Evidence-based polytherapies and long-term mortality after acute myocardial infarction in very old subjects compared with elderly and adults: a nested case-control study

Background: Clinical trials have demonstrated that selected secondary prevention medications for patients after acute myocardial infarction (AMI) reduce mortality. Yet, these medications are generally underprescribed in daily practice, and older people are often absent from drug trials. Objectives: To examine the relationship between adherence to evidence-based (EB) drugs and post-AMI mortality, focusing on the effects of single therapy and polytherapy in very old patients (≥80 years) compared with elderly and adults (<80 years). Methods: Patients hospitalised for AMI between 01/01/2008 and 30/06/2011 and resident in the Local Health Authority of Bologna were followed up until 31/12/2011. Medication adherence was calculated as the proportion of days covered for filled prescriptions of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), β-blockers, antiplatelet drugs, and statins. We adopted a risk set sampling method, and the adjusted relationship between medication adherence (PDC≥75%) and mortality was investigated using conditional multiple logistic regression. Results: The study population comprised 4861 patients. During a median follow-up of 2.8 years, 1116 deaths (23.0%) were observed. Adherence to the 4 EB drugs was 7.1%, while nonadherence to any of the drugs was 19.7%. For both patients aged ≥80 years and those aged <80 years, rate ratios of death linearly decreased as the number of EB drugs taken increased. There was a significant inverse relationship between adherence to each of 4 medications and mortality, although its magnitude was higher for ACEIs/ARBs (adj. rate ratio=0.60, 95%CI=0.52–0.69) and statins (0.60, 0.50–0.72), and lower for β-blockers (0.75, 0.61–0.92) and antiplatelet drugs (0.73, 0.63–0.84). Conclusions: The beneficial effect of EB polytherapy on long-term mortality following AMI is evident also in nontrial older populations. Given that adherence to combination therapies is largely suboptimal, the implementation of strategies and initiatives to increase the use of post-AMI secondary preventive medications in old patients is crucial.

The role of proactive coping strategies and perceived health status for Social well-being and life-project in old age.

The latter part of the 20th century was a period characterized by a fundamental demographic transition of western society. This substantial and structural demographic change proposes several challenges to contemporary society and fosters the emergence of new issues and challenges. Among these, none is more crucial than the comprehension of the mechanisms and the processes that lead people to positive aging. Rowe and Kahn’s model of successful aging highlights the interplay between social engagement with life, health, and functioning for a positive aging experience. Other systemic models of successful aging (Kahana et al., 1996; 2003; Stevernik et al., 2006) emphasize the role of internal and external resources for attaining positive aging. Among these, the proactive coping strategies are indicated as important active strategies for avoiding the depletion of resources, counterbalancing the declines and maintaining social and civic involvement. The study has analyzed the role of proactive coping strategies for two facets of positive aging, the experience of a high social well-being and the presence of personal projects in fundamental life domains. As expected, the proactive coping strategies, referred to as the active management of the environment, the accumulation of resources and the actualization of human potentials are confirmed as positive predictors of high level of social well-being and of many personal projects focused on family, culture, leisure time, civic and social participation. Perceived health status give a significant contribution only to the possession of many personal projects. Gender and level of school education give also a significant contribution to these two dimensions of positive aging, highlighting how positive aging is rooted not only in the possession of personal resources, but also in historical models of education and in positive longitudinal chains related to early development.

X-ray properties and evolution of high-redshift AGN, and the gas content of host galaxies

