cardiologia di segnale e rischio residuo
TRANSCRIPT
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Cardiologia di segnaleCardiologiaDi segnaleE rischioresiduo
Carlo maggio
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Chi rischia di più?
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Maggior rischio a breve termine
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Come ridurre il rischio?
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Strategie multiple
Cinture di
sicurezzaAir bag
Telaio
Seggiolini
ABS ESP TCS ISA
AlcolStupefacenti
Farmaci
Cellulare
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Residual riskinherent risk – impact of risk controls
illusionerealtà (talora)
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Maggior rischio a lungo termine
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Come ridurre il rischio?
MetforminaNifedipinaAspirinaStatina
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Non stiamo esagerando?
StricninaWhy not?
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Residual riskdurante terapia medica
illusione realtà(talora)
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carlomaggio.it Lieb 2015
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Triple Whammy
Loboz 2004
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Triple whammy: GFR reduction
NSAID
PGI2 & PGE2
ACE-I & ARB
GFR
Ang II
GFR
Diuretics
GFR
Loboz 2004
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Attenzione: non rinneghiamo la medicina
Maria Sklodowska1867-1934
Premi Nobel 1903-1911
Scipione Riva Rocci1863-1937
Inventore sfigmomanometroPolonsky 2017
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Breast arterial calcification on mammography
Punctate vascularcalcification
Tram-trackcalcification
Polonsky 2017
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Farmaci per malatio se rischio elevato
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Linee guida
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A chi?
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Turning torsoMalmö
Santiago Calatrava
Everything you can imaginenature has already created
Albert Einstein
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carlomaggio.itCopyright © American Heart Association, Inc. All rights reserved.
Long-term benefits ofRegular endurance exercise
Rowe 2014
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carlomaggio.itCopyright © American Heart Association, Inc. All rights reserved.
Carbohydrate quality
Mozaffarian 2016
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Scopri le similitudini
Pienza
Dieta Mediterranea
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Circulation meal timing frequency
St-Onge 2017
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Breakfast skipping:higher cardiovascular risk
St-Onge 2017
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DietaGIFT: colazione abbondante
Speciani 2016
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Chain of performancein Functional Medicine
Stress CDDfocus
SNA ISADisbiosi
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costituzioni
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Personalità
Tipo AAggressivo
OstileCompetitivo
Tipo BBeato
TranquilloNon competitivo
Tipo CCancro
Ignora i propri bisogni
Vita per gli altri
Tipo DDepresso
InattivoDisperato
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carlomaggio.it Denis 2014
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FDR CVS e K
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Cancro
Aumento
Glicemia
StressOssidativo
Angiogenesi
Infiammazione
Immunodepression
e
AcidosiIpossia
MosaicoOncogen
o
Dott. Luca Imperatori
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carlomaggio.itCopyright © American Heart Association, Inc. All rights reserved.
Low-fat or Mediterranean diet?
Mozaffarian 2016
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Rapporto Neutrofili/Linfociti
What’s wrong?
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Rapporto Neutrofili/Linfociti
N/L = 4,18*
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N/L ratio Insulin resistance
Low grade chronic inflammation
Lou 2015
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NLR e HOMA-ir
HOMA-IR ≤ 2 HOMA-IR > 2
Lou 2015
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Metaflammation:Metabolically triggered inflammation
Surplus metabolico Nutrienti alieni
Gregor 2011
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Obesità e infiammazione
Ouchi 2011
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• Cartolina con i quattro bianchi
Dieta antinfiammatoria
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Cibi ricchi in omega-3Frutta secca con guscioSemiVerdure a foglia verdeFruttaCibi a basso indice glicemicoAlcune spezie
Cibi antinfiammatori
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carlomaggio.itCopyright © American Heart Association, Inc. All rights reserved.
Key cellular actions lipoxins - resolvins
Spite 2010
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Depressione emortalità cardiaca
• Depressione:– Può aumentare il rischio
di mortalità cardiaca• Iperattività
dell’ortosimpatico– Riduzione dell’HRV– Predisposizione a
aritmie ventricolari
Penninx 2001
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Neurocezione: minacciaCapacità circuiti neurali di distinguere
situazioni sicure o di pericolo
Minaccia Simpatico
Vago amielini
co
Porges 2014
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Neurocezione: sicurezzaSicurezza = Vago mielinico = Ingaggio
sociale
Sicurezza
Inibizione
simpatico
Vago mielinic
o
Porges 2014
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Ingaggio sociale: m. stapedio
Borg 1989
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Magnesium Depression
Serefko 2013
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Na
K
Mg
Ca
Quadrato: oligoelementi
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Aritmie
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Bibliografia 1Catapano Alberico L. et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016;37:2999-3058Gregor M.F. and Hotamisliglil G.S. Inflammatory Mechanism in Obesity. Annu Rev Immunol. 2011; 29: 415-445 Hernáez A. et al. Mediterranean Diet Improves High-Density Lipoprotein Function in High-Cardiovascular-Risk Individuals. Circulation. 2017; 135: 633-643Johnson. Lessons from comparative physiology: could uric acid represent a physiologic alarm signal gone awry in western society? J Comp Physiol B. 2009; 179(1): 67-76Lieb Wolfgang et al. Residual Cardiovascular Risk in Individuals on Blood Pressure-Lowering Treatment. J Am Heart Assoc. 2015;4:e002155 doi:10.1161/JAHA.115.002155Loboz Katarzyna and Shenfield Gillian M. Drug combinations and impaired renal function – the “triple Whammy”. Br J Clin Pharmacol. 2004;59(2):239-243Lou M. et al. Relationship between neutrophil-lymphocyte ratio and insulin resistance in newly diagnosed type 2 diabetes mellitus patients. BMC Endocrine Disorders. 2015;15:9. DOI 10.1186/s12902-0002-9
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Bibliografia 2Mozaffarian. Dietary and Policy Priorities for Cardiovascular Disease, Diabetes and Obesity. Circulation. 2016;133:187-225Polonsky Tama S. and Greenland Philip. Breast Arterial Calcification. Circulation. 2017;135:499501Rowe G.C. et al. Running Forward. New Frontiers in Endurance Exercise Biology. Circulation. 2014;129:798-810Ouchi N. et al. Adipokines in inflammation and metabolic disease. Nat Rev Immunol. 2011; 11(2): 85-97Speciani. Guida pratica alla dietaGIFT e all’alimentazione di segnale. Tecniche Nuove. Milano. 2016Spite M and Serhan C.N.. Novel lipid mediators promote resolution of acute inflammatiom: impact of aspirin and statins. Circ Res. 2010; 107: 1170-1184St-Onge Marie-Pierre et al. Meal Timing and Frequency: Implications fo Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Associaton. Circulation. 2017;135:00-00. DOI:10.1161/CIR.0000000000000476