Mm Ferrario

Prevalence and Natural History of Graves' Orbitopathy in a Large Series of Patients With Newly Diagnosed Graves' Hyperthyroidism Seen at a Single Center

BACKGROUNDnThe prevalence and natural history of Graves orbitopathy (GO) are poorly documented.nnnMETHODSnA large series of 346 patients with newly diagnosed and recent onset Graves hyperthyroidism seen at a single (nontertiary referral) center over an 8-year period were enrolled in an observational prospective study and evaluated for GO activity and severity according to the EUGOGO (European Group on Graves Orbitopathy) criteria. After excluding patients immediately treated for moderate-to-severe GO, patients undergoing total thyroidectomy or radioactive iodine treatment, and patients lost to follow-up, 237 patients were submitted to antithyroid drug (ATD) treatment, with ocular evaluation at 6, 12, and 18 months.nnnRESULTSnAmong the whole cohort, at presentation 255 (73.7%) had no ocular involvement, 70 (20.2%) had mild and inactive GO, 20 (5.8%) had moderate-to-severe and active GO, and 1 (0.3%) had sight-threatening GO with dysthyroid optic neuropathy. Of the 237 patients who completed the 18-month follow-up during or after ATD treatment, 194 (81.9%) had no GO at baseline. Progression to moderate-to-severe GO occurred in 5 (2.6%) of these patients. Of the 43 (18.1%) patients with mild and inactive GO at baseline, 1 (2.4%) progressed to moderate-to-severe GO, and 25 (58.1%) experienced complete remission.nnnCONCLUSIONSnMost patients with newly diagnosed Graves disease have no ocular involvement. Moderate-to-severe and active GO or sight-threatening GO are rare at presentation and rarely develop during ATD treatment. Most patients (>80%) with no GO at baseline do not develop GO after an 18-month follow-up period. Remission of mild GO occurs in the majority of cases.

The phenotype of newly diagnosed Graves' disease in Italy in recent years is milder than in the past: results of a large observational longitudinal study.

AbstractObjectiveThe Merseburg triad (hyperthyroidism, goiter, and orbitopathy) characterizes classical description of Graves’ disease (GD). Aim of this observational, longitudinal study was to evaluate the current clinical features of newly diagnosed GD in Italy.Materials and methodsnIn two Northern Italy centers (Varese and Pavia), 283 consecutive patients (211 women, 72 men; mean age 47.4xa0years) with newly diagnosed GD were recruited in the years 2010–2014. Diagnosis was based on established criteria, and thyroid volume was assessed by ultrasonography. A clinical severity score (CSS) to assess the overall disease severity was developed by grading each component of the Merseburg triad.ResultsnAt diagnosis, 45xa0% of patients had no goiter, and 30xa0% had a small goiter. The proportion of goitrous patients was much lower than in two Italian studies performed 20–30xa0years ago. Hyperthyroidism was subclinical in 16xa0% and mild in 29xa0% of patients, and Graves’ orbitopathy was present in 20xa0%, usually mild, and active in only 2.5xa0% of patients. Using the CSS, less than half (44xa0%) of the patients had severe GD, while 22xa0% had mild and 34xa0% moderate disease. CSS was associated with a significantly higher risk of poorly controlled hyperthyroidism at 6xa0months.ConclusionsIn Italy, a relevant proportion of Graves’ patients at diagnosis have mild to moderate GD; about half of them have no goiter, slightly less than one-fifth have subclinical hyperthyroidism, and only 20xa0% have GO. Thus, the clinical phenotype of GD is milder than in the past, possibly due to both earlier diagnosis and treatment, and improved iodine nutrition.

Association between job strain and biomarkers of glucose homeostasis: results from the MONICA–Brianza cohort study

Hypertension is the leading cause of cardiovascular disease and death. Despite increased knowledge of its importance in cardiovascular disease, the worldwide prevalence is still increasing and there is considerable scope for improvement of awareness, treatment and control. In this review, five major issues in hypertension management in secondary prevention of cardiovascular disease will be outlined. The first two issues will address hypertension diagnosis: out-of-office blood pressure measurements and the detection of secondary hypertension. The last three issues will address hypertension treatment: lifestyle modification, medication adherence and blood pressure targets. For each of the five issues, we will outline existing knowledge, gaps in existing knowledge, barriers preventing full implementation of guideline recommendations, and possible solutions to improve management of the current disquieting situation.

