Leone Poli

Carotid plaque, aging, and risk factors. A study of 457 subjects.

Background and Purpose The aim of this study was to assess the prevalence of extracranial carotid artery atherosclerosis and its relation to principal cardiovascular risk factors at different ages in a sample of the general population. Methods B-mode ultrasonography was used to investigate the carotid district in 457 subjects (231 men and 226 women; mean age, 55.4±18.7 years; range, 18 to 97 years) in the metropolitan area. The ultrasonographic findings were then related to risk factors. Results Carotid plaques were found in 178 subjects (38.9%). The prevalence of atherosclerosis, number of plaques, and severity of stenosis were observed to increase with age. Age (P<.0001), cigarette smoking (P<.0001), male sex (P<.001), total cholesterol (P<.05), and, inversely, the ratio of high-density lipoprotein cholesterol to total cholesterol (P<.05) were found to be independently associated with carotid atherosclerosis. Stratified analysis by sex and age showed effect modifications by age on cigarette smoking, total cholesterol, and the ratio of high-density lipoprotein cholesterol to total cholesterol. After multivariate analysis including interaction terms, cigarette smoking and cholesterol levels were no longer found to be associated with carotid atherosclerosis in elderly subjects. Age (P<.01), total cholesterol (P<.05), and diabetes (P<.05) were positively related to the severity of vascular narrowing. Conclusions There is a high prevalence of asymptomatic carotid atherosclerosis in the general population, particularly among the very old. The association between risk factors and carotid atherosclerosis is less pronounced in the elderly than in younger subjects.

Risk of cognitive decline in older patients after carotid endarterectomy: an observational study.

OBJECTIVES: To determine whether patients undergoing carotid endarterectomy (CE) for symptomatic left internal carotid artery (LICA) stenosis have greater risk of cognitive decline than patients with asymptomatic LICA disease or right internal carotid artery (RICA) disease.

Body fat and C-reactive protein levels in healthy non-obese men

BACKGROUND AND AIM The relationships between C-reactive protein (CRP) levels, adipose tissue and metabolic alterations have not been clearly established in healthy non-obese subjects. We investigated the relationships between body fat, CRP levels and metabolic variables in healthy, non-obese sons of patients affected by metabolic syndrome (MS). METHODS AND RESULTS Age, CRP and interleukin 6 (IL-6) levels, anthropometric measures (body mass index, BMI; waist circumference and waist-to-hip ratio, WHR), total and regional fat content (as determined by means of dual X-ray absorptiometry, DXA), total and LDL cholesterol, and the metabolic variables related to MS (HDL-cholesterol, triglyceride, glucose and insulin levels; the fasting insulin resistance index, FIRI; blood pressure) were evaluated in 85 healthy non-obese sons of MS patients. Linear and multiple regression analyses were used to evaluate the relationships between body fat, metabolic variables and CRP levels, and to investigate whether the association between body fat content and metabolic variables persists after adjustment for CRP levels. Body fat was associated with all of the investigated variables. CRP levels were associated with total and regional body fat, the anthropometric index of weight, age, and with some metabolic alterations (HDL-cholesterol and triglyceride levels, systolic blood pressure, and fasting insulin and LDL-cholesterol levels). The associations between total body fat and the metabolic variables did not change after adjustment for CRP levels. Total body fat was the best predictor of CRP levels (p<0.0001). CONCLUSIONS In healthy, non-obese sons of MS patients, total body fat is the best predictor of CRP levels, and remains closely associated with metabolic abnormalities after adjustment for CRP levels. These findings strongly support the hypothesis that body fat is the main determinant of metabolic abnormalities and a low inflammatory state, at least in healthy subjects.

