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Simona Giampaoli

Publications and source records attributed to Simona Giampaoli.

32 records · Page 2Linked to original sources
PubMed2004

Magnetic resonance imaging of the brain in diabetes: the Cardiovascular Determinants of Dementia (CASCADE) Study.

Diabetic patients are at increased risk for stroke, but little is known about the presence of other brain lesions. We studied the association of magnetic resonance imaging-detected brain lesions to diabetes in 1,252 individuals aged 65-75 years who were randomly selected from eight European population registries or defined working populations. All scans were centrally read for brain abnormalities, including infarcts, white matter lesions, and atrophy. We used a three-point scale to rate periventricular white matter lesions, and the volume of subcortical lesions was calculated according to their number and size. Subjective grading of cortical atrophy by lobe and summation of the lobar grades resulted in a total cortical atrophy score. The mean of three linear measurements of the ventricular diameter relative to the intracranial cavity defined the severity of subcortical atrophy. After adjustment for possible confounders, diabetes was associated with cortical brain atrophy but not with any focal brain lesions or subcortical atrophy. There was a strong interaction of diabetes and hypertension, such that the association between diabetes and cortical atrophy existed only in hypertensive but not in normotensive participants. Cognitive and pathological data are needed to determine the clinical significance of these findings as well as to understand the mechanisms underlying these associations.

Aged↗
PubMed2004

[The global cardiovascular risk chart].

BACKGROUND: Risk charts, built through risk functions deriving from longitudinal studies, are used in order to identify individuals at high risk for cardiovascular disease. For this reason the function has been identified and the global cardiovascular risk chart of the CUORE Project has been prepared, using Italian data coming from different cohorts enrolled between the '80s and the '90s, whose risk factors had been collected by standardized procedures. METHODS: The following risk factors have been used: age (10-year period, 40-49, 50-59, 60-69 years), gender (men and women), systolic blood pressure (< or = 129, 130-149, 150-169, > or = 170 mmHg), serum cholesterol (< or = 173, 174-212, 213-251, 252-290, > or = 291 mg/dl), smoking habit (yes, no) and presence of diabetes (yes, no); the first coronary or cerebrovascular event in people aged 40-69 years with no other previous cardiovascular events was considered as endpoint; survival has been assessed up to December 1998. RESULTS: Out of 18,028 people aged 40-69 years with no previous cardiovascular events, 647 first major cardiovascular events have been identified and validated, 449 coronary and 198 cerebrovascular. Charts are divided according to men and women and to diabetics and non-diabetics respectively; the different colors represent the percent level of risk and go from light green (< 5% in 10 years for men, < 1% in 5 years for women), dark green (between 5 and 10% for men, between 1 and 3% for women), yellow (between 10 and 15% for men, between 3 and 5% for women), orange (between 15 and 20% for men, between 5 and 7% for women), red (between 20 and 30% for men, between 7 and 10% for women), violet (> 30% for men, > 10% for women). CONCLUSIONS: The risk charts were built with data collected in recent years on men and women with a median follow-up of 10 years for men and 5 years for women, considering the first major fatal or non-fatal cardiovascular event as endpoint. Such a tool is easy to be applied by general practitioners and cardiologists in order to achieve a fast and objective evaluation of global cardiovascular risk.

Adult↗
PubMed2004

[Diabetes in Italy: a public health problem].

BACKGROUND: Type 2 diabetes is the most frequent form of diabetes in the adult population and is associated with an increasing risk of cardiovascular diseases. The objective of this study was to describe the prevalence and the state of control in an Italian population sample examined within the Osservatorio Epidemiologico Cardiovascolare study. METHODS: The sample of this study consisted in 8972 subjects, men and women aged 35-74 years. A fasting capillary blood glucose > or = 126 mg/dl or being on antidiabetic treatment were the criteria used to define diabetes, while a fasting capillary blood glucose < 140 mg/dl was considered to represent effective treatment (controlled diabetes) in treated patients. RESULTS: Diabetes was present in 8.4% of men and 6% in women. The prevalence of glucose intolerance was 8.2% in men and 4.3% in women. Only 50.7% of diabetic men and 56.5% of diabetic women knew about their disease; among these people, 21% was on treatment with oral antidiabetics and/or insulin. Such a therapy was effective in 39.5% of the treated cases. CONCLUSIONS: The prevalence of diabetes as well as glucose intolerance was greater in men and in the regions of the Center and South of Italy. The state of control of diabetes cannot be considered satisfactory; women and older age groups, when prevention strategies are less important, appear to be under better care.

Administration, Oral↗
PubMed2004

[Evaluation of the global cardiovascular absolute risk: the Progetto CUORE individual score].

