Drug Induced Liver Injury (DILI) due to variability in monacolin K content in Red Yeast Rice (RYR): An expert opinion

Introduction: Red yeast rice (RYR) is an effective cholesterol-lowering nutraceutical reversibly inhibiting 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase. As liver damage is a possible (albeit are) side effect of HMG-CoA inhibitors, it make sense to focus on the tolerability of the liver to RYR extracts. The aim of this paper is to offer an expert opinion on the risk of liver damage by the use of RYR extract. Methods: A review of the available literature has been carried out and critically reviewed by the authors. Results: According to a large meta-analysis of 53 randomized clinical trials comprising 112 treatment arms, which included 8535 subjects with 4437 in the RYR arm and 4303 in the control arm of the study, RYR administration was not associated with increased risk of Drug Induced Liver Injury (DILI) during RYR treatment. Single cases of DILI have been associated with the use of RYR supplements. Even if the causal relationship is hardly demonstrable, it is possible that products containing impurities or toxic elements such as citrinin or unstandardized dosages of bioactive compounds like monacolins, could be implicated in liver toxicity. Conclusion: DILI associated with RYR intake are exceptional and hardly associated to RYR per se rather than to low-quality products. Nutrivigilance and stricter manufacturing regulations should be implemented and are recommended in order to protect consumers from low quality and potentially dangerous dietary supplements

AWARENESS OF MAJOR CARDIOVASCULAR RISK FACTORS AND ITS RELATIONSHIP WITH MARKERS OF VASCULAR AGING: DATA FROM THE BRISIGHELLA HEART STUDY

Objective: An adequate perception of own cardiovascular disease risk profi le is fundamental to improve adherence to life-style rules and preventive treatment. The aim of our study was to evaluate the vascular aging of subjects aware and not aware to be hypertensive, hypercholesterolemic, hypertriglyceridemic or diabetics. Design and method: During the last Brisighella Heart Study Survey, we interviewed 1652 subjects without overt cardiovascular diseases (M: 46.6%, F: 53.4%) about their awareness of hypertension, hypercholesterolemia, hypertriglyceridemia or type 2 diabetes. The diagnosis was assessed by either laboratory and clinical data sampled during the survey, on-treatment therapies or general practitioner clinical forms. Then we compared the augmentation index and pulse wave velocity of subjects aware and not aware of the investigated cardiovascular risk factors. Results: 1049 participants declared not to be hypertensive, while 32 were not sure. Among them, respectively, 246 (23.5%) and 16 (50%) were hypertensive. Subjects not aware of their hypertension had signifi cantly higher aortic blood pressure than aware ones (p < 0.001). 841 participants declared not to be hypercholesterolemic, while 60 were not sure. Among them, respectively, 152 (18.1%) and 24 (40%) were hypercholesterolemic. Subjects not aware of their hypercholesterolemia had signifi cantly higher augmentation index than the aware ones (p < 0.05). 1226 participants declared not to be hypertriglyceridemic, while 200 were not sure. Among them, respectively, 240 (19.2%) and 88 (44%) were hypertriglyceridemic. Subjects not aware of their hypertriglyceridemia had signifi cantly higher TG levels aware ones (p < 0.05), although this seemed to not related to increased arterial stiffness. 1472 participants declared not to be diabetic, while 20 were not sure. Among them, respectively, 28 (2.0%) and 5 (25.0%) were diabetics. Subjects not aware of their diabetes had signifi cantly higher augmentation index than the aware ones (p < 0.05). Conclusions: The lack of awareness of hypertension and hypercholesterolemia is relatively frequent in general population and potentially exposing at risk subject to early vascular aging

Attitudes and preferences for the clinical management of hypertension and hypertension-related cardiac disease in general practice: results of the Italian Hypertension and Heart Survey.