Autopsy and Multiple Pathology in the Elderly

We examined autopsy reports and the clinical diagnoses of 600 patients (200 in 1967 and 400 in 1987). For each patient we considered age, diagnostic error, main diseases and presence of multiple pathology. The number of diagnostic errors increased from 1967 to 1987. The diagnostic error was particularly high for pulmonary embolism and septic shock and significantly higher in patients > 65 than < or = 65 years old. Multiple pathology was higher in old patients: we found 4 or more diseases in 195/270 (72.2%) patients > 65 years and in only 135/330 (40.9%) patients < or = 65 years. The average period of hospitalization was directly proportional to the number of diseases present in the same patient.

Hemodynamic, hemorheologic, and hemocoagulative changes after treatment with picotamide in patients affected by peripheral arterial disease (PAD) of the lower limbs.

Effects of picotamide on platelet activity and on some hemorheologic, coagu lative, and hemodynamic parameters were investigated in a randomized, dou ble-blind, placebo-controlled study for eighteen months. Twenty patients, average age 61.5±9.6 (SD) years, with peripheral arterial disease (PAD) at functional stage 2 of the Fontaine classification and with intermittent claudica tion for at least six months were studied. Ten patients received tablets of picotamide, 300 mg three times a day, and 10 subjects received three identical placebo tablets each day. Similar atheroscler otic disease risk factors were present in both groups. Picotamide induced a significant decrease of plasma viscosity, fibrinogen, and beta-thromboglobulin and an increase of amplitude of the photoplethysmo graphic wave.

Age-Related Transcranial Doppler Findings in the Evaluation of Cerebral Circulation during Postprandial and Postural Tests

We used transcranial Doppler (TCD) to investigate whether there are cerebral circulation differences between young and elderly subjects in response to postprandial postural changes. Preprandial and postprandial systolic and diastolic blood pressure, heart rate, mean middle cerebral artery (MCA) velocity (Vmean MCA), systolic/diastolic MCA velocity ratio (Vs/Vd MCA) and pulsatility index (PI) were determined in 15 healthy elderly subjects (mean age 74.3 ± 6.5 years) and in 10 younger subjects (mean age 31.6 ± 7.2 years) in the supine position and after a postural change. As compared with young subjects, elderly ones showed a greater postprandial systolic pressure decline (p < 0.05) associated with a significant decrease of Vmean MCA (p < 0.05), and a greater increase of Vs/Vd and PI (p < 0.05 both). We conclude that, as compared with young subjects, elderly ones have reduced cerebrovascular adaptive response to pressure modifications induced by postprandial postural changes.

A four year clinical and echographic follow-up of asymptomatic carotid plaque.

Eighty-five patients with asymptomatic carotid plaque—a diagnosis revealed by B-mode high-resolution echotomography—were followed up for four years; the echoplaque changes were compared with the clinical history. Eight patients died (2 from stroke, 4 from myocardial infarction, and 2 from lung tumor) and were excluded from the follow-up. Three patients underwent carotid thromboen darterectomy (TEA) (1 bilateral), and these 4 carotids were not considered in the total series. At the first echo Doppler evaluation of 150 carotids, plaques were observed in 112; 38 vessels were free of lesions. Of the 150 carotids, 8 revealed a new plaques. In regard to the echogenic pattern, 95 of the 112 plaques (84.8%) remained unchanged, 16 (14.3%) progressed, and regression of a small homogeneous plaque was observed in 1 patient (0.9%). An increase of the degree of vascular stenosis, was observed in 23 of the 150 carotids (15.3%). Cerebral ischemic symptoms occurred in 5 patients. In 1 patient who suffered from stroke, a new, soft, dyshomogeneous plaque in the carotid of the side of the lesion was observed. In 3 patients (2 with strokes, 1 with transient ischemic attack) the occlusion of a previous severe stenosis was observed. The fifth pa tient had a stroke on the side of an unchanged, ulcerated hemodynamic lesion. A valid criterion for identifying a risky plaque should be the joint evaluation of the echostructural characteristics and the degree of stenosis.

The ankle-brachial index is not related to mortality in elderly subjects living in nursing homes.

