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Girona, Spain

Mascitelli L.,Medical Service | Pezzetta F.,Cardiology Service | Sullivan J.L.,University of Central Florida
Medical Hypotheses | Year: 2010

A consensus view has emerged favoring an anticancer effect of long-term aspirin use. Aspirin-induced loss of stored iron from chronic gastrointestinal bleeding is proposed as a mechanism underlying this beneficial effect. In iron depletion, less iron may be available for carcinogenesis through free-radical mediated mechanisms and for promotion of tumor growth. Low-dose aspirin increases gastrointestinal losses of transfused radiolabeled autologous red cells. Observational studies report lower serum ferritin values with regular aspirin use. A protective effect of induced iron reduction against cancer mortality has been confirmed in a recent trial (FeAST) with subjects randomized to iron reduction or observation. Serum ferritin reductions in the FeAST trial were within conventionally normal reference ranges and were quantitatively similar to ferritin reductions in observational studies in regular aspirin users. Delayed anticancer effects of aspirin are compatible with the proposed mechanism, as continual microbleeding has a gradual cumulative effect on stored iron. © 2009 Elsevier Ltd. All rights reserved. Source

Mascitelli L.,Comando Brigata Alpina Julia | Goldstein M.R.,Fountain | Pezzetta F.,Cardiology Service
Journal of Cardiovascular Medicine | Year: 2011

We suggest that lower body iron stores, and not the loss of ovarian function, explain the differences between men and women, and between fertile and menopausal women in the development of coronary heart disease. © 2010 Italian Federation of Cardiology. Source

Mallamaci F.,Nephrology and Renal Transplantation Unit Ospedali Riuniti | Mallamaci F.,National Research Council Italy | Benedetto F.A.,Cardiology Service | Tripepi R.,National Research Council Italy | And 6 more authors.
JACC: Cardiovascular Imaging | Year: 2010

Objectives: This study sought to investigate clinical and echocardiographic correlates of the lung comets score. Background: Early detection of pulmonary congestion is a fundamental goal for the prevention of congestive heart failure in high-risk patients. Methods: We undertook an inclusive survey by a validated ultrasound (US) technique in a hemodialysis center to estimate the prevalence of pulmonary congestion and its reversibility after dialysis in a population of 75 hemodialysis patients. Results: Chest US examinations were successfully completed in all patients (N = 75). Before dialysis, 47 patients (63%) exhibited moderate to severe lung congestion. This alteration was commonly observed in patients with heart failure but also in the majority of asymptomatic (32 of 56, 57%) and normohydrated (19 of 38, 50%) patients. Lung water excess was unrelated with hydration status but it was strongly associated with New York Heart Association functional class (p < 0.0001), left ventricular ejection fraction (r = 0.55, p < 0.001), early filling to early diastolic mitral annular velocity (r = 0.48, p < 0.001), left atrial volume (r = 0.39, p = 0.001), and pulmonary pressure (r = 0.36, p = 0.002). Lung water reduced after dialysis, but 23 patients (31%) still had pulmonary congestion of moderate to severe degree. Lung water after dialysis maintained a strong association with left ventricular ejection fraction (r = 0.59, p < 0.001), left atrial volume (r = 0.30, p = 0.01), and pulmonary pressure (r = 0.32, p = 0.006) denoting the critical role of cardiac performance in the control of this water compartment in end-stage renal disease. In a multiple regression model including traditional and nontraditional risk factors only left ventricular ejection fraction maintained an independent link with lung water excess (beta = 0.61, p < 0.001). Repeatability studies of the chest US technique (Bland-Altman plots) showed good interobserver and inter-US probes reproducibility. Conclusions: Pulmonary congestion is highly prevalent in symptomatic (New York Heart Association functional class III to IV) and asymptomatic dialysis patients. Chest ultrasound is a reliable technique that detects pulmonary congestion at a pre-clinical stage in end-stage renal disease. © 2010 American College of Cardiology Foundation. Source

Mascitelli L.,Comando Brigata Alpina Julia | Pezzetta F.,Cardiology Service | Goldstein M.R.,Fountain
Archives of Medical Research | Year: 2010

Ezetimibe is a lipid-lowering agent that inhibits intestinal absorption of dietary cholesterol. It substantially lowers low-density lipoprotein cholesterol levels when used alone or in combination with statins. Although there is a growing push for the continued use of ezetimibe for the prevention of cardiovascular disease, ezetimibe studies available so far are inconsistent, without allowing use of the drug with confidence. © 2010 IMSS. Source

Platonov P.G.,Lund University | Cygankiewicz I.,Medical University of Lodz | Stridh M.,Lund University | Holmqvist F.,Lund University | And 5 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2012

Background-Atrial fibrillatory rate (AFR) is a measure of atrial remodeling caused by atrial fibrillation (AF), and its acceleration negatively affects outcome of interventions for persistent AF. However, the prognostic value of AFR in patients with congestive heart failure (CHF) has not been studied. We sought to evaluate whether AFR can predict outcome in patients with mild to moderate (New York Health Association II-III) CHF. Methods and Results-High-resolution 20-minute long Holter ECGs obtained from 169 CHF patients with AF at enrollment were analyzed. AFR was estimated using spatiotemporal QRST cancellation and time-frequency analysis. The patients were followed for a median of 44 months, with primary end point defined as total mortality and secondary end points as sudden death and heart failure death. Atrial signal quality was sufficient for AFR estimation in 142 patients (mean age 69±11 years, 101 male). Of those, 48 patients died during follow-up, including 18 because of CHF progression. Mean AFR was 390±60 fpm and decreased with age (r=-0.3, P<0.001). Patients with AFR ≤371 fpm (lower tertile) had 44% 3-year mortality as compared with 26% with higher AFR. Lower AFR was an independent predictor of all cause mortality (HR=1.99, 95% CI=1.09 -3.63, P=0.025) and CHF death (HR=3.74, 95% CI=1.38 -10.14, P=0.010) after adjustment for significant clinical covariates in multivariable Cox analysis. Conclusions-In CHF patients with AF, reduced AFR assessed using noninvasive approach is associated with increased risk of death because of heart failure progression, and may be considered a predictor of outcome. © 2012 American Heart Association, Inc. Source

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