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Global Cardiovascular Disease Risk Management in Italian Patients with Metabolic Syndrome in the Clinical Practice Setting

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Abstract

Background: Metabolic syndrome is a highly prevalent condition in the Italian population. This study assesses the feasibility and efficacy of a multifactorial approach for primary prevention of cardiovascular disease risk assessment in patients with metabolic syndrome in the daily clinical practice setting.

Methods: 726 patients were enrolled (males : females = 7 : 3), their ages ranging from 26 to 70 years, with metabolic syndrome and cardiovascular death risk ≥5%, computed by means of the European Systematic COronary Risk Evaluation (SCORE) algorithm. The first phase (3 months) consisted of an improvement in lifestyle and, if necessary, the initial administration of an antihypertensive therapy (valsartan 160 mg/day for patients with blood pressure ≥140/90 mmHg and ≥130/80 mmHg for diabetic patients). During phase 2 (6 months), patients with systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg (≥130/80 mmHg for diabetic patients) were administered valsartan 160 mg/day + hydrochlorothiazide 12.5 mg/day combined; those with total cholesterol levels ≥190 mg/dL (≥175 mg/dL for diabetic patients) started treatment with fluvastatin 80 mg prolonged release (XL), as prescribed in the guidelines. A control group was approached with another conventional treatment.

Results: After 9 months of monitoring, the SBP dropped by 27 mmHg in the valsartan-treated patients and by 11 mmHg in the control group, while the DBP dropped by 12 mmHg in the former group and 2 mmHg in the latter. Total cholesterolaemia was reduced by 47 mg/dL in patients undergoing fluvastatin and valsartan therapy, by 19 mg/dL in those treated with valsartan only and by 33 mg/dL in those administered another conventional treatment. Relative risk reduction observed after 9 months, compared with the beginning of the study, was almost 48% in the valsartan/valsartan + fluvastatin group, versus 28% observed with the other conventional treatment. The reduction of risk at 60 years of age was an average of 39% at 3 months and 48% at 9 months, compared with the beginning of the study. Therapeutic success was accomplished with 78% of the patients treated with valsartan/valsartan + fluvastatin, compared with 47% of patients in the conventional therapy group.

Conclusion: The present study demonstrated that the normalization of the main cardiovascular risk factors in patients with metabolic syndrome may be easily achieved in standard clinical practice settings, by leading an adequate lifestyle and, if necessary, the administration of antihypertensive and/or lipid-lowering monotherapy at the usual doses.

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Acknowledgements

The authors thank Novartis Farma for their unconditional support to the LesScore study. The authors have no direct conflicts of interest relevant to the publication of this manuscript, beyond Dr Peruzzi who is employed by Novartis Farma. The authors thank all the LesScore investigators reported in the Appendix and all the SIMG centres involved in the study.

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Authors and Affiliations

  1. Internal Medicine, Aging and Kidney Diseases Department, Sant’Orsola-Malpighi Hospital - University of Bologna, Via Massarenti 9, 40138, Bologna, Italy

    Ettore Ambrosioni,  Arrigo F. G. Cicero & Claudio Borghi

  2. Italian Society of General Medicine (SIMG), Florence, Italy

    Damiano Parretti, Alessandro Filippi & Alessandro Rossi

  3. Medical Department, Novartis Farma, Origgio, Italy

    Elena Peruzzi

Authors
  1. Ettore Ambrosioni
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  2. Arrigo F. G. Cicero
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  3. Damiano Parretti
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  4. Alessandro Filippi
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  5. Alessandro Rossi
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  6. Elena Peruzzi
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  7. Claudio Borghi
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Corresponding author

Correspondence to Arrigo F. G. Cicero.

Appendix

Appendix

  • Prof. Borghi Claudio; Prof. Ambrosioni Ettore, Bologna (BO)

  • Prof. Traisci Giancarlo, Pescara (PE)

  • Dr Pancera Paolo, Legnago (VR)

  • Prof. Policicchio Domenico, Monteforte Irpino (AV)

  • Dr Caridi Giuseppe, Soverato (CZ)

  • Dr Lambiase Claudio, Mercato San Severino (SA)

  • Dr Lazzari Flavio, Gardone Val Trompia (BS)

  • Dr Balsanelli Mario, Lido di Ostia Levante (RM)

  • Dr Mancuso Gerardo, Lamezia Terme (CZ)

  • Dr Calatola Pasqualino, Salerno (SA)

  • Prof. Bobbio Pallavicini Enrico, Crema (CR)

  • Dr Tramice Gianfranco, Potenza (PZ)

  • Dr.ssa Lenzi Silvia, Pisa (PI)

  • Dr Diaco Tomamso, Rivolta d’Adda (CR)

  • Dr D’Amore Francesco, Roma (RM)

