Open Access by Damiano Baldassarre
Interventions aimed to prevent cardiovascular diseases (CVD) are more effective if administered t... more Interventions aimed to prevent cardiovascular diseases (CVD) are more effective if administered to subjects carefully selected according to their CVD risk. Usually, this risk is evaluated on the basis of the presence and severity of conventional vascular risk factors (VRFs); however, atherosclerosis, the main pathologic substrate of CVD, is not directly revealed by VRFs. The measurement of the arterial wall, using imaging techniques, has increased the early identification of individuals prone to develop atherosclerosis and to quantify its changes over time.
B-mode ultrasound is a technique which allows a non-invasive assessment of the arterial wall of peripheral arteries (e.g. extracranial carotid arteries), and provides measures of the intima-media thickness complex (C-IMT) and additional data on the occurrence, localization and morphology of plaques.
Being an independent predictor of vascular events, C-IMT has been considered as a tool to optimize the estimation of CVD risk but this application is still a matter of debate. Though the technique is innocuous, relatively inexpensive and repeatable, its use in the clinical practice is limited by the lack of standardized protocols and clear guidelines.
This review outlines the rationale for the potential use of C-IMT in the stratification of cardio- and cerebro-vascular risk and discusses several topics related to the measurement of this variable, which are still controversial among experts of the field.
Interventions aimed to prevent cardiovascular diseases (CVD) are more effective if administered t... more Interventions aimed to prevent cardiovascular diseases (CVD) are more effective if administered to subjects carefully selected according to their CVD risk. Usually, this risk is evaluated on the basis of the presence and severity of conventional vascular risk factors (VRFs); however, atherosclerosis, the main pathologic substrate of CVD, is not directly revealed by VRFs. The measurement of the arterial wall, using imaging techniques, has increased the early identification of individuals prone to develop atherosclerosis and to quantify its changes over time.
B-mode ultrasound is a technique which allows a non-invasive assessment of the arterial wall of peripheral arteries (e.g. extracranial carotid arteries), and provides measures of the intima-media thickness complex (C-IMT) and additional data on the occurrence, localization and morphology of plaques.
Being an independent predictor of vascular events, C-IMT has been considered as a tool to optimize the estimation of CVD risk but this application is still a matter of debate. Though the technique is innocuous, relatively inexpensive and repeatable, its use in the clinical practice is limited by the lack of standardized protocols and clear guidelines.
This review outlines the rationale for the potential use of C-IMT in the stratification of cardio- and cerebro-vascular risk and discusses several topics related to the measurement of this variable, which are still controversial among experts of the field.
Papers by Damiano Baldassarre
Fibrinolysis, May 1, 1996
Nutrition, Metabolism and Cardiovascular Diseases, 2021
Journal of the American Heart Association
Background The association between common carotid artery intima‐media thickness (CCA‐IMT) and inc... more Background The association between common carotid artery intima‐media thickness (CCA‐IMT) and incident carotid plaque has not been characterized fully. We therefore aimed to precisely quantify the relationship between CCA‐IMT and carotid plaque development. Methods and Results We undertook an individual participant data meta‐analysis of 20 prospective studies from the Proof‐ATHERO (Prospective Studies of Atherosclerosis) consortium that recorded baseline CCA‐IMT and incident carotid plaque involving 21 494 individuals without a history of cardiovascular disease and without preexisting carotid plaque at baseline. Mean baseline age was 56 years (SD, 9 years), 55% were women, and mean baseline CCA‐IMT was 0.71 mm (SD, 0.17 mm). Over a median follow‐up of 5.9 years (5th–95th percentile, 1.9–19.0 years), 8278 individuals developed first‐ever carotid plaque. We combined study‐specific odds ratios (ORs) for incident carotid plaque using random‐effects meta‐analysis. Baseline CCA‐IMT was ap...
Gerontology, 2020
Atherosclerosis – the pathophysiological mechanism shared by most cardiovascular diseases – can b... more Atherosclerosis – the pathophysiological mechanism shared by most cardiovascular diseases – can be directly or indirectly assessed by a variety of clinical tests including measurement of carotid intima-media thickness, carotid plaque, ankle-brachial index, pulse wave velocity, and coronary artery calcium. The Prospective Studies of Atherosclerosis (Proof-ATHERO) consortium (https://clinicalepi.i-med.ac.at/research/proof-athero/) collates de-identified individual-participant data of studies with information on atherosclerosis measures, risk factors for cardiovascular disease, and incidence of cardiovascular diseases. It currently comprises 74 studies that involve 106,846 participants from 25 countries and over 40 cities. In summary, 21 studies recruited participants from the general population (n = 67,784), 16 from high-risk populations (n = 22,677), and 37 as part of clinical trials (n = 16,385). Baseline years of contributing studies range from April 1980 to July 2014; the lates...
