Progetto Cuore Research Articles

Sex Differences in Cardiovascular Risk Profiles of Patients with Rheumatoid Arthritis: Results from an Italian Multicentre Cohort

Objective: The effect of sex and gender-related variables on the evaluation of cardiovascular (CV) risk in rheumatoid arthritis patients has been poorly explored. We investigated the differences in CV risk features and scores according to sex in a wide rheumatoid arthritis (RA) cohort. Methods: This is a cross-sectional analysis of a consecutive RA cohort. Disease-specific clinical and serologic variables, traditional CV risk factors and the 10-year CV risk calculated by the SCORE-2, Progetto CUORE and Expanded Risk Score-RA algorithms were compared in males and females. Results: A total of 820 patients (193 men, 627 women) were included. Disease activity was similar between the two sexes. A significantly higher prevalence of traditional CV risk factors and higher mean CV risk scores were detected in male compared to female patients. In the multiple linear regression analysis, a higher HAQ, csDMARD use and ACPA positivity were significantly associated with an increased CV risk in females, while b/tsDMARDs was associated with a lower CV risk in males according to different algorithms. Conclusions: The distribution of traditional CV risk factors and the 10-year risk of CV disease significantly differed in female and male patients despite similar disease activity. Disease-specific variables may contribute differently to CV risk according to sex. The CV screening in RA should also take into account the different distribution of CV risk factors between sexes.

Increased cardiometabolic risk and prevalence of ascending aorta dilation in patients with nonfunctioning adrenal incidentaloma: a retrospective propensity score-matched study.

The cardiometabolic implications of Non-Functioning Adrenal Incidentaloma (NFAI) is still matter of debate. This study takes a novel approach to analyze this association, accounting for the influence of various confounding factors. We present the findings of a retrospective, cross-sectional, and case-control study. Data from all NFAI patients in primary prevention, referred to the University of Turin between 2000 and 2023, were collected and compared with subjects without adrenal disease, using propensity score matching analysis. A total of 1997 patients were included (906 patients with NFAI; 1091 controls). Adrenal tumor group was associated with high levels of cardiovascular risk scores in both univariate and multiple linear regression analyses (Progetto CUORE: EC 11.00, 95% CI 2.72-44.46, p = 0.001; SCORE: EC 1.97, 95% CI 1.01-3.81, p = 0.046). Regarding cardiometabolic complications, multivariable logistic regression revealed an independent association between NFAI and ascending aorta dilation (OR 4.64, 95% CI 2.24-9.63, p = 0.000), after adjusting for age, sex, smoking status, metabolic syndrome, number of antihypertensive drugs, estimated glomerular filtration rate (eGFR), and normetanephrine levels. Propensity score matching analysis (1:1 matching ratio), based on the same logistic regression model, confirmed the association of NFAI with aortic dilation (β = 0.083, 95% CI 0.008-0.157, p = 0.030). No significant associations were found with metabolic syndrome, type II diabetes, eGFR <60 mL/min/1.73 m2, microalbuminuria, atrial fibrillation, or hypertensive heart disease. This study suggests that patients with NFAI face increased cardiometabolic risk and high prevalence of ascending aorta dilation. Routine evaluation of NFAI patients should include thorough cardiovascular assessment and consideration of treatments aimed at reducing cardiovascular risk.

(006) GENITAL VASCULAR RESISTANCE AS A PREDICTOR OF CARDIOVASCULAR RISK ACCORDING TO THE ANALYSIS OF THE PROGETTO CUORE IN PREMENOPAUSAL WOMEN

Abstract Introduction Gender disparity persists in the relationship between sexual dysfunction and cardiovascular risk (CV). It is well- known that erectile dysfunction (ED) represents a sign of subclinical CV pathology and that alterations in color Doppler penile ultrasound parameters serve as predictive markers of major CV events. Female sexual dysfunction (FSD) is a complex condition that involves psychological and organic components, including the cardiovascular system, and affects the quality of life of over a third of women. However, despite its high prevalence, little attention has been paid to the vascular system responsible for blood supply to the female genital apparatus. In men, the hypothesis of penile artery size is a proposed pathophysiological mechanism to address the relationship between the onset of ED symptoms and cardiovascular disease. In recent years, it has also been highlighted that compromised genital vascularization may be a precursor to cardiovascular diseases in women. Objective Our ami gas to investigate the association between clitoral pulsatility index (PI), evaluated through Clitoral color Doppler ultrasound (CDU), and cardiometabolic risk factors in women referred to the Andrology, Women’s Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy. Methods In an observational study, a total of 361 women with a mean age of 45.1 (±13.3) years were evaluated. All patients underwent a thorough medical history assessment, an evaluation of anthropometric parameters, blood sampling for measurement of metabolic and hormonal parameters and a Doppler ultrasound of the clitoral cavernous artery to measure the PI. Results 23.5% of the patients were overweight and 11.6% were obese, 16.3% had hypertension, and 18.6% had metabolic syndrome. In the multivariate analysis, after adjusting for age, the PI was positively correlated with body mass index (BMI) (ß=0.160, p=0.003) and waist circumference (ß=0.186, p=0.002). Furthermore, all women underwent cardiovascular risk assessment, as indicated by Progetto CUORE, assigning a score based on the presence of risk factors (blood pressure, cholesterol levels, smoking, diabetes, age, gender) to estimate the absolute global cardiovascular risk over the next 10 years. We observed that, particularly in women of reproductive age, the clitoral PI was positively correlated with the Progetto CUORE score (r=0.136, p=0.035). Conclusions Clitoral PI increases in relation to several cardiometabolic risk factors. It is therefore relevant to understand how common cardiometabolic alterations may influence vascular function in the female genital tract and whether treating these alterations leads to an improvement in clitoral ultrasound indices, especially in young premenopausal women. Disclosure No.

