Ateroskleróza, lipidy a vnitřní lékařství

Richard Češka

Vnitr Lek 2015, 61(11):919  

Atherosclerosis: from etiology to its possible influencing

Michal Vrablík

Vnitr Lek 2015, 61(11):925-931  

Atherosclerosis as an inflammatory process affecting vessel wall has more forms usually occurring together. Classical atherosclerotic vascular lesion characterised by lipid accumulation in the subendothelial space is frequently accompanied by changes in deeper layers of arterial wall, in which increased extracellular tissue mass and smooth muscle cells activation represent the most prominent feature. Due to a specific constellation of risk factors the first or second pathology may be more expressed. While initiation and progression of classical atherosclerosis are mostly driven by lipoproteins (especially of LDL class) the most important factor of...

Practical approach to statin intolerance

Tomáš Štulc, Šárka Beránková, Richard Češka

Vnitr Lek 2015, 61(11):936-941  

Statins significantly decrease the cardiovascular risk and the reduction of cholesterol by statins has become a milestone in the prevention of cardiovascular diseases for a large group of patients. In spite of that an adequate use of statins in many patients is limited by adverse symptoms which lead to interruption of the therapy in some patients and low adherence to the therapy in others. Therefore the subject of statin intolerance is of great clinical importance. Statin intolerance can be defined as an incidence of myalgia or other adverse symptoms associated with a statin therapy, which lead to its interruption. Nonetheless, even if such symptoms...

Early diagnosis of familial hypercholesterolemia in Czech Republic in pursuance of MedPed Project

Tomáš Freiberger, Michal Vrablík

Vnitr Lek 2015, 61(11):942-945  

Recent studies have revealed the prevalence of familial hypercholesterolemia (FH) is approximately twice higher than previously estimated and, thus, the disease affects one in 250 persons from the general population. Therefore FH remains the most frequent inherited metabolic disorder. Due to the genetic defect LDL-cholesterol accumulates both in the plasma and tissues leading to premature and accelerated atherosclerosis. Untreated patients with FH might suffer from myocardial infarction in the third or fourth decade, one third of these events being fatal. The disease is underdiagnosed and undertreated worldwide. In the Czech Republic the MedPed project...

PCSK9 inhibition as the new hope for patients with familial hypercholesterolemia, statin intolerance and eventually for those at the highest cardiovascular risk? Focused on alirocumab, Praluent®

Richard Češka

Vnitr Lek 2015, 61(11):946-951  

At the present time there are novel hypolipidemics registered globally (alirocumab was the first drug of this group in the world registered by an American drug agency FDA) and in Europe, which in many ways differ from the medicines administered until now. They are bringing another advancement in the treatment of disorders of lipid metabolism and in preventive cardiology. Alirocumab is a fully human monoclonal antibody to PCSK-9 enzyme (proprotein convertase subtilisin kexin-9). PCSK-9 enzyme plays an important role in the metabolism of LDL-cholesterol through affecting the breakdown and eventually the amount and activity of LDL-receptors. From the...

Evolocumab and PROFICIO Project: Initial Results

Pavel Kraml

Vnitr Lek 2015, 61(11):953-957  

The PROFICIO project includes 20 clinical studies evaluating the effect of evolocumab on the incidence of cardiovascular disease including its safety profile and tolerance. Most of the included studies follow the average proportional decrease of LDL-cholesterol concentrations over 10 and 12 weeks of administering evolocumab as compared to the input values. The first results were announced at the congress of the European Society of Cardiology (ESC) in London at the end of August and beginning of September 2015. This subanalysis comprised 3146 patients, who underwent one of the selected studies of phase 3 clinical testing and who were administered a...

