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Acta Diabetologica

, Volume 54, Issue 2, pp 123–131 | Cite as

Are all people with diabetes and cardiovascular risk factors or microvascular complications at very high risk? Findings from the Risk and Prevention Study

  • Irene Marzona
  • Fausto Avanzini
  • Giuseppe Lucisano
  • Mauro Tettamanti
  • Marta Baviera
  • Antonio Nicolucci
  • Maria Carla Roncaglioni
  • Risk & Prevention Collaborative Group
Original Article

Abstract

Aims

To verify whether it is possible, in people with diabetes mellitus (DM) considered at very high cardiovascular (CV) risk, stratify this risk better and identify significant modifiable risk factor (including lifestyle habits) to help patients and clinicians improve CV prevention.

Methods

People with DM and microvascular diseases or one or more CV risk factors (hypertension, hyperlipidemia, smoking, poor dietary habits, overweight, physical inactivity) included in the Risk and Prevention study were selected. We considered the combined endpoint of non-fatal acute myocardial infarction and stroke and CV death. A multivariate Cox proportional analysis was carried out to identify relevant predictors. We also used the RECPAM method to identify subgroups of patients at higher risk.

Results

In our study, the rate of major CV events was lower than expected (5 % in 5 years). Predictors of CV events were age, male, sex, heart failure, previous atherosclerotic disease, atrial fibrillation, insulin treatment, high HbA1c, heart rate and other CV diseases while being physically active was protective. RECPAM analysis indicated that history of atherosclerotic diseases and a low BMI defined worse prognosis (HR 4.51 95 % CI 3.04–6.69). Among subjects with no previous atherosclerotic disease, men with HbA1c more than 8 % were at higher CV risk (HR 2.77; 95 % CI 1.86–4.14) with respect to women.

Conclusions

In this population, the rate of major CV events was lower than expected. This prediction model could help clinicians identify people with DM at higher CV risk and support them in achieving goals of physical activity and HbA1c.

Keywords

Diabetes mellitus Major cardiovascular events Prediction model Lifestyle habits 

Notes

Acknowledgments

We thank F. Clerici, A. Palumbo and G. Sgaroni for their help in the conduction of the study and J.D. Baggott (all from IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri”) for kindly editing the manuscript.

Authors’ contributions

Fausto Avanzini, Irene Marzona, Maria Carla Roncaglioni, Antonio Nicolucci and Marta Baviera participated in the conception and design of the study and data interpretation. Mauro Tettamanti and Giuseppe Lucisano did the statistical analyses. Fausto Avanzini, Maria Carla Roncaglioni and Irene Marzona wrote the first draft of the report. All authors contributed to writing and have seen and approved the final version.

Funding

Società Prodotti Antibiotici (SPA), Pfizer and Sigma Tau supported the study with an unrestricted grant.

Risk & Prevention Collaborative Group are as follows:

Steering Committee M. Tombesi (chairman), G. Tognoni (co-chairman), E. Massa, W. Marrocco, M. Micalella, V. Caimi, P. Longoni, F. Avanzini, M.G. Franzosi.

Scientific and Organizing Secretariat

M.C. Roncaglioni (coordinator), I. Marzona, M. Baviera, L. Monesi, I. Pangrazzi, S. Barlera, V. Milani, E. Nicolis, C. Casola, F. Clerici, A. Palumbo, G. Sgaroni. IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri,” Via Giuseppe La Masa 19, 20156 Milan, Italy and R. Marchioli, M.G. Silletta (coordinators), R. Pioggiarella, M. Scarano, RM. Marfisi, A. Flamminio, L. Macino, B. Ferri, C. Pera, A. Polidoro. Fondazione Mario Negri Sud, Via Nazionale, 66030 S. Maria Imbaro (CH), Italy.

The Rischio and Prevenzione study is sponsored by the Rischio and Prevenzione Collaborative Group which therefore has full responsibility for the formulation of the protocol, the conduction of the study and the utilization of the results.