A real opportunity to modify cardiovascular risk through primary care and prevention: A pilot study.

Cardiovascular diseases (CVDs) represent a major threat to health and primary prevention outstands as the most effective instrument to face this issue, addressing multiple risk factors at a time and influencing behavioral patterns. Community nurses have been involved in many interdisciplinary prevention activities, resulting in effective control of CV risk factors. We conducted a pilot study aiming at describing the impact on the CV risk profile of an 18-month interdisciplinary intervention on lifestyle habits. From September 2018 to May 2020, four general practitioners (GPs) working in the Roman neighborhood of Torresina recruited patients having a cardiovascular risk score (CRS) equal to or higher than 3% and lower than 20%; those patients were included in a nutritional, physical, and psychological counseling program. Assessments of patients' health status were led at baseline, 6, 12, and 18 months by a nutritionist, a physiotherapist, a psychologist, their GPs, and a community nurse. The CRS was estimated at every examination, based on the Italian Progetto Cuore algorithm. A total of 76 patients were included (mean age of 54.6 years; 33 men and 43 women). Mean CRS showed a significant reduction between baseline and 12 months (from 4.9 to 3.8); both total cholesterol and systolic blood pressure (SBP) significantly decreased at 6 months of follow-up (respectively, from 211.1 to 192 and from 133.1 to 123.1). Nonetheless, the reduction was later maintained only for SBP. However, during the last 6 months of the intervention, the COVID-19 pandemic broke out, thus, it is not possible to know how much the results achieved at 18 months were influenced by the restrictive measures introduced by the Italian government. When stratifying according to the presence of hypertension/diabetes and physical activity, no differences in the CRS could be highlighted between the two groups. Our pilot study proved that an interdisciplinary counseling intervention program can improve CV risk profile and could be further spread to people that, according to their CRS, would benefit more from changes in lifestyles.

Traditional and disease-related non-computed variables affect algorithms for cardiovascular risk estimation in Sjögren's syndrome and rheumatoid arthritis.

Several cardiovascular (CV) risk algorithms are available to predict CV events in the general population. Their performance and validity in rheumatic disease patients is suboptimal as some disease-specific variables which strongly contribute to the pathogenesis of CV disease are not included in these CV algorithms. We aimed to evaluate the performance of two CV algorithms and investigate which variables not included in the score contribute to CV risk score in a cohort of rheumatoid arthritis (RA) and Sjögren's syndrome (SS) patients. A consecutive cohort of 77 RA and 68 SS patients without prior CV events was included. Clinical and serological features and traditional CV risk factors were collected. The 10-year CV risk was assessed by Reynold Risk Score (RSS) and "Progetto Cuore" algorithms. Prevalence of traditional CV risk factors and 10-year risk of fatal and non-fatal CV events assessed by RSS and "Progetto Cuore" were similar between the two cohorts. Multiple linear regression model showed that, among variables not included in both algorithms, body mass index (BMI) and disease activity were predictors of "Progetto Cuore" while BMI and bone erosions of RSS in RA. In SS, C-reactive protein was predictor of "Progetto Cuore" while hypertension, ESSDAI and LDL-cholesterol of RSS. The 10-year risk of fatal and non-fatal CV events is similar in RA and SS. Traditional CV risk factors, as hypertension, strongly contribute to CV risk in these patients. Inflammatory parameters and disease activity are two disease-specific variables which should be included in CV algorithm assessment in rheumatic disease patients.

