rome and Coronary-Disease

At the end of the Rome Project of Coronary Heart Disease (CHD) Prevention (PPCC) lasted 6 years and involving 3131 treated and 2896 control men aged 40-59 belonging to occupational groups, the mean values of some coronary risk factors (systolic blood pressure, serum cholesterol, smoking habits, body mass index) were favourably reduced in treated men as compared to controls. Incidence (-25.4%) and mortality (-26.8%) from CHD were also lower, in 6 years, in treated vs control groups. Ten years after the end of the project and of the treatment procedures in "treated men", a subgroup of 1013 former treated men and one of 843 former controls could be re-examined, whereas mortality data could be collected in those 3395 men who were examined at the end of the 6-year project. The 16 year examination showed that serum cholesterol, blood pressure, body mass index and cigarette consumption are now lower, on the average, in former control men, as compared to that of former treated ones. The finding is largely justified by different behaviours of eating, smoking and motion habits and by the motivation and behaviour toward health problems. Coronary mortality, during the last 10 years, was higher among the former treated men as compared to that of former control men (+50.0%; p less than 0.05%). The reverse trend observed in these 10 years is likely explained by a psychological "rebound" phenomenon occurred in the former treated men and to some beneficial effects, in the former control men, bound to the secular trend which presently characterizes some living habits of the Italian population.

Topics: Cause of Death; Coronary Disease; Humans; Primary Prevention; Program Evaluation; Risk Factors; Rome; Time Factors

The Rome Project of Coronary Heart Disease Prevention is a primary preventive trial carried out among 6,027 working men ages 40-59; 3,131 constituted the treatment group and the remaining 2,896 the control group. The preventive action aimed at reducing mean levels of serum cholesterol (generally through dietary prescription and, in a small number of subjects, by drug treatment), high blood pressure (by drugs), smoking habits (by advice to reduce or stop smoking), overweight (by means of diet), and sedentary lifestyle by increased physical activity). The treatment was carried out during a 6-year period and consisted of individual sessions administered to about one-third of higher-risk subjects, while mass education was administered to all men allocated to treatment. No intervention was offered to the control group. The mean changes in levels of the main coronary risk factors in the treatment vs the control group were computed in different ways. Net changes in the treatment group after 6 years, after adjustment for several confounding variables, were -0.71% for body weight, +0.77% for the cigarette consumption, -3.00% for systolic blood pressure, -5.39% for serum cholesterol, and -18% for the estimated multivariate coronary risk. After 8 years of observation, mortality from all causes was lower by 9.8% (one-tailed P = 0.140) in the treatment than in the control group, whereas mortality from coronary heart disease was lower by 23.7% (one-tailed P = 0.059). The incidence of fatal plus nonfatal coronary heart disease events (hard criteria), which could be measured only for the first 6 years, was reduced by 30.9% (one-tailed P = 0.005) in the treatment as compared with the control group.

Topics: Adult; Blood Pressure; Body Weight; Cholesterol; Coronary Disease; Follow-Up Studies; Humans; Life Style; Male; Middle Aged; Patient Dropouts; Primary Prevention; Risk; Rome; Smoking

Transoral gastroplasty (TOGA) is a safe and less invasive procedure than traditional bariatric surgery. We studied the effects of TOGA on the risk of progression from prediabetes to overt type 2 diabetes mellitus (T2DM) or on regression from diabetes or prediabetes to a lower risk category.. Prospective, observational study (October 2008 to October 2010) performed at Catholic University, Rome, Italy. Fifty consecutive subjects 18-60 years old, 35 ≥ body mass index < 55 kg/m², were enrolled. Glucose tolerance, insulin sensitivity, and secretion were studied at baseline and 1 week and 1, 6, and 12 months after TOGA. Plasma glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and ghrelin levels were measured.. Forty-three patients (86%) completed the 1-year postoperative follow-up. Patients lost 16.90% of baseline weight (P level × factor time <0.001). Body mass index decreased from 42.24 ± 3.43 to 34.65 ± 4.58 kg/m² (P < .001). Twenty-three patients (53.5%) were diagnosed as normal glucose tolerance (NGT) before treatment, 2 (4.6%) were impaired fasting glucose (IFG), 12 (27.9%) were impaired glucose tolerance (IGT), 1 (2.3%) had both IFG and IGT, and 5 (11.6%) had T2DM. At 1-year posttreatment, the percentages changed to 86.0% NGT, 2.3% IFG, 11.6% IGT, 0% IFG plus IGT, and 0% T2DM, respectively. Peripheral insulin resistance and homeostasis model of assessment-insulin resistance improved significantly. Fasting glucose-dependent insulinotropic peptide and ghrelin decreased from 316.9 ± 143.1 to 156.2 ± 68.2 pg/mL (P < .001) and from 630.6 ± 52.1 to 456.7 ± 73.1 pg/mL (P < .001), respectively, whereas GLP-1 increased from 16.2 ± 4.9 to 23.7 ± 9.5 pg/mL (P < .001).. TOGA induced glucose disposal improvement with regression of diabetes to NGT or IGT and regression of IGT and IFG to NGT in half of the cases. Regressors showed a much larger increase of GLP-1 levels than progressors.

