European Journal of Internal Medicine最新文献

{"title":"Clinical characteristics and outcomes of Takotsubo syndrome in patients with chronic obstructive pulmonary disease.","authors":"Luca Arcari, Giacomo Tini, Michela Zuccanti, Giovanni Camastra, Alessandro Cianca, Emanuela Belmonte, Giulio Montefusco, Riccardo Scirpa, Claudia Malerba, Fabrizio Lupparelli, Matteo Sclafani, Viviana Maestrini, Beatrice Musumeci, Emanuele Barbato, Luca Cacciotti","doi":"10.1016/j.ejim.2024.10.026","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.10.026","url":null,"abstract":"<p><strong>Background: </strong>takotsubo syndrome (TTS) is an acute heart failure syndrome characterized by a relevant comorbid background, including chronic obstructive pulmonary disease (COPD). However, TTS patients with COPD are still not well characterized.</p><p><strong>Aim: </strong>to describe the clinical characteristics and outcomes of patients with TTS and COPD.</p><p><strong>Methods: </strong>n = 440 TTS patients were dichotomized according to the presence of COPD. Endpoint of the study were in-hospital complications (composite of death, major arrhythmias, cardiogenic shock and acute pulmonary edema), TTS recurrence and long-term mortality at follow-up.</p><p><strong>Results: </strong>mean age of the population was 72±11, 10 % males. COPD prevalence was 16 % (n = 69). On subgroup analysis, patients with COPD were more likely smokers (41 % vs 13 %, p < 0.001), with higher rates of dyspnea and physical triggers at presentation (52 % vs 18 %, p < 0.001 and 52 % vs 32 %, p = 0.001 respectively) and lower left ventricular ejection fraction (36 % vs 39 %, p = 0.035) In-hospital complications were more common in patients with COPD (26 % vs 13 %, p = 0.006), driven by higher rates of acute pulmonary edema (19 % vs 6 %, p < 0.001) and cardiogenic shock (10 % vs 4 %, p = 0.023). At multivariable logistic regression analysis, COPD was independently associated with in-hospital complications occurrence (Odds Ratio 2.10, 95 % CI 1.09-4.05; p = 0.027). At univariable Cox regression analysis COPD was associated with TTS recurrence (Hazard Ratio (HR 9.82, 95 % CI 3.2-30.12; p < 0.001)), at multivariable Cox regression analysis with long-term mortality (HR 2.97, 95 % CI 1.44-6.12; p = 0.003).</p><p><strong>Conclusion: </strong>COPD marks a vulnerable TTS phenotype including higher risk of in-hospital complications, long-term recurrence and mortality.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modifiable lifestyle factors in the primordial prevention of hypertension in three US cohorts.","authors":"Rikuta Hamaya, Molin Wang, Ellen Hertzmark, Nancy R Cook, JoAnn E Manson, Qi Sun, Meir J Stampfer, Kenneth J Mukamal, Gary Curhan, Eric B Rimm","doi":"10.1016/j.ejim.2024.10.028","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.10.028","url":null,"abstract":"<p><strong>Background: </strong>Evidence is lacking on the relative contributions of specific lifestyle factors and their overall contribution to prevention of hypertension, in particular early-onset hypertension.</p><p><strong>Methods: </strong>This prospective cohort study included participants of the Nurses' Health Study (NHS, N = 52,780 women, aged 40-67 in 1986), the NHS II (N = 83,871 women, aged 27-46 in 1991), and the Health Professionals Follow-up Study (HPFS, N = 31,269 men, aged 40-75 in 1986), who were free from hypertension, cardiovascular disease and cancer at baseline. Four modifiable lifestyles were evaluated based on hypertension guidelines: BMI, moderate-to-vigorous physical activity, Dietary Approaches to Stop Hypertension (DASH) score, and alcohol intake. Primary outcome was incident self-reported diagnosis of hypertension with 27-31 years of follow-up.</p><p><strong>Results: </strong>Each lifestyle factor was associated with incident hypertension in dose-dependent manners across the cohorts, with BMI having the strongest associations. On average, adhering to BMI <25 kg/m² was associated with 20.3 [18.5, 22.0], 25.0 [23.2, 26.8], and 18.6 [16.7, 20.7] months longer periods free from hypertension during 25-year follow-up in each cohort respectively. BMI accounted for approximately 20 % of incident hypertension in NHS and HPFS, and 35 % of early-onset hypertension (age < 55 y). Moderate-to-vigorous physical activity and diet accounted for 10-15 % of incident hypertension in women, and the contributions were greater for early-onset hypertension.</p><p><strong>Conclusion: </strong>Healthy weight during adulthood was most substantially associated with incident hypertension among lifestyle factors, but diet, physical activity, and alcohol intake were also related to the risk across all ages, and hypertension-free periods, with stronger associations in early-onset hypertension.