[Sexual activity in women with cardiovascular disease: a literature review].

Female sexual dysfunction (FSD) is a complex condition that involves both psychological and organic domains, including the cardiovascular system, and has an impact on quality of life in more than one third of women. However, only few papers are available in the medical literature regarding FSD and its relation with cardiac diseases. In this review, we discuss the physiology of sexual intercourse in women, the pathophysiology of FSD, the sexual counseling to provide, and the therapeutic choices to minimize the negative impact of cardiovascular diseases on female sexual activity.

[Why do cardiologists disregard sexual health of their patients? A critical review].

Sexual activity is an essential aspect of normal human function, well-being and quality of life. Sexual dysfunction is a common problem of increasing incidence in patients with cardiovascular disease, particularly younger and male, and continues over time in life, but these issues are not often discussed in daily practice both for a limited patient-physician relationship and clinicians' poor knowledge. Many studies suggest that the majority of patients and their partners have questions or concerns about their sexual health.

[Nonvalvular atrial fibrillation: data from the Observatory of Cardiovascular Diseases in the province of Trieste (Italy)].

Background: Nonvalvular atrial fibrillation (NVAF) is the most common arrhythmia in outpatients and is associated with increased mortality, thromboembolic and hemorrhagic events. Although several international studies have evaluated its prognostic impact in the real world, Italian data are still lacking. Our aim was to define the prevalence, comorbidity, treatment and outcome in a population of "real-life" outpatients with NVAF.

Oral anticoagulation and VKORC1 polymorphism in patients with a mechanical heart prosthesis: a 6-year follow-up.

Therapy with Vitamin K antagonists (VKA) effectively reduces the thrombosis risk in many clinical conditions. Genetic variants of vitamin K epoxide reductase (VKORC-1) are associated with increased VKA effect and bleeding risk. It is unknown whether these variants could also affect the long-term outcome in patients with high-dosage oral anticoagulation and/or more difficult adherence to the therapeutic INR range.

[Nurse involvement in primary care: it is the key to improve the outcomes in primary and secondary prevention?].

Difficulties in management of risk factors, lifestyle and medications adherence to achieve secondary prevention of ischemic heart disease were described. Many studies indicate that the benefit of cardiac rehabilitation therapy after acute coronary events is only partially maintained during the following year. Thereafter, new strategies of medical care are needed to improve the long-term outcomes in coronary patients.

[The challenge of improving evidence-based therapy adherence in the secondary prevention of coronary artery disease: the next frontier of cardiac rehabilitation].

Non-adherence to prescribed drug regimens is an increasing medical problem affecting physicians and patients and contribute to negative outcomes, such as the increased risk of subsequent cardiovascular events. Analysis of various patient populations shows that the choice of drug, its tolerability and the duration of treatment influence the non-adherence. Intervention is required toward patients and health-care providers to improve medication adherence.

[Clinical practice: Ebstein's anomaly].

Ebstein's anomaly is a rare malformation of the tricuspid valve that has anatomopathologic and clinical implications, accounting for < 1% of all cardiac malformations. Usually, the tricuspid valve has three leaflets and, if Ebstein's anomaly occurs, such leaflets are malformed: one-two leaflets are stuck to the wall of the heart so that they cannot move normally, furthermore other abnormalities can also coexist. Therefore, the awareness of the different anatomical, hemodynamic and clinical variables of Ebstein's anomaly is crucial to treat properly, surgically or not, such malformation.

[Adherence to cardioprotective medications in coronary heart disease].

Treatment of patients with ischemic heart disease relies on evidence-based medications such as beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, aspirin and statins, which are considered cornerstones to control symptoms, improve quality of life, reduce future events, and prolong survival. In spite of the clear benefits of therapy, previous studies have shown differences between the large randomized populations and the "real world" about long-term treatment in terms of efficacy, tolerability, costs, side effects and drug interactions. Moreover, a different awareness of the patient's compliance has been highlighted in relation to the setting (hospital, family doctor, etc.