Estimated 10-year cardiovascular risk in a large Italian cohort of rheumatoid arthritis patients: Data from the Cardiovascular Obesity and Rheumatic DISease (CORDIS) Study Group

BackgroundSeveral cardiovascular (CV) risk algorithms are available to predict CV events in the general population. However, their performance in patients with rheumatoid arthritis (RA) might differ from the general population. This cross-sectional multicentre study aimed to estimate the 10-year CV risk using two different algorithms in a large RA cohort and in patients with osteoarthritis (OA). MethodsIn a consecutive series of RA patients and matched OA controls without prior CV events, clinical and serologic data and traditional CV risk factors were recorded. The 10-year CV risk was assessed with the Systematic COronary Risk Evaluation (SCORE) and the “Progetto Cuore” algorithms. Results1,467 RA patients and 342 OA subjects were included. RA patients were more frequently diabetic (9.9% vs 6.4%; p=0.04) and smokers (20.4% vs 12.5%; p=0.002) but had lower prevalence of obesity (15% vs 21%; p=0.003). Dyslipidaemia was more prevalent in OA (32.5% vs 21.7%; p<0.0001). The 10-year estimated CV risk was 1.6% (95%CI 1.3-1.9) in RA and 1.4% (95%CI 1.3-1.6) in OA (p=0.002) according to SCORE and 6.5% (95%CI 6.1-6.9) in RA and 4.4% (95%CI 3.9-5.1) in OA (p<0.001) according to “Progetto Cuore”. Regardless of the score used, RA patients had a 3- to-4-fold increased 10-year risk of CV events compared to OA subjects. ConclusionRA patients have a significantly higher 10-year risk of CV events than OA subjects. In addition to effective disease control and joint damage prevention, specific protective measures targeting modifiable traditional CV risk factors should be implemented in RA.

Liver Fibrosis Biomarkers Accurately Exclude Advanced Fibrosis and Are Associated with Higher Cardiovascular Risk Scores in Patients with NAFLD or Viral Chronic Liver Disease.

Liver fibrosis predicts liver-related and cardiovascular outcomes in chronic liver disease patients. We compared the diagnostic performance of various liver fibrosis biomarkers for identifying histological significant/advanced fibrosis. Additionally, the correlations of such liver fibrosis biomarkers with cardiovascular risk (CVR) scores were evaluated. 173 patients with viral hepatitis (157 HCV and 16 HBV) and 107 with a non-alcoholic fatty liver disease (NAFLD) were consecutively enrolled. Various liver fibrosis biomarkers: aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (ARR), AST to Platelet Ratio Index (APRI), Fibrosis-4 (FiB-4), Forns index, NAFLD fibrosis score (NFS), BARD (body mass index (BMI), AAR, Diabetes) score, and Hepamet fibrosis score (HFS), were used to identify significant/advanced fibrosis. CVR was assessed by using the SCORE, the Progetto CUORE, or the Framingham risk scoring systems. Liver fibrosis biomarkers performed better in predicting advanced rather than significant liver fibrosis in all patients, regardless of chronic liver disease aetiology. Forns index and HFS performed best in predicting advanced fibrosis in patients with viral chronic liver disease and NAFLD. Lower cut-offs of these liver fibrosis biomarkers had high negative predictive values for advanced fibrosis overall, as well as in patients with NAFLD or viral chronic liver disease. FIB-4, Forns index, NFS, and HFS were positively correlated with SCORE and Framingham risk scores. In conclusion, liver fibrosis biomarkers accurately exclude advanced fibrosis and positively correlate with CVR scores in patients with chronic liver disease.

Cardiovascular risk estimation with 5 different algorithms before and after 5 years of bDMARD treatment in rheumatoid arthritis.

Assessing cardiovascular (CV) risk represents a challenge for clinicians because more variables can impact CV risk. The aim of this study was to evaluate the change of CV risk after 5years of biological treatment in rheumatoid arthritis (RA) patients and impact of prolonged low disease activity on 5 different CV risk algorithms. We estimated the CV risk, at baseline and at 5-year follow-up (FU), with the Systematic COronary Risk Evaluation(SCORE) charts, the algorithm 'Progetto Cuore', the QRISK3-2018 score, the Reynold Risk Score(RRS) and the Expanded Risk Score in RA(ERS-RA). Clinical disease activity index(CDAI) was used to define RA activity. Wilcoxon signed-rank test was used to compare CV risk scores. In 110 patients with a 5-year FU on biological disease-modifying anti-rheumatic drug treatment, we observed an increase in the 10-year CV risk estimated by SCORE charts [from mean (SD) 0.9% (1.4) to 1.1% (1.5), P<.001], 'Progetto Cuore' [from mean (SD) 5.5% (7.2) to 6.2% (6.8), P<.001], QRISK3-2018 [from mean (SD) 9.3% (10.1) to 11.9% (10.8), P<.001) and RRS [from mean (SD) 5.6% (6.4) to 6.2% (7.5), P<.05], mainly due to age raise. ERS-RA highlighted a significant decrease of estimated CV risk in patients with persistent CDAI≤10[from mean (SD) 9.6% (11.2) to 7.3% (6.4), P<.05], despite age increase and its impact on the CV risk score. Algorithms commonly used to estimate 10-year CV risk in RA perform differently. Scores that include specific inflammatory RA-related variables seem to decrease with amelioration of disease activity. Further investigations are warranted to explore the predictive value of their changing over time.

