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Carotid atherosclerosis in severe obesity: A pilot study
XVII S.I.S.A. National Congress
337
EVALUATION OF APPROPRIATE HOSPITAL STAY I N PATIENTS W I T H ATHEROSCLEROSIS WITHOUT COMPLICATION (DRG 1 3 3 )
NUTRITIONAL AND PSYCHO'PHYSICAL (NPPR) I N OBESE PATIENTS
F Rubba,* S P a n i c o * * , S Maccarone*, L Quagliata*, M Triassi*
Savina C, Valerii B, Coletti C, Sentuti M, Castellaneta E, Tassi L, Paolini M, Donini LM, Cannella C
Dip. Scienze Mediche Preventive, Universit~ Federico II, Napoli, * * Dip. Medicina Clinica e Sperimentale, Universit~Federico II, Napoli Evaluation of health services appropriateness is becoming a crucial point of health system assessment. We analyzed appropriateness of Cardiovascular DRG 133 (Atherosclerosis without complications) using codified evaluation criteria (PRUO) in order to clarify clinical and hospital issues regarding early cardiovascular disease. We reviewed 95 clinical reports of University of Naples, Federico II, Hospital with attributed DRG 133. By using logistic regression (STATA 7), we analyzed the probability (Odds Ratio) of an appropriate hospital-day. Our results show the burden of inappropriateness for Atherosclerosis without complications under 70 years (Age 61-69 inappropriateness was 38,7%; OR of appropriate hospital day :0.87/CI 0.79-0.97) and in a long hospital stay (inappropriateness was 37.5 % over 8 days, 49% over 15 days). Data are consistent with increasing incidence of cardiovascular accidents over 70 years. Hospital role toward Atherosclerosis without complications (DRG 133) patients could be to assess global risk and to manage complications.
CAROTID ATHEROSCLEROSIS I N SEVERE OBESITY: A PILOT STUDY S Savino, C Vinci, V Bicchiega, F Nibbio, G Guzzaloni, ML Petroni, F Balzola, A Liuzzi,
RECONDITIONING
Istituto di Scienza dell'Alimentazione, Universit~di Roma "La Sapienza"; Casa di Cura "Villa delle Quercie" di Nemi (RN) Diagnosis and treatment of obesity must be performed with a complex approach. NPPR program includes a starting multidimensional evaluation (fitness, nutritional and psychological assessment) and a multi-integrated treatment (hypocaloric diet, physical reconditioning, cognitive-behavioural psychotherapy, educational program). 168 new patients were admitted to Nutritional outpatient's clinic in the second semester of 2002. Results were evaluated for three groups of patients: subjects enlisted in the NPPR (20.8%), subjects that already practised physical activity (26.2%), subjects that, besides not practising spontaneous physical activity, had not the opportunity or refused to participate to NPPR (53%). The NPPR program allowed a greater loss of weight and fat mass both in absolute value and as a ratio of weight loss. The follow-up of these subjects, conducted in 3uly 2003 through structured telephone interview, shows that subjects belonging to NPPR group had been on diet and continued physical activity for a longer time. When considering the type of treatment undergone, significant differences in maintaining of weight (substantiaLly unchanged in the 3 groups) and eating habits (meaningfully improved in all groups) were not noticed instead.
CAROTID ARTERY I N T I M A L - M E D I A L WALL THICKENING PLASMA HOMOCYSTEIN E CIRCULATING LEVELS HYPERTENSIVE PATIENTS
AND IN
Soto Parra H 1, Antico A 2, Lattanzio F3, Di I o r i o C4, Mezzetti A 1, Cipollone F 1, Bucci M 1,
IRCCS IstitutoAuxologico Ospedale San Giuseppe, Piancavallo (VB). Obesity is generally considered to be associated to increased CV risk. However, most epidemiological data have been collected in mild- to moderate-degree obese populations and might not be applicable to severe obesity. In this respect, recent study have underlined how severe obesity is characterised by a paradoxical reduction of total cholesterol when compared to obesity of minor degree. On the other side, insulin-resistance shows a linear trend with increased degree of obesity. Aim of the present study was to evaluate common carotid intima-media thickness (IMT) and diameter (CD) in a representative sample of subjects with severe obesity (BMI > 35 kg/m2) consecutively presented for a diagnostic evaluation for obesity at our Institution. We studied 73 subjects (29 M, 44 F), median age 57 years, range 28-72, median BMI 45.2 (range 35.1-54.8 kg/m2), who underwent highresolution B-mode ultrasound evaluation. Right-side IMT resulted 0.88 +/-0.27 mm in males, 0.84 +/-0.26 mm in females, while left-side IMT resulted 0.92 +/-0.29 mm and 0.90 +/- 0.27 mm, respectively. Rightside CD resulted 8.55 +/-1.06 mm in males, 8.16 +/- 1.08 mm in females; left-side CD resulted 8.72 +/-1.14 mm and 8.05 +/-1.22 mm, respectively. These values, once age- and gender-controlled, are comparable with those reported for the general population, thus suggesting that severe obesity represents a peculiar entity for what concerns atherosclerotic risk which warrants further investigation.
