Elisa Grandi

Psychosocial factors and metabolic parameters: Is there any association in elderly people? The Massa Lombarda Project

Objective: Several studies claim that psychophysical stress and depression contribute significantly to cardiovascular disease (CVD) development. The aim of our research is to discover and analyse a possible relationship between two psychosocial disorders (depression and perceived mental stress) and traditional cardiovascular risk markers. Methods: We selected 106 subjects (58 males and 48 females), mean age 79.5 ± 3.8-years old, from the Massa Lombarda Project, an epidemiological study, including 7000 north Italian adult subjects. We carried out anamnesis, clinical and blood tests. Then, we administered the Perceived Stress Questionnaire (PSQ range score 0–1) and the Self-Rating Depression Scale (SRDS range score 50–70 Z), as validated instruments for depression and stress evaluation, which focus on the individuals subjective perception and emotional response. Statistical descriptive and inferential analyses of data collected were performed. Results: The multiple linear regression analysis showed a negative correlation between PSQ index score and uric acid, low-density lipoprotein cholesterol (LDL-c), body mass index (BMI), systolic and diastolic blood pressure values, a positive and statistically significant correlation between PSQ index score and triglycerides (p < 0.05). We found an inverse relationship between Zung SRDS score and LDL-c, uric acid, glucose waist circumference values, this correlation was significant only for uric acid (p < 0.01). Besides, a positive and significant correlation between Zung SRDS and triglycerides (p < 0.05) was observed. Conclusion: We suppose that psycho-emotional stress and depression disorder, often diagnosed in elderly people, may influence different metabolic parameters (triglycerides, uric acid and BMI) that are involved in the complex process of metabolic syndrome.

Relative role of major risk factors for Type 2 diabetes development in the historical cohort of the Brisighella Heart Study: an 8-year follow-up.

Aim  The aim of this study was to evaluate and quantify the role of different risk factors in the long‐term development of Type 2 diabetes mellitus in a rural Italian population.

High serum uric acid is associated to poorly controlled blood pressure and higher arterial stiffness in hypertensive subjects

INTRODUCTION 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<0.001) in undiagnosed and uncontrolled hypertensive patients, while controlled hypertensive patients had PWV values comparable to normotensive controls. A similar trend has been observed for the augmentation index (AI). A worse BP control was associated with SUA levels (OR 1277, 95% CI 1134-1600 per mg/dL), AI (OR 1066, 95%CI 1041-1092 per unit), and PWV (OR 1201, 95% CI 1089-1423, per m/s), but not with age, body mass index, nor estimated glomerular filtration rate. CONCLUSION Based on our data, SUA seems to be associated with an inadequate BP control in subjects treated with antihypertensive drugs, and subjects with both uncontrolled BP and relatively high SUA levels have also an increased arterial stiffness that (per se) could be a cause of worse BP control under treatment.

Hemodynamic Effects of Lactotripeptides from Casein Hydrolysate in Mediterranean Normotensive Subjects and Patients with High-Normal Blood Pressure: A Randomized, Double-Blind, Crossover Clinical Trial

Contrasting data partially support a certain antihypertensive efficacy of lactotripeptides derived from enzymatic treatment of casein hydrolysate. We carried out a randomized, double-blind, crossover clinical study to investigate the antihypertensive efficacy of a short-term treatment with lactotripeptides in Mediterranean subjects with normal or high-normal blood pressure (BP). We consecutively enrolled 55 untreated subjects (men:women = 30:25), 40.3 ± 9.8 years old, with normal or high-normal BP. After 4 weeks of dietary standardization, they were allocated to treatment with a fruit juice containing 3 mg of added Ile-Pro-Pro/Val-Pro-Pro lactotripeptides or with placebo for 4 weeks. After a 4-week washout period, they were then assigned to the alternative treatment for a further period of 4 weeks. Overall, no significant difference has been observed in office BP comparing baseline data with those posttreatment. Repeating the analysis by basal BP level, a mild but significant reduction in systolic BP (-1.7 ± 2.3 mm Hg; t = 3.5, P = .002) has been observed only in subjects with high-normal BP after treatment with lactotripeptides. With regard to 24-hour BP measurement, after lactotripeptide treatment only, the subjects experienced a significant reduction in diurnal diastolic BP (-1.6 ± 5.4 mm Hg; P = .042), diurnal mean BP (-2.1 ± 5.9 mm Hg; P = .19), and 24-hour (-5.4 ± 14.2 mm Hg; P = .011) and diurnal (-7.1 ± 19.2%; P = .014) diastolic BP value measurements relative to normal values. No modification has been observed in relation to plasma renin activity and aldosteronemia. In conclusion, diurnal diastolic BP is significantly reduced by lactrotripeptide supplementation in untreated Mediterranean subjects with normal or high-normal BP. Office systolic BP is reduced only in subjects with high-normal BP.