THU0127 Estimated cardiovascular risk in a large cohort of rheumatoid arthritis patients from the “Cardiovascular Obesity and Rheumatic DISease (CORDIS)” Study Group of the Italian Society of Rheumatology.

Background:Rheumatoid arthritis (RA) patients present high cardiovascular (CV) morbidity and mortality and EULAR recommends estimating their CV-risk [1]. The Systematic Coronary Risk Evaluation (SCORE) algorithm is suggested if National Guidelines are lack, but few data are available about different strategies.Objectives:To estimate the 10-years CV-risk using different algorithms in RA compared to osteoarthritis (OA) patients, as control group.Methods:A total of 1467 RA patients (78.3% female; mean age 59.8±11.5 years; mean disease duration 131±109 months), fulfilling the 2010 EULAR/ACR classification criteria, and 342 age and sex matched patients with OA (79.8% female; mean age 58.7±11.5 years) were enrolled in this multicentre cross-sectional study during 2019. Clinical and laboratory data were registered, and individual CV-risk was calculated using: SCORE chart, “Progetto Cuore” model (PCM), QRisk3, Reynolds Risk Scores (RRS) and Expanded Risk Score in RA (ERS-RA), as stated by suitable algorithms. Statistical analysis was performed using the Statistical System Graphpad Instat 8.0 (San Diego, CA-USA).Results:In 46 (3%) RA patients a previous CV event was observed. Among traditional CV-risk factors, RA patients presented higher frequency of diabetes (9.9% vs 6.4%; p=0.04) and lower prevalence of dyslipidaemia (21.7% vs 32.5%; p&lt;0.0001) compared to OA patients. Prevalence of hypertension was similar in both groups (40% vs 39.2%). Mean BMI (25.6±4.8 vs 26.6±4.4; p&lt;0.0001) and prevalence of obesity (15% vs 21%; p=0.003) were significantly lower in RA patients. Finally, RA patients were more frequently smokers (20.4% vs 12.5% - p=0.002). 441 (30%) RA patients were in CDAI remission, 998 (68%) patients were on csDMARDs while a biologic agent was used in 617 (42%) patients. About 43% of RA patients were on a mean prednisone-dose of 4.5±3.5 mg/day. The 10-years CV-risk resulted 2 to 3-fold higher in RA compared to OA patients using the different algorithms. The QRisk3 estimated the highest CV risk in our cohort of patients, while the ERS-RA and RRS were significantly higher than PCM and SCORE.Conclusion:Our study demonstrates a higher estimated CV-risk in RA compared to OA patients. The commonly used algorithms to estimate CV-risk in clinical practice perform differently, evaluating different traditional CV-risk factors and disease specific characteristic, as for QRisk3 or ERS-RA. Rheumatologist should impact on both traditional and RA related modifiable CV-risk factors.

THU0119 COULD SYNOVITIS AND TENOSYNOVITIS DETECTED BY ULTRASOUND BE CONSIDERED A RISK FACTOR FOR SHORT-TERM FLARE IN RA PATIENTS IN CLINICAL REMISSION

Background:The clinical value of ultrasound (US) detected synovitis and tenosynovitis as predictors of flares in RA patients in clinical remission is not clear.Objectives:To investigate the value of US detected synovitis and tenosynovitis as risk factors for short term flare in RA patients in clinical remission.Methods:Consecutive RA patients in clinical remission (DAS28 ERS &lt; 2.6) for at least 3 months, underwent Power Doppler ultrasound (PDUS) examination of: 1st to 6th extensor compartments at the wrist, 2nd to 5th flexor, posterior tibial tendons and peroneals. Regarding joints, carpal joints, 1st to 5th MCP and 2nd to 5th interphalangeal proximal (IPP). Synovitis and tenosynovitis were defined according to OMERACT. Patients were followed for one year. Disease flare was defined as any increase of disease activity generating the need of change in therapy by the attending rheumatologist.Results:Ninety patients were included. Patients´ characteristics are shown in the table. After one year of follow-up, 26 patients (29%) experienced a flare. At baseline 39%, 23% and 8% had US detected synovitis, tenosynovitis or both respectively. The presence of US detected tenosynovitis (RR: 4.9; 95% CI: 2.2-10.8), but not of US detected synovitis (RR: 1.3; 95% CI: 0.76-2.2), showed an increased risk of having a flare. In the multivariable analysis, and after adjusting by age, gender, disease duration, DAS28, DMARDs and biologics use, and the US detected synovitis, only subclinical tenosynovitis (OR: 9.8 95% CI: 2.5-39.1; p=0.001) and baseline DAS28 (OR: 5.7, 95% CI: 1.1-31.6; p= 0.047) were significantly associated with an increased risk of flare.Conclusion:Subclinical tenosynovitis, but not synovitis, was associated with disease flare in patients with RA in clinical remission. This feature might have physio-pathological implications.