Low ankle-brachial index (ABI) levels are associated with increased risk of all-cause and cardiovascular mortality in middle-aged and older adults. We evaluated the association between low ABI and all-cause and cardiovascular mortality in elderly patients living in nursing homes. In 632 subjects (mean age 82.1 ±7.4 years, 137 men) living in 3 municipal nursing homes, ABI, prevalent cardiovascular diseases, and conventional risk factors were evaluated at baseline in 1998. After a 3-year follow-up the relation between a low ABI and mortality outcomes was evaluated by using multivariable Cox proportional hazards analysis. A low ABI (<0.90) was observed in 177 participants (28%). After 3 years, 304 subjects (48.1%) died; death occurred in 53.6% of those with low ABI and in 45.9% of those with normal ABI. No significant relation between low ABI and all-cause (hazard ratio [HR] 1.1, 95% confidence interval [CI] 0.7-2.0) or cardiovascular mortality (HR 1.3, 95% CI 0.8-2.1) was observed. Among elderly patients living in nursing homes, there is a high prevalence of low ABI, which is not related to all-cause and cardiovascular mortality.

The ankle-arm blood pressure index is strongly predictive for cardiovascular mortality in men

In recent years some reports suggested that the presence of peripheral arterial disease (PAD) or a decrease in the ankle-arm blood pressure index (AAI) are associated with a substantial increase in cardiovascular mortality. The end-point of the study was to evaluate whether the AAI is an independent predictor of mortality in adult men. Date and cause of death were ascertained for a cohort of 215 male outpatients who underwent ultrasonographic examination of lower extremity circulation in the Noninvasive Vascular Diagnostic Laboratory of our University Department. The study was designed over a 10-year period of observation: total and cardiovascular mortality were considered. An AAI of 0.90 or less was selected as cutpoint for the definition of PAD. The death rates were significantly higher among patients with PAD than in normal subjects. After adjusting for age and other covariates (Cox proportional-hazards models), the baseline AAI was strongly, independently, inversely correlated with all-cause mortality (relative risk = 0.09, 95% confidence interval /CI/ = 0.03-0.3), cardiovascular disease mortality (relative risk = 0.02, 95% CI = 0.001-0.15) and ischemic heart disease mortality (relative risk = 0.03, 95% CI = 0.005-0.24). The independent association did not change after the exclusion of patients with history of previous cardiovascular events at baseline and after excluding patients who survived one year or less since the baseline evaluation. Our results confirm that a decreased AAI is associated with a substantial increase in cardiovascular mortality. Routine evaluation of the AAI could be of help for identifying high risk patients.

Peripheral Atherosclerotic Disease: Aging and Risk Factors

The aim of this study was to assess the prevalence of peripheral atherosclerotic disease (PAD) and its relation to principal cardiovascular risk factors, at different ages, in a sample of the general population. Ultrasonographic methods (continuous wave Doppler and high-resolution B-mode Doppler) were used to evaluate the ankle-to-arm ratio and to investigate the femoral district in 457 free-living subjects (231 men and 226 women, mean age 55.4 ±18.7 years) resident in the metropolitan area of Turin. PAD, detected by ankle-to-arm ratio, was observed in 148 subjects (32.4%). Femoral plaques were found in 180 subjects (39.4%). The overall prevalence of atherosclerosis, number of plaques, and percentage of stenosis were observed to increase with age (P < 0.0001). In the multiple logistic regression model, analysis of subjects under sixty-five years of age showed independent associations between femoral atherosclerosis and age (P < 0.0001), LDL cholesterol (P < 0.01), cigarette smoking (P < 0.05), and years of exposure to smoking (P < 0.05); analysis of subjects over sixty-five years of age showed positive and independent associations only with age (P < 0.001), male gender (P < 0.01), and cigarette smoking (P < 0.05). The authors conclude that there is a high prevalence of asymptomatic lower limb atherosclerosis in the general population, particularly among the very old. The association between risk factors and femoral atherosclerosis is less pronounced in the elderly than in younger subjects.