Topics: Adolescent; Adult; Body Mass Index; Coronary Disease; Diabetes Mellitus, Type 2; Disease Progression; Follow-Up Studies; Gastric Inhibitory Polypeptide; Gastroplasty; Ghrelin; Glucagon-Like Peptide 1; Humans; Insulin Resistance; Middle Aged; Obesity; Obesity, Morbid; Prediabetic State; Prospective Studies; Risk; Rome; Weight Loss; Young Adult

The aim of the Chest Pain Unit at Policlinico Umberto I in Rome was to implement simple diagnostic flow-charts in subjects with non-traumatic chest pain for an early identification of patients at high, intermediate and low risk of acute coronary syndrome (ACS). A total of 4.74% of all patients admitted to the Emergency Department were hospitalized in the Chest Pain Unit. 15.72% of them received a diagnosis of atypical chest pain with low risk of ACS; 26,42% were diagnosed of stable angina pectoris; 11.37% were affected by chronic coronary heart disease with medium risk of ACS and 12.83% were at high risk of acute coronary syndrome.

Topics: Acute Coronary Syndrome; Adolescent; Adult; Aged; Angina Pectoris; Chest Pain; Coronary Care Units; Coronary Disease; Diagnosis, Differential; Electronic Health Records; Female; Hospitals, Teaching; Humans; Male; Middle Aged; Patient Admission; Retrospective Studies; Risk Assessment; Risk Factors; Rome

Heart and coronary calcifications in hemodialysis patients are of very common occurrence and linked to cardiovascular events and mortality. Several studies have been published with similar results. Most of them were mainly cross-sectional and some of the prospective protocols were aimed to evaluate the results of the control of altered biochemical parameters of mineral disturbances with special regard to serum calcium, phosphate and CaxP with the use of calcium containing and calcium free phosphate chelating agents. The aim of the present study was to evaluate in hemodialysis patients classic and some non classic risk factors as predictors of calcification changes after one year and to evaluate the impact of progression on survival.. 81 patients on hemodialysis were studied, with a wide age range and HD vintage. Several classic parameters and some less classic risk factors were studied like fetuin-A, CRP, 25-OHD and leptin. Calcifications, as Agatston scores, were evaluated with Multislice CT basally and after 12-18 months.. Coronary artery calcifications were observed in 71 of 81 patients. Non parametric correlations between Agatston scores and Age, HD Age, PTH and CRP were significant. Delta increments of Agatston scores correlated also with serum calcium, CaxP, Fetuin-A, triglycerides and serum albumin. Logistic regression analysis showed Age, PTH and serum calcium as important predictors of Delta Agatston scores. LN transformation of the not normally distributed variables restricted the significant correlations to Age, BMI and CRP. Considering the Delta Agatston scores as dependent, significant predictors were Age, PTH and HDL. A strong association was found between basal calcification scores and Delta increment at one year. By logistic analysis, the one year increments in Agatston scores were found to be predictors of mortality. Diabetic and hypertensive patients have significantly higher Delta scores.. Progression of calcification is of common occurrence, with special regard to elevated basal scores, and is predictive of survival. Higher predictive value of survival is linked to the one year increment of calcification scores. Some classic and non classic risk factors play an important role in progression. Some of them could be controlled with appropriate management with possible improvement of mortality.

Topics: Adult; Aged; alpha-2-HS-Glycoprotein; Biomarkers; Blood Proteins; C-Reactive Protein; Calcifediol; Calcinosis; Comorbidity; Coronary Disease; Diabetic Nephropathies; Disease Progression; Follow-Up Studies; Humans; Kidney Failure, Chronic; Leptin; Male; Middle Aged; Renal Dialysis; Risk Factors; Rome; Severity of Illness Index; Survival Analysis; Tomography, Spiral Computed