In this thesis, I have investigated the evolution of the high-redshift (z > 3) AGN population by collecting data from some of the major Chandra and XMM-Newton surveys. The final sample (141 sources) is one of the largest selected at z> 3 in the X- rays and it is characterised by a very high redshift completeness (98%). I derived the spectral slopes and obscurations through a spectral anaysis and I assessed the high-z evolution by deriving the luminosity function and the number counts of the sample. The best representation of the AGN evolution is a pure density evolution (PDE) model: the AGN space density is found to decrease by a factor of 10 from z=3 to z=5. I also found that about 50% of AGN are obscured by large column densities (logNH > 23). By comparing these data with those in the Local Universe, I found a positive evolution of the obscured AGN fraction with redshift, especially for luminous (logLx > 44) AGN. I also studied the gas content of z < 1 AGN-hosting galaxies and compared it with that of inactive galaxies. For the first time, I applied to AGN a method to derive the gas mass previously used for inactive galaxies only. AGN are found to live preferentially in gas-rich galaxies. This result on the one hand can help us in understanding the AGN triggering mechanisms, on the other hand explains why AGN are preferentially hosted by star-forming galaxies.

The dynamics of early-type galaxies as a tool to understand their hot coronae and their IMF

Dynamical models of galaxies are a powerful tool to study and understand several astrophysical problems related to galaxy formation and evolution. This thesis is focussed on a particular type of dynamical models, that are widely used in literature, and are based on the solution of the Jeans equations. By means of a numerical Jeans solver code, developed on purpose and able to build state-of-the-art advanced axisymmetric galaxy models, two of the main currently investigated issues in the field of research of early-type galaxies (ETGs) are addressed. The first topic concerns the hot and X-ray emitting gaseous coronae that surround ETGs. The main goal is to explain why flat and rotating galaxies generally exhibit haloes with lower gas temperatures and luminosities with respect to rounder and velocity dispersion supported systems. The second astrophysical problem addressed concerns instead the stellar initial mass function (IMF) of ETGs. Nowadays, this is a very controversial issue due to a growing number of works on ETGs, based on different and independent techniques, that show evidences of a systematic variation of the IMF normalization as a function of galaxy velocity dispersion or mass. These studies are changing the previous opinion that the IMF of ETGs was the same as that of spiral galaxies, and hence universal throughout the whole large family of galaxies.

Tracing AGN accretion and star formation in Herschel galaxies

In this Thesis, we study the physical properties and the cosmic evolution of AGN and their host galaxies since z∼3. Our analysis exploits samples of star forming galaxies detected with Herschel at far-IR wavelengths (from 70 up to 500 micron) in different extragalactic surveys, such as COSMOS and the deep GOODS (South and North) fields. The broad-band ancillary data available in COSMOS and the GOODS fields, allows us to implement Herschel and Spitzer photometry with multi-wavelength ancillary data. We perform a multicomponent SED-fitting decomposition to decouple the emission due to star formation from that due to AGN accretion, and to estimate both host-galaxy parameters (such as stellar mass, M* and star formation rate, SFR), and nuclear intrinsic bolometric luminosities. We use the individual estimates of AGN bolometric luminosity obtained through SED-fitting decomposition to reconstruct the redshit evolution of the AGN bolometric luminosity function since z∼3. The resulting trends are used to estimate the overall AGN accretion rate density at different cosmic epochs and to trace the first ever estimate of the AGN accretion history from an IR survey. Later on, we focus our study on the connection between AGN accretion and integrated galaxy properties. We analyse the relationships of AGN accretion with galaxy properties in the SFR-M* plane and at different cosmic epochs. Finally, we infer what is the parameter that best correlates with AGN accretion, comparing our results with previous studies and discussing their physical implications in the context of current scenarios of AGN/galaxy evolution.

