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Competing Interests: The authors declare no conflict of interest.

Background and Aim: To evaluate the relationship between HDL-Cholesterol (HDL-C), hypertension, and left ventricular hypertrophy (LVH) in a large sample of Caucasian youths with overweight/obesity (OW/OB)., Methods and Results: A cross-sectional multicenter study was performed in 1469 youths (age 6-16 years) with OW/OB observed in the period 2016-2020. An additional independent sample of 244 youths with an echocardiographic evaluation, observed in a single center was analyzed. The sample was divided in six quantiles (Q) of HDL-C: Q1: >56, Q2: ≤56 > 51, Q3: ≤51 > 45, Q4: ≤45 > 41, Q5: ≤41 > 39, Q6: <39 mg/dL. The nadir of the relationship was identified in youths in the first quantile. Among HDL-Cholesterol quantiles the distribution of hypertension was non-linear with a percentage of 25.0%, 40.1%, 33.6%, 31.3%, 35.2% and 39.7% in the six quantiles, respectively. The percentage of LVH was 21.8%, 43.6%, 48.8%, 35.5%, 38.5% and 52.0% in the six quantiles, respectively. The highest odds [95%Cl] of hypertension were 2.05 (1.33-3.16) (P < 0.01) in Q2, 1.67 (1.10-2.55) (P < 0.05) in Q3 and 1.59 (1.05-2.41) (P < 0.05) in Q6 vs Q1. The odds of LVH were 3.86 (1.15-10.24) (P < 0.05) in Q2, 4.16 (1.58-10.91) (P < 0.05) in Q3 and 3.60 (1.44-9.02) (P < 0.05) in Q6 vs Q1, independently by centers, age, sex, prepubertal stage, and body mass index., Conclusion: Contrary to the common belief, the present study shows that high levels of HDL-C may be not considered a negative predictor of hypertension and LVH, two risk factors for future CV disease., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Aim: Recently, the European Society of Cardiology task force released a Consensus document (ESC-CD) on pediatric hypertension (HTN) supporting the use of normative tables (age range 6-16 years) for the diagnosis of HTN, while the Hypertension Canada Guidelines (HTN-CGs) proposed static cutoffs. We aimed to assess the prevalence of HTN by ESC-CD or HTN-CGs and their association with glomerular function and left ventricular (LV) geometry in youths with overweight/obesity (OW/OB)., Methods and Results: Data of 3446 youths were analyzed. HTN by was defined using normative tables (ESC-CD) or static cutoffs of BP ≥ 120/80 in children (age <12 years) and ≥130/85 mmHg in adolescents (age ≥12 years) (HTN-CGs). Mildly reduced glomerular filtration rate was defined by GFR <90 ≥ 60 mL/min/1.73 m 2 . Concentric LV hypertrophy (cLVH) was assessed in 500 youths and defined by LVH and high relative wall thickness as proposed by ESC-CD. Prevalence of HTN was 27.9% by ESC-CD and 22.7% by HTN-CGs. The association with mildly reduced glomerular filtration rate was significant only in hypertensive adolescents classified by HTN-CGs [Odds Ratio (OR), 95%Cl] 2.16 (1.44-3.24), whereas the association with cLVH was significant using both criteria: children OR 2.18 (1.29-3.67) by ESC-CD and 2.27 (1.32-3.89) by HTN-CGs; adolescents OR 2.62 (1.17-5.84) by ESC-CD and 2.83 (1.14-7.02) by HTN-CGs., Conclusion: Although static cutoffs may represent a simplification for HTN identification, tables by ESC-CD detect a higher number of hypertensive youths before a clear appearance of glomerular impairment, which offers advantages in terms of primary cardiovascular prevention., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Introduction: The Coronavirus disease 2019 (COVID-19) outbreak is a whole Earth health emergency related to a highly pathogenic human coronavirus responsible for severe acute respiratory syndrome (SARS-CoV-2). Despite the fact that the majority of infected patients were managed in outpatient settings, little is known about the clinical characteristics of COVID-19 patients not requiring hospitalization. The aim of our study was to describe the clinical comorbidity and the pharmacological therapies of COVID-19 patients managed in outpatient settings., Materials and Methods: We performed an observational, retrospective analysis of laboratory-confirmed COVID-19 patients managed in outpatient settings in Naples, Italy between 9 March and 1 May 2020. Data were sourced from the prospectively maintained Health Search (HS)/Thales database, shared by 128 primary care physicians (PCPs) in Naples, Italy. The clinical features and pharmacological therapies of COVID-19 patients not requiring hospitalization and managed in outpatient settings have been described., Results: A total of 351 laboratory-confirmed COVID-19 patients (mean age 54 ± 17 years; 193 males) with outpatient management were evaluated. Hypertension was the most prevalent comorbidity (35%). The distribution of cardiovascular comorbidities showed no gender-related differences. A total of 201 patients (57.3%) were treated with at least one experimental drug for COVID-19. Azithromycin, alone (42.78%) or in combination (27.44%), was the most widely used experimental anti-COVID drug in outpatient settings. Low Molecular Weight Heparin and Cortisone were prescribed in 24.87% and 19.4% of the study population, respectively. At multivariate regression model, diabetes (risk ratio (RR): 3.74; 95% CI 1.05 to 13.34; p = 0.04) and hypertension (RR: 1.69; 95% CI 1.05 to 2.7; p = 0.03) were significantly associated with the experimental anti-COVID drug administration. Moreover, only diabetes (RR: 2.43; 95% CI 1.01 to 5.8; p = 0.03) was significantly associated with heparin administration., Conclusions: Our data show a high prevalence of hypertension, more likely treated with renin-angiotensin-aldosterone system (RASS) inhibitors, among COVID-19 patients not requiring hospitalization. Experimental COVID-19 therapies have been prescribed to COVID-19 patients considered at risk for increased venous thromboembolism based on concomitant comorbidities, in particular diabetes and hypertension.

