The prevalence of abdominal obesity in Slovakia. The IDEA Slovakia study

A. Dukát, J. Lietava, B. Krahulec, M. Čaprnda, I. Vacula, J. Sirotiaková, V. Kosmálová, P. Minárik

Vnitr Lek 2007, 53(4):326-330  

Abdominal obesity represents an independent risk factor for subsequent severe cardiovascular events. It is one of the important diagnostic criteria for Metabolic Syndrome whose predictive value for severe cardiovascular events is similar to that of elevated LDL-cholesterol levels. The prevalence of abdominal obesity in the context of Metabolic Syndrome still has not been systematically monitored in Slovakia. The IDEA program evaluated a sample of 4183 patients in 103 centres in Slovakia. It has shown that only one in three adult inhabitants of Slovakia has a normal body weight. Almost every second inhabitant of Slovakia has intraabdominal obesity (by...

Long term experience with trerpostinil infusion treatment in patients with pulmonary arterial hypertension in the Czech Republic

P. Jansa, D. Ambrož, J. Marešová, L. Jelínková, P. Poláček, T. Paleček, M. Aschermann, A. Linhart

Vnitr Lek 2007, 53(4):333-337  

Introduction:Pulmonary arterial hypertension (PAH) is a serious primary illness of the pulmonary arterioles, characterised by progressive precapillary pulmonary hypertension. The conventional therapy for this condition is so-called specific pharmacotherapy, which addresses the key mechanisms in the pathophysiology of the illness, making use of drugs from the prostanoid group, endothelin receptor antagonists and phosphodiesterase inhibitors. Treprostinil is a stable analogue of prostacyclin, which can be administered subcutaneously, intravenously or by inhalation. Patient sample and method:In the centre for pulmonary hypertension...

The effect of treatment with fenofibrate on the risk profile of patients with metabolic syndrome and mixed dyslipidemia treated on an outpatient basis

H. Rosolová, V. Bláha, R. Češka, Z. Hamouz, T. Pelikánová, V. Soška, M. Souček, P. Sucharda

Vnitr Lek 2007, 53(4):339-346  

The study has shown that patients with metabolic syndrome and typical dyslipidemia treated on an outpatient basis by general practitioners or specialists are those whose anamneses include IHD or diabetes and who are very often indicated for combined statin-fibrate therapy. Fenofibrate therapy combined with a single lifestyle intervention in the form of individual interview resulted in the following improvement of the risk profile of the above patients: significant decrease in body weight and waist circumference, decrease in blood pressure and fasting glycemia; improvement of typical dyslipidemia in 90 % of patients, however, only 30 % of patients achieved...

Molecular genetics of myocardial infarction

M. Aschermann, K. Sedláček, O. Aschermann, A. Linhart

Vnitr Lek 2007, 53(4):348-353  

The incidence of atherosclerosis is very high and the typical risk factors such as lipids, blood pressure, smoking, dietary habits and lifestyle in general have an 80 % share in its development. Heredity also has a significant share and genome-related information has been given growing attention in recent years. A number of links between polymorphisms found at certain gene positions and the probability of acute myocardial infarction at a young age have been currently described. Cross-sectional studies have been focused on the identification of particular genotypes and alleles which can be responsible for early development of atherosclerosis and acute...

Chronic pancreatitis - etiological classifications and diagnostic criteria

P. Dítě

Vnitr Lek 2007, 53(4):354-358  

Current etiological classifications divide chronic pancreatitis into a toxo-nutritive form where the main agent is alcohol, and an idiopathic genetically induced form, an auto-immune form, and a recidivistic and obstructive form. It is clear that the different etiologies of the illness are associated with different histological findings. Knowledge of these is vitally important for targeted therapy and assessment of the progress of the disease. Even though chronic pancreatitis is still defined as a chronic, longstanding progressive process of fibrosis of the gland, it has been shown that precisely due to histological differences in the morphology of...