To identify individuals at high risk for cardiovascular disease, the function of the Progetto CUORE has been identified and the global cardiovascular risk score has been built using data from different cohorts enrolled in the North, Center and South of Italy between the 80s and the 90s, whose risk factors had been collected using standardised procedures. A follow-up with a median duration of 9.5 years for men and 8.0 years for women has been achieved. Age, systolic blood pressure, total cholesterol, HDL-cholesterol, smoking habit, diabetes and hypertension treatment have been included in the function; the first major coronary or cerebrovascular event was considered as endpoint; 10-year survival has been assessed both for men and women. Out of 20 647 people aged 35-69 years with no previous cardiovascular events, 971 major cardiovascular events (636 coronary and 335 cerebrovascular) have been identified and validated. Risk factors coefficients have been assessed using the Cox proportional hazard model separately for men and women. The individual score is easy to be applied by general practitioners and cardiologists in order to achieve a fast and objective evaluation of the absolute global cardiovascular risk in primary prevention.

Adult↗
PubMed2003

Hypertension treatment and control in five European countries, Canada, and the United States.

Levels of hypertension treatment and control have been noted to vary between Europe and North America, although direct comparisons with similar methods have not been undertaken. In this study, we sought to estimate the relative impact of hypertension treatment strategies in Germany, Sweden, England, Spain, Italy, Canada, and the United States by using sample surveys conducted in the 1990s. Hypertension was defined as a blood pressure of 160/95 mm Hg or 140/90 mm Hg, plus persons taking antihypertensive medication. "Controlled hypertension" was defined as a blood pressure less than threshold among persons taking antihypertensive medications. Among persons 35 to 64 years, 66% of hypertensives in the United States had their blood pressure controlled at 160/95 mm Hg, compared with 49% in Canada and 23% to 38% in Europe. Similar discrepancies were apparent at the 140/90 mm Hg threshold, at which 29% of hypertensives in the United States, 17% in Canada, and </=10% in European countries had their blood pressure controlled. At the 140/90 mm Hg cutpoint, two thirds to three quarters of the hypertensives in Canada and Europe were untreated compared with slightly less than half in the United States. Although guidelines vary among countries, resulting in different case definitions, this does not account entirely for the varying success of different national control efforts. Low treatment and control rates in Europe, combined with a higher prevalence of hypertension, could contribute to a higher burden of cardiovascular disease risk attributable to elevated blood pressure compared with that in North America.

Adolescent↗
PubMed2003

Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States.

CONTEXT: Geographic variations in cardiovascular disease (CVD) and associated risk factors have been recognized worldwide. However, little attention has been directed to potential differences in hypertension between Europe and North America. OBJECTIVE: To determine whether higher blood pressure (BP) levels and hypertension are more prevalent in Europe than in the United States and Canada. DESIGN, SETTING, AND PARTICIPANTS: Sample surveys that were national in scope and conducted in the 1990s were identified in Germany, Finland, Sweden, England, Spain, Italy, Canada, and the United States. Collaborating investigators provided tabular data in a consistent format by age and sex for persons at least 35 years of age. Population registries were the main basis for sampling. Survey sizes ranged from 1800 to 23 100, with response rates of 61% to 87.5%. The data were analyzed to provide age-specific and age-adjusted estimates of BP and hypertension prevalence by country and region (eg, European vs North American). MAIN OUTCOME MEASURES: Blood pressure levels and prevalence of hypertension in Europe, the United States, and Canada. RESULTS: Average BP was 136/83 mm Hg in the European countries and 127/77 mm Hg in Canada and the United States among men and women combined who were 35 to 74 years of age. This difference already existed among younger persons (35-39 years) in whom treatment was uncommon (ie, 124/78 mm Hg and 115/75 mm Hg, respectively), and the slope with age was steeper in the European countries. For all age groups, BP measurements were lowest in the United States and highest in Germany. The age- and sex-adjusted prevalence of hypertension was 28% in the North American countries and 44% in the European countries at the 140/90 mm Hg threshold. The findings for men and women by region were similar. Hypertension prevalence was strongly correlated with stroke mortality (r = 0.78) and more modestly with total CVD (r = 0.44). CONCLUSIONS: Despite extensive research on geographic patterns of CVD, the 60% higher prevalence of hypertension in Europe compared with the United States and Canada has not been generally appreciated. The implication of this finding for national prevention strategies should be vigorously explored.

Adult↗
PubMed2003

Socio-economic-position overall and cause-specific mortality in an Italian rural population.