Evaluation of Cardiovascular Risk in Patient with Primary Non-alcoholic Fatty Liver Disease.

The study aimed to investigate, in patients with primary non-alcoholic fatty liver disease (NAFLD), the presence of possible relationships between the degree of steatosis or fibrosis and the individual cardiovascular risk and possibly whether a difference between those various methods exists. Thirty-four adult patients with primary NAFLD were included in this study. Clinical evaluation included an ultrasonographic examination for the determination of the severity of steatosis. Two different clinical indirect indexes of the severity of hepatic fibrosis were used: the FIB-4 score and the NAFLD fibrosis score. Then, the individual cardiovascular 10-years risk according to 5 different scores: "Progetto Cuore" of the Italian Institute of Health, Framingham score 2004-ATP III, Framingham risk score 2008, ACC/AHA ASCVD risk score 2013, ACC/AHA ASCV risk score new model score 2 were estimated. The severity of steatosis evaluated by ultrasonography was significantly correlated only with ACC/AHA ASCVD RISK 2013, ACC/AHA ASCVD New Model 2 2018 and Framingham 2008 risk scores. The severity of fibrosis evaluated by the FIB-4 score or with NAFLD fibrosis score was significantly correlated only with cardiovascular risk evaluated with ACC/AHA ASCVD 2013, ACC/AHA ASCVD New Model 2 2018 and Framingham risk score 2008. Some of the methods for the estimation of cardiovascular risk (ACC/AHA ASCVD 2013, new model 2 2018, and, also Framingham score 2008) have a clear advantage over Framingham score 2004 and "Progetto Cuore" of the Italian Institute of Health in terms of correlation with the severity of NAFLD. They are, therefore, more clinically useful.

Cardiovascular Risk Assessment in People Living With HIV: A Systematic Review and Meta-Analysis of Real-Life Data.

People living with HIV (PLWHIV) have a 2-fold higher risk of having a cardiovascular event than HIV-negative individuals. The objective of this article is to estimate the pooled proportion of moderate-high cardiovascular risk in PLWHIV obtained through different scores. In addition, this study also aims to establish the prevalence of dyslipidemia, smoking habits, diabetes and high blood pressure in the included studies. A bibliographic search was conducted in MEDLINE for studies on cardiovascular risk assessment in PLWHVI that took place during the period of inception to July 2018. The eligibility criteria for inclusion were: cross-sectional or longitudinal studies on HIV-positive adults in which the prevalence of moderate-high cardiovascular risk (or data to calculate it) was reported, and included at least one of the following cardiovascular risk scores: Framingham, ASCVD, D:A:D, Progetto Cuore, PROCAM, SCORE, Regicor, and World Health Organization scores. Bibliographic search identified 278 studies. Finally, thirty-nine peer-reviewed publications were identified for a collective total of 13698 subjects. The pooled prevalence of moderate-high cardiovascular risk in PLWHIV obtained with nine different scores through random-effect modeling was 20.41% (95% CI: 16.77-24.31). The most prevalent concomitant cardiovascular risk factor was dyslipidemia (39.5%), smoking (33.0 %), high blood pressure (19.8%) and diabetes (7.24%). Data obtained in this systematic review indicate that more than 1 in every five subjects with HIV have a moderate-high cardiovascular risk. In consequence, the burden of cardiovascular disease in PLWHIV represents a public health problem. There is an urgent need to develop strategies to prevent and detect cardiovascular risk effectively in PLWHIV.

Predictive Utility of Cardiovascular Risk Prediction Algorithms in Inflammatory Rheumatic Diseases: A Systematic Review.