Adiponectin and atherosclerosis

D. Haluzíková, T. Roubíček, M. Haluzík

Vnitr Lek 2007, 53(4):359-363  

Obesity combined with other components of the insulin resistance syndrome is an important risk factor for atherosclerosis and its complications. The exact mechanisms through which the above diseases are linked have not yet been fully elucidated. One of the possible links may be a disturbance of the endocrine function of the adipose tissue of obese persons which produces an increased amount of proinflammatory and proatherogenic hormones and a lower amount of factors protecting against such pathologies. Adiponectin is the only hormone produced by the adipose tissue with a proven antiinflammatory and antiatherosclerotic effect. This hormone is predominantly...

Does the rennin inhibitor aliskiren offer promising novel opportunities in the treatment of cardiovascular diseases?

K. Horký

Vnitr Lek 2007, 53(4):364-370  

The renin-angiotensin-aldosterone system (RAAS) plays an important part in the pathogenesis of arterial hypertension and the complications it causes in organs (the heart, the circulatory system, the brain, the kidneys), heart failure and kidney diseases. Materials that block the most upstream point of the RAAS cascade (ACE inhibitors - ACEI, AT₁-receptor (AT₁R) blockers, aldosterone receptor blockers) have greatly expanded our options in the treatment and primary and secondary prevention of cardiovascular and renal diseases. ACEI and AT₁R blockers interrupt the normal feedback provided by the release of renin into the...

Genetics of dyslipidemia - yesterday, today, and tomorrow

J. A. Hubáček, M. Vrablík

Vnitr Lek 2007, 53(4):371-376  

The great majority of plasmatic lipid and lipoprotein metabolism disorders are genetically determined diseases (primary dyslipidemias). Only a minority of prevailingly severe dyslipidemias is monogenic, and a greater part of them is inherited as a polygenic trait. Analyses of the genetic background of dyslipidemia are made difficult by the complexity of lipoprotein metabolism and also by gene-gene, gene-gender and gene-environment interactions. Association studies, animal models, whole genome scans and gene expression analyses are used in the study of the genetic background of primary dyslipidemias. There are several genetically well characterized...

Wall sheer stress in carotid artery and its role in the development of atherosclerosis

E. Chytilová, J. Malík

Vnitr Lek 2007, 53(4):377-381  

Atherosclerosis is associated with systemic risk factors such as arterial hypertension, hyperlipidemia, diabetes mellitus and smoking. Yet it is a focal disease, predominantly affecting predisposed areas. The principal local hemodynamic factor is wall shear stress, i.e. the frictional force acting tangentially on the endothelial cell surface. The effect of wall shear stress on the endothelium depends on its magnitude and direction, as well as on the local vessel geometry and blood flow characteristics. Wall shear stress is an important determinant of endothelial function and phenotype. The article deals with the influence of wall shear stress on endothelial...

Thyroid diseases, dyslipidemia and cardiovascular risk

J. Jiskra, Z. Límanová, M. Antošová

Vnitr Lek 2007, 53(4):382-385  

By affecting the metabolism of lipids, hypothyroidism accelerates the process of atherogenesis and increases cardiovascular risk. In manifest hypothyroidism the number of LDL receptors in the liver decreases and there is an increase in levels of overall cholesterol, LDL-cholesterol and apolipoprotein B in the blood. Levels of HDL particles remain normal or even rise slightly as a result of reduced activity of the Cholesterol ester transfer protein (CETP) and hepatic lipase. This leads to a reduction in the transport of cholesterol esters from HDL-(2) to VLDL and IDL. Subclinical hypothyroidism also has a negative effect on the lipid profile, but is...

How corticoids, growth hormone and oestrogens influence lipids and atherosclerosis

J. Marek, V. Hána, M. Kršek

Vnitr Lek 2007, 53(4):386-390  

The hormones with a strong influence on the lipid spectrum and the development of atherosclerosis include cortisol, growth hormone and oestrogens. Cortisol accelerates atherosclerosis both through dyslipidemia and through an increase in visceral fat, hypertension, increased insulin resistance and the development of reduced glucose tolerance which may result in diabetes mellitus. Even when a cortisol excess disappears, as is the case of patients cured of Cushing syndrome, arterial walls remain permanently vulnerable to the atherosclerotic process. In conditions involving a lack of growth hormone, dyslipidemia develops and increases the burden on the...