Nature communications, Apr 26, 2017
Few genome-wide association studies (GWAS) account for environmental exposures, like smoking, pot... more Few genome-wide association studies (GWAS) account for environmental exposures, like smoking, potentially impacting the overall trait variance when investigating the genetic contribution to obesity-related traits. Here, we use GWAS data from 51,080 current smokers and 190,178 nonsmokers (87% European descent) to identify loci influencing BMI and central adiposity, measured as waist circumference and waist-to-hip ratio both adjusted for BMI. We identify 23 novel genetic loci, and 9 loci with convincing evidence of gene-smoking interaction (GxSMK) on obesity-related traits. We show consistent direction of effect for all identified loci and significance for 18 novel and for 5 interaction loci in an independent study sample. These loci highlight novel biological functions, including response to oxidative stress, addictive behaviour, and regulatory functions emphasizing the importance of accounting for environment in genetic analyses. Our results suggest that tobacco smoking may alter th...
Circulation, Nov 11, 2016
Background: Experimental studies indicate that two archetype chemokines circulating in the blood,... more Background: Experimental studies indicate that two archetype chemokines circulating in the blood, IL-8 and GRO-α, are critical for atherogenesis. However, their association with measures of subclinical atherosclerosis has not been investigated. Hypothesis: Here we test the hypothesis that circulating IL8 and GRO-α protein are associated with the carotid artery intima media thickness (c-IMT) in a large European multicenter study: the c-IMT and c-IMT Progression as Predictors of Vascular Events in a High Risk European Population ( IMPROVE ) study . Methods: IMPROVE study participants (n=3,703), recruited in 5 European Countries (Sweden, Finland, the Netherlands, France and Italy), had at least three cardiovascular (CV) risk factors but not prevalent CV diseases. C-IMT measures (mm) (c-IMT mean , c-IMT max and c-IMT mean-max ) were recorded at baseline. Each measurement represent the average of 8 (4 left and 4 right) carotid segments. IL8 and GRO-α were measured in plasma from 3,452 participants (women, n=1,784; men, n=1,668) using the Olink ProSeek CVD array I and expressed in arbitrary units. We evaluated the association, expressed as beta coefficient (β) and 95% confidence intervals (CI), between chemokines and c-IMT using median regression. Models were adjusted by sex, age, body mass index, hypertension, diabetes, current smokers, hypercholesterolemia and latitude. Results: Higher levels of IL8 and GRO-α were observed in participants from Northern Europe as compared to those from Southern Europe [IL8: 50 (41-62) vs 36 (28-49) and GRO-α 108 (70-176) vs 42(22-95)]. At multivariable analysis only in men, levels of IL8 were positively associated with c-IMT measures: c-IMT mean [1.0 x 10 -4 (6.5 x 10 -5 -1.4 x 10 -4 ), p max [(6.5 x 10 -4 ,(4.8 x 10 -4 -8.2 x 10 -4 ), p mean-max [1.7 x 10 -4 , (1.3 x 10 -4 -2.2 x 10 -4 ), p Conclusions: The chemokine IL8, but not GRO-α, was associated with baseline c-IMT in men at high risk of CV events. Furthermore, our results suggest the presence of a European north-to-south gradient in chemokine levels. New studies are warranted to disentangle potential differences between IL8 and CV risk across sexes.
Indirizzo per la corrispondenza Dr. Damiano Baldassarre Dipartimento di Scienze Farmacologiche Un... more Indirizzo per la corrispondenza Dr. Damiano Baldassarre Dipartimento di Scienze Farmacologiche Università degli Studi di Milano Via Balzaretti, 9 20133 Milano E-mail: damiano.baldassarre@unimi.it Sommario Le misure d’intervento terapeutico, volte a ridurre il rischio di sviluppare malattie cardiovascolari (MCV), sono tanto più efficaci quanto più applicate ad individui accuratamente selezionati in base al loro rischio cardiovascolare (RC). Generalmente, il RC è valutato in base alla presenza/assenza di fattori di rischio cardiovascolare (FRC) convenzionali. Tuttavia, la malattia aterosclerotica, una delle forze trainanti delle MCV, non sempre è rilevata dai FRC in modo adeguato. La misura diretta della parete arteriosa, con tecniche di imaging, ha aumentato la possibilità di individuare precocemente i soggetti predisposti a sviluppare la malattia aterosclerotica e di quantificarne le variazioni nel tempo. Lo spessore del complesso medio intimale delle carotidi extracraniche (C-IMT),...