We performed a systematic review of the literature to describe current knowledge of cardiovascular (CV) risk prediction algorithms in rheumatic diseases. A systematic search of MEDLINE, EMBASE, and Cochrane Central databases was performed. The search was restricted to original publications in English, had to include clinical CV events as study outcomes, assess the predictive properties of at least 1 CV risk prediction algorithm, and include patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), or psoriasis. By design, only cohort studies that followed participants for CV events were selected. Eleven of 146 identified manuscripts were included. Studies evaluated the predictive performance of the Framingham Risk Score, QRISK2, Systematic Coronary Risk Evaluation (SCORE), Reynolds Risk Score, American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE), Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA), and the Italian Progetto CUORE score. Approaches to improve predictive performance of general risk algorithms in patients with RA included the use of multipliers, biomarkers, disease-specific variables, or a combination of these to modify or develop an algorithm. In both SLE and PsA patients, multipliers were applied to general risk algorithms. In studies of RA and SLE patients, efforts to include nontraditional risk factors, disease-related variables, multipliers, and biomarkers largely failed to substantially improve risk estimates. Our study confirmed that general risk algorithms mostly underestimate and at times overestimate CV risk in rheumatic patients. We did not find studies that evaluated models for psoriasis or AS, which further demonstrates a need for research in these populations.

Performance and calibration of the algorithm ASSIGN in predicting cardiovascular disease in Italian patients with psoriatic arthritis.

The increased cardiovascular (CV) risk is one of the major challenges in the management of patients with psoriatic arthritis (PsA). Recently, EULAR suggested to adapt the already available CV risk algorithms with a 1.5 multiplication factor in all the patients with rheumatoid arthritis (RA), but it is still uncertain if this adaptation could also be applied to patients with PsA. This study aims to evaluate the performance and calibration of the CV risk algorithm ASSIGN and its adaptations for RA (ASSIGN-RA) and according to EULAR recommendations in a cohort of patients with PsA (ASSIGN*1.5). Prospectively, collected data from two Italian cohorts has been analyzed. The discriminatory ability for CV risk prediction was assessed using the areas under the ROC curves. Calibration between predicted and observed events was assessed by Hosmer-Lemeshow (HL) test and calibration plots. For each algorithm, sensitivity and specificity were calculated for low- to high-risk cut-off (20%). One hundred fifty-five patients were enrolled with an observation of 1550patient/years. Area under the ROC were 0.8179 (95% CI 0.72014 to 0.91558) for ASSIGN, 0.8160 (95% CI 0.71661 to 0.91529) for ASSIGN-RA, and 0.8179 (95% CI 0.72014 to 0.91558) for ASSIGN*1.5. HL tests did not demonstrate poor model fit for none of the algorithms. Discriminative ability and calibration were not improved by adaptation of the algorithms according to EULAR recommendations. Up to 20% of CV events occurred in patients at "low risk". No difference in performance has been observed between ASSIGN, Progetto CUORE, and QRISK2. ASSIGN could represent a useful tool in predicting CV risk in patients with PsA. Adaptation for RA or according to EULAR recommendations did not show any further improvement in performance and calibration.

Cross-sectional epidemiological study to evaluate the cardiovascular profile of a cohort of blood donors.

Cardiovascular diseases are among the most frequent causes of mortality and morbidity in industrialised countries. The identification of subjects at high risk of cardiovascular diseases is one of the main aims of individual primary prevention programmes and is the essential background for instituting interventions aimed at reducing modifiable risk factors, from lifestyle changes to pharmacological interventions. DONORS AND METHOD: In order to evaluate the absolute global risk of cardiovascular disease in the population of blood donors of the Transfusion and Immunohaematology Centre of the Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena of Milan, we used the absolute global cardiovascular risk (CVR) score of the Progetto Cuore. Between September 2004 and June 2006, 11,093 blood donors were evaluated for their suitability for donating blood. The criteria for inclusion in the calculation of the individual values of the absolute global CVR score were: age between 35 and 65 years old, fasted for at least 12 hours, and no previous reported or diagnosed cardiovascular episodes. Each donor was also asked to provide written informed consent to participation in the study. THE POPULATION OF BLOOD DONORS WAS DIVIDED INTO FOUR GROUPS ACCORDING TO THEIR CVR SCORE: CVR < 3%, CVR between 3% and 10%, CVR between 10% and 20%; CVR above 20%. The characteristics of the population were analysed subdividing the subjects according to age and gender. Although most of the blood donors belonged to the group with low CVR, it was nevertheless possible to identify a group of donors with high CVR. It is to be hoped that CVR is calculated ever more widely in the population of blood donors in order to identify individuals at high CVR and also with the aim of reducing the levels of risk factors in the population with low or moderate CVR.

Characteristics of compensated hypogonadism in patients with sexual dysfunction.