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to the 2019 ESC/EAS guidelines for dyslipidaemia management in a large rheumatoid arthritis cohort: Data from the CORDIS Study Group of the Italian Society of Rheumatology.","authors":"Fabio Cacciapaglia, Francesca Romana Spinelli, Gian Luca Erre, Matteo Piga, Garifallia Sakellariou, Andreina Manfredi, Marco Fornaro, Ombretta Viapiana, Simone Perniola, Elisa Gremese, Fabiola Atzeni, Elena Bartoloni","doi":"10.1016/j.ejim.2024.10.029","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.10.029","url":null,"abstract":"<p><strong>Background/aim: </strong>Lipid-lowering therapy prescription is low in rheumatoid arthritis (RA) patients, often not achieving lipid threshold target despite treatment. However, evidence derives from small, monocentric cohorts. We assessed adherence to lipid-lowering treatment for primary cardiovascular (CV) prevention in a RA cohort according to international guidelines.</p><p><strong>Methods: </strong>A cross-sectional analysis of an Italian RA cohort was performed. Disease-related features and traditional CV risk factors were collected. The 10-year CV risk was estimated by Systematic COronary Risk Evaluation 2 (SCORE-2) algorithm. The primary preventive dyslipidaemia strategy was assessed according to 2019 European Society of Cardiology/European Atherosclerosis Society guidelines.</p><p><strong>Results: </strong>1.133 RA patients (78.2% female, aged 60.6±10.2 years) free from CV events were included. According to SCORE-2, 42.9% of patients were at moderate risk (1-5-%), 33.3% at high risk (5-10%) and 23.7% at very high risk (>10%). In the whole cohort, 12.9% of patients with <5%, 23.6% with 5-10% and 32.3% with >10% risk were on statin, respectively (p<0.001). According to 2019 ESC/EAS guidelines, 51.5% of patients had LDL-c at target. Among patients with LDL-c not at target, 76% were not on lipid-lowering treatment. At multivariate analysis, patients with higher CV risk had significantly lower probability of LDL-c at target.</p><p><strong>Conclusion: </strong>In a wide Italian RA cohort, more than 50% of patients had high or very high CV risk. In these, lipid-lowering treatment prescription is suboptimal leading to not achievement of LDL-c target. Physicians should improve lipid screening and primary prevention therapy to reduce CV risk and improve CV comorbidity in RA patients.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The new ESC 2024 guidelines on the management of peripheral arterial and aortic diseases: Lights and shadows.","authors":"Claudio Cimminiello, Mauro Molteni","doi":"10.1016/j.ejim.2024.10.025","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.10.025","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New strategies for the treatment of hyperkalemia.","authors":"Stefano Masi, Herman Dalpiaz, Sara Piludu, Federica Piani, Giulia Fiorini, Claudio Borghi","doi":"10.1016/j.ejim.2024.10.016","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.10.016","url":null,"abstract":"<p><p>Renin-angiotensin-aldosterone system inhibitors (RAASi) and mineralocorticoid receptor antagonists (MRAs) are key drugs in the management of patients with cardiovascular diseases (CVD), particularly those with hypertension, diabetes, chronic kidney disease and heart failure (HF), given their demonstrated effectiveness in reducing the risk of both surrogate and hard endpoints. Despite their positive impact on the outcome, patients with RAASi and MRAs are particularly vulnerable to hyperkalaemia, with approximately 50 % of these individuals experiencing two or more recurrences annually. The common practice of reducing the dose or discontinuing the treatment with RAASi and MRAs in conditions of hyperkalaemia results in suboptimal management of these patients, with a potential impact on their mortality and morbidity risk. Recent guidelines from cardiovascular and renal international societies increasingly recognize the need for alternative strategies to manage the risk of hyperkalaemia, allowing the continuation of RAASi and MRA therapies. In this review, we summarise the new potential options available to manage hyperkalaemia in patients with CVD and the recommendations of the most recent guidelines on the topic.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution and outcomes of aortic dilations in giant cell arteritis","authors":"","doi":"10.1016/j.ejim.2024.03.038","DOIUrl":"10.1016/j.ejim.2024.03.038","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify factors associated with the progression of giant cell arteritis (GCA)-related or associated aortic dilations.</div></div><div><h3>Methods</h3><div>In this retrospective study, 47 GCA patients with aortic dilation were longitudinally analyzed. Each patient underwent ≥2 imaging scans of the aorta during the follow-up. Three progression statuses of aortic dilations were distinguished: fast-progressive (FP) defined by a progression of the aortic diameter ≥5 mm/year or ≥1 cm/2 years, slow progressive (SP) by a progression of the aortic diameter &gt;1 mm during the follow-up, and not progressive (NP) when aortic diameter remained stable.</div></div><div><h3>Results</h3><div>Among the 47 patients with aortic dilation, the thoracic section was involved in 87 % of patients. Within a total follow-up of 89 [6–272] months, we identified 13 (28 %) patients with FP dilations, and 16 (34 %) and 18 (38 %) patients with SP and NP dilations, respectively. No differences regarding baseline characteristics, cardiovascular risk factors or treatments were observed among the 3 groups. However, FP patients more frequently showed atheromatous disease (<em>p</em> = 0.04), with a more frequent use of statins (<em>p</em> = 0.04) and antiplatelet agents (<em>p</em><span> = 0.02). Among the 27 (57 %) patients with aortitis, aortic dilation developed on an inflammatory segment in 23 (85 %). Among the FP patients who underwent aortic surgery with available histology (</span><em>n</em> = 3), all presented active vasculitis.