Principal investigators

DAbbatino, M Acquati, G Addorisio, D Adinolfi, L Adreani, M R Agistri, A Agneta, M L Agnolio, N Agostini, G Agostino, A Airò, N Alaimo, M Albano, N Albano, G Alecci, S Alemanno, A Alexanian, M Alfarano, L Alfè, N Alonzo, S Alvino, A Ancora, S Andiloro, E Andreatta, S Angeli, F Angiari, V Angilletti, C Annicchiarico, M Anzivino, R Aprea, A Aprile, E Aprile, I Aprile, L Aprile, V Armellani, M Arnetoli, A Aronica, V Autiero, G Bacca, A M Baccalaro, M Bacci, G Baglio, M Bagnani, A Baiano, A Baldari, L Ballarini, G Banchi, R Bandera, F Bandini, M Baratella, A Barbieri, A Barbieri Vita, M Bardi, M Barlocchi, P Baron, M Bartoli, A Basile, F Basile, S Basile, A Battaggia, A Battaglia, A Baù, G Beconcini, R Beggio, P A Belfiore, M Belicchi, S Bellamoli, C Bellini, M Bellomo, C Benetollo, R Benetti, E Beretta, P Bertalero, F G Bertaso, U Bertolani, G Bettelli, G Biagiotti, S Bianchi, G Bianco, F Biccari, F Bigioli, M Bindi, G Bisanti, E M Bitetti, M P Blasetti, F Blesi, V Boato, S Boga, E Boidi, G Boldrin, A Bollati, L Bolzan, S Bolzonella, P Bonardi, G B Bonato, M Bonci, G Bonfitto, E Bonincontro, F Boninsegna, D Bonissone, L Bono, E Bonollo, M Borghi, N Borioli, M Borsatto, T Bosco, M Bosisio Pioltelli, C Botarelli, S Botassis, F Bottini, C Bottos, G Bova, V Bova, A Bozzani, R M Bozzetto, V T Braga, M Braglia, E Bramati, C Brazzoli, G Breglia, A Brescia, D Briganti, G Brigato, A Brocchi, F A Brosio, E Bruni, E Buscaglia, M D Bussini, A Bussotti, F Buzzaccarini, A Buzzatti, G Caccamo, C Cacciavillani, G Caggiano, V Caimi, F P Calciano, M Calderisi, S Calienno, P Caltagirone, I Calzolari, M Cammisa, M Campanaro, G B Campanella, F Campese, G Canali, D E L Candiani, R Canepa, D Canini, A Canino, E A Cantoro, V Capilupi, P Capotosto, B Cappelli, G Capraro, F A Carafa, Q Carano, V Carcaterra, D Carriero, G Carrozzo, M Cartanese, M Casalena, M Casarola, C Caso, M Casotto, F Castaldi, R Castegnaro, G Castellani, S Castri, E Catalano, N Catinello, G Caturano, R Cavallaro, A M Cavallo, G Cavallo, M T Cavion, G Cavirani, F Cazzaniga, D Cazzetta, V Cecconi, A Cefalo, M Celebrano, A Celora, P Centonze, D Cerati, D Cesaretti, G Checchia, A Checchin, M Cherubini, L Chianese, A Chiappa, M V Chiappa, G Chiariello, G Chiavini, M Chicco, F Chiumeo, A Ciacciarelli, D Ciaci, R Ciancaglini, C Cicale, S Cicale, A Cipolla, A Ciruolo, A L Citeri, G Citterio, M Clerici, E Coazzoli, G Collecchia, F Colletta, I Colombo, P Colorio, S Coluccia, M Comerio, P Comoretto, M Compagni, O Conte, S Contri, A Contrisciani, T Coppetti, F Corasaniti, M T Corradi, A Corsano, A Corsini, N Corti, G Costantini, A Costantino, S Cotroneo, D Cozzi, M G Cravello, E Cristiano, R Cucchi, L Cusmai, G B D’ Errico, P D’Agostino, P D’Agostino, L Dal Bianco, U Dal Mutto, G Dal Pozzo, P Dallapiccola, G Dallatorre, G Dalle Molle, E Dalloni, A D’Aloiso, G D’Amicis, R Danese, D Danieli, G Danisi, M A D’Anna, G Danti, S D’Ascanio, G Davidde, D De Angeli, R De Bastiani, A De Battisti, A De Bellis, A De Bellis, G De Berardinis, F De Carlo, D De Giorgi, R De Gobbi, E De Lorenzis, P De Luca, G De Martini, M De Marzi, D De Matteis, S De Padova, P De Polo, N De Sabato, T De Stefano, M T De Vita, U De Vito, V De Zolt, F Debernardi, A Del Carlo, G Del Re, F Del Zotti, R D’Elia, P Della Giovanna, L