In the last few years, a view that subclinical endocrine disorders represent milder forms of the clinically overt disease has emerged. Accordingly, it has been proposed that compensated hypogonadism represents a genuine clinical subset of late-onset hypogonadism. The aim of the present study is to investigate the associations of compensated hypogonadism with particular clinical and psychological characteristics of male subjects complaining of sexual dysfunction. After excluding documented genetic causes of hypogonadism, an unselected consecutive series of 4,173 patients consulting our unit for sexual dysfunction was studied. Compensated hypogonadism was identified according to the European Male Ageing study criteria: total testosterone ≥10.5 nmol/L and luteinizing hormone >9.4 U/L. Several hormonal, biochemical, and instrumental (penile Doppler ultrasound) parameters were studied, along with results of the Structured Interview on Erectile Dysfunction (SIEDY) and ANDROTEST. One hundred seventy (4.1%) subjects had compensated hypogonadism, whereas 827 (19.8%) had overt hypogonadism. After adjustment for confounding factors, no specific sexual symptoms were associated with compensated hypogonadism. However, compensated hypogonadism individuals more often reported psychiatric symptoms, as detected by Middlesex Hospital Questionnaire score, when compared with both eugonadal and overt hypogonadal subjects (adjusted odds ratios = 1.018 [1.005;1.031] and 1.014 [1.001;1.028], respectively; both P < 0.005). In addition, subjects with compensated or overt hypogonadism had an increased predicted risk of cardiovascular events (as assessed by Progetto Cuore risk algorithm) when compared with eugonadal individuals. Accordingly, mortality related to major adverse cardiovascular events (MACEs), but not MACE incidence, was significantly higher in subjects with both compensated and overt hypogonadism when compared with eugonadal subjects. The present data do not support the concept that compensated (subclinical) hypogonadism represents a new clinical entity. The possibility that subclinical hypogonadism could be a normal response of the hypothalamus-pituitary-testis axis to somatic illness should be considered. Further studies are urgently needed to clarify this latter point.

Smoking cessation and the risk of cardiovascular disease outcomes predicted from established risk scores: results of the Cardiovascular Risk Assessment among Smokers in Primary Care in Europe (CV-ASPIRE) study.

BackgroundSmoking is a major risk factor for cardiovascular disease (CVD). This multicenter, cross-sectional survey was designed to estimate the cardiovascular (CV) risk attributable to smoking using risk assessment tools, to better understand patient behaviors and characteristics related to smoking, and characterize physician practice patterns.Methods1,439 smokers were recruited from Europe during 2011. Smokers were ≥40 years old, smoked > 10 cigarettes/day and had recent measurements on blood pressure and lipids. CV risk was calculated using the SCORE system, Framingham risk equations, and Progetto CUORE model. The CV risk attributable to smoking was evaluated using a simulated control (hypothetical non-smoker) with identical characteristics as the enrolled smoker. Risks assessed included CV mortality, coronary heart disease (CHD), CVD and hard CHD. Demographics, comorbidities, primary reasons for consultation, behavior towards previous attempts to quit, and interest in smoking cessation was assessed. Dependence on nicotine was evaluated using the Fagerström Test for Nicotine Dependence. GP practice patterns were assessed through a questionnaire.ResultsThe prediction models consistently demonstrated a high CV risk attributable to smoking. For instance, the SCORE model demonstrated that this study population of smokers have a 100% increased probability of death due to cardiovascular disease in the next 10-years compared to non-smokers. A considerable amount of patients would like to hear from their GP about the different alternatives available to support their quitting attempt.ConclusionsThe findings of this study reinforce the importance of smoking as a significant predictor of long-term cardiovascular events. One of the best gains in health could be obtained by tackling the most important modifiable risk factors; these results suggest smoking is among the most important.

The Identification of Prediabetes Condition with ARIC Algorithm Predicts Long-Term CV Events in Patients with Erectile Dysfunction

The Atherosclerosis Risk in Communities (ARIC) algorithm is one of the most efficient instruments for the prediction of incident type 2 diabetes. Recently, it has been shown to predict another relevant cardiovascular (CV) risk factor, such as chronic kidney disease. To verify whether, in patients with erectile dysfunction (ED), the use of ARIC diabetes risk score might improve the efficacy in predicting major CV events of other CV risk algorithms specifically developed for the assessment of CV risk. A consecutive series of 2,437 men (mean age 52.5 ± 12.9 years) attending our outpatient clinic for sexual dysfunction was retrospectively studied. A subset of this sample (N = 1,687) was enrolled in a longitudinal study (mean follow-up of 4.3 ± 2.6 years). The assessment of metabolic risk was evaluated with the ARIC algorithm. The assessment of CV risk was evaluated using the Progetto Cuore risk engine. In the cross-sectional study, ARIC score was inversely related with testosterone levels, sexual functioning, and penile blood flow. When longitudinal sample was analyzed, higher baseline ARIC score significantly predicted major adverse cardiovascular event (MACE) even when subjects with diabetes mellitus at baseline were excluded from the analysis (hazard ratio = 1.522 [1.086-2.135]; P = 0.015 for trend). In addition, among subjects classified as "low risk" (CV risk <20% at 10 years corresponding to <9% at 4.3 years) by Progetto Cuore, a receiving operating curve (ROC) analysis for ARIC (vs. MACE) allowed the identification of a threshold of 0.22, which had a positive predictive value for 4.3-year MACE of 9%. Applying the ARIC score (with a threshold of 0.22) to Progetto Cuore "low-risk" subjects, we could classify as "at high risk" 89.8% of subjects with incident MACE vs. 79.6% with Progetto Cuore only. In patients with ED, identifying prediabetes, even with algorithms, predicts long-term CV events.