CRP - a marker of a pro-inflammatory state and cardiovascular risk

R. Poledne, Z. Valenta, J. Piťha

Vnitr Lek 2007, 53(4):391-395  

The importance of elevated basal levels C-reactive protein (CRP) measured by a highly sensitive test has been known for over 10 years. Increased hsCRP concentration correlates with most of the classical risk factors in cardiovascular disease, however. This seriously complicates the interpretation of the elevated concentration. Concentrations of hsCRP are partly genetically determined and can easily be affected positively by lifestyle changes. These two factors lead us to conclude that the setting of hsCRP should not be used routinely at present in assessing the individual risk of complications for atherosclerosis.

Secondary dyslipidemias and their treatment

V. Soška

Vnitr Lek 2007, 53(4):396-400  

Secondary dyslipidemias may develop as a result of other diseases or some major exogenous influences. The most common are secondary dyslipidemias due to the following diseases: poorly controlled diabetes mellitus, hypothyreosis, hyperfunction of suprarenal glands, cholestasis, chronic renal diseases (chronic renal failure, nephrotic syndrome), acute infectious diseases. A very common cause of secondary dyslipidemia is abuse of alcohol. Also some drugs may induce dyslipidemias: corticosteroids, immunosuppressive drugs, less frequently also thiazide diuretics and non-selective beta-blockers. Secondary dyslipidemia is physiologic during pregnancy. If...

Can reduction in resting heart rate be beneficial for patients?

M. Souček

Vnitr Lek 2007, 53(4):401-403  

The relationship between resting heart rate and mortality is well documented in healthy people and patients with hypertension, heart failure, non-fatal myocardial infarction, metabolic syndrome and in old people. Resting tachycardia also contributes to reduced life length and is an important independent predictor of cardiovascular morbidity and mortality [1]. It therefore seems reasonable to reduce both heart rate and myocardial oxygen consumption. Simple measurement of resting heart rate can provide useful prognostic information. The most common pharmacological treatments to control heart rate are beta-blockers or calcium channel blockers (verpamil,...

Regular aerobic physical activity improves the lipid profile in persons with excessive body weight

Z. Stránská, M. Matoulek, P. Fábin, Z. Vilikus, Š. Svačina

Vnitr Lek 2007, 53(4):404-407  

A review of physical activity-induced lipid changes is presented. The review was compared with results we obtained in a reconditioning program involving 25 untrained obese patients who attended the reconditioning centre of the 1st Faculty of Medicine of Charles University for three months. A significant decrease was found in both HDL-cholesterol, triglycerides and the atherosclerosis index. No significant changes were recorded in the total and LDL-cholesterol level. Conclusion: Aerobic physical activity can induce changes in lipid levels in overweight and obese patients. Indication of regular aerobic physical activity should not be omitted in current...

Side effects of pharmacotherapy on lipid levels

Š. Svačina

Vnitr Lek 2007, 53(4):408-411  

Modern and effective pharmacotherapy for hypolipidemia usually compensates the negative effect of certain groups of drugs on lipid levels. Nevertheless, the fact that some psychotropic, antiepileptic, antihypertensive or hormonal drugs may have a certain negative impact should be taken into consideration. The article provides an overview of some of the drug groups provoking dyslipidemia, as well as an overview of drugs with a positive effect on dyslipidemia.

Intravenous treatment of acute heart failure

J. Špinar, J. Vítovec

Vnitr Lek 2007, 53(4):412-419  

Acute heart failure is a disease with various etiologies that is difficult to treat and has a poor prognosis. If causal treatment - revascularization, treatment of a hypertensive crisis - is not possible, symptomatic treatment takes over, based primarily on intravenous treatment with diuretics, vasodilators and/or positive inotropes. Despite undoubted progress in this form of treatment, large, randomised clinical studies have never proved the success of this treatment or confirmed an improvement in prognosis. For this reason most recommendations are based only on clinical experience and surrogate targets such as a reduction in BNP or shortening of...

Dual inhibition of cholesterol using the drug combination ezetimibe/simvastatin?