Middle-Term Dietary Supplementation with Red Yeast Rice Plus Coenzyme Q10 Improves Lipid Pattern, Endothelial Reactivity and Arterial Stiffness in Moderately Hypercholesterolemic Subjects

Aim: The aim of our study was to investigate whether treatment with red yeast rice added with Coenzyme Q10 is associated with changes in endothelial function and arterial stiffness. Methods: This double blind, placebo-controlled, randomized clinical trial was carried out on 40 non-smoker moderately hypercholesterolemic subjects (ClinicalTrial.gov ID NCT02492464). After 4 weeks of diet and physical activity, patients were allocated to treatment with placebo or with an active product containing 10 mg monacolins and 30 mg Coenzyme Q10, to be assumed for 6 months. Endothelial reactivity and arterial stiffness have been measured through the validated Vicorder® device. Results: During monacolin treatment, patients experienced a more favorable percentage change in low density lipoprotein (LDL)-cholesterol (after monacolin treatment: -26.3%; after placebo treatment: +3.4%, p < 0.05). Endothelial reactivity (pulse volume displacement after monacolin treatment: +6.0%; after placebo treatment: -0.3%, p < 0.05), and arterial stiffness (pulse wave velocity (PWV) after monacolin treatment: -4.7%; after placebo: +1.1%, p < 0.05) also significantly improved only after monacolin treatment. Conclusion: The long-term assumption of the tested dietary supplement is associated with an improvement in LDL-cholesterolemia, endothelial reactivity and PWV in moderately hypercholesterolemic subjects.

Effect of red yeast rice combined with antioxidants on lipid pattern, hs-CRP level, and endothelial function in moderately hypercholesterolemic subjects

Our aim was to test, through a crossover, double-blind, placebo-controlled randomized clinical trial, if a short-term treatment with 10 mg monacolins combined with antioxidants could improve lipid pattern, high-sensitivity C-reactive protein (hs-CRP), and endothelial function in a small cohort of moderately hypercholesterolemic subjects. Thus, 25 healthy, moderately hypercholesterolemic subjects were consecutively enrolled and, after 4 weeks of stabilization diet, were randomized to the sequence placebo followed by a washout, monacolins or monacolins followed by a washout, placebo, with each period being 4 weeks long. At each study step, a complete lipid pattern, safety parameters, hs-CRP, and endothelial function have been measured. When compared to the placebo phase, during monacolin treatment, patients experienced a more favorable percentage change in total cholesterol (TC) (TC after monacolin treatment, −18.35%; TC after placebo treatment, −5.39%), low-density lipoprotein cholesterol (LDL-C) (LDL after monacolin treatment, −22.36%; LDL after placebo treatment, −1.38%), non-high-density lipoprotein cholesterol (HDL-C) (non-HDL after monacolin treatment, −22.83%; non-HDL after placebo treatment: −7.15%), hs-CRP (hs-CRP after monacolin treatment: −2.33%; hs-CRP after placebo treatment, 2.11%), and endothelial function (pulse volume displacement after monacolin treatment, 18.59%; pulse volume displacement after placebo treatment, −6.69%). No significant difference was observed with regard to triglycerides, HDL-cholesterol, and safety parameters. On the basis of our data, we could demonstrate that a 10 mg monacolin nutraceutical treatment appears to safely reduce cholesterolemia, hs-CRP, and markers of vascular remodeling in moderately hypercholesterolemic subjects. These results need to be confirmed in larger patient samples and in studies with longer duration.

