Dario Di Minno | Università degli Studi di Napoli "Federico II" (original) (raw)

Papers by Dario Di Minno

Nutrition Metabolism and Cardiovascular Diseases, 2010

Antiphospholipid antibodies are a heterogeneous group of auto-antibodies against phospholipids-bi... more Antiphospholipid antibodies are a heterogeneous group of auto-antibodies against phospholipids-binding proteins. The antiphospholipid syndrome is an autoimmune disorder characterized by the clinical association of antiphospholipid antibodies with a condition of hypercoagulability that can affect any blood vessel. Involvement of larger vessels, such as arteries or veins, manifests in the form of thrombosis or thromboembolism, whereas involvement of small vessels manifests as thrombotic micro-angiopathy. The antiphospholipid syndrome is also characterized by the presence of recurrent fetal loss. Patients who are persistently positive for antiphospholipid tests, and who have an arterial thrombosis or venous thrombosis history, are at increased risk of recurrence. Oral anticoagulant therapy is the mainstay of treatment for the thrombotic manifestations of the syndrome. Therapy with anticoagulant drugs should be long-term. On the other hand, although the thromboembolic potential of antiphospholipid antibodies has been well documented, there is still no general consensus on the prophylactic treatment of antiphospholipid antibodies carriers who have never developed vascular/obstetric manifestations. The effect of primary prophylaxis in antiphospholipid antibodies positive individuals is not well known and no evidence-based recommendations exist for thrombosis prevention in these individuals. However, the presence of risk factors for thrombosis increases the risk of first event of antiphospholipid antibodies positive patients. In conclusion, there is still much to learn on primary prophylaxis of asymptomatic antiphospholipid antibodies carriers. Hopefully, evidence-based guidelines will be available in the future.

Thrombosis Research, 2009

GH-deficient adults IGF-1 insulin PAI-1 t-PA r-HGH treatment

Journal of Inflammation, 2009

Background: Obesity is a leading risk factor for metabolic syndrome whose further expression is n... more Background: Obesity is a leading risk factor for metabolic syndrome whose further expression is non-alcoholic fatty liver disease. Metabolic syndrome is associated with a proinflammatory state that contributes to insulin resistance. Finally, a "metabolically benign obesity" that is not accompanied by insulin resistance has recently been postulated to exist.

Internal and Emergency Medicine

The aim of this narrative review is to assess the potential association between arterial and veno... more The aim of this narrative review is to assess the potential association between arterial and venous thrombotic events. Several studies have suggested that the major cardiovascular risk factors, alone or in combination (e.g. in the metabolic syndrome), are significantly associated with venous thromboembolism (VTE). Recent evidence also suggests that microalbuminuria and non-alcoholic liver steatosis, both markers of arterial disease, may independently predict the risk for VTE. An association between a history of VTE and the risk of future arterial events is also well documented, inflammation and endothelial dysfunction being thought as the common soil on which further investigation in the area should be pursued. The existence of a common pathophysiologic background is also suggested by the evidence that aspirin, low-molecular weight heparin (LMWH) and warfarin are recommended for the prevention and treatment of both venous and arterial thrombosis. In addition, rosuvastatin recently has been shown to prevent venous thromboembolism (VTE) in a time-dependent fashion. Together, these data argue for patients with a history of VTE as being at intermediate/high cardiovascular risk, a concept that implies that VTE patients should undergo a careful assessment for the presence of cardiovascular risk factors and adequate lifestyle changes. The value of routine screening for asymptomatic atherosclerosis (e.g. 2D echocardiography, microalbuminuria, arterial vessel ultrasonography) in these patients should be confirmed in future studies.

Pathophysiology of Haemostasis and Thrombosis, 2002

In the 80&amp;amp;amp;amp;amp;#39;s, retrospective studies showed an inverse relation bet... more In the 80&amp;amp;amp;amp;amp;#39;s, retrospective studies showed an inverse relation between fish consumption and ischemic heart disease (IHD) mortality. In parallel, fish fats containing the polyunsaturated fatty acid (PUFA) eicosapentaenoic (EPA) were shown to impair platelet aggregation and thromboxane formation. The results of the large prospective trials, the Diet and Reinfarction Trial (DART) and the Lyon Heart Study in the secondary prevention of myocardial infarction, have further supported the interrelationships between diet and dietary prevention of IHD. In the DART Study, the cardioprotection by EPA was paralleled by an increase plasma content of EPA. In the Lyon, in addition to changes in the content of EPA, changes in other well known variables (i.e. leukocytes and vitamin E), often abnormal in subjects prone to arterial thrombosis, have been found. The GISSI Prevenzione Trial was a prospective, multicentric, open labeled trial with a factorial design, in which 11,324 recent (&amp;amp;amp;amp;amp;lt;3 mo) survivors of a first myocardial infarction were assigned to receive, in addition to the usual strategy, a supplementation of n-3 PUFA, vitamin E, or the combination of the two. Cardiovascular death (-30%), coronary heart disease death (-35%), total death (-20%) and sudden death (-45%) were all significantly reduced by the n-3 PUFA supplementation. The reduced tendency to sudden death of survivors of myocardial infarction on treatment with n-3 PUFA are in keeping with a series of scanty but reliable clinical data as well as of experimental studies. However, we believe that large-scale prospective multicentric randomized trials aimed at preventing sudden death in high-risk patients as well as at testing the effects of n-3 PUFA in patients with intracoronary devices and sustained ventricular arrhythmias, are a major direction to be followed to better understand the n-3 PUFA and sudden death issue.