STUDY OBJECTIVE: To investigate the association between socio-economic position, overall and cause-specific mortality, and risk factors in a sample of men and women in the Italian population. DESIGN: Cohort study. MATISS Project (Malattie Aterosclerotiche Istituto Superiore di Sanità). SETTING: Rural area, Province of Latina, Lazio, central Italy. PARTICIPANTS: Baseline data were obtained for 8512 subjects (3982 men and 4530 women), 20-75 years of age, of whom 713 died during 11 (range 2; 15) years of follow-up. Education and occupation (used as measures of socio-economic position), smoking history, alcohol consumption, health status measures, blood pressure, plasma lipids and ECGs were collected at baseline. Linear and logistic regressions were performed to examine the association between socioeconomic position and risk factors. The hazard ratios (HRs) of all-cause, CVD and cancer mortality, according to educational level and occupational categories were computed using Cox proportional hazard models. MAIN RESULTS: The lower social groups had a more adverse risk factors profile with the exception of smoking habit in women and HDL cholesterol in men. The risk of death in college educated men was 50% of that found for men with no formal education. The risk of cancer in the least educated was 60% higher than for highly educated men. No clear pattern was observed in women. The HRs were not substantially changed when controlling for potential confounding factors. In both men and women mortality did not vary by occupational class. CONCLUSIONS: The association observed between education and mortality was stronger than previously reported in Italy. This may reflect changes in risk factors profile; in particular with regard to smoking habit. The effect of changes in risk factor distribution will become apparent in future mortality and morbidity patterns.

Adult↗
PubMed2003

Self-reported disability and its association with performance-based limitation in elderly men: a comparison of three European countries.

OBJECTIVES: To compare self-reported disability and performance-based limitation and their association in elderly men from three European countries. DESIGN: Cross-sectional data from a cohort study collected around 1990. SETTING: Three cohorts from Finland, the Netherlands, and Italy. PARTICIPANTS: One thousand one hundred sixty-one men aged 70 and older. MEASUREMENTS: Disability and functional limitation were measured in a standardized way in three countries. Self-reported disability was estimated by questionnaire, assessing three domains of activities of daily living: instrumental activities of daily living, mobility, and activities of daily living (score 0-3). Functional limitation was measured by performance tests (score 0-16), with 0 indicated the healthiest score. RESULTS: Self-reported disability and performance-based limitation scores differed between countries. Mean self-reported disability score was worse in Italy (0.72) and the Netherlands (0.70) than in Finland (0.54). Italian men scored worst on the performance-based tests (mean 4.80 vs 4.04 for Finland and 3.74 for the Netherlands). Differences in self-reported disability remained after adjusting for performance scores: Dutch men reported more disabilities (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.23-2.25) than men in Finland (reference group) and Italy (OR = 1.08, 95% CI = 0.77-1.53). Self-reported disability was positively associated with performance-based score (OR = 1.28, 95% CI = 1.21-1.35) and did not differ between countries. CONCLUSION: Cross-cultural variation was noted in self-reported disability adjusted for performance score. These differences may be due to sociocultural and physical environmental factors. Self-reported disability was consistently associated with performance-based limitation in Finland, the Netherlands, and Italy.

Activities of Daily Living↗
PubMed2003

Stroke research in GenomEUtwin.

Stroke is one of the leading causes of severe disability and death in the world. In the present article we outline possibilities and limitations for future stroke research within the GenomEUtwin. The combined sample of twins born before 1958 from Denmark, Finland, and Sweden, and available for follow-up into the second millennium for non-fatal and fatal stroke events through national inpatient and death registers exceeds 70,000 twin pairs. This sample size will enable the study of genetic influences on stroke and major stroke subtypes. Large samples of twins in GenomEUtwin have been followed up repeatedly through interviews and questionnaires concerning a variety of exposures and potential risk factors for stroke. We briefly outline how this information can be combined with the health register information for epidemiologic and genetic epidemiologic studies of stroke. We also present the number of twin pairs concordant and discordant for stroke in Denmark, Finland and Sweden, and time lags between events for twins concordant for stroke. This information illustrates that the number of affected sib pairs for linkage studies is relatively limited, but the sample sizes are promising for association studies.

Denmark↗
PubMed1994

Health and Social Consequences of Prolonging Life, With Special Reference To Cardiovascular Diseases: The Italian Situation.

During the last century, the reduction of birth and all-cause mortality rates have resulted in an increase in the life expectancy and the proportion of the elderly population in many countries. For example, elderly women represent more than 16% and elderly men comprise more than 12% of the population in Italy. The health consequences of these demographic shifts in population is important, because older people experience reductions in some physiologic functions and in increased incidence of chronic, mainly cardiovascular, diseases. Data derived from a survey of men between the ages of 71 and 91 years, who are the survivors of the original rural samples of the Italian section of the Seven Countries Study, show the large contribution of cardiovascular diseases to the long list of chronic conditions. The indicators of self-sufficiency, dementia, and of the self-perception of poor health proved much more common among subjects with cardiovascular diseases than in those with other chronic conditions.

Journal Article↗