Several studies have shown that alterations in left ventricular (LV) structure and function, such as an increased LV mass (LVM), a reduction of systolic contractility, and an impairment of LV diastolic function, have an adverse prognostic value (ie, that they are associated with an increased risk of cardiovascular morbid and fatal events, independently on other cardiovascular risk factors).1,2 More recently, evidence has been obtained that this is the case also for anatomic alterations of the left atrium (LA), the enlargement of which has been found to predict independently the development of heart failure, 3 and other cardiovascular events.4,5 LA enlargement, however, frequently occurs with an increased LVM or a frank LV hypertrophy (LVH), 6,7 both changes being commonly generated by an increase in blood pressure (BP), 8 and limited information exists on whether LA enlargement increases cardiovascular risk also when associated with or superimposed on LV structural changes.This has been the aim of the present study, which has examined the long-term risk of cardiovascular morbid and fatal events (as well as of all-cause mortality) in a population in which LA enlargement and LV hypertrophy were present in isolation or combination, their combined absence representing the control group. A strength of the study is that BP was measured in and outside the physician's office, which allowed to correct the data for the effect of BP elevation on cardiovascular risk more accurately than by using office BP. 9 Methods Subjects and MeasurementsThe details of the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study have been reported elsewhere.10 Briefly, the study was performed in 1990 to 1991 on 3200 individuals aged between 25 and 74 years, who were selected to be representative of the Monza population, based on the criteria of the World Health Organization Monitoring Diseases (WHO-MONICA) project performed in the same geographic area.11 The participation rate was 64%, and the demographic characteristics and medical history of nonparticipants were similar to those of participants. All subjects underwent a Abstract-We estimated the risk of cardiovascular events, cardiovascular mortality, and all-cause mortality associated with left atrium (LA) enlargement alone or combined with echocardiographic left ventricular hypertrophy (LVH) in 1785 representatives of the general population of Monza recruited for the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study. LA enlargement was assessed by measuring LA diameter via echocardiography. LA enlargement was defined as a LA diameter >2.3 cm/m 2 , whereas LVH was defined as a left ventricular mass index ≥114 g/m 2 and 99 g/m 2 in men and women, respectively. Death certificates and hospital diagnoses were collected over an average 148 months follow-up. During follow-up, there were 175 deaths (of which 59 for cardiovascular causes) and 139 cardiovascular fatal and nonfatal events. Compared with subjects with neither LA enlargement nor LVH, subjects with isolate...

HIV subjects showed a higher prevalence and a different pattern of metabolic syndrome components. HAART, more than HIV infection per se, appeared to be responsible for the increased prevalence of metabolic syndrome and arterial function derangement.

HIV infected subjects present an unfavorable cardiovascular (CV) risk profile that is determined by the infection itself, highly active anti-retroviral therapy (HAART) and other factors, such as chronic kidney disease (CKD). Information is scant and contradictory on whether these factors are associated with arterial stiffness and blood pressure (BP) alteration. Our study aimed to evaluate those parameters in HIV-positive subjects both with and without HAART and with and without CKD, which was defined as the presence of microalbuminuria with a normal glomerular filtration rate. We enrolled 94 HIV-infected subjects without known CV risk factors and compared them with 37 control subjects. We recorded brachial and central BP (pulse wave analysis) and pulse wave velocity ( SphygmoCor). HIV-positive subjects of similar ages and with similar BP values showed central pulse pressure values that were significantly greater than those of controls; this was also the case for the Aix value. Central systolic and pulse pressure values and Aix were significantly greater in HIV-positive subjects with HAART and CKD than in the other HIV-positive subgroups and control subjects. PWV was also superimposable between groups when the data were analyzed relative to the presence of HAART and CKD. Our study shows that the unfavorable CV risk profile associated with HIV infection includes an increase in both central BP and Aix. The central BP increase seems to be favored by renal damage, which apparently has a role in the early stages of the disease.

In WBS children, the higher night-time HR, Aix and reflection magnitude and their impaired physiological reduction in the day-night shift suggests an abnormal sympathetic cardiovascular control, an augmented wave reflection and an increase in small arteries resistance. These alterations possibly due to a sympathetic overactivity can be regarded as earlier hallmarks of cardiovascular dysfunction in these patients.