Dell’Acqua, R L Dell’Orco, G Demaria, M G Di Benedetto, G Di Chiara, V Di Corcia, O Di Domizio, P Di Donato, S Di Donato, G Di Fermo, M Di Franco, G Di Giovannantonio, G Di Lascio, G Di Lecce, N Di Lorenzo, T Di Maro, Q Di Mattia, E Di Michele, R S Di Modica, D Di Murro, M C Di Noi, V Di Paoli, M Di Santi, A Di Sanzo, C Di Turi, A Diazzi, I Dileo, A P D’Ingianna, A Dolci, G Donà, C Donato, P Donato, A Donini, M E Donna, T V Donvito, L Esposito, N Esposito, M Evangelista, G Faita, M Falco, D A Falcone, F Falorni, A Fanciullacci, L Fanton, L Fasolo, R Fassina, A Fassone, P Fatarella, F Fedele, I Fera, L Fera, S Ferioli, M G Ferlini, R Ferlino, G Ferrante, F N Ferrara, M F Ferrarese, G Ferrari, O Ferrari, A Ferreri, M Ferroni, G Fezzi, C Figaroli, M G Fina, A Fioretta, C Fiorucci, R Firrincieli, M Fischetti, G Fischietti, D C Fiume, G Flecchia, G Forastiere, B Fossati, P L Franceschi, L Franchi, F Franzoso, G Frapporti, G Frasca, A Frisotti, G Fumagalli, D Fusco, P Gabriele, A Gabrieli, D Gagliano, G Galimberti, A Galli, N Gallicchio, F Gallio, T Gallipoli, P Gallo, T Galopin, L Gambarelli, A Garbin, G M Garozzo, R Gasparri, M Gastaldo, E Gatti, P Gazzaniga, N Gennachi, R V Gentile, P Germani, F Gesualdi, E Gherardi, C Ghezzi, M G Ghidini, F Ghionda, L Giacci, D Gialdini, C Giampaolo, R Giancane, A Giannanti, S Giannese, L Giannini, M Giaretta, R Giaretta, L Giavardi, P Giordano, E Giordano, B Giordano, G M Gioria, R Giugliano, E A Grassi, A Greco, L Greco, N Grilletti, N Grimaldi, G Grisetti, G Groppelli, L Gualtieri, M Guarducci, G Guastella, M Guerra, F Guerrini, A Guglielmini, A Guido, P Gulotta, E Iacono, G Iadarola, G Ianiro, V Iarussi, M L Ieluzzi, C Ierardi, F Ingaldi, S Interlandi, M Iocca, A Iorno, E Ioverno, R Iurato, L La Pace, C La Piscopia, R La Selva, M Lafratta, M Lamparelli, G Lanaro, R Lancerotto, M Larcher, M Lassandro, G Lattuada, P Laurino, C Lefons, F Legrottaglie, A Lemma, D Leone, F Leone, A Leso, G Leuzzi, G Levato, L Libardi, N Libralesso, P I Licini, G Licursi, F Lidonnici, C Lillo, L Liveri, A Livio, R A Loiero, M Loison, G Lombardo, T Lombardo, V Lomunno, S Lomuscio, A Lonedo, E Longo, P Longoni, L Lora, A Lotterio, L Lucatello, A Luongo, M Lupoli, C Macchia, G Macri, M Mafessanti, V Maggialetti, A Maggioni, M Magnani, G Maiellaro, A Mancuso, A R Maniglio, G L Mannari, A Manni, B Manocchio, M Mao, A Maranò, E Maraone, D Marascio, P Marcheselli, B Marchetto, S Marchetto, A Marchi, G L Marchi, C Mariano, S Marinacci, S Marinelli, G Marini, VC Marra, F Marrali, C Marseglia, G Martello, C Martino, G Martino, M Martino, C F Marulli, G Maruzzi, A Marzotti, G Mascheroni, P Mascolo, G Masoch, R Masone, E Massa, L Massa, M Massafra, M Massi, D M Massignani, A M Matarese, G Matini, R Mauro, M Mazzi, A Mazzillo, E Mazzocato, N S Mazzoleni, A Mazzone, A Melacci, E Mele, P Meliota, S Menaspà, F Meneghello, G Merola, L Merone, A Metrucci, V Mezzina, A Micchi, A Michielon, N Migliore, G Minero, F Minotta, C Mirandola, S Mistrorigo, L Modafferi, R Moitre, E Mola, C Monachese, C Mongiardini, F Montagna, M Montani, I Montemurno, R Montolli, S Montorsi, M Montresor, M G Monzani, F Morabito, G Mori, A Moro, M F Mosca, F Motti, L Muddolon, M Mugnai, F Muscas, F Naimoli, G Nanci, E Nargi, R Nasorri, G Nastrini, M Negossi, A Negrini, A Negroni, V Neola, F