Thrombosis Research, 2010

Thrombosis Research, 2011

Background: Although patients with idiopathic VTE are at higher than normal risk of asymptomatic ... more Background: Although patients with idiopathic VTE are at higher than normal risk of asymptomatic atherosclerosis and of cardiovascular events, the impact of cardiovascular risk factors on VTE is poorly understood. Objective: To assess the prevalence of the metabolic syndrome and of its components in patients with earlyonset idiopathic VTE. Methods: As many as 323 patients referred to our Thrombosis Ward for a recent (b6-months) early-onset idiopathic venous thromboembolism (VTE), were compared with 868 gender-and age-matched subjects, in whom a history of venous thrombosis had been excluded, referred during the same period time to our Ward. All had undergone a clinical assessment for smoking habits and for the presence of the components of the metabolic syndrome. Results: The metabolic syndrome was detected in 76/323 cases (23.5%) and in 81/868 controls (9.3%) (p b 0.001; OR:2.990; 95%C.I.:2.119-4.217). Smoking was more common in patients with idiopathic VTE than in controls. In addition to the metabolic syndrome as a whole, its major individual determinants (arterial hypertension, impaired fasting glucose plasma levels, abdominal obesity, hypertriglyceridemia, low HDLcholesterol) significantly correlated with idiopathic VTE (p always b 0.05). The prevalence of thrombotic events was lower in females than in males (p = 0.000; OR:2.217), the latter being most often hypertensives, smokers, hypertriglyceridemics, carriers of a metabolic syndrome and of impaired fasting glucose than females. In a multivariate analysis, arterial hypertension, impaired fasting glucose, abdominal obesity, and hypercholesterolemia independently predicted idiopathic venous events. Conclusions: Both metabolic syndrome as a whole and its major components individually considered, independently predict early-onset idiopathic VTE.

Thrombosis and Haemostasis, 2010

In the 1980s, observational retrospective studies showed an inverse relation between coronary hea... more In the 1980s, observational retrospective studies showed an inverse relation between coronary heart disease (CHD) and consumption of fish containing fatty acids that belong to the omega (ω)-3 family. Large case-control studies and prospective intervention trials consistently showed that ω-3 fatty acids supplementation lowers fatal myocardial infarction (MI) and sudden cardiac death. By analysing the strengths of the results of individual studies and how the meta-analyses agree with them, putting together relevant backgrounds, and identifying open questions, the following findings/directions emerge. (i) Dietary and non-dietary intake of ω-3 fatty acids reduces overall mortality, mortality due to MI, and sudden death in patients with CHD; (ii) Fish oil consumption directly or indirectly affects cardiac electrophysiology. Fish oil reduces heart rate, a major risk factor for sudden death; (iii) Among patients with implantable cardioverter defibrillators, ω-3 fatty acids do not reduce the risk of ventricular tachycardia/ventricular fibrillation and may actually be pro-arrhythmic; (iv) The consumption of ω-3 fatty acids leads to a 10-33% net decrease of triglyceride levels. The effect is dose-dependent, larger in studies with higher mean baseline triglyceride levels, and consistent in different populations (healthy people, people with dyslipidaemia, diabetes, or known cardiovascular risk factors); (v) Outcomes for which a small beneficial effect ω-3 fatty acids is found include blood pressure (about 2 mmHg reduction), re-stenosis rates after coronary angioplasty (14% reduction), and exercise tolerance testing. Major experimental data provide strength (biological plausibility) for these findings, and define directions for newer clinical trials with ω-3 fatty acids.

Journal of The American Geriatrics Society, 2008

OBJECTIVES: To determine the clinical, historical, and instrumental findings associated with unfa... more OBJECTIVES: To determine the clinical, historical, and instrumental findings associated with unfavorable short-term and long-term prognosis in elderly patients (≥65) receiving thrombolytic therapy for pulmonary embolism (PE).DESIGN: Case-control retrospective study.SETTING: General medicine acute care ward.PARTICIPANTS: Sixty-seven elderly patients with PE complicated by hemodynamic instability (massive PE) admitted to the “Antonio Cardarelli” Hospital from January 1, 2002, to December 31, 2004, and evaluated during their hospital stay and 174.4±4.6 days after discharge.MEASUREMENTS: PE diagnosis was confirmed using spiral computed tomography angiography. Hemodynamic instability was defined as cardiogenic shock and systolic blood pressure less than 90 mmHg or a pressure drop of 40 mmHg or more for longer than 15 minutes not due to new-onset arrhythmia, hypovolemia, or sepsis.INTERVENTION: Weight-adapted unfractionated heparin and recombinant tissue plasminogen activator.RESULTS: Nine patients (13.4%) died during hospitalization. Higher troponin-I (cTn-I) serum levels at admission to the emergency department and the occurrence of thrombocytopenia after thrombolysis were significantly associated with in-hospital death. Nineteen of the 58 survivors (32.7%) died during follow-up. The risk factors for long-term death were historical findings of cancer and cardiovascular disease at hospital admission.CONCLUSION: Higher cTn-I serum levels in the acute phase and the occurrence of thrombocytopenia after thrombolysis were significantly associated with in-hospital mortality in elderly patients with massive PE. In the same setting, historical findings of cancer and cardiovascular disease are strong predictors of death in the long term.