Coronary artery bypass grafting is reported to have a higher (2-3 times) mortality in women than in men, most likely due to older age, higher incidence of hypertension, diabetes mellitus, hypercholesterolemia, obesity, angina and preoperative myocardial infarction, smaller diameter of coronary arteries, and smaller body surface area.. From January 1992 to December 1997, 347 female and 2098 male patients were submitted to isolated coronary artery bypass grafting. For both groups were considered: a) clinical presentation (age, height, weight, body surface area, NYHA and CCS functional classes, incidence of preoperative myocardial infarction); b) risk factors for cardiovascular diseases (diabetes mellitus, smoking habit, dyslipidemia, hypertension, familiarity); c) concomitant diseases (obesity, chronic obstructive pulmonary disease, peripheral vascular disease, thyroid dysfunction); d) hemodynamic and anatomical data (extent of coronary artery disease, diameter of coronary arteries, left ventricular function); e) surgical procedure (number and type of grafts used, urgent procedures, incidence of redo procedures). Early (up to 30 days after surgery) results were evaluated in terms of complications and mortality.. On admission, women were older than men (p = 0.0001), were shorter (p < 0.0001), weighed less (p < 0.0001), and had a smaller body surface area (p < 0.0001); they had more severe angina (p = 0.002), diabetes mellitus (p = 0.002), hypercholesterolemia (p = 0.003), thyroid dysfunction (p < 0.0001), their coronary arteries were smaller (left anterior descending artery, p = 0.05; obtuse marginal branch, p = 0.008; diagonal branch, p = 0.01), and had less grafts implanted at surgery (p = 0.02). There was no difference between women and men in the use of the internal thoracic artery. Women did not have a higher mortality than men (4.6 vs 3.2%). Uni- and multivariate analysis did not show extraoperative risk factors for women; for men older age (p = 0.005) and poor left ventricular function (p = 0.01) were independent predictive factors of operative mortality.. In spite of what is suggested by the literature, coronary artery bypass grafting does not have a significant higher operative risk for women than men, probably due to surgical technique refinements and extensive use of the internal thoracic artery.

Topics: Aged; Aged, 80 and over; Chi-Square Distribution; Coronary Artery Bypass; Coronary Disease; Female; Hospital Mortality; Humans; Logistic Models; Male; Middle Aged; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors; Rome; Sex Distribution; Time Factors

Topics: Coronary Disease; Exercise; Greece; History, 19th Century; History, 20th Century; History, Ancient; Humans; Occupational Diseases; Rome; Sports; United Kingdom

3395 men aged 46-65 belonging to occupational groups in Rome were examined in 1980 for the measurement of a number of potential coronary risk factors and of other personal characteristics. They represented the 76.5% of the enrolled roster. In 2853 men free from previous major coronary events and with all the measurements available, 98 died from CHD in the next 10 years. The multivariate analysis performed by the Cox model showed the significant predictive role of age, systolic blood pressure, non-HDL cholesterol, blood glucose and heart rate. The relative risk (for a distance of 2 standard deviations from the mean) was of 2.3, 2.1, 1.4, 1.7 and 1.4 respectively. Smoking habits, body mass index, xanthelasma, leisure physical activity, serum triglycerides, uric acid and a stress score did not contribute to the prediction of coronary deaths. HDL cholesterol produced a negative but not significant coefficient. As compared to the previously available Italian risk functions the role of non-HDL cholesterol and of blood glucose represents the most remarkable contribution.

Topics: Cohort Studies; Coronary Disease; Follow-Up Studies; Humans; Male; Multivariate Analysis; Occupations; Prognosis; Risk Factors; Rome

Topics: Adult; Age Factors; Coronary Disease; Dietary Fats; Energy Intake; Health Education; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Obesity; Physical Exertion; Risk; Rome; Smoking Prevention

A study on the relationships between habitual alcohol consumption and the main coronary risk factors was carried out in 520 consecutive high-risk men examined during an annual rescreening of a working population group within the Rome Project of Coronary Heart Disease Prevention. Alcohol intake was determined by means of a semiquantitative questionnaire. The mean daily wine intake was about 0.5 liter, the consumption of other alcoholic beverages being negligible. No statistically significant correlations were found between average daily wine consumption and the main coronary risk factors, while a strongly positive correlation (p less than 0.001) was observed with plasma HDL-cholesterol levels. Also differences in HDL-cholesterol between occasional drinkers and moderate drinkers were statistically significant. No differences were observed in total cholesterol and triglycerides. The findings suggest that habitual moderate amounts of alcohol may increase HDL-cholesterol between occasional drinkers and moderate drinkers were statistically significant. No differences were observed in total cholesterol and triglycerides. The findings suggest that habitual moderate amounts of alcohol may increase HDL-cholesterol levels.

Topics: Adult; Alcoholism; Cholesterol; Cholesterol, HDL; Coronary Disease; Employment; Humans; Lipoproteins, HDL; Male; Middle Aged; Risk; Rome; Wine

Classical writings suggest that the Roman emperor Hadrian died from congestive heart failure resulting from hypertension and coronary atherosclerosis. This diagnosis is supported by the identification of bilateral diagonal ear creases on sculptures of several busts of Hadrian as well as literary evidence of behavior pattern A.

