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The primary aim of the STAR Study (Statins Target Assessment in Real practice) was to determine the LDL-cholesterol reduction and to analyse patient's and therapeutic factors associated to LDL-cholesterol target attainment in newly treated subjects with statins in an unselected population in clinical practice setting. Administrative databases (including pharmaceutical prescriptions and hospital admissions) and laboratory test databases (including LDL-cholesterol values) of five local health units, distributed in Emilia Romagna, Toscana and Umbria, were linked. A retrospective cohort study was conducted and all subjects aged > or =18 years with a first prescription for statins (newly treated subjects) between January 1st, 2007 and June 30th, 2008 were included. All statin prescriptions over a 12 months follow-up period were considered and used to calculate adherence to treatment. Baseline and follow-up LDL-cholesterol, respectively, were defined according to the nearest determination to the first prescription for statins and to the end of the follow-up period. A total of 3.232 subjects was included, 1.516 males (47%) and 1.716 females (53%), with an average age equal to 65.9 +/- 11.3 years. Among included subjects, 22.,6% had a gap to LDL-cholesterol target <10%, 30.0% between 10 and 29%, 20.7% between 30 and 49%, and 26.7% . or =50%. Among those with a gap to target > or =50%, 30-49%, and 10-29%, respectively, LDL-cholesterol target was attained by 7.1%, 41.8%, and 62.% of subjects. LDL-cholesterol target attainment was associated to gap to target, adherence with treatment, and type of statin.

Epidemiological studies identified several risk factors as cardiovascular disease correlates, including smoking, obesity, hypertension, diabetes, and increased plasma lipids. High blood cholesterol, and in particular LDL cholesterol levels, represents a major determinant of coronary artery disease, in particular when included in the context of a comprehensive risk profile. The more recent guidelines (especially NCEP ATP III in the United States, and the European Joint Task Force) have suggested the opportunity to favor treatment of those subjects with higher global cardiovascular risk, first of all of those individuals with coronary artery disease or another cardiovascular manifestation or diabetes, then of subjects with clustered risk factors or with markedly raised levels of single risk factors, eventually of other subjects. In this perspective the treatment also of slight dyslipidemias has been shown capable of reducing cardiovascular event incidence and mortality. Recent investigations, aiming at evaluating the impact of these "clinical recommendations" in the treatment of dyslipidemias or other cardiovascular risk factors within a framework of high global cardiovascular risk (EURO-ASPIRE II, L-TAP, etc.), showed inadequate attention of community-based medicine, disclosed by the insufficient number of subjects investigated and by the large number of untreated or undertreated patients. Rosuvastatin, a recently marketed inhibitor of the 3-hydroxy-3-methylglutaryl coenzyme A reductase, is an effective drug which may normalize high plasma cholesterol among high-risk subjects more often than other similar molecules, thus permitting to reach stringent guideline lipid targets. It is hoped that coronary risk charts based on Italian data will be implemented, with the purpose of better finding and treating those subjects who may benefit, at a suitable level of cardiovascular risk.

Background: Hypothyroidism is a frequent cause of hyperlipidemia, particularly in women, but its true prevalence, both in the general population and in dyslipidemic subjects, is unknown. It is uncertain if low thyroid function significantly influence HDL metabolism and if sub-clinical disease may cause metabolic abnormalities and increase cardiovascular risk., Methods: Three-hundred and three consecutive female patients (mean age 59.2 +/- 0.5 yrs), observed in a metabolic ward because of dyslipidemia, were evaluated., Results: Forty-three women (14.1% of the total) showed sub-clinical hypothyroidism, while in 12 cases (4.0%) overt hypothyroidism was diagnosed; 8 further women (2.6%) had been previously diagnosed to be hypothyroid and were under hormone replacement therapy. On the whole, hypothyroid patients showed higher mean triglyceride levels and lower HDL-cholesterol than dyslipidemic euthyroid women, but the difference did not reach statistical significance. Total cholesterol concentration did not change with impaired thyroid function. Hypothyroid patients reported a clinical history of cardiovascular disease, or had severe atherosclerosis demonstrated, more often than euthyroid subjects (25.0% vs 19.7%, p = n.s.). When only women with arterial disease were considered, HDL plasma levels were significantly lower in the hypothyroid than in the euthyroid group (44.3 +/- 3.1 vs 56.2 +/- 1.7 mg/dl, respectively; p < 0.01). Hypertriglyceridemia and obesity often coexisted., Conclusions: In conclusion, among dyslipidemic women, unrecognised hypothyroidism is highly prevalent (both sub-clinical and manifest). In hypothyroid subjects atherosclerosis seem to associate with particularly low HDL plasma levels. This might precede atherosclerosis development (reinforced by concomitant thyroid failure) and represent a marker of the polymetabolic syndrome.