Position of lipoprotein apheresis in present

Vladimír Bláha, Milan Bláha, Miriam Lánská, Eduard Havel, Pavel Vyroubal, Zdeněk Zadák, Michal Vrablík, Jan Piťha, Pavel Žák, Luboš Sobotka

Vnitr Lek 2015, 61(11):958-964  

Lipoprotein apheresis (LA) is an effective treatment method the patients with severe hypercholesterolemia, resistant to the standard therapy. LA is an extracorporeal elimination technique, which specifically removes low density lipoprotein (LDL) cholesterol from the circulation. At present, lipoprotein apheresis, combined with high-dose statin and ezetimibe therapy, is the best available means of treating patients with homozygous and statin refractory heterozygous familial hypercholesterolaemia (FH). However, the extent of cholesterol-lowering achieved is often insufficient to meet the targets set by current guidelines. The recent advent of new classes...

The effect of a simvastatin and ezetimib combination on blood lipids and cardiovascular events in diabetic patients (comments on the subanalysis results within the IMPROVE-IT study)

Vladimír Soška

Vnitr Lek 2015, 61(11):965-969  

IMPROVE-IT study demonstrated that the addition 10 mg of ezetimibe to 40 mg of simvastatin in patients after acute coronary syndrome reduces significantly not only their LDL-cholesterol, but also the number of cardiovascular events. Recently published subanalysis of this study was focused on whether these combinations of drugs is more preferable for patients with diabetes mellitus or for patients without diabetes. The addition of ezetimibe to a simvastatin resulted in a greater decline of LDL-cholesterol level in diabetic group than in patients without diabetes. In patients with diabetes mellitus their cardiovascular morbidity and mortality were decreased...

What is the contribution of the review of the evidence on reducing macrovascular risk in patients with atherogenic dyslipidemia? Report on consensus of experts in the importance of the combined therapy by fenofibrate with statin

Hana Rosolová

Vnitr Lek 2015, 61(11):971-975  

A meeting of European experts in cardiovascular (CV) disease and lipids was convened in Paris, November 2014, where an important problem of preventive cardiology - residual vascular risk done by atherogenic dyslipidemia (AD) - was discussed. On the basis of discussion have the experts summarised a consensus concerning AD, its CV risk and up to date evidence of combined therapy with statin and fenofibrate on CV risk. Atherogenic dyslipidemia should be the secondary aim of dyslipidemia treatment, because it is a reason of residual vascular risk. Non-HDL-cholesterol should be the secondary target of AD treatment, which is a most unexpensive and easiest...

The TECOS, EXAMINE and SAVOR studies - how do they differ and what are their outcomes?

Jindřich Špinar, Lenka Špinarová, Jiří Vítovec

Vnitr Lek 2015, 61(11):976-983  

The treatment of diabetes mellitus type 2 is effective, but still is not optimal. DPP4 inhibitors (gliptins) are a new group of peroral antidiabetic drugs. The third clinical mortality study with gliptins in patients with diabetes mellitus type 2 was finished in 2015. The studies are known under acronym TECOS, SAVOR and EXAMINE and the tested drugs are sitagliptin, saxagliptin and alogliptin. The studies included about 37 000 patients. The studies confirmed the cardiovascular safety of the DPP4 inhibitors, but the question about increased heart failure remains open. The effectiveness of lowering glycaemia (glycated haemoglobin) was confirmed and also...

Clinical importance of basal insulin analogues and insulin Toujeo® 300 units/ml

Alena Adamíková

Vnitr Lek 2015, 61(11):985-988  

Type 2 diabetes mellitus is a heterogeneous disease that requires a personalized approach to treatment with goals tailored to capabilities and abilities of the patient, his other diseases so as to ensure good diabetes control without the risk of hypoglycemic events and the development or progression of late diabetic complications. Recommendations for treatment of diabetes is classified in second-line as a one of the possibilities of treatment of basal insulin immediately after the failure of therapy with metformin and diet. The new generation of basal insulin analogues provides its effect profile and features a completely new quality to the treatment...

Stanovisko k nové moderní hypolipidemické léčbě

Richard Češka, Miloš Táborský, Michal Vrablík

Vnitr Lek 2015, 61(11):933-935  

I. sympozium pracovní skupiny Kardio 35 České kardiologické společnosti

Michal Šnorek

Vnitr Lek 2015, 61(11):989-990