Circulation-cardiovascular Genetics, Dec 1, 2012
Circulation, Aug 18, 2009
European Journal of Preventive Cardiology, Nov 21, 2020
The Carotid Atherosclerosis Italian Ultrasound study (CAIUS) is a multicenter, parallel group, do... more The Carotid Atherosclerosis Italian Ultrasound study (CAIUS) is a multicenter, parallel group, double-blind clinical trial, performed in 305 asymptomatic, moderately hyper-cholesterolemic patients, which demonstrated an inhibitory effect of pravastatin on the carotid intima-media thickness (IMT) progression. In the present post-hoc analysis of the CAIUS study we investigated whether the effect of pravastatin is related to the hypocholesterolemic effect of the drug. In the overall group of patients (placebo and pravastatin treated) covariance analysis showed that while the treatment was significantly related to the reduction of IMT progressione, the IMT progression did not correlate with the extent of LDL-C lowering. The pravastatin treated group was then stratified into quartiles of LDL-C lowering. In all quartiles, independently on the extent of response in terms of LDL-C lowering, reduction of IMT progression was observed. No significant difference was found among quartiles and no trend could be identified. Finally when treated patients were subdivided into responders (\u394LDL-C>10%) or non-responders (\u394LDL-C 6410%) the two group showed similar pattern of response in terms of inhibition of IMT progression. We conclude that the effect of pravastatin on the IMT progression rate is independent on the hypocholesterolemic effect of the drug
European Journal of Nutrition, Mar 24, 2020
Cholesteryl ester transfer protein (CETP) is a plasma glycoprotein that is bound mainly to HDL pa... more Cholesteryl ester transfer protein (CETP) is a plasma glycoprotein that is bound mainly to HDL particles and mediates the transfer of neutral lipids (CE and TG) between HDL and apoB-containing lipoproteins (LDL and VLDL). Inhibition of CETP is considered a potential approach to treat dyslipidemia; however, discussion regarding CETP inhibition as a potential strategy for prevention of atherosclerosis has been controversial. As the role of CETP in the atherogenic process is still not fully clarified, we studied the association of CETP concentration with intima-media thickness of the carotid artery (IMT) in subjects with high cardiovascular risk and free of any pharmacological treatments. The plasma CETP concentration was measured by an immunoenzymatic assay developed in our laboratory in a subgroup (n=540) of subjects enrolled in the multicenter, longitudinal, observational IMPROVE study. Mean and maximum IMT of the whole carotid tree was measured by B-mode ultrasonography in all subjects. In the entire cohort, CETP quartiles were not associated with carotid mean and maximum IMT (P for trend 0.64 and 0.66, respectively), also after adjustment for age, gender, HDL-C, and triglycerides. In the whole group of examined subjects, plasma CETP concentration correlated positively with HDL-C (P< 0.0001). The present findings show that in European individuals at high cardiovascular risk CETP concentration is not a major determinant of carotid IMT
European Heart Journal, Aug 1, 2011
Purpose: The harmful effect of smoking on atherosclerosis and cardiovascular health is well estab... more Purpose: The harmful effect of smoking on atherosclerosis and cardiovascular health is well established. Educational campaigns have been successful in reducing the number of smokers in men but not in women, where the number of smokers (initially lower than men) is even increasing. We investigated the gender differences in the association of tobacco smoke with subclinical atherosclerosis and atherosclerosis progression also taking into account the effects of other variables strongly associated with tobacco smoke: C reactive protein (CRP) and number of white blood cells (WBC) as inflammation markers, and education as an index of social class. Methods: The IMPROVE Study cohort includes 1694 men and 1893 women (age 54-79 yr) at high risk of cardiovascular disease of five European countries. Baseline mean and maximum IMT of the left and right common carotids, bifurcations and internal carotid arteries and the fastest IMT-progression (15 months of follow up) detected in the whole carotid tree regardless of its location were computed. Associations were assessed by multivariable analysis adjusting for conventional cardiovascular risk factors and recruiting centre. Results: Pack-years, a lifelong index of tobacco exposure, significantly associated with baseline C-IMT in both genders. However, the estimated C-IMT increase for each pack-year was more than double in women than in men (3.7\ub10.7 vs. 1.5\ub10.5 \ub5m) with a significant gender 7 dose interaction (P=0.01). Moreover, the estimated increase in the fastest C-IMT progression associated with a unit of cigarettes/day, an index of daily dose of tobacco exposure, was more than five-fold in women than in men (5.5\ub11.3 vs. 