H. Vaverková

Vnitr Lek 2007, 53(4):421-427  

The latest clinical intervention studies of statins have shown that more aggressive reductions in LDL-cholesterol to values lower than existing target values for persons with a high risk of cardiovascular disease produce greater success in terms of halted progression and even regression of the atherosclerotic process and fewer cardiovascular events. This has lead to a series of international and national recommendations for a further reduction in target values for LDL-cholesterol, which is often difficult to achieve with the usual dosage of statins. The combination of a statin with ezetimibe, acting as a dual inhibition mechanism against the synthesis...

Diagnostic and therapeutic procedures in pheochromacytoma: current trends

J. Widimský jr, T. Zelinka, O. Petrák, B. Štrauch, L. Šafařík, M. Kasalický, A. Vranková, R. Holaj

Vnitr Lek 2007, 53(4):428-433  

Pheochromacytoma is a relatively rare cause of arterial hypertension. Untreated pheochromacytoma may however lead to a fatal hypertensive crisis during anaesthesia or another form of stress. It is therefore important to correctly diagnose this disease. 24-hour monitoring of blood pressure (BP) can already contribute to the diagnosis of pheochromacytoma based on the frequent occurrence of BP variability and the absence of a night-time fall in BP. 5 gene mutations have so far been identified that may be responsible for the familial form of pheochromacytoma: mutation of the von Hippel-Lindau (VHL) gene, leading to the onset of VHL syndrome, mutation of...

Lipoprotein (a)

L. Zlatohlávek, K. Zídková, M. Vrablík

Vnitr Lek 2007, 53(4):434-440  

The lipids are transported by lipoproteins in the blood system. Lipoprotein (a) [Lp (a)] is a unique lipoprotein of the human plasma discovered by professor Berg in 1963. Lp (a) consists of apolipoprotein (a) and LDL particles (apolipoprotein B100). The level and size of Lp (a) are highly variable and largely determined heredity. Clinical studies on animal models have shown that elevated Lp (a) levels are linked with a higher risk of atherosclerosis, even though not all of the conclusions based on the studies that have been carried are convincing. Concentration over 35 mg/dl is considered to be a risk level. Surprisingly high Lp (a) levels in old age...

Seberová E. Alergická rýma

Jindřich Lokaj

Vnitr Lek 2007, 53(4):451  

Petrů V, Krčmová I. Anafylaktická reakce

Jindřich Lokaj

Vnitr Lek 2007, 53(4):451-452  

Beran J, Havlík J. Pneumokokové nákazy a možnosti očkování proti nim

Jindřich Lokaj

Vnitr Lek 2007, 53(4):452-453  

Štolfa J, Štork J et al. Psoritická artritida a psoriáza

Petr Němec

Vnitr Lek 2007, 53(4):453  

Keil R et al. Gastroskopie

Bohuslav Kianička

Vnitr Lek 2007, 53(4):454  

Astl J. Chirurgická léčba nemocí štítné žlázy

Věra Olšovská

Vnitr Lek 2007, 53(4):454  

Chrobák L et al. Propedeutika vnitřního lékařství. Nové, zcela přepracované vydání doplněné testy

Petr Svačina

Vnitr Lek 2007, 53(4):455  

Špinar J, Vítovec J et al. Jak dobře žít s nemocným srdcem

Petr Svačina

Vnitr Lek 2007, 53(4):455-456  

Předseda České internistické společnosti Richard Češka padesátníkem

Štěpán Svačina, Petr Sucharda

Vnitr Lek 2007, 53(4):325  

K osmdesátinám prof. MUDr. Ladislava Chrobáka, CSc.

Karel Indrák

Vnitr Lek 2007, 53(4):446-449  

Obezita a metabolický syndrom - více otázek než odpovědí?

P. Sucharda

Vnitr Lek 2007, 53(4):441-443  

Interna - co ji spojuje a co ji naopak rozděluje

V. Pacovský

Vnitr Lek 2007, 53(4):444-445  

Šobrův den, XXIII. konference o hyperlipoproteinemiích. Praha, 7. června 2006. Abstrakta

Vnitr Lek 2007, 53(4):459-466