On the Luminous and Dark Matter Distribution in Early-Type Galaxies

The way mass is distributed in galaxies plays a major role in shaping their evolution across cosmic time. The galaxy's total mass is usually determined by tracing the motion of stars in its potential, which can be probed observationally by measuring stellar spectra at different distances from the galactic centre, whose kinematics is used to constrain dynamical models. A class of such models, commonly used to accurately determine the distribution of luminous and dark matter in galaxies, is that of equilibrium models. In this Thesis, a novel approach to the design of equilibrium dynamical models, in which the distribution function is an analytic function of the action integrals, is presented. Axisymmetric and rotating models are used to explain observations of a sample of nearby early-type galaxies in the Calar Alto Legacy Integral Field Area survey. Photometric and spectroscopic data for round and flattened galaxies are well fitted by the models, which are then used to get the galaxies' total mass distribution and orbital anisotropy. The time evolution of massive early-type galaxies is also investigated with numerical models. Their structural properties (mass, size, velocity dispersion) are observed to evolve, on average, with redshift. In particular, they appear to be significantly more compact at higher redshift, at fixed stellar mass, so it is interesting to investigate what drives such evolution. This Thesis focuses on the role played by dark-matter haloes: their mass-size and mass-velocity dispersion correlations evolve similarly to the analogous correlations of ellipticals; at fixed halo mass, the haloes are more compact at higher redshift, similarly to massive galaxies; a simple model, in which all the galaxy's size and velocity-dispersion evolution is due to the cosmological evolution of the underlying halo population, reproduces the observed size and velocity-dispersion of massive compact early-type galaxies up to redshift of about 2.

Kinematics of local and high-z galaxies through 3D modeling of emission-line datacubes

The kinematics is a fundamental tool to infer the dynamical structure of galaxies and to understand their formation and evolution. Spectroscopic observations of gas emission lines are often used to derive rotation curves and velocity dispersions. It is however difficult to disentangle these two quantities in low spatial-resolution data because of beam smearing. In this thesis, we present 3D-Barolo, a new software to derive the gas kinematics of disk galaxies from emission-line data-cubes. The code builds tilted-ring models in the 3D observational space and compares them with the actual data-cubes. 3D-Barolo works with data at a wide range of spatial resolutions without being affected by instrumental biases. We use 3D-Barolo to derive rotation curves and velocity dispersions of several galaxies in both the local and the high-redshift Universe. We run our code on HI observations of nearby galaxies and we compare our results with 2D traditional approaches. We show that a 3D approach to the derivation of the gas kinematics has to be preferred to a 2D approach whenever a galaxy is resolved with less than about 20 elements across the disk. We moreover analyze a sample of galaxies at z~1, observed in the H-alpha line with the KMOS/VLT spectrograph. Our 3D modeling reveals that the kinematics of these high-z systems is comparable to that of local disk galaxies, with steeply-rising rotation curves followed by a flat part and H-alpha velocity dispersions of 15-40 km/s over the whole disks. This evidence suggests that disk galaxies were already fully settled about 7-8 billion years ago. In summary, 3D-Barolo is a powerful and robust tool to separate physical and instrumental effects and to derive a reliable kinematics. The analysis of large samples of galaxies at different redshifts with 3D-Barolo will provide new insights on how galaxies assemble and evolve throughout cosmic time.

Accretion of Mass and Angular Momentum onto The Discs of Spiral Galaxies

In this Thesis, we study the accretion of mass and angular momentum onto the disc of spiral galaxies from a global and a local perspective and comparing theory predictions with several observational data. First, we propose a method to measure the specific mass and radial growth rates of stellar discs, based on their star formation rate density profiles and we apply it to a sample of nearby spiral galaxies. We find a positive radial growth rate for almost all galaxies in our sample. Our galaxies grow in size, on average, at one third of the rate at which they grow in mass. Our results are in agreement with theoretical expectations if known scaling relations of disc galaxies are not evolving with time. We also propose a novel method to reconstruct accretion profiles and the local angular momentum of the accreting material from the observed structural and chemical properties of spiral galaxies. Applied to the Milky Way and to one external galaxy, our analysis indicates that accretion occurs at relatively large radii and has a local deficit of angular momentum with respect to the disc. Finally, we show how structure and kinematics of hot gaseous coronae, which are believed to be the source of mass and angular momentum of massive spiral galaxies, can be reconstructed from their angular momentum and entropy distributions. We find that isothermal models with cosmologically motivated angular momentum distributions are compatible with several independent observational constraints. We also consider more complex baroclinic equilibria: we describe a new parametrization for these states, a new self-similar family of solution and a method for reconstructing structure and kinematics from the joint angular momentum/entropy distribution.