Secondary Prevention and Extreme Cardiovascular Risk Evaluation (SEVERE-1), Focus on Prevalence and Associated Risk Factors: The Study Protocol

INTRODUCTION

Despite significant improvement in secondary CardioVascular (CV) preventive strategies, some acute and chronic coronary syndrome (ACS and CCS) patients will suffer recurrent events (also called "extreme CV risk"). Recently new biochemical markers, such as uric acid (UA), lipoprotein A [Lp(a)] and several markers of inflammation, have been described to be associated with CV events recurrence. The SEcondary preVention and Extreme cardiovascular Risk Evaluation (SEVERE-1) study will accurately characterize extreme CV risk patients enrolled in cardiac rehabilitation (CR) programs.

AIM

 Our aims will be to describe the prevalence of extreme CV risk and its association with newly described biochemical CV risk factors.

AIM

Our aims will be to describe the prevalence of extreme CV risk and its association with newly described biochemical CV risk factors.

METHODS

We will prospectively enrol 730 ACS/CCS patients at the beginning of a CR program. Extreme CV risk will be retrospectively defined as the presence of a previous (within 2 years) CV events in the patients' clinical history. UA, Lp(a) and inflammatory markers (interleukin-6 and -18, tumor necrosis factor alpha, C-reactive protein, calprotectin and osteoprotegerin) will be assessed in ACS/CCS patients with extreme CV risk and compared with those without extreme CV risk but also with two control groups: 1180 hypertensives and 765 healthy subjects. The association between these biomarkers and extreme CV risk will be assessed with a multivariable model and two scoring systems will be created for an accurate identification of extreme CV risk patients. The first one will use only clinical variables while the second one will introduce the biochemical markers. Finally, by exome sequencing we will both evaluate polygenic risk score ability to predict recurrent events and perform mendellian randomization analysis on CV biomarkers.

CONCLUSIONS

Our study proposal was granted by the European Union PNRR M6/C2 call. With this study we will give definitive data on extreme CV risk prevalence rising attention on this condition and leading cardiologist to do a better diagnosis and to carry out a more intensive treatment optimization that will finally leads to a reduction of future ACS recurrence. This will be even more important for cardiologists working in CR that is a very important place for CV risk definition and therapies refinement.

How can resilience moderate the effects of the COVID-19 pandemic on mental health?

Introduction

The COVID-19 pandemic represents a new form of trauma, which is impacting on the mental health of the general population. However, the effects of this new trauma are variable, being mediated by individual factors such as the levels of resilience and the coping strategies.

Objectives

The aims of the present study are: 1) describe the levels of resilience and the type of coping strategies adopted by the Italian general adult population during the first wave of the pandemic; 2) evaluate the protective role of coping strategies and resilience on the levels of depressive, anxiety and stress symptoms.

Methods

An online survey has been developed, which includes several validated self-reported questionnaires for the evaluation of participants’ mental health condition, coping strategies and levels of resilience. The main outcome measure is the Depression Anxiety and Stress Scale-21 (DASS-21).

Results

The finale sample consists of 20,720 participants, more than half reported low levels of resilience, which were not associated with age or gender. The levels of resilience did not differ among the general population, patients with pre-existing mental disorders and those infected by COVID-19. People with low levels of resilience rarely used adaptive coping strategies. The levels of resilience did not have any influence on stress, depressive or anxiety symptoms.

Conclusions

The presence of low levels of resilience in the general population may be the missing link between the pandemic and increasing concerns on mental health problems. This could be important for the development of ad-hoc supportive and preventive psychosocial interventions.

Disclosure

No significant relationships.

P364 IMPORTANCE OF URIC ACID THRESHOLD IN ITS CORRELATION WITH METABOLIC SYNDROME

Background

The relationship between Hyperuricemia and Cardiovascular risk has been established but whether or not a correlation between Serum Uric Acid (SUA) and Metabolic Syndrome (MS) exists is still a matter of debate. Indeed whether SUA level is part of MS diagnosis or just a pure marker of an unfavourable metabolic profile has not been demonstrated. Besides it’s unknown whether SUA’s addition to MS definition makes a difference in terms of prognosis. In our study we focused on evaluating in a group of hypertensive patients, the correlation between MS diagnosis and SUA defined with two different cut–off: 1) ≥6 mg/dL for women and ≥7 for men (classic cut–off); 2) >5.6 mg/dL for both sexes (recently proposed by the URRAH Project).

Methods

We enrolled 473 Hypertensive patients followed by the Hypertension Unit of San Gerardo Hospital (Monza, Italy), in which SUA was measured. Patients with Hyperuricemia were identified according to the two different thresholds. NCEP–ATP–III criteria were used for diagnosis of MS.

Results

MS was diagnosed in 33.6% while Hyperuricemia was found in 14.8% of subjects according to the traditional cut–off and 35.9% according to URRAH study’s cut–off. Hyperuricemia and MS coexist in 9.7% (traditional cut–off) and 17.3% (URRAH’s threshold) of the population. Hyperuricemia was more frequent in MS than in non–MS subjects (29 vs 7.6%, p–value<0.0001 for cut–off 6/7 mg/dL and 51.6 vs 28.0%, p–value<0.0001 for cut–off 5.6 mg/dL). Linear regression models showed that SUA is related to MS diagnosis (β = 1.597, p–value<0.0001). At logistic analysis Hyperuricemia was strongly related to MS when defined by the HURRAH‘s cut–off (OR = 0.303, p–value<0.0001). The same relation is weak, although significan, when Hyperuricemia was defined by the classic cut–off (OR = 0.182, p–value<0.0001).