[Lower is better: ENHANCE affair].

Ezetimibe lowers the intestinal absorption of cholesterol, being complementary to the effects of statin. To check its efficacy in lowering the carotid intima-media thickness, in 2002 a multicenter international trial called ENHANCE was started, in order to assess by ultrasound the regression of atherosclerotic plaques. The protocol tested the use of simvastatin 80 mg + placebo versus simvastatin 80 mg + ezetimibe 10 mg in 720 randomized patients.

Thirty-nine-year survival with the Starr-edwards mitral valve prosthesis.

We report a case of a 57 year-old woman with Starr-Edwards model 6120 mitral valve replacement and Kay-Shiley bioprosthetic tricuspid valve replacement in 1968 at Niguarda Hospital in Milan. The mitral caged-ball has proved its excellent durability and its good hemodynamic performance in many patients, even if subject to high tendency to thrombosis. In literature there is no evidence of durability of this prosthesis longer than 35 years.

[Disease management system in patients with chronic heart failure].

Healthcare managers are more and more interested in the role of general practitioners (GP) in the treatment of cardiovascular diseases. Continuing adjustments of the health organization are the old/new challenge in improving patient care. The European Society of Cardiology guidelines recommend a disease-management program for heart failure (HF); moreover, observational studies and randomized controlled trials have reported better patient outcomes if patients are in charge of cardiologists rather than GPs or other physicians.

[Remarks on angina pectoris].

In the first volume of the New England Journal of Medicine of 1812, J. Warren published a paper on the subject of angina pectoris, in which clearly emerge the difficulties facing the physicians of that time in trying to formulate a correct diagnosis and prescribe the right therapy. We thought it would be certainly of interest to offer our readers an Italian translation of this article, obviously with some stylistic modifications and supplemented with information coming from other historical scientific works.

[Can we prevent the progression of aortic valve sclerosis and stenosis? The need for a prospective, randomized trial].

Cardiologists long assumed that aortic valve sclerosis/stenosis is a wear-and-tear, degenerative process; recent studies suggested that lipoproteins can play a key role in the development of both sclerosis/stenosis in the aortic valve. Thus, sclerosis/stenosis cannot be considered as a simple degenerative process, but on the contrary it is complex and involves multiple pathogenetic mechanisms. Experimental, clinical and epidemiological data support the link between aortic valvulopathy and atherosclerosis: both are caused by inflammation, lipid deposition, and accumulation of extracellular bone matrix protein.

[New perspectives for anticoagulation in non-rheumatic atrial fibrillation: oral antithrombins].

Non-rheumatic atrial fibrillation (NRAF) is one among the major public health problems, because it is associated with a high incidence of stroke or systemic thromboembolism. Warfarin significantly reduces cerebral/systemic events mainly in high-risk patients; unfortunately such drug is often as well under-used in eligible patients as under-dosed in treated patients. Traditional therapy with oral anticoagulants has several disadvatages: narrow therapeutic window, and often unpredictable dose-response so that frequent monitoring of the INR is required.

[Family screening of patients with premature coronary artery disease: opportunities and challenges of cardiovascular health in the 21st century].

A positive family history of premature coronary heart disease is a strong and independent risk factor for relatives and its effect is synergistic with other traditional and not traditional risk factors. It is well documented a familial aggregation of premature coronary heart disease particularly related to family clustering of several cardiovascular risk factors. The screening and the identification, by a comprehensive cardiovascular risk factor assessment, of high-risk relatives of patients with premature coronary artery disease by cardiologists and general practitioners is crucial.

[Ximelagatran: a promising new drug for oral anticoagulation].

Ximelagatran is the first orally available direct thrombin inhibitor. Ximelagatran is a pro-drug with an antithrombotic effect comparable to that of warfarin. Clinical studies have demonstrated that ximelagatran is as effective as warfarin in the prevention of deep-vein thrombosis, of stroke in patients with nonvalvular atrial fibrillation, and of the adverse cardiovascular events in patients with recent myocardial infarction.