Background and Aim: To compare cardiometabolic risk profile and preclinical signs of target organ damage in youth with normal and elevated blood pressure (BP), according to the American Academy of Pediatrics (AAP) guidelines., Methods and Results: This cross-sectional multicenter study included 2739 youth (5-17 year-old; 170 normal-weight, 610 overweight and 1959 with obesity) defined non hypertensive by the AAP guidelines. Anthropometric, biochemical and liver ultrasound data were available in the whole population; carotid artery ultrasound and echocardiographic assessments were available respectively in 427 and 264 youth. Elevated BP was defined as BP ≥ 90th to <95th percentile for age, gender and height in children or BP ≥ 120/80 to <130/80 in adolescents. The overall prevalence of elevated BP was 18.3%, and significantly increased from normal-weight to obese youth. Young people with elevated BP showed higher levels of body mass index (BMI), insulin resistance and a higher prevalence of liver steatosis (45% vs 36%, p < 0.0001) than normotensive youth, whilst they did not differ for the other cardiometabolic risk factors, neither for carotid intima media thickness or left ventricular mass. Compared with normotensive youth, individuals with elevated BP had an odds ratio (95%Cl) of 3.60 (2.00-6.46) for overweight/obesity, 1.46 (1.19-1.78) for insulin-resistance and 1.45 (1.19-1.77) for liver steatosis, controlling for centers, age and prepubertal stage. The odds for insulin resistance and liver steatosis persisted elevated after correction for BMI-SDS., Conclusion: Compared to normotensive youth, elevated BP is associated with increased BMI, insulin resistance and liver steatosis, without significant target organ damage., Competing Interests: Declaration of Competing Interest Nothing to disclose., (Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: Two different systems for the screening and diagnosis of hypertension (HTN) in children currently coexist, namely, the guidelines of the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH). The two systems differ in the lowered cut-offs proposed by the AAP versus ESH., Objectives: We evaluated whether the reclassification of hypertension by the AAP guidelines in young people who were defined non-hypertensive by the ESH criteria would classify differently overweight/obese youth in relation to their cardiovascular risk profile., Methods: A sample of 2929 overweight/obese young people (6-16 years) defined non-hypertensive by ESH (ESH - ) was analysed. Echocardiographic data were available in 438 youth., Results: Using the AAP criteria, 327/2929 (11%) young people were categorized as hypertensive (ESH - /AAP + ). These youth were older, exhibited higher body mass index, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), triglycerides, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, blood pressure, left ventricular mass index and lower HDL-C ( p  <0.025-0.0001) compared with ESH - /AAP - . The ESH - /AAP + group showed a higher proportion of insulin resistance (i.e. HOMA-IR ≥3.9 in boys and 4.2 in girls) 35% vs . 25% ( p  <0.0001), high TC/HDL-C ratio (≥3.8 mg/dl) 35% vs . 26% ( p  = 0.001) and left ventricular hypertrophy (left ventricular mass index ≥45 g/h 2.16 ) 67% vs . 45% ( p  = 0.008) as compared with ESH - /AAP - ., Conclusions: The reclassification of hypertension by the AAP guidelines in young people overweight/obese defined non-hypertensive by the ESH criteria identified a significant number of individuals with high blood pressure and abnormal cardiovascular risk. Our data support the need of a revision of the ESH criteria.