Lipid-lowering and anti-inflammatory effects of omega 3 ethyl esters and krill oil: a randomized, cross-over, clinical trial

Introduction Polyunsaturated fatty acids (PUFAs) derived from different sources could have different lipid-lowering effects in humans. The main aim of our study was to compare the short-term triglyceride-lowering efficacy of krill oil and purified omega 3 ethyl ester PUFAs in mildly overweight hypertriglyceridemic subjects. Material and methods This double-blind, randomized clinical trial was carried out in 25 moderately hypertriglyceridemic subjects (TG = 150–500 mg/dl). After a 4-week run-in, participants were allocated to treatment with similar pills containing omega 3 ethyl ester PUFAs 1000 mg twice a day vs. krill oil 500 mg twice a day. After 4 weeks of treatment, participants were asked to observe a 4-week wash-out period, and they were then assigned to the alternative treatment for a further period of 4 weeks. Results Although both PUFA sources were able to improve TG plasma levels, esterified omega 3 PUFAs were more efficacious than krill oil (p < 0.05). Nonetheless, only krill oil treatment was able to significantly improve high-density lipoprotein cholesterol and apolipoprotein AI levels, compared to both baseline (p < 0.05) and end of treatment with esterified omega 3 PUFAs (p < 0.05) values. Both treatments were able to significantly reduce high-sensitivity C-reactive protein (hs-CRP) levels from the baseline (p < 0.05), but krill oil improved it more efficaciously than esterified omega 3 PUFAs (p < 0.05). Conclusions Krill oil has lipid-lowering effects comparable with those obtained through a 4-fold higher dose of purified omega 3 ethyl ester PUFAs in mildly overweight hypertriglyceridemic subjects, while more efficaciously reducing hs-CRP.

Relationship Between Serum Uric Acid and Electrocardiographic Alterations in a Large Sample of General Population: Data From the Brisighella Heart Study

IntroductionSerum uric acid (SUA) may contribute to the increased cardiovascular damage through direct injury to the endothelium and alteration of cardiovascular function.AimTo 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.MethodsFor 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.ResultsThe 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.ConclusionSUA level is related the prevalence of both organic and rhythm ECG alterations in a wide sample of general population.

Serum LDL cholesterol levels and new onset of arterial hypertension: an 8-year follow-up

Serum cholesterol has been demonstrated to correlate with blood pressure values; therefore, abnormal levels of serum cholesterol might contribute to the development of hypertension. The aim of this study was to assess the new onset of hypertension over a period of 8 years in a pharmacologically untreated population sample in normo‐ and hypercholesterolemic individuals.

Effect of a Lipid-Lowering Nutraceutical on Pulse-Wave-Velocity in Hypercholesterolemic Patients with or without Chronic Kidney Disease

The recent literature has put a large interest on nutraceuticals with lipid lowering activity for the management of moderate cholesterolemia in subjects with mildly increased cardiovascular disease risk. The aim of our study was to evaluate the middle-term effect of a combined lipid-lowering nutraceutical on lipid parameters and aortic stiffness. For this study we consecutively enrolled 40 moderately hypercholesterolemic outpatients with mild-to-moderate chronic kidney disease (CKD) and 40 cross-matched hypercholesterolemic subjects without CKD. All the patient were treated daily with a combined nutraceutical containing red yeast rice (3 mg monacolin K) and berberine (500 mg). At the baseline and after 6 months of treatment we measured blood pressure, pulse wave velocity (PWV) and ematochemistry parameters. No significant change has been observed during the study in both groups regarding body mass index, blood pressure, liver transaminases, creatinin-phosfokinase and eGFR. In non CKD patients TC improved by (-21,6%), LDL-Cholesterol by (-24,2%), non HDL-Cholesterol (-24,0%) and TG (- 20,8%). In CKD patients TC improved by (-21,1%), LDL-Cholesterol by (-23,7%), non HDL-Cholesterol (-23,9%) and TG (- 20,4%). No difference among groups has been observed regarding the effects on lipid metabolism. The PWV has significantly improved in both groups (p<0.01) without differences between groups. In summary, a combined lipid-lowering nutraceutical improved lipid pattern and PWV in both non CKD and mild-to-