Topics: Coronary Disease; Ear, External; Famous Persons; History, Ancient; Humans; Male; Medicine in the Arts; Middle Aged; Rome; Sculpture; Somatotypes

The role of essential hypertension in the pathogenesis of cerebral vessel disorders (not only hemorrhagic, but also ischemic) is greater than in the pathogenesis of the heart ischemic disease. An analysis of the evidences left by ancient doctors, when compared with statistical data of our time, gives one grounds to believe that cerebral hemorrhages have been a rather common disease, at least, since the time of the antique civilization of Greece and Rome, whereas ischemic heart disease has become a widespread disease among the population of the developed countries only in our time. This makes it possible to assume that the role of essential hypertension and that of atherosclerosis are not equal in the "diseases of civilization", if the diseases of today's developed society are meant.

Topics: Adult; Arteriosclerosis; Asia; Cerebral Hemorrhage; Cerebral Infarction; Cerebrovascular Disorders; Coronary Disease; Egypt; Europe; Female; Greece; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; Humans; Hypertension; Male; Middle Aged; Rome; Sex Factors

Within four middle-aged population groups enrolled in the Rome Project of Coronary Heart Disease Prevention, a theoretic estimation of coronary heart disease (CHD) incidence in 5 years has been made on the basis of some risk factors (age, systolic blood pressure, serum cholesterol, smoking habit, physical activity at work, body mass index), employing four different solutions of the multiple longistic function (MLF) derived from previous population studies and a simple risk score adopted by the WHO European Collaborative Group to which this study belongs. The use of different MLF solutions provides rather different levels of estimated incidence, but the ranking and the relative risk between population groups are substancially constant and little dependent on the different solutions. Moreover, an acceptable similarity has been found in terms of estimated risk between the pool of the treatment and that of the control population groups (ratio between 0.97 and 1.09). A reasonable hypothesis indicates that in the absence of preventive action the annual incidence of severe CHD (hard criteria) should be around 6 per 1,000. The estimation of the relative risk within single population groups allows to identify strata of people with different risk, which suggests, again in the absence of any preventive action, a concentration of 25-30% of all new cases of disease in a 10% of the population and about 40-45% in a 20% of the same.

Topics: Adult; Age Factors; Body Weight; Coronary Disease; Humans; Hypercholesterolemia; Hyperlipidemias; Hypertension; Middle Aged; Occupations; Risk; Rome; Smoking

In the Roman Project of Coronary Heart Disease Prevention two different techniques were employed for the identification of individuals at high coronary risk within the treatment groups of the Project. The "risk score" is a simple additive system developed by the working groups of WHO, while the "multiple logistic function" is a complex mathematical model of multivariate analysis. Both of them consider 5 risk factors (age, systolic blood pressure, serum cholesterol, smoking habits and physical activity at work) and are applied for the identification of individuals belonging to the upper 20% of a risk rank list. The two techniques apparently provide similar predictive performances when applied to epidemiological prospective material collected in other studies where the morbid events are already known. When employed in the study population groups they identify, as high risk individuals, different subgroups of population, which overlap only partially. On the basis of theoretical and practical considerations, it has been decided to employ both techniques and to extend, as a consequence, the proportion of high risk individual, eligible for individual treatment, from 20% to about 30% of the total.

Topics: Adult; Age Factors; Cholesterol; Coronary Disease; Humans; Hypertension; Male; Middle Aged; Occupations; Physical Exertion; Risk; Rome; Smoking

Topics: Adult; Age Factors; Antihypertensive Agents; Body Weight; Cholesterol; Coronary Disease; Humans; Hypertension; Male; Mass Screening; Middle Aged; Occupations; Physical Exertion; Rome; Smoking; Stress, Physiological

Topics: Adult; Alcohol Drinking; Blood Glucose; Cholesterol; Coronary Disease; Humans; Lipoproteins; Male; Middle Aged; Physical Exertion; Risk; Rome; Wine

Topics: Coronary Disease; Egypt; England; France; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; Rome; Sicily; United States

Topics: Adult; Age Factors; Analysis of Variance; Angina Pectoris; Coronary Disease; Finland; Greece; Humans; International Cooperation; Male; Mediterranean Islands; Middle Aged; Myocardial Infarction; Netherlands; Occupations; Prognosis; Railroads; Rome; Statistics as Topic; United States; Yugoslavia

Topics: Adult; Analysis of Variance; Coronary Disease; Follow-Up Studies; Humans; International Cooperation; Italy; Male; Middle Aged; Myocardial Infarction; Occupations; Railroads; Rome; Rural Health; United States; Urban Population

Topics: Adult; Cholesterol; Coronary Disease; Electrocardiography; Health Surveys; Humans; Male; Middle Aged; Railroads; Rome; Smoking