</div></div><div><h3>Conclusion</h3><div>This study suggests that aortic inflammation, as well as atheromatous disease, might participate in the fast progression of aortic dilation in GCA.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"129 ","pages":"Pages 71-77"},"PeriodicalIF":5.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary hypertension associated to left heart disease: Phenotypes and treatment","authors":"Rosalinda Madonna ,&nbsp;Filippo Biondi ,&nbsp;Sandra Ghelardoni ,&nbsp;Alberto D'Alleva ,&nbsp;Stefano Quarta ,&nbsp;Marika Massaro","doi":"10.1016/j.ejim.2024.07.030","DOIUrl":"10.1016/j.ejim.2024.07.030","url":null,"abstract":"<div><div>Pulmonary hypertension associated to left heart disease (PH-LHD) refers to a clinical and haemodynamic condition of pulmonary hypertension associated with a heterogeneous group of diseases affecting any of the compartments that form the left ventricle and left atrium. PH-LHD is the most common cause of PH, accounting for 65–80 % of diagnoses. Based on the haemodynamic phase of the disease, PH-LDH is classified into three subgroups: postcapillary PH, isolated postcapillary PH and combined pre-postcapillary PH (CpcPH). Several signaling pathways involved in the regulation of vascular tone are dysfunctional in PH-LHD, including nitric oxide, MAP kinase and endothelin-1 pathways.</div><div>These pathways are the same as those altered in PH group 1, however PH-LHD can heardly be treated by specific drugs that act on the pulmonary circulation.</div><div>In this manuscript we provide a state of the art of the available clinical trials investigating the safety and efficacy of PAH-specific drugs, as well as drugs active in patients with heart failure and PH-LHD. We also discuss the different phenotypes of PH-LHD, as well as molecular targets and signaling pathways potentially involved in the pathophysiology of the disease. Finally we will mention some new emerging therapies that can be used to treat this form of PH.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"129 ","pages":"Pages 1-15"},"PeriodicalIF":5.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behaviour therapy for obesity in older adults.","authors":"Meltem Koca, Laurence J Dobbie, Andreea Ciudin, Meltem Halil","doi":"10.1016/j.ejim.2024.10.022","DOIUrl":"https://doi.org/10.1016/j.ejim.2024.10.022","url":null,"abstract":"<p><p>Obesity presents a significant public health challenge, with a growing prevalence among older adults and addressing obesity in older adults presents unique challenges. Behaviour therapy is a cornerstone in obesity management, yet its application in older populations, is underexplored. This narrative review, based on the current literature, examines the role of behavioural change techniques (BCTs) in addressing obesity in older adults, highlighting the need for tailored interventions that consider age-related challenges. BCTs are integral in promoting long-term behaviour change, enhancing self-management, and ensuring adherence to treatment plans. While existing evidence suggests the efficacy of several BCTs such as self-monitoring, goal setting, motivational interviewing, and social support in obesity management, further research is needed to understand their impact in older age groups with multimorbidity and combinations of geriatric syndromes. The impact of these techniques may vary based on factors such as patients' clinical features, cognitive function, sensory deficits, social factors and psychological aspects unique to aging individuals. Therefore, the design and implementation of BCTs in this population require careful evaluation and customization. Tailored interventions that consider the unique needs of this population, such as preserving muscle mass and addressing functional limitations, are essential. Future research should focus on large-scale, well-designed trials to elucidate the optimal BCTs for older individuals, ensuring interventions are diverse and inclusive to meet the needs of older adults with obesity.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive performance of hepatocellular carcinoma risk scores in chronic hepatitis C patients with advanced fibrosis after achieving sustained virological response: Insights from European Association for the study of the Liver Policy recommendations","authors":"Riham Soliman,&nbsp;James Lok,&nbsp;Saima Ajaz,&nbsp;Kosh Agarwal,&nbsp;María Guerra","doi":"10.1016/j.ejim.2024.08.018","DOIUrl":"10.1016/j.ejim.2024.08.018","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"129 ","pages":"Pages 155-157"},"PeriodicalIF":5.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabis is probably not the best choice for weight reduction","authors":"Ran Abuhasira","doi":"10.1016/j.ejim.2024.09.001","DOIUrl":"10.1016/j.ejim.2024.09.001","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"129 ","pages":"Pages 28-29"},"PeriodicalIF":5.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}