ABSTRACT
Hundred and forty elderly patients (76 males and 64 females, over 65 years of age) were consecutively admitted to the Institute between November 1989 and April 1993, in order to (i) verify if the risk factors, reported in other Italian areas and regions of the world, are prevalent also in our region, and (ii) outline a secondary prevention strategy against the statistically most important risk factors. There were 111 cases of ischemic stroke (58 males and 53 females) and 29 cases of reversible ischemic attack (RIA) (18 males and 11 females). The percental occurrence of the following risk factors were determined: total cholesterol > 240 mg/dl, HDL cholesterol < 35 mg/dl, triglycerides > 180 mg/dl, fibrinogen > 450 mg/dl, hematocrit > 45%, hypertension, diabetes mellitus, cigarette smoking, familial ischemic events, previous ischemic CVD, ischemic cardiac disease, embolic cardiopathy. In males with ischemic stroke the most frequent risk factors were: hypertension (43%), fibrinogen > 450 mg/dl (37.9%), diabetes mellitus, cigarette smoking and previous ischemic CVD (25.8%). In females with ischemic stroke a clear prevalence of hypertension (69.8%), ischemic cardiopathy and previous ischemic CVD (47%) and diabetes mellitus (41.5%) were observed. In males with RIA hypertension (50%) and cigarette smoking (38%). Females with RIA presented a high prevalence of reduced HDL cholesterol, lower than 35 mg/dl (77.7%), hypertension (63.6%) and ischemic cardiopathy (54.5%). The results indicate that there are no highly significant differences between the data reported by other authors on the most important acute ischemic CVD risk factors in Italy and elsewhere. Arterial hypertension and diabetes mellitus are the most important risk factors of cerebral ischemic events in both sexes. The diffusion of cigarette smoking among women in the last thirty years must be taken into consideration. Although it does not represent a risk factor for elderly women today, it may do in the future. Therefore, antismoking campaigns must be more decisive and targeted at both sexes.
ABSTRACT
Some clinical, histological and virological features, efficacy and safety of interferon (IFN) therapy were evaluated in elderly patients with chronic hepatitis C (CHC). We enrolled 22 patients aged 65-75 (mean age: 68.3 +/- 3.17 years); 15 males and 7 females. In all cases the hepatitis C virus RNA (HCV-RNA) was determined before, during and after the therapy, and HCV sub-types were established; 15 patients underwent hepatobiopsy. At entry, the duration of disease was: 6 patients 1-3 years, 2 patients 4-10 years, 14 patients 11-30 years; alanine-aminotransferase (ALT) = (3.17 +/- 1.15) x N (N = normal value); aspartate-transaminase (AST) = 2.28 +/- 1.6 x N; gamma-glutamyl-transpeptidase (gGT) = 1.4 +/- 1.1 x N; platelets = 164,000 +/- 66,000/mm(3); histological pattern: 2 mild chronic active hepatitis (CAH), 5 CAH, 2 severe CAM, 6 CAH with liver cirrhosis (LC); histological activity index (HAI) (14 patients) = 11.14 +/- 4.5 (range 5-17); scores according to Scheuer: lobular 2.28 +/- 1.13, portal 2.71 +/- 0.99, fibrosis 2.35 +/-1.33; HCV-RNA +ve: 20 patients, HCV-RNA -ve: 2 patients; HCV-subtypes: 1b 20/20 (100%), 1b+1a 1/20 (5%), 1b+ 2a 1/20 (5%). Treatment was applied to 18 patients, for 3-12 months; 5 received alpha-IFN2a; 5 received alpha-IFN2b, 3 lymphoblastoid IFN, all at a dose of 3 mU thrice per week; 3 patients received 6 mU beta-IFN thrice per week. Therapy over 6 months was applied to 16 patients: Complete response (CR) was observed in 8 patients (50%), one of them was with long-term CR (over 12 months after therapy); 5 have had relapse and 2 patients are still under treatment. Partial response (PR) was observed in 4 patients (25%), no response (NR) in 4 patients (25%). Side effects were moderate and self-limited. Loss of HCV-RNA was shown in some patients with PR and in all patients with CR, but only temporarily.