Niccolini, C M Niro, C Nosengo, G Novella, C Nuti, F Obici, C Olita, S S Oliverio, I Olivieri, S Oriente, G Orlando, C Paci, G Pagano, C Pagliara, G Paita, G Paladini, G Paladino, T Palano, A Palatella, P Palermo, M Palmisano, P Pando, P Panessa, F Panigo, G Panozzo, F Panvini, F Panzieri, A Panzino, F Panzitta, N Paoli, R Papagna, M G Papaleo, G Papalia, R Parisi, N Parotti, D Parravicini, P Passarella, G A Pastore, M Patafio, P Pavone, W Pedroli, M Pedroni, G Pelligra, M Pellizzari, A Penati, M Perlot, A Perrone, A Perrone, G Perrone, P Peruzzi, C Peselli, L Petracchini, L Petrera, S Petrone, C Peverelli, F Pianorsi, G P Piazza, G Piazzolla, A Picci, G Pienabarca, T P Pietronigro, P Pignocchino, R Pilone, D Pinto, E Pirovano, D Pirrotta, V Pisante, P Pitotto, L Pittari, A Piva, A Pizzoglio, O R Plantera, W Plebani, S Plessi, D Podrecca, V Poerio, F Poggiani, W Pogliani, L Poli, F G Poloni, R Porcelli, S Porto, L Pranzo, C Prevedello, C Profeta, D Profico, A Punzi, G M Quaglia, M Racano, A Raccone, F Radice, C A Raho, R Raimondi, M Rainò, R Ramponi, A Ramunni, A L Ramunni, F Ravasio, M Ravera, G Re Sartò, G Rebustello, S Regazzoli, C Restelli, M Rezzonico, F Ricchiuto, S Rigo, G Rigon, R Rigon, O V Rinaldi, M Rinaldi, P G Risplendente, M Rispoli, R Riundi, M G Riva, A L Rizzi, D Rizzi, L D Rizzo, L Rocchi, B Rondinone, B Rosa, F Rosati, F Roselli, A Rossetti, C Rossetti, R Rossi, P R Rossi, A Rossi, C L Rossi, A Rossitto, R Ruffini, A Ruffo, S Ruggio, M Ruo, B Russo, L Russo, R Russo, S Russo, U Russo, V Russo, G Ruta, F Sacchi, F Sacco Botto, A Saia, G Salladini, S Salmoiraghi, F Saluzzo, C Salvatore, E Salvatori, G Salvio, P Sandri, T Sandrini, V Sangermano, N Santoni, A D Saracino, A Saracino, P Sarasin, C Sardo Infirri, B Sarrì, G Sartori, N Sartori, C Sauro, M Scaglioni, C Scalfi, A M Scamardella, G Scandale, L Scandone, G Scannavini, R Scarati, A Scardi, F M Scarpa, P Scazzi, A Schifone, G Schiroso, G Scigliano, A Scilla, M Sciortino, G Scolaro, E Scollo, G Scorretti, R Sellitti, A Selmo, G Selvaggio, A Sempio, F Seren, L Serio, C Serra, L Serra, D Siciliano, A Sideri, M Sighele, R Signore, F Siliberto, M Silvestro, G Simioni, G Simmini, L Simonato, F Sinchetto, E Sizzano, G Smajato, M Smaldone, G Sola, L Sordillo, C S Sovran, P Spagnul, F Spanò, S Sproviero, A Squintani, L Stella, V Stilo, B Stocchiero, M C Stornello, G Stracka, S Strada, G Stranieri, N Stucci, N Stufano, A Suppa, A Suppa, V G Susca, M Sutti, M Taddei, E Tagliabue, G Tagliente, F Talato, P Talerico, R Talia, R Taranto, M Tartaglia, N Tauro, A Tedesco, P Tieri, M Tirelli, L Tocci, P Todesco, M Tognolo, A Tomba, P Tonello, R Tonon, L Toscano, A Tosi, G Tosi, S Toso, P Travaglio, L Tremul, C Tresso, P Triacchini, L Triggiano, A Trigilio, J Trimeloni, G Tripicchio, G S Tritto, F Trono, E Trotta, G Trotta, A Tubertini, C Turri, L Turri, M P Tuttolani, M Urago, G Ursini, F Valcanover, L Valente, M Valenti, F Valentini, G Vallone, P Valz, L Valzano, V Vanin, M Vatteroni, L Vegetti, D Vendrame, I Veramonti, G Veronelli, A Vesco, G Vicariotto, G Vignale, P L Villa, R Vinciguerra, A Visco, G Visentin, E Visonà, E Vitali, S Vitali, F Vitti, D A Volpone, N Zambon, A Zammarrelli, A Zanaboni, D Zane, B Zanetti, R Zanibellato, M Zappetti, P Zappone, G Zerilli, V Zirino, R Zoccali, F Zuin.