Risk Factors Associated with Primary and Secondary Reduced Libido in Male Patients with Sexual Dysfunction

Hypoactive sexual desire is defined as a persistent or recurrent deficient or absent sexual fantasies or desire for sexual activity that should not be comorbid with other medical conditions or with the use of psychoactive medications. Reduced libido is a symptom referring more to a reduction in sexual drive for sexual activity. To investigate the risk factors of primary reduced libido (i.e., not associated with conditions causing loss of libido such as hypogonadism, hyperprolactinemia, psychopathology, and/or psychoactive medications) or secondary reduced libido (i.e., with aforementioned conditions) in male patients with sexual dysfunction. A consecutive series of 3,714 men (mean age 53.2 ± 12.5 years) was retrospectively studied. Patient's reduced libido was evaluated using question #14 of structured interview for erectile dysfunction (SIEDY) ("Did you have more or less desire to make love in the last 3 months?"). Reduced libido was comorbid with erectile dysfunction, premature ejaculation, and delayed ejaculation in 38%, 28.2%, and 50%, respectively, whereas it was isolated in 5.1%. Reduced libido prevalence was substantially increased by hypogonadism, almost doubled by psychopathology and universally present in subjects with hyperprolactinemia (secondary reduced libido). Subjects with primary reduced libido are characterized by higher postschool qualification, more disturbances in domestic and dyadic relationships, and an overall healthy body (lower glycemia and triglyceride levels). Accordingly, in patients with primary reduced libido, the risk of major cardiovascular events as calculated with the Progetto Cuore algorithm was lower than in the rest of the sample. Features of hypogonadism- or psychopathology-associated reduced libido essentially reflect their underlying conditions. Comorbidity with other sexual dysfunctions did not affect the main characteristics of primary or secondary reduced libido. Primary and secondary reduced libido have different risk factors and clinical characteristics. Recognizing primary or secondary reduced libido will help clinicians to identify comorbidities and to tailor appropriate treatments.

Awareness, treatment, and control of major cardiovascular risk factors in a small-scale Italian community: results of a screening campaign

IntroductionHypertension, hypercholesterolemia, and diabetes are the main causes of cardiovascular diseases in developed countries. However, these conditions are still poorly recognized and treated.ObjectiveThis study aimed at estimating the prevalence, awareness, treatment, and control rates of major cardiovascular risk factors in an unselected sample of individuals of a small community located in northern Italy.MethodsWe screened 344 sequential subjects in this study. Data collection included family and clinical history, anthropometric data, blood pressure, blood glucose, and serum cholesterol values. Individual cardiovascular risk profiles were assessed by risk charts of the Progetto Cuore.ResultsBased on personal history and/or measured values, 78.2% of subjects had hypercholesterolemia (total cholesterol levels > 190 mg/dL), 61.0% had central obesity (waist circumference ≥ 94 cm for men and ≥80 cm for women), 51.2% had arterial hypertension (blood pressure ≥ 140/90 mmHg), 8.1% had diabetes (blood glucose ≥ 126 mg/dL), 22.7% had impaired fasting glucose (blood glucose 100–125 mg/dL), and 35.5% were overweight (body mass index 25–29 kg/m2). Alcohol drinkers and smokers accounted for 46.2% and 22.4% of subjects, respectively. Awareness of hypertension, hypercholesterolemia, and diabetes was poor, and control of these risk factors, except for diabetes, was even worse. Prevalence of high blood pressure, high serum cholesterol, overweight, and obesity significantly increased with aging. Hypercholesterolemia and obesity were significantly more common in women, while overweight and diabetes in men. In 15.4% of participants, the risk of a major cardiovascular event in the next 10 years was either high or very high.ConclusionIn a small community in a wealthy region of Italy, the prevalence of major cardiovascular risk factors is high, while awareness, treatment, and control are poor. Such a result highlights the importance of screening campaigns as a strategy to improve early diagnosis and access to treatment, and thus effective prevention of cardiovascular diseases in the general population.