1Aging Research Center, University of Chieti ~/ascular Department, 3Clinical Pathology Lab., 4UCIC, Hospital of Chieti
Surgery
BACKGROUND. Moderately elevated plasma homocysteine levels (HCTL) are associated with an increased risk for cardiovascular disease, independent of classic risk facbors (RF). The relationship between HCT and hypertension is still unclear. The ultrasound evidence of arterial wall intima-media thickness (carotid IMT > 0.9 mm) or atherosclerotic plaque may influence the prognosis in hypertensive patients (HY-pts). Our aim was to evaluate circulating HCT-L in HY-pts with and without a recent cardiovascular event (secondary and primary prevention) and the relationship with intima media thickness (IMT) of carotid arteries in t~ese patients. METHODS. We enrolled 10 HY-pts in secondary prevention (after a myocardial infarction or acute coronary syndrome = PREV 2 group), with no other risk factors (RF), age (35-58 yrs) and sex matched with 10 treated HY-pts (PREV 1 group). Subjects with secondary hypertension, nephropathy and pregnancy were excluded. HCT was measured in plasma by fluorescence polarization immunoassay. IMT was assessed by hi-resolution ultrasound on both common carotid artery. RESULTS. The PREV 1 group had significantly lower HCT-L than PREV 2 group (8.92=1:2.99 umol/L, vs 12.65=1:3 umol/L, p=0.018). In the selected population of HY-pts studied as a whole, a significant correlation between HCT-L and IMT was observed (n=20, r=0.619, p=0.004). CONCLUSIONS. This study remarks the importance to known HCT-L in HY-pts with no other RF but documented IMT, because this relationship could have prognosis and treatment implication.
337
EVALUATION OF APPROPRIATE HOSPITAL STAY I N PATIENTS W I T H ATHEROSCLEROSIS WITHOUT COMPLICATION (DRG 1 3 3 )
NUTRITIONAL AND PSYCHO'PHYSICAL (NPPR) I N OBESE PATIENTS
F Rubba,* S P a n i c o * * , S Maccarone*, L Quagliata*, M Triassi*
Savina C, Valerii B, Coletti C, Sentuti M, Castellaneta E, Tassi L, Paolini M, Donini LM, Cannella C
Dip. Scienze Mediche Preventive, Universit~ Federico II, Napoli, * * Dip. Medicina Clinica e Sperimentale, Universit~Federico II, Napoli Evaluation of health services appropriateness is becoming a crucial point of health system assessment. We analyzed appropriateness of Cardiovascular DRG 133 (Atherosclerosis without complications) using codified evaluation criteria (PRUO) in order to clarify clinical and hospital issues regarding early cardiovascular disease. We reviewed 95 clinical reports of University of Naples, Federico II, Hospital with attributed DRG 133. By using logistic regression (STATA 7), we analyzed the probability (Odds Ratio) of an appropriate hospital-day. Our results show the burden of inappropriateness for Atherosclerosis without complications under 70 years (Age 61-69 inappropriateness was 38,7%; OR of appropriate hospital day :0.87/CI 0.79-0.97) and in a long hospital stay (inappropriateness was 37.5 % over 8 days, 49% over 15 days). Data are consistent with increasing incidence of cardiovascular accidents over 70 years. Hospital role toward Atherosclerosis without complications (DRG 133) patients could be to assess global risk and to manage complications.
