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Abbatecola A.M.,Italian National Research Center On Aging Inrca | Chiodini P.,The Second University of Naples | Gallo C.,The Second University of Naples | Lakatta E.,U.S. National Institute on Aging | And 7 more authors.
Age | Year: 2012

Age-related mechanisms that lead to sarcopenia are not entirely understood. Basal leg blood flow declines with aging by augmented sympathetic vasoconstriction and arterial stiffening, thus a dysfunction in blood vessel dynamics may have an independent role on sarcopenia. We determined whether pulse wave velocity (PWV), marker of arterial stiffness, was associated with skeletal muscle decline. Observational cohort study of older adults(70-79 years) living in Pittsburgh, PA, USA or Memphis, TN, USA. Analyses included 2,405 participants. Correlations among muscle parameters including skeletal muscle density and intermuscular adipose tissue using mid-thigh CT scans were assessed. Linear mixed models tested the association between the change in the sarcopenic index (SI) (assessed by dual energy X-ray absorptiometry) over time and baseline PWV independently of multiple confounders. SI was defined: appendicular lean mass/squared height and calculated at every follow-up (n=6). Baseline PWV was significantly higher in black women compared to white women (930±431 vs. 843±366; p=0.0001), while there were no significant differences between black and white men (943±402 vs. 911±375; p=0.1786). Baseline analyses showed an independent negative association between PWV and muscle parameters after adjusting for confounders in both genders. The PWV-by-race interaction was significant in women and analyses are reported separately by race. Prospective mixed models showed that PWV was an independent determinant of the SI in all men (β=-0.1043; p=0.0065) and in white women (β=-0.1091; p=0.0192). In analyses examining the effect of arterial stiffness on limb lean mass over time, PWV correlated with lower leg (β=-0.2196; p=0.0002)and arm mass (β=-0.0985; p=0.0011) in all men and lower leg mass(β=-0.1608; p=0.0027)in white women. In older persons, arterial stiffening is associated with skeletal muscle mass decline differently for race and gender. © 2011 American Aging Association.

Evans W.J.,Glaxosmithkline | Evans W.J.,Duke University | Paolisso G.,The Second University of Naples | Abbatecola A.M.,Italian National Research Center On Aging Inrca | And 4 more authors.
Biogerontology | Year: 2010

The frailty syndrome is increasingly recognized by geriatricians to identify elders at an extreme risk of adverse health outcomes. The physiological changes that result in frailty are complex and up to now have been extremely difficult to characterize due to the frequent coexistence of acute and chronic illness. Frailty is characterized by an decline in the functional reserve with several alterations in diverse physiological systems, including lower energy metabolism, decreased skeletal muscle mass and quality, altered hormonal and inflammatory functions. This altered network leads to an extreme vulnerability for disease, functional dependency, hospitalization and death. One of the most important core components of the frailty syndrome is a decreased reserve in skeletal muscle functioning which is clinically characterized by a loss in muscle mass and strength (sarcopenia), in walking performance and in endurance associated with a perception of exhaustion and fatigue. There are a number of physiological changes that occur in senescent muscle tissues that have a critical effect on body metabolism. The causes of sarcopenia are multi-factorial and can include disuse, changing hormonal function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. In this review, we will explore the dysregulation of some biological mechanisms that may contribute to the pathophysiology of the frailty syndrome through age-related changes in skeletal muscle mass and function. © 2010 Springer Science+Business Media B.V.

Arcoraci V.,Messina University | Santoni L.,Pfizer | Ferrara R.,Messina University | Furneri G.,Italian National Research Center On Aging Inrca | And 3 more authors.
International Journal of Immunopathology and Pharmacology | Year: 2014

