Ada Dormi

5-Methyltetrahydrofolate Administration Is Associated with Prolonged Survival and Reduced Inflammation in ESRD Patients

BACKGROUNDnHemodialysis (HD) patients have a greatly increased risk of cardiovascular morbidity and mortality. For this reason, attempts are often made to normalize hyperhomocysteinemia. This randomized prospective study sought to determine which risk factors are predictors of mortality and whether high doses of folates or 5-methyltetrahydrofolate (5-MTHF) could improve hyperhomocysteinemia and survival in HD patients.nnnMETHODSn341 patients were divided into two groups: group A was treated with 50 mg i.v. 5-MTHF, and group B was treated with 5 mg/day oral folic acid. Both groups received i.v. vitamin B(6) and B(12). By dividing patients into C-reactive protein (CRP) quartiles, group A had the highest survival for CRP <12 mg/l, whereas no survival difference was found for group B. CRP was the only predictive risk factor for death (RR 1.17, range 1.04-1.30, p = 0.02). Dialysis age, hyperhomocysteinemia, methylenetetrahydrofolate reductase polymorphism, albumin, lipoprotein (a) and folate did not influence mortality risk. Survival in group A was higher than that in group B, namely 36.2 +/- 20.9 vs. 26.1 +/- 22.2 months (p = 0.003).nnnRESULTSnOur results suggest that CRP, but not hyperhomocysteinemia, is the main risk factor for mortality in HD patients receiving vitamin supplements. Intravenous 5-MTHF seems to improve survival in HD patients independent from homocysteine lowering.

Interaction between serum cholesterol levels and the renin-angiotensin system on the new onset of arterial hypertension in subjects with high-normal blood pressure.

Objectives To investigate the possible interactions between serum cholesterol levels and the renin–angiotensin system on the development of stable hypertension in subjects with high-normal blood pressure (BP). Background Hypercholesterolemia increases angiotensin-II type 1 (AT1) receptor density and pressor responsiveness to angiotensin II, and has been reported to contribute to the development of hypertension. The effects of elevated serum cholesterol levels on BP control might be exaggerated by concomitant activation of the renin–angiotensin system, and their combination might contribute to the development of stable hypertension. Methods We investigated the relationship between serum cholesterol levels, plasma renin activity (PRA) and the long-term development of hypertension in 66 young (age < 45 years) patients with high-normal BP and elevated (> 200 mg/dl, n = 46: HC) or normal (≤200 mg/dl, n = 20: NC) serum cholesterol levels and in 20 normotensive, normocholesterolemic controls (C). The main outcome measure was the prospective evaluation of the 15-year incidence of stable hypertension in the different populations. Results New-onset hypertension was higher in patients with high-normal BP and HC when compared to NC patients [relative risk (RR) = 1.9; 95% confidence interval (CI), 1.1–4.3, P < 0.001] and control subjects (RR = 3.1; 95% CI = 1.4–5.3, P < 0.001). High PRA increased the overall rate of hypertension in both HC and NC. The interaction between HC and PRA was more evident in patients with borderline high cholesterol levels (200–240 mg/dl) where the adjusted relative risk of new onset of hypertension was 2.17 (95% CI 1.2–3.74; P < 0.05) in high PRA subjects and 1.17 (95% CI 0.67–2.23; P = 0.87) in subjects with normal PRA. Conclusion We support the hypothesis that the presence of hypercholesterolemia can promote the development of stable hypertension through its interaction with the circulating renin–angiotensin system in patients with high-normal blood pressure.

Persistence on Treatment and Blood Pressure Control with Different First-Line Antihypertensive Treatments: A Prospective Evaluation

We enrolled 347 hypertensive patients, randomly allocated them to different first-line treatments, and followed-up for 24 months. Persistence on treatment was significantly higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs. CCBs (51.6%), β-blockers (44.8%), and diuretics (34.4%). No ARB, ACE inhibitor, β-blocker, or diuretic was associated with a greater persistence in therapy as compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs. other CCBs (59.3% vs. 46.6%). Systolic and diastolic BP decreased more in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) when compared to ß-blockers (-4.0/-2.3 mmHg) and diuretics (-2.3/-2.1 mmHg).

Detection of familial combined hyperlipoproteinaemia patients in the Brisighella Heart Study historical cohort: an epidemiological approach.

Familial combined hyperlipoproteinaemia (FCH) is the most common inherited disorder of the lipid metabolism in patients with premature coronary heart disease; it is characterized by a primary variability of the plasma lipid phenotype. Our aim was to estimate its prevalence in the Brisighella Heart Study cohort, a large North-Italian rural population sample monitored from 1972 to 2004. At 2004 survey, 1303 subjects were selected if they were tested in ≥5 four-yearly surveys (mean age 63.74 ± 14.97 years); their first-degree relatives involved in the study were excluded from the FCH prevalence estimation. At each survey, subjects were classified as hypercholesterolaemic, hypertriglyceridaemic or mixed hyperlipidaemic on the basis of their LDL-C (>160 mg/dl) and TG (TG > 200 mg/dl) plasma concentrations. A primary hyperlipoproteinaemia was suspected on the basis of personal and familial case history, BMI and dietary habits in 4% of