Pharmacists of the local health units

M Altomonte, N. Anelli, F Angiò, P Annale, S Antonacci, R Anzilotta, F Bano, O Basadonna, L Beduschi, P Becagli, G Bellotti, C Blotta, G Bruno, A Cappuccini, S Caramatti, M P Cariolato, M Castellana, L Castellani, R Catania, A Chielli, A Chinellato, A Ciaccia, E Clerici, A Cocci, G Costanzo, F D’Ercole, G De Stefano, F Decè, N Di Cicco, A Di Marco, C Donati Sarti, E Draghi, G Dusi, V Esposito, L Ferraro, A Ferretti, E Ferri, L Foggetti, A Foglia, E Fonzi, G Frau, M R Fuoco, G Furci, L Gallo, V Garra, A Giannini, A Gris, R Iacovino, R Interrigi, R Joppi, B Laner, G La Fortezza, A La Padula, M R Lista, G Lupi, D Maffei, G Maggioni, L Magnani, E Marrazzo, L Marcon, V Marinò, A Maroni, C Martinelli, E Mastandrea, F Mastropierro, A T Meo, P Mero, E Minesso, V Moschetta, E Mosele, C Nanni, A Negretti, C Nisticò, A Orsini, M Osti, M C Pacilli, C Pennestre, G Picerno, K Piol, L Pivano, E Pizzuti, L Poggi, I Poidomani, M Pozzetto, M L Presti, R Ravani, V Recalenda, F Romagnuolo, S Rossignoli, E Rossin, C Sabatella, F Sacco, F Sanità, E Sansone, F Servadei, M T Sisto, A Sorio, A Sorrentino, E Spinelli, A Spolaor, A Squillacioti, P Stella, A Talerico, C Todisco, M Vadino, C Zuliani.