Lowering blood cholesterol levels reduces the risk of coronary heart disease. However, the effect of interventions depends on the patients' adherence to treatment. Primary care plays an important role in the detection, treatment and monitoring of disease, therefore different educational programs (EP) have been implemented to improve disease management in general practice. The present study is aimed to assess whether a general practitioner auditing and feedback EP may improve dyslipidaemia management in a primary care setting and to evaluate patients' adherence to prescribed lipid-lowering treatment. The quality of cardiovascular and cerebrovascular disease prevention before and after the implementation of an EP offered to 25 general practitioners (GPs), was evaluated. Clinical and prescription data on patients receiving at least one lipid-lowering treatment was collected. To evaluate the quality of the healthcare service provided, clinical and biochemical outcomes, and drug-utilization, process indicators were set up. Adherence was evaluated before and after the EP as the "Medication Possession Ratio" (MPR). A correlation analysis was carried out to estimate the effect of the MPR in achieving pre-defined clinical end-points. Prescription data for lipid-lowering drugs was collected in a sample of 839 patients. While no differences in the achievement of blood lipid targets were observed, a slight but significant improvement of the MPR was registered after the EP (MPR >0.8=64.2% vs 60.6%, p=0.0426). Moreover, high levels of statin adherence were associated with the achievement of total blood cholesterol target (OR=3.3 for MPR >0.8 vs MPR <0.5, 95% CI: 1.7-6.7) or LDL therapeutic goal (OR=3.3 for MPR >0.8 vs MPR <0.5, 95% CI: 1.5-7.2). The EP partially improved the defined clinical targets; probably, a more patient-based approach could be more appropriate to achieve the defined target. Further studies are needed to identify how healthcare services can be improved.

Santillo E.,Italian National Research Center On Aging Inrca | Migale M.,Italian National Research Center On Aging Inrca | Marini L.,Italian National Research Center On Aging Inrca | Fallavollita L.,Italian National Research Center On Aging Inrca | And 2 more authors.
Journal of Cardiology Cases | Year: 2015

A 51-year-old man developed symptoms (palpitations) related to a large left atrial mass attached to interatrial septum discovered by trans-thoracic heart ultrasonography. Six months earlier this patient had undergone radiofrequency ablation (RFA) of an atrial flutter substrate. The left atrial mass was removed surgically using cardiopulmonary bypass with disappearance of symptoms. A post-operative diagnosis of atrial myxoma was made. The present case shows that a big left-atrial tumor could manifest with only mild unspecific symptoms such as palpitations. It is not clear whether the development of myxomas could be related to RFA or occurrence of heart tumors after RFA (already reported in medical literature) or whether it could be just chance without a causal link with ablation procedures.<. Learning objective: It is essential to consider myxoma in the differential diagnosis of cardiac masses identified in patients after radiofrequency ablation since some cases of myxoma development after radiofrequency ablation have recently been described in the literature. Transthoracic echocardiography is a precise technique in the evaluation of cardiac masses, but a high index of clinical suspicion is necessary in order to define intracardiac pathologies that could be missed for unspecific symptoms of presentation.>. © 2015 Japanese College of Cardiology.

Corsonello A.,Italian National Research Center On Aging Inrca | Montesanto A.,University of Calabria | Berardelli M.,University of Calabria | de Rango F.,University of Calabria | And 5 more authors.
Age and Ageing | Year: 2010

Background: Several studies suggest that a decreased thyroid activity might be favourable in oldest-old subjects and that subclinical thyroid hyperfunction may be detrimental. Objectives: to verify whether declining levels of circulating thyroid hormones may contribute to longevity. Design: cross-sectional observational study. Setting: all subjects were born in Calabria (southern Italy) and their ancestry in the region was ascertained up to the grandparents. Subjects: six hundred and four home-dwelling subjects (301 females, 303 males), divided into three groups: 278 individuals 60-85 years old; 179 children or nieces/nephews of centenarians who are 60-85 years old; 147 individuals older than 85 years. Methods: thyroid function parameters were measured in the frame of a comprehensive geriatric assessment. Results: FT3 and FT4 levels were negatively associated with age. Lower levels of FT3, FT4 and TSH were found in centenarians' children and nieces/nephews with respect to age-matched controls. Indeed, being a relative of centenarians qualified as an independent correlate of thyroid parameters. Conclusions: age-related subtle thyroid hypofunction (either due to a familial component or due to a reset of the thyroid function occurring between the sixth and the eighth decade of life) appears to be related to longevity. © The Author 2010. Published by Oxford University Press on behalf of the British Geriatrics Society.

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