Physical performance in newly diagnosed hypothyroidism: a pilot study

ObjectiveHypothyroidism is complicated by neuromuscular symptoms (myalgias, slowness of movements, and tiredness) and signs (easy fatigability and cramps), which may have a negative impact on general well-being and quality of life. In a pilot, prospective, controlled study, we investigated the features of muscle dysfunction in hypothyroidism by disease questionnaire, biochemical measures, and physical performance tests.Materials and MethodsFifty-seven consecutive patients with newly diagnosed hypothyroidism were enrolled, 27 subclinical (S-Hypo) and 30 overt (O-Hypo). A series of 30 euthyroid subjects, with similar demographic characteristics, served as controls. Patients were administered a short disease questionnaire and underwent laboratory exams and standardized physical tests, both at baseline and after restoration of biochemical euthyroidism.ResultsCompared to euthyroid controls, the O-Hypo group showed significantly higher prevalence of neuromuscular symptoms and significantly higher serum creatine phosphokinase (CPK) levels (p valueu2009<u20090.0001). S-Hypo had slightly higher CPK levels and prevalence of neuromuscular symptoms than controls. Both S-Hypo and O-Hypo patients performed worse than controls in the six-minute walking test. Differences between patients and controls in handgrip strength test and timed chair standing test failed to reach statistical significance (although a trend was noticeable), possibly due to the small sample size. In O-Hypo, an inverse correlation was found between CPK levels and the handgrip strength test (p valueu2009<u20090.001). Restoration of euthyroidism was associated with normalization of questionnaire responses, six-minute walking test, as well as serum CPK levels.ConclusionIn addition to neuromuscular symptoms, hypothyroidism is associated with abnormalities of physical performance. The six-minute walking test is the most valuable test to assess this aspect. In the pilot study, levothyroxine therapy could reverse muscle functional abnormalities.

Prevalence of abdominal aortic aneurysms and its relation with cardiovascular risk stratification: protocol of the Risk of Cardiovascular diseases and abdominal aortic Aneurysm in Varese (RoCAV) population based study.

BackgroundRecent meta-analyses suggested that screening program for abdominal aortic aneurysms (AAA) in 65-year old males is cost-effective at prevalence of about 1%. Since some events occur also in females and among the youngers, screening could be feasible among those at higher risk, such as smokers or individuals with a family history of AAA. The RoCAV (Risk of Cardiovascular diseases and abdominal aortic Aneurysms in Varese) Project is a population-based study aimed to evaluate AAA prevalence in Northern Italy in males over-65xa0years as well as among females and younger males, and to identify new markers for risk stratification by collecting a large set of CVD risk factors. The aims of the project are: (i) cross-sectional evaluation of AAA prevalence (ii); evaluation of standard CVD risk score as criteria for selecting subgroup at higher risk to be included in a screening program; (iii) identification of new risk markers and risk score algorithm for AAA and CVD risk stratification; (iv) cost-effective evaluation during the follow-up.MethodsMales aged 50–75 years and females aged 60–75 years, resident in the city of Varese (Lombardy Region), were randomly selected from the civil registry. Among 5198 successfully invited, 3777 subjects accepted to participate and were finally recruited (participation rate 63.8%) from June 2013 to May 2016. Trained operators administered a computerized anamnestic questionnaire, measured anthropometric parameters (BMI, body circumferences, skinfolds), blood pressure, ankle-brachial index, pulse wave velocity and performed abdominal aortic ultrasound scan, ECG and spirometry. All methods were internationally validated. A blood sample was collected and stored in biobank. A follow-up will be carried out through linkage with electronic records.DiscussionParticipation rate and data quality assessment were as expected and will reasonably allow to reach the project aims. The expected impact in public health of the RoCAV project will be the potential implementation of a AAA screening program to the whole region as well as the formulation of new criteria for risk assessment of AAA and CVD.

1661b Exploring the combined effect of job strain and occupational physical activity on cardiovascular disease incidence

Introduction The aim of the study is to investigate the interplay between job strain (JS) and occupational physical activity (OPA) in determining the risk of major cardiovascular diseases (CVD), in a working male population. Methods n=1515 participants to three population-based (WHO-MONICA Brianza II and III survey and PAMELA) North Italian cohorts, 25–64 years old, employed and CVD-free at baseline, were available for the analyses. JS was investigated using the Job Content Questionnaire (MONICA-MOPSY short version), and dichotomized as high vs no-high strain. A habitual OPA score was derived from the Baecke Questionnaire (8 items) and categorised in tertiles. Age-adjusted hazard ratios (HRs) and 95% confidence intervals for incidence of CVD (first coronary heart disease or ischaemic stroke, fatal or non-fatal) events were estimated from Cox-proportional hazard models. A sensitivity analysis was carried out stratifying by sport PA levels. Result In a median 17 years of follow-up, n=102u2009first CVD events occurred. As compared to the intermediate OPA tertile, workers with low and high OPA showed higher HRs of 1.67 (95% CI: 0.96 to 2.92) and 2.01 (1.17–3.46), respectively. Stratifying by sport PA, the above reported HRs for low and high OPA workers increased to 2.32 (1.15; 4.69) and to 2.54 (1.09; 5.95) when sport PA was below and above the median, respectively. High vs non-high JS workers evidenced an HR of 1.27 (0.76–2.11). When adjusting for age, BMI, alcohol intake, smoking and sport PA, a joint effect was detected between OPA and JS, with the highest HR for workers in the low OPA and high JS category [2.70 (1.17; 6.26)] as compared to workers in the intermediate OPA and non-high JS. Discussion We observed a joint additive effect between sedentary work and high JS on the incidence of cardiovascular events.

Worker healthy effect in cardiovascular disease prospective cohorts. Does it still matter? Comparing survival curves of northern Italian population-based and factory-based cohorts

BOOK EuroPRevent 2013 Rome, Italy