Background and Purpose: Stroke is the third main cause of death in western countries. To evaluate its ever-changing characteristics and the impact of recent public campaigns on cardiovascular risk factors (CRFs) in stroke morbidity and mortality, we carried out a retrospective investigation on subjects with cerebrovascular disease in different periods., Methods: All clinical data of patients with acute cerebrovascular disease (TIA or stroke) admitted to a regional hospital (Padua, Italy) during two distinct years (1985 and 1992) were examined (381 in 1985 and 440 in 1992). In every case the characteristics of the episode, clinical course, concomitant CRFs and relevant biochemical and instrumental examinations were recorded., Results: Altogether Transient Ischemic Attack (TIA) represented almost half the records; remaining cases could be classified as ischemic stroke (66% vs 55%), Intracerebral Haemorrhage (17% vs 26%) and subarachnoideal haemorrhage (17% vs 19%) (1985 vs 1992, respectively). The mean hospitalization period was longer in the most recent year, particularly in haemorrhagic patients (H-P, subarachnoid + intracerebral haemorrhage); the in-hospital case fatality rate was reduced in HP while it was significantly increased in those with Cerebral Ischemia (CI-P, TIA + ischemic stroke). The prevalence of blood hypertension, atrial fibrillation and dyslipidaemias rose significantly in 1992 compared to 1985. High plasma lipids were more frequently present in CI-P than in H-P; their 7-year increase was particularly related to combined forms, rather then isolated hypercholesterolemia or hypertriglyceridemia., Conclusions: These results do not agree with an hypothetical improvement in the prognosis of stroke in the period we considered. Besides the efforts aiming at reducing CRFs in the short term have not shown to be successful.

In this study we evaluated the potential differences in normal electrocardiographic parameters between two groups of young patients belonging to different races (Caucasians and Blacks). For this purpose 100 electrocardiograms had been taken, coded and compared in 50 Italian males and 50 north-Africans who came to an Emergency Department because of minor condition. On the whole we could not find significant differences between the two groups, except for a small increase in P-wave duration in black people. We conclude that the same parameters used to evaluate normal electrocardiograms in white people, may be satisfactory applied also for black individuals. This fact is worthy of attention since more and more extracomunitarian patients are addressing the Italian Health Service.

Several diseases, and particularly cardiovascular affections, show a periodic fluctuation in their occurrence. We investigated acute myocardial infarction (AMI) incidence in connection with the day of the week, looking for a link with psycho-social phenomena. Eight hundred and fifty-two patients with AMI were considered: they had been admitted to the emergency department of two main towns of northeastern Italy during a calendar year. Eight hundred and seventeen (533 men, 284 women) were eligible for the purpose of this study. The time of symptom onset was recorded, cardiovascular risk factors and occupational condition were evaluated. All data were analyzed through chi-square test of uniformity and Halberg single cosinor test. No statistically significant difference from the uniform distribution appeared in acute events occurrence both in patients as a whole and in single subgroups subdivided according to gender and age. However, the preferential distribution during the days of the week was somewhat different between men (highest incidence at the extreme of the week) and women (highest incidence about mid-week). Statistically significant differences in AMI occurrence in the week were evidenced when patients were analyzed after subdivision according to their occupational condition: working subjects, in comparison with not-working individuals, showed a higher AMI incidence at the beginning of the week with respect to subsequent days. It is therefore likely that the stress associated with the return to work (according to the weekly working pattern of western society) represents an additional important cause of AMI. The mechanisms for that are only speculative.

The concentration of lithogenic and antilithogenic substances in urine shows circadian fluctuations. With this investigation we intended to verify the presence of a chronobiologic rhythm of colic pain in urinary tract calculosis. Four hundred and forty seven consecutive patients with a clinical symptomatology related to urinary tract colic pain were studied. They were subdivided according to sex and age (297 M, 150 F; > or = 65 ys 29, < 65 ys 428). Urinary and blood chemical analysis and instrumental examinations permitted to confirm the clinical diagnosis. To evaluate the circadian and circannual variability, acute events were grouped into one calendar year by the month and into a ideal day by the hour of occurrence respectively. Chronobiologic analysis was performed utilising Halberg single cosinor test. The results pointed out that the symptomatology related to urinary tract colic pain presents a circadian rhythmicity either in patients as a whole or in single subgroups (males, females, younger or older than 65 ys). Besides no seasonal variability was demonstrated, perhaps because of the mild climate present in the geographic area in which the study was carried on.