Conclusions

Hyperuricemia is related with MS diagnosis especially when defined by the recently defined cut–off of 5.6 mg/dL.

Identification of risk-factors for the development of depressive symptoms in perinatal period: A longitudinal study

Introduction

Perinatal depression is a severe and disabling condition, which affects negatively both mothers’ and children’s mental health and well-being. About 12.8% of pregnant women report depressive symptoms in the perinatal period.

Objectives

The aims of the present study are to: 1) identify factors (socio-demographic and clinical) associated with an increased risk of developing PD; 2) promote a screening program on PD.

Methods

All pregnant women were assessed at each trimester of pregnancy, three days after the childbirth and after 1, 3, 6 and 12 months, with the Edinburgh Postpartum Depression Scale (EPDS). Women scoring ≥10 on the EPDS were invited to receive a full psychiatric evaluation to confirm the diagnosis.

Results

420 women were recruited. 52.9%, 27.6% and 31.6% of participants presented an EPDS≥ 10 score at The I, II and III trimester of pregnancy, respectively. The percentage of patients with and EPS score ≥19 is 16.6%, 6.8%, 6.8%, 11.3% and 7.8% in 3 days following the childbirth and after 3, 6, 9 and 12 months, respectively. Higher EPDS scores are predicted by the presence of anxiety symptoms before pregnancy and of depressive and anxiety symptoms in previous pregnancies (p<0.05). Women with family conflicts and with anxiety symptoms in the partner are more likely to report higher EPDS scores (p<0.001).

Conclusions

Our results confirm that perinatal depression is a highly prevalent condition. An early identification of depressive symptoms during this period is crucial in order to reduce the long-term negative impact on the mothers, the newborn and other family members.

Disclosure

No significant relationships.

The role of affective temperaments in predicting symptom severity in bipolar disorder

Introduction

Bipolar disorder (BD) is one of the most burdensome psychiatric illnesses, being associated with a negative long-term outcome and high suicide rate. Although affective temperaments are considered possible mediators of outcome, their role on the course and outcome of BD remains poorly studied.

Objectives

The aims of the present study are to describe the clinical characteristics of patients with BD more frequently associated with the different affective temperaments and to verify which affective temperaments are associated with a more severe clinical picture in a sample of patients with BD.

Methods

All patients with BD referring to the outpatient units of two Italian university sites have been recruited. Patients’ psychiatric symptoms, affective temperaments, and quality of life were investigated through validated assessment instruments.

Results

199 patients were recruited. 54.8% of patients had a diagnosis of bipolar I disorder. 56.8% of the sample reported at least one episode of aggressive behaviours and 30.2% of suicidal attempt. Predominant cyclothymic and irritable temperaments predicted more frequent relapses, a poorer quality of life (p<;0.05), more aggressive behaviours and suicide attempts (p<;0.01). The predominant hyperthymic disposition was a protective factor for several outcome measures, including relapses and suicidality (p<;0.01), and was correlated with a less severity of psychiatric symptoms and later age at onset (p<;0.05).

Conclusions

Early identification of affective temperaments in BD patients can help clinicians to identify those who could show a worse prognosis. A screening of affective temperaments can be useful to develop early targeted integrated pharmacological and psychosocial interventions.

Disclosure

No significant relationships.

Study of the 4He(4He,4He)4He* inelastic scattering at the MAGNEX facility

The 4He(4He,4He)4He* inelastic scattering was revisited in a new coincidence measurement at the MAGNEX facility of Istituto Nazionale di Fisica Nucleare – Laboratori Nazionali del Sud. The 4He + 4He → 4He + 4He* → 4He + 3H + 1H and 4He + 4He → 4He + 4He* → 4He + 3He + n reactions were measured simultaneously by detecting the 4He particles at the MAGNEX magnetic spectrometer in coincidence with the 3H and 3He at the OSCAR silicon telescope. The main concept of the experiment is described and the data reduction strategy is reported.

Glomus coccygeum: a review

With limited information about the coccygeal glomus found in classic textbooks, we deemed it necessary to review the subject. The illustrations presented in this article derive from four coccygeal glomera incidentally encountered during examination of pilonidal disease specimens. Familiarization with its microanatomical features may help to avoid inappropriate interpretation of this enigmatic structure.

Induction of a preferred sense of twist in flexible diphenyls by carbohydrate scaffolds. Synthesis of two "naked" ellagitannin analogous

The synthesis of "naked" ellagitannin analogues 1 and 2, having a preferred sense of twist of the diphenyl moiety, with a rhamnose and a glucose template, is reported. A clear induction in the chirality of the diphenyl moiety, mediated through a 10-membered ring via ester linkages, was observed. The chiral scaffold of glucose (diequatorial 2,3-hydroxyl groups) exerts a remarkable stronger atropdiastereoselective effect onto the diphenoyl group than the rhamnose ring (axial-equatorial 2,3-hydroxyl groups), according to the Schmidt-Haslam hypothesis.

[A cluster of mucolipidosis III in a village of Calabria]

The authors report three cases of patients with clinical findings of Mucolipidosis III. Contractures of joint, stiffness of the hands short stature and coarse faces were observed. The lisosomal enzyme activities in serum and leucocytes were measured. The same activities were measured in extracts and by means of cultured skin fibroblast cells. These data are concordant with literature. These patients come from a Calabrian village of 100 habitants 90% of whom have the same surname.