CAROTID ATHEROSCLEROSIS I N SEVERE OBESITY: A PILOT STUDY S Savino, C Vinci, V Bicchiega, F Nibbio, G Guzzaloni, ML Petroni, F Balzola, A Liuzzi,
RECONDITIONING
Istituto di Scienza dell'Alimentazione, Universit~di Roma "La Sapienza"; Casa di Cura "Villa delle Quercie" di Nemi (RN) Diagnosis and treatment of obesity must be performed with a complex approach. NPPR program includes a starting multidimensional evaluation (fitness, nutritional and psychological assessment) and a multi-integrated treatment (hypocaloric diet, physical reconditioning, cognitive-behavioural psychotherapy, educational program). 168 new patients were admitted to Nutritional outpatient's clinic in the second semester of 2002. Results were evaluated for three groups of patients: subjects enlisted in the NPPR (20.8%), subjects that already practised physical activity (26.2%), subjects that, besides not practising spontaneous physical activity, had not the opportunity or refused to participate to NPPR (53%). The NPPR program allowed a greater loss of weight and fat mass both in absolute value and as a ratio of weight loss. The follow-up of these subjects, conducted in 3uly 2003 through structured telephone interview, shows that subjects belonging to NPPR group had been on diet and continued physical activity for a longer time. When considering the type of treatment undergone, significant differences in maintaining of weight (substantiaLly unchanged in the 3 groups) and eating habits (meaningfully improved in all groups) were not noticed instead.
CAROTID ARTERY I N T I M A L - M E D I A L WALL THICKENING PLASMA HOMOCYSTEIN E CIRCULATING LEVELS HYPERTENSIVE PATIENTS
AND IN
Soto Parra H 1, Antico A 2, Lattanzio F3, Di I o r i o C4, Mezzetti A 1, Cipollone F 1, Bucci M 1,
IRCCS IstitutoAuxologico Ospedale San Giuseppe, Piancavallo (VB). Obesity is generally considered to be associated to increased CV risk. However, most epidemiological data have been collected in mild- to moderate-degree obese populations and might not be applicable to severe obesity. In this respect, recent study have underlined how severe obesity is characterised by a paradoxical reduction of total cholesterol when compared to obesity of minor degree. On the other side, insulin-resistance shows a linear trend with increased degree of obesity. Aim of the present study was to evaluate common carotid intima-media thickness (IMT) and diameter (CD) in a representative sample of subjects with severe obesity (BMI > 35 kg/m2) consecutively presented for a diagnostic evaluation for obesity at our Institution. We studied 73 subjects (29 M, 44 F), median age 57 years, range 28-72, median BMI 45.2 (range 35.1-54.8 kg/m2), who underwent highresolution B-mode ultrasound evaluation. Right-side IMT resulted 0.88 +/-0.27 mm in males, 0.84 +/-0.26 mm in females, while left-side IMT resulted 0.92 +/-0.29 mm and 0.90 +/- 0.27 mm, respectively. Rightside CD resulted 8.55 +/-1.06 mm in males, 8.16 +/- 1.08 mm in females; left-side CD resulted 8.72 +/-1.14 mm and 8.05 +/-1.22 mm, respectively. These values, once age- and gender-controlled, are comparable with those reported for the general population, thus suggesting that severe obesity represents a peculiar entity for what concerns atherosclerotic risk which warrants further investigation.
1Aging Research Center, University of Chieti ~/ascular Department, 3Clinical Pathology Lab., 4UCIC, Hospital of Chieti
Surgery
BACKGROUND. Moderately elevated plasma homocysteine levels (HCTL) are associated with an increased risk for cardiovascular disease, independent of classic risk facbors (RF). The relationship between HCT and hypertension is still unclear. The ultrasound evidence of arterial wall intima-media thickness (carotid IMT > 0.9 mm) or atherosclerotic plaque may influence the prognosis in hypertensive patients (HY-pts). Our aim was to evaluate circulating HCT-L in HY-pts with and without a recent cardiovascular event (secondary and primary prevention) and the relationship with intima media thickness (IMT) of carotid arteries in t~ese patients. METHODS. We enrolled 10 HY-pts in secondary prevention (after a myocardial infarction or acute coronary syndrome = PREV 2 group), with no other risk factors (RF), age (35-58 yrs) and sex matched with 10 treated HY-pts (PREV 1 group). Subjects with secondary hypertension, nephropathy and pregnancy were excluded. HCT was measured in plasma by fluorescence polarization immunoassay. IMT was assessed by hi-resolution ultrasound on both common carotid artery. RESULTS. The PREV 1 group had significantly lower HCT-L than PREV 2 group (8.92=1:2.99 umol/L, vs 12.65=1:3 umol/L, p=0.018). In the selected population of HY-pts studied as a whole, a significant correlation between HCT-L and IMT was observed (n=20, r=0.619, p=0.004). CONCLUSIONS. This study remarks the importance to known HCT-L in HY-pts with no other RF but documented IMT, because this relationship could have prognosis and treatment implication.