  • Dr Lenti Salvatore, Arezzo (AR)

  • Prof. Sommariva Domenico, Garbagnate Milanese (MI)

  • Dr Prinzi Domenico, Giugliano in Campania (NA)

  • Dr Urbinati Stefano, Bologna (BO)

  • Dr Perseghin Gianluca, Milano (MI)

  • Prof. Lagi Alfonso, Firenze (FI)

  • Dr Maragoni Giorgio, Spoleto (PG)

  • Dr Inserra Vincenzo, Catania (CT)

  • Dr Marino Giovanni, Mazara del Vallo (TP)

  • Dr Abrignani Maurizio, Erice (TP)

  • Dr Aquilina Michele, Forli (FO)

  • Dr Zerella Francesco, Benevento (BN)

  • Dr.ssa Cicogna Sabrina, L’Aquila (AQ)

  • Dr.ssa Brancati Anna Maria, Roma (RM)

  • Dr.ssa Tuveri Marta, Monserrato (CA)

  • Dr Vailati Alberto, Pavia (PV)

  • Dr Di Palma Francesco, Torre Annunziata (NA)

  • Dr Napolitano Francesco, Pollena Trocchia (NA)

  • Dr Pancaldi Leonardo, Bentivoglio (BO)

  • Dr Paroli Antonio, Brescia (BS)

  • Dr Occhi Giuseppe, Sondalo (SO)

  • Dr.ssa Vitrano Maria Gabriella, Palermo (PA)

  • Dr D’Addetta Giovanni, Cerignola (FG)

  • Dr Pascal Giancarlo, Suzzara (MN)

  • Dr Pedretti Giovanni, Borgo val di Taro (PR)

  • Dr Bossi Antonio, Treviglio (BG)

  • Dr Tatti Patrizio, Marino (RM)

  • Dr Lentini Pietro, Roma (RM)

  • Dr Giorgi Gabriele, Frascati (RM)

  • Dr De Curtis Guglielmo, San Benedetto del Tronto (AP)

  • Dr Bianchi Stefano, Livorno (LI)

  • Dr Ventura Vincenzo, Barcellona Pozzo di Gotto (ME)

  • Prof. Madaffari Bruno, Reggio Calabria (RC)

  • Dr Cozzalupi Mauro, Fivizzano (MS)

  • Dr.ssa Mancuso Paola, Cosenza (CS)

  • Dr Piroli Enrico, Tarquinia (VT)

  • Dr Baldo Vittorio, Roma (RM)

  • Prof. Beltramello Giampietro, Bassano del Grappa (VI)

  • Dr.ssa Fabbri Alba, Ravenna (RA)

  • Dr Riccio Carmine, Caserta (CE)

  • Dr Franchini Giovanni, Bari (BA)

  • Dr Mariani Marco, Pesaro (PS)

  • Dr Ruggiero Domenico, Terlizzi (BA)

  • Dr.ssa Morelloni Silvana, Novi Ligure (AL)

  • Prof. Agabiti-Rosei Enrico, Brescia (BS)

  • Dr Gregorio Giovanni, Vallo della Lucania (SA)

  • Dr.ssa Rosatello Annalisa, Alba (CN)

  • Prof. Bertolini Stefano, Genova (GE)

  • Dr Bertoli Daniele, Sarzana (SP)

  • Dr.ssa Tosadori Alessandra, Cirie (TO)

  • Prof. Masotti Giulio, Firenze (FI)

  • Dr Sartori Federico, Chioggia (VE)

  • Dr Travaglino Franco, Biella (BI)

  • Dr Tota Nicola, Acquaviva delle Fonti (BA)

  • Prof. Loperfido Francesco, Roma (RM)

  • Dr Melandri Francesco, Sassuolo (MO)

  • Dr Perna Gian Piero, Torrette di Ancona (AN)

  • Dr Diana Antonio, Savigliano (CN)

  • Dr Baldi Federico, Vercelli (VC)

  • Dr Altomare Emanuele, Foggia (FG)

  • Dr Vendemiale Gianluigi, San Giovanni Rotondo (FG)

  • Dr Casanova Roberto, Faenza (RA)

  • Dr Zingerle Hermann, Silandro (BZ)

  • Dr Virgili Flavio, Mestre (VE)

  • Dr Di Pietro Sergio, Roma (RM)

  • Dr Ventimiglia Corrado, Palermo (PA)

  • Dr Miccoli Fiorenzo, San Remo (IM)

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  • Dr Previtera Stefano, Magliano Sabina (RI)

  • Dr Berra Sergio Antonio, Rho (MI)

  • Prof. Marchese Domenico, Piove di Sacco (PD)

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  • Dr Provenzano Vincenzo, Partinico (PA)

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  • Dr Salvati Filippo, Guardiagrele (CH)

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  • Dr Formoso Gianni, Lecce (LE)