1.0\ub11.3 \ub5m/yr), (P-int =0.008). Also the relationships between C-IMT and CRP (P-int =0.015), WBC (P-int =0.011) and education (P-int =0.014) were different in men and women. Gender differences were also observed considering the relationships between current smoking and CRP (P-int =0.045) and WBC (P-int =0.049). Finally, a significant gender difference was also found in the relationship between education and smoking exposure (P-int =0.0003). Conclusions. The effects of tobacco smoking on cross-sectional subclinical atherosclerotic burden, and on atherosclerosis progression appear to be more harmful in women than in men, prompting studies on gender specific mechanisms and development of preventive actions expressly oriented to women. Inflammation and social class seems to be implicated in the complex interrelation between tobacco smoke, gender and subclinical atherosclerosis
Circulation, 2010
A proposed innovative approach to compute individual carotid intima-media thickness progression /... more A proposed innovative approach to compute individual carotid intima-media thickness progression / F. Veglia, D. Baldassarre, M. Amato, A. Ravani, D. Sansaro, C. Tedesco, A. Discacciati, B. Frigerio, S. Castelnuovo, E. Tremoli. - In: Circulation. - ISSN 0009-7322. - ISSN ...
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Open Access by Damiano Baldassarre
B-mode ultrasound is a technique which allows a non-invasive assessment of the arterial wall of peripheral arteries (e.g. extracranial carotid arteries), and provides measures of the intima-media thickness complex (C-IMT) and additional data on the occurrence, localization and morphology of plaques.
Being an independent predictor of vascular events, C-IMT has been considered as a tool to optimize the estimation of CVD risk but this application is still a matter of debate. Though the technique is innocuous, relatively inexpensive and repeatable, its use in the clinical practice is limited by the lack of standardized protocols and clear guidelines.
This review outlines the rationale for the potential use of C-IMT in the stratification of cardio- and cerebro-vascular risk and discusses several topics related to the measurement of this variable, which are still controversial among experts of the field.
B-mode ultrasound is a technique which allows a non-invasive assessment of the arterial wall of peripheral arteries (e.g. extracranial carotid arteries), and provides measures of the intima-media thickness complex (C-IMT) and additional data on the occurrence, localization and morphology of plaques.
Being an independent predictor of vascular events, C-IMT has been considered as a tool to optimize the estimation of CVD risk but this application is still a matter of debate. Though the technique is innocuous, relatively inexpensive and repeatable, its use in the clinical practice is limited by the lack of standardized protocols and clear guidelines.
This review outlines the rationale for the potential use of C-IMT in the stratification of cardio- and cerebro-vascular risk and discusses several topics related to the measurement of this variable, which are still controversial among experts of the field.
Papers by Damiano Baldassarre
B-mode ultrasound is a technique which allows a non-invasive assessment of the arterial wall of peripheral arteries (e.g. extracranial carotid arteries), and provides measures of the intima-media thickness complex (C-IMT) and additional data on the occurrence, localization and morphology of plaques.
Being an independent predictor of vascular events, C-IMT has been considered as a tool to optimize the estimation of CVD risk but this application is still a matter of debate. Though the technique is innocuous, relatively inexpensive and repeatable, its use in the clinical practice is limited by the lack of standardized protocols and clear guidelines.
This review outlines the rationale for the potential use of C-IMT in the stratification of cardio- and cerebro-vascular risk and discusses several topics related to the measurement of this variable, which are still controversial among experts of the field.
B-mode ultrasound is a technique which allows a non-invasive assessment of the arterial wall of peripheral arteries (e.g. extracranial carotid arteries), and provides measures of the intima-media thickness complex (C-IMT) and additional data on the occurrence, localization and morphology of plaques.
Being an independent predictor of vascular events, C-IMT has been considered as a tool to optimize the estimation of CVD risk but this application is still a matter of debate. Though the technique is innocuous, relatively inexpensive and repeatable, its use in the clinical practice is limited by the lack of standardized protocols and clear guidelines.
This review outlines the rationale for the potential use of C-IMT in the stratification of cardio- and cerebro-vascular risk and discusses several topics related to the measurement of this variable, which are still controversial among experts of the field.