The aim of this study was to evaluate attitudes and preferences for the clinical management of hypertensive patients with cardiac organ disease, including left ventricular hypertrophy (LVH) and coronary artery disease (CAD), in Italy. A predefined 15-item questionnaire was anonymously administered to a large community sample of general practitioners (GPs) and specialised physicians between November 2012 and June 2013. Estimated prevalence of hypertension-related clinical conditions was stratified into four groups (10-20%, 20-40%, 40-50%, >50%); preferences were reported as percentage among valid answers to the survey questionnaire. A total of 1319 physicians (672 males, age 55.0±7.1 years, age of medical activity 27.1±7.6 years), among whom 1264 GPs and 55 specialised physicians, was included. LVH was reported to be the most frequent marker of organ damage by the majority of physicians (73.5%). LV diastolic dysfunction was reported to be relatively frequent (>40%) by more than half of the specialised physicians (58.2%) and less frequent (10-20%) by GPs (49.8%); LV systolic dysfunction, atrial fibrillation and CAD were considered to be less frequent (10-20%) by the majority of physicians (61.3, 71.6 and 53.3%, respectively). Echocardiography was the preferred diagnostic tool used to estimate LVH (76.6%). Tight blood pressure control (130/80 mm Hg) was considered to be the most appropriate by the majority of physicians, both in hypertensive patients with LVH and in those with CAD. With the well-known limitations of a cross-sectional survey, this study provides information on attitudes and preferences for the clinical management of outpatients with hypertension and high CV risk profile in general practice in Italy

Metabolic approaches to antihypertensive treatment in diabetic patients

Comparison of the effects of barnidipine+losartan compared with telmisartan+hydrochlorothiazide on several parameters of insulin sensitivity in patients with hypertension and type 2 diabetes mellitus

RELATIONSHIPS BETWEEN DIURETIC-RELATED HYPERURICEMIA AND CARDIOVASCULAR EVENTS: DATA FROM THE URIC ACID RIGHT FOR HEART HEALTH STUDY

Objective: Although the relationship between hyperuricemia and cardiovascular events has been extensively examined, data on the role of diuretic-related hyperuricemia are still scanty. The present study was designed to collect information on the relationship between diuretic-related hyperuricemia and cardiovascular events. Methods: The URic acid Right for heArt Health (URRAH) study is a nationwide, multicentre, observational cohort study involving data on individuals recruited from all the Italy territory under the patronage of the Italian Society of Hypertension with an average follow-up period of 122.3 \ub1 66.9 months. Patients were classified into four groups according to the diuretic use (yes vs. no) and serum uric acid (SUA) levels (higher vs. lower than the median value of 4.8 mg/dl). All-cause death, cardiovascular deaths and first cardiovascular event were considered as outcomes. Results: Seventeen thousand, seven hundred and forty-seven individuals were included in the analysis. Mean age was 57.1 \ub1 15.2 years, men were 45.3% and SBP and DBP amounted to 144.1 \ub1 24.6 and 85.2 \ub1 13.2 mmHg. 17.2% of individuals take diuretics of whom 58% had SUA higher than median value. Patients with hyperuricemia without diuretic use served as reference group. In multivariate adjusted analysis (sex, age, SBP, BMI, glucose, total cholesterol, and glomerular filtration rate) individuals with hyperuricemia and diuretic use exhibit a similar risk for the three outcomes as compared with the reference group. Conclusion: Our study showed that diuretic-related hyperuricemia carry a similar risk of cardiovascular events and all-cause mortality when compared with individuals that present hyperuricemia in absence of diuretic therapy

Short-term trends in the prevalence, awareness, treatment, and control of arterial hypertension in Peru

The prevalence of hypertension has been declining in low- and middle-income countries (LMIC), particularly in Latin America and the Caribbean. However, we have not identified studies that evaluate trends for awareness, treatment, and control of hypertension in LMIC. We aimed to describe the trends in the prevalence, awareness, treatment, and control of hypertension in Peru. A cross-sectional analysis was conducted using secondary data (4 years) of the Demographic and Health Survey of Peru (ENDES, Spanish acronym), which is conducted annually and is representative at the country level. The age-standardized prevalence was estimated using the World Health Organization population as the reference population. The trend over time was evaluated with the score test for trend of odds. A total of 109,401 participants were included. In Peru, from 2015 to 2018, the age-standardized prevalence of hypertension increased (p < 0.001), while the proportion of people with disease awareness (p < 0.001) and controlled hypertension decreased (p = 0.01). During that same period, the proportion of people with treatment for hypertension did not vary over time (p = 0.13). In 2018, the age-standardized prevalence of hypertension was 20.6%, and the proportion of people with disease awareness, treatment, and control of arterial hypertension was 43.5%, 20.6%, 5.3%, respectively. People with low socioeconomic status and people living in rural areas have the lowest proportion of awareness, treatment, and control of hypertension