Objectives: To investigate the anthropometric and metabolic correlates of different patterns of left ventricular (LV) geometry in a cohort of outpatient children with high prevalence of obesity., Study Design: Anthropometric measures, lipid profile, blood pressure (BP), fasting plasma glucose (FPG), and echocardiographic variables were evaluated in 281 white children (6-16 years), of whom 105 were obese and 105 were morbidly obese. Patterns of LV geometry were defined as follows: normal geometry, eccentric LV hypertrophy (LVH), concentric LV remodeling, and concentric LVH., Results: One hundred forty-eight children exhibited normal LV geometry, 53 eccentric LVH, 36 concentric LV remodeling, and 44 concentric LVH. The 4 groups differed in body mass index, waist circumference, waist-to-height ratio, triglycerides/high-density lipoprotein cholesterol ratio (Tg/HDL-C), and BP (P < .05-.0001). A statistically significant impairment of diastolic function (expressed as greater E/E', P < .002) was observed across patterns of LV geometry. Among anthropometric measures, waist-to-height ratio showed better performance in relation to LVH, with an optimal cut-point of 0.58, compared with body mass index and waist circumference. Children with concentric LVH exhibited the worst metabolic risk profile, with greater prevalence of visceral obesity, high Tg/HDL-C, high BP, and high-normal FPG, than children with normal LV geometry., Conclusions: In children with high levels of obesity, an unfavorable "cardiometabolic phenotype" can be identified, which includes concentric LVH, visceral obesity, high BP, high Tg/HDL-C, and high-normal FPG., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To evaluate the relationship between estimated glomerular filtration rate (eGFR) and cardiometabolic risk factors (CMRF) in an outpatient pediatric population with high prevalence of obesity., Design and Methods: eGFR was evaluated in 901 children unselected for chronic kidney disease of whom 694 were overweight/obese (6-16 years) and 207 were age- and sex-matched normal weight (NW). We generated three categories of eGFR: mild-low eGFR (< 20th percentile), high eGFR (>80th percentile) and intermediate eGFR (20-80th percentile), considered as the reference category, Results: Children with either mild-low or high eGFR category showed a 2-4 fold higher Odds ratio of high blood pressure, left ventricular hypertrophy, and microalbuminuria compared with children of the intermediate eGFR category. In addition, children with mild-low eGFR levels showed a 1.5-2 fold higher Odds ratio of impaired fasting glucose and high white blood cell count compared with children with intermediate eGFR levels., Conclusions: In outpatient children with high prevalence of obesity, children with either mildly reduced or high eGFR have an increased burden of CMRF. Children with eGFR < 97 mL/min/1.73 m² show a worse CMR profile. This finding supports the usefulness to assess eGFR to identify children with unfavorable CMR profile.

Background: The hospital stay for "uncomplicated" acute myocardial infarction (AMI) is often too long. A reduction in the length of hospitalization, if proven to be safe, is advantageous in terms of costs and health organization. Accordingly the aims of the present, prospective study, were to evaluate: 1) the patients with AMI eligible for early discharge; 2) the incidence of adverse cardiovascular events within 2 weeks of myocardial infarction; 3) the incidence of cardiovascular mortality at 6-month follow-up., Methods: On the fifth day after AMI, 331 of 526 patients, consecutively admitted to our coronary care unit between March 1997 and August 1999, were assigned to "complicated" and "uncomplicated" AMI groups, according to clinical and non-invasive criteria. Uncomplicated myocardial infarction eligible for early discharge was defined in patients < 75 years, as the absence of a high risk personality, stroke, left bundle branch block, transient myocardial ischemia after the first 24 hours from AMI, clinical signs or echocardiographic evidence of left ventricular dysfunction (ejection fraction < 40%), ventricular fibrillation, sustained ventricular tachycardia, symptomatic bradyarrhythmias after the first 48 hours from AMI, cardioversion or defibrillation (after the first 48 hours) or the need for coronary angioplasty or coronary artery bypass grafting. Uncomplicated patients were discharged on the sixth day after AMI (hospital stay 6.5+/-0.72 days). A symptom-limited ergometric stress test was planned in the uncomplicated group 14 days after AMI. "Hard" (death, reinfarction) and "non-hard" (unstable angina, myocardial revascularization) adverse cardiovascular events were monitored at 2 weeks of follow-up, and cardiovascular mortality at 6-month follow-up., Results: Four (1.2%) hard (0.3% exitus and 0.9% reinfarction) and 7 (2.1%) non-hard adverse events occurred among patients with uncomplicated AMI at 2 weeks of follow-up. Patients with uncomplicated AMI who developed adverse events, presented during the primary coronary event creatine kinase (CK) and CK-MB serum levels which were significantly lower than those observed in patients who did not present adverse events. In the complicated group (hospital stay 9.9+/-1.79 days), from day 6 to 14 after AMI, 65 (33%) hard and non-hard events occurred. A significant reduction in mortality between the uncomplicated and complicated group (2.11 vs 27.17%, p < 0.0001) was observed at 6-month follow-up. Multivariate analysis showed a statistically significant difference for age and thrombolytic treatment., Conclusions: This first Italian prospective study demonstrated the possibility of identifying, 5 days after AMI and on the basis of simple criteria and without a stress test, a low risk population of patients eligible for early discharge.