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  • Dr.ssa Negro Maria, Nettuno (RM)

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  • Prof. Uccioli Luigi, Roma (RM)

  • Dr Temperilli Luigi, Roma (RM)

  • Dr Papini Enrico, Albano Laziale (RM)

  • Dr Serra Alberto, Anzio (RM)

  • Dr Lavra Giuseppe, Roma (RM)

  • Dr Galati Alfonso, Roma (RM)

  • Prof.ssa Mingrone Geltrude, Roma (RM)

  • Dr Fichera Francesco, Roma (RM)

  • Dr.ssa Forte Elisa, Fondi (LT)

  • Dr Sposito Silvio, Velletri (RM)

  • Dr Bruzzese Vincenzo, Roma (RM)

  • Prof. Cocchi Alberto, Roma (RM)

  • Dr Bizzarri Francesco, Montefiascone (VT)

  • Dr Gentile Giuseppe, Palombara Sabina (RM)

  • Dr Semprini Marco, Tivoli (RM)

  • Prof. Fedele Francesco, Roma (RM)

  • Prof. Alimonti Pietro, Roma (RM)

  • Dr Mancinella Angelo, Roma (RM)

  • Dr Mastandrea Michelangelo, Frosinone (FR)

  • Dr Napolitano Clemente, Latina (LT)

  • Dr.ssa Damasco Anna Maria Cristina, Monterotondo (RM)

  • Dr Uguccioni Massimo, Roma (RM)

  • Prof. Melina Domenico, Roma (RM)

  • Dr Blasio Antonio, Roma (RM)

  • Prof. Pannarale Giuseppe, Roma (RM)

  • Dr Giambra Maurizio, Roma (RM)

  • Prof. Santini Massimo, Roma (RM)

  • Dr.ssa Cruciani Laura, Latina (LT)

  • Dr Lo Pinto Sandro, Roma (RM)

  • Dr Angotti Stefania, Roma (RM)

  • Dr Principe Francesco, Roma (RM)

  • Dr Natali Roberto, Perugia (PG)

  • Dr Germini Fabrizio, Perugia (PG)

  • Dr Parretti Damiano, Perugia (PG)

  • Dr Rossi Francesco, Perugia (PG)

  • Dr Scarponi Tiziano, Perugia (PG)

  • Dr Coppini Bruno, Perugia (PG)

  • Dr Grilli Piero, Pianello (PG)

  • Dr Baglioni Gregorio, Torgiano (PG)

  • Dr Falcinelli Remo, Montefalco (PG)

  • Dr Menghini Sergio, Foligno (PG)

  • Dr Equniozzi Roberto, Foligno (PG)

  • Dr Piselli Leonardo, Spoleto (PG)

  • Dr Marcucci Angelo, Spoleto (PG)

  • Dr Montironi Massimo, Nocera Umbra (PG)

  • Dr Martini Feliciano, Foligno (PG)

  • Dr Properzi Alfredo, Bevagna (PG)

  • Dr Draghini Leonardo, Torgiano (PG)

  • Dr Thomas Giovanni Battista, Campello sul Clitunno (PG)

  • Dr Giorgetti Francesco, Deruta (PG)

  • Dr Sgrelli Valerio, Perugia (PG)

  • Dr.ssa Surace Maria Antonietta, Perugia (PG)

  • Dr.ssa Russo Carolina, Grosseto (GR)

  • Dr.ssa Casini Marcella, Grosseto (GR)

  • Dr Bellumori Giovanni, Grosseto (GR)

  • Dr.ssa Steri Lia, Grosseto (GR)

  • Dr Salvetti Andrea, Grosseto (GR)

  • Dr Zuccarello Mario, Grosseto (GR)

  • Dr Ruggeri Mauro, Prato (PO)

  • Dr Capacci Walter, Prato (PO)

  • Dr.ssa Meoni Cristina, Prato (PO)

  • Dr Vannucchi Carlo Enrico, Prato (PO)

  • Dr Brachi Paolo Alberto, Prato (PO)

  • Dr.ssa Spina Concetta, Prato (PO)

  • Dr Cappelli Andrea, Prato (PO)

  • Dr Daly Claudio, Prato (PO)

  • Dr Camilli Francesco, Montefalco (PG)

  • Dr.ssa Cecchini Cesarina, Foligno (PG)

  • Dr Cartei Alessandro, Prato (PO)

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Ambrosioni, E., Cicero, A.F.G., Parretti, D. et al. Global Cardiovascular Disease Risk Management in Italian Patients with Metabolic Syndrome in the Clinical Practice Setting. High Blood Press Cardiovasc Prev 15, 37–45 (2008). https://doi.org/10.2165/00151642-200815020-00001

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  • DOI: https://doi.org/10.2165/00151642-200815020-00001

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