Compliance with ethical standards

Conflict of interest

All the authors declare no conflict interests.

Ethical standard

The R&P Study has been reviewed by the appropriate ethics committees and has therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki.

Human and animal rights

This study involved human participants and the protocol was approved by the Italian Regulatory Authorities and by the Local Ethic Committees.

Informed consent

All patients provided informed consent before enrollment.

Supplementary material

592_2016_899_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 22 kb)

References

  1. 1.
    International Diabetes Federation (2011) Global Burden: prevalence and Projections, 2011 and 2030. http://www.diabetesatlas.org/content/diabetes-and-impairedglucose-tolerance
  2. 2.
    Monesi L, Tettamanti M, Cortesi L et al (2014) Elevated risk of death and major cardiovascular events in subjects with newly diagnosed diabetes: findings from an administrative database. Nutr Metab Cardiovasc Dis 24:263–270CrossRefPubMedGoogle Scholar
  3. 3.
    Donnan PT, Donnelly L, New JP, Morris AD (2006) Derivation and validation of prediction score for major coronary heart disease events in a UK type 2 diabetic population. Diabetes Care 29:1231–1236CrossRefPubMedGoogle Scholar
  4. 4.
    Cederholm J, Eeg-Olofsson K, Eliasson B et al (2008) Risk prediction of cardiovascular disease in type 2 diabetes. Diabetes Care 31:2038–2043CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Yang X, So WY, Kong APS et al (2008) Development and validation of a total coronary heart disease risk score in type 2 diabetes mellitus. Am J Cardiol 101:596–601CrossRefPubMedGoogle Scholar
  6. 6.
    Kengne AP, Patel A, Marre M et al (2011) Contemporary model for cardiovascular risk prediction in people with type 2 diabetes. Eur J Cardiovasc Prev Rehabil 18:393–398CrossRefPubMedGoogle Scholar
  7. 7.
    Elley CR, Robinson E, Kenealy T, Bramley D, Drury PL (2010) Derivation and validation of a new cardiovascular risk score for people with type 2 diabetes. Diabetes Care 33:1347–1352CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Stevens RJ, Kothari V, Adler AI, Stratton IM, Holman RR (2001) The UKPDS risk engine: a model for the risk of coronary heart disease in type II diabetes (UKPDS 56). Clin Sci 101:671–679CrossRefPubMedGoogle Scholar
  9. 9.
    Piniés JA, González-Carril F, Artegoitia JM et al (2014) Development of a prediction model for fatal and non-fatal coronary heart disease and cardiovascular disease in patients with newly diagnosed type 2 diabetes mellitus: the Basque Country Prospective Complication and Mortality Study risk engine (BASCORE). Diabetologia 57:2324–2333CrossRefPubMedGoogle Scholar
  10. 10.
    Zhetelius B, Eliasson B, Eeg-Olofsson K et al (2011) A new model for 5-year risk of cardiovascular disease in type 2 diabetes, from the Swedish National Diabetes Register (NDR). Diabetes Res Clin Pract 93:276–284CrossRefGoogle Scholar
  11. 11.
    Davis WA, Knuiman MW, Davis ME (2010) An Australian cardiovascular risk equation for type 2 diabetes: the Fremantle Diabetes Study. Intern Med J 40:286–292CrossRefPubMedGoogle Scholar
  12. 12.
    D’Agostino RB, Wolf PA, Belanger AJ, Kannel WB (1994) Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study. Stroke 25:40–43CrossRefPubMedGoogle Scholar
  13. 13.
    Kothari V, Stevens RJ, Adler AI et al (2002) UKPDS 60: risk of stroke in type 2 diabetes estimated by the UK prospective diabetes study risk engine. Stroke 33:1776–1781CrossRefPubMedGoogle Scholar
  14. 14.
