assay. AS was definied by carotid-femoral pulse wave velocity (PWV).Results: Out of 462 patients, 271 showed normal glucose tolerance (HT/NGT), 146 impaired glucose tolerance (HT/IGT) and 45 were diabetic (HT/T2DM). Iron ...
Scientific Reports, 2020
Several studies in patients with chronic kidney disease or normal renal function have shown that ... more Several studies in patients with chronic kidney disease or normal renal function have shown that high levels of tissue non-specific alkaline phosphatase (ALP) are associated with an increased risk of all cause and cardiovascular (CV) mortality. Considering the independent prognostic role of renal function, we investigated the possible association between ALP levels and estimated glomerular filtration rate (e-GFR) in a large cohort of hypertensive subjects. We enrolled 2157 never-treated uncomplicated hypertensive patients with ALP levels within normal range. In the whole population, e-GFR was strongly related to ALP (r = −0.43, P < 0.0001) with similar magnitude in females and in males, resulting ALP the second independent predictor of renal function. In a multiple linear regression model, both on crude (P < 0.001) and adjusted (P = 0.01) analyses age significantly modified the effect of a fixed increase in ALP (20 UI/L) on renal function so that the reduction in e-GFR associa...
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Papers by Francesco Perticone