    Yang X, So WY, King APS et al (2007) Development and validation of stroke risk equation for Hong Kong chinese patients with type 2 diabetes. Diabetes Care 30:65–70CrossRefPubMedGoogle Scholar
  15. 15.
    The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of The European Society of Cardiology (ESC)and developed in collaboration with the European Association for the Study of Diabetes (EASD) (2013) ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 34:3035–3087CrossRefGoogle Scholar
  16. 16.
    Score European High-Low risk chart. www.escardio.org/. EACPR
  17. 17.
    The Risk and Prevention Study Collaborative Group (2013) N-3 fatty acids in patients with multiple cardiovascular risk factors. N Engl J Med 368:1800–1808CrossRefGoogle Scholar
  18. 18.
    Ciampi A (1992) Constructing prediction trees from data: the RECPAM approach Proceedings from the Prague 1991 summer school on computational aspects of model choice. Physica, Heidelberg, pp 165–178Google Scholar
  19. 19.
    Durante C (2015) The natural history of benign thyroid nodules. JAMA 313:926–935CrossRefPubMedGoogle Scholar
  20. 20.
    Pintaudi B (2014) Improvement of selective screening strategy for gestational diabetes through a more accurate definition of high-risk groups. Eur J Endocr 170:87–93CrossRefGoogle Scholar
  21. 21.
  22. 22.
    Rana JS, Liu JY, Moffet HH et al (2015) Diabetes and prior coronary heart disease are not necessarily risk equivalent for future coronary heart disease events. J Gen Intern Med 31:387–393CrossRefPubMedGoogle Scholar
  23. 23.
    Baviera M, Cortesi L, Tettamanti M et al (2014) Changes in prescribing patterns and clinical outcomes in elderly diabetic patients in 2000 and 2010: analysis of a large Italian population-based study. Eur J Clin Pharmacol 70:965–974CrossRefPubMedGoogle Scholar
  24. 24.
    Gesrtein HC, Swedberg K, Carlosson J et al (2008) The hemoglobin A1c level as progressive risk factor for cardiovascular death, hospitalization for heart failure, or death in patients with chronic heart failure. Arch Intern Med 168:1699–1704CrossRefGoogle Scholar
  25. 25.
    Erkström N, Schiöler L, Svensson AM et al (2012) Effectiveness and safety of metformin in 51675 patients with type 2 diabetes and different levels of renal function: a cohort study from the Swedish National Diabetes Register. BMJ Open 2:e001076. doi: 10.1136/bmjopen-2012-001076 CrossRefGoogle Scholar
  26. 26.
    Gamble JM, Simpson SH, Eurich DT, Majumdar SR, Johnson JA (2010) Insulin use and increased risk of mortality in type 2 diabetes: a cohort study. Diabetes Obes Metab 12:47–53CrossRefPubMedGoogle Scholar
  27. 27.
    Sluik D, Buijsse B, Muckelbauer R et al (2012) Physical activity and mortality in individuals with diabetes mellitus. Arch Intern Med 172:1285–1295CrossRefPubMedGoogle Scholar
  28. 28.
    Ravnskov U, Diamond DM, Hama R et al (2016) Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ Open 6:e010401CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  • Irene Marzona
    • 1
  • Fausto Avanzini
    • 1
  • Giuseppe Lucisano
    • 2
  • Mauro Tettamanti
    • 3
  • Marta Baviera
    • 1
  • Antonio Nicolucci
    • 2
  • Maria Carla Roncaglioni
    • 1
  • Risk & Prevention Collaborative Group
    • 1
  1. 1.Laboratory of Cardiovascular PreventionIRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”MilanItaly
  2. 2.Center for Outcomes Research and Clinical EpidemiologyPescaraItaly
  3. 3.Laboratory of Geriatric NeuropsychiatryIRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”MilanItaly

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