Slovo úvodem

Michal Vrablík

Vnitr Lek 2018, 64(12):1121  

The changes in cardiovascular prevention practice between 1995-2017 in the Czech Republic: a comparison of EUROASPIRE I, II, III, IV and V study

Otto Mayer jr, Jan Bruthans, Martina Rychecká

Vnitr Lek 2018, 64(12):1190-1199  

Background:Appropriate secondary prevention after myocardial infarction is at least similarly important than the manage-ment of acute phase. A serie of EUROASPIRE surveys evaluated the real implementation of secondary prevention principles (as defined by current "Guidelines") into clinical practice in stable coronary heart disease (CHD) patients. This analysis presented changes in adherence to recommended principles overtime, between 1995 and 2017 in Czech cohorts of EUROASPIRE project. Methods:Five independent descriptive surveys were undertaken in 1995/1996, 1999/2000, 2006/2007, 2012/2013 and 2016/2017. Consecutive patients...

A summary of the EAS consensus concerning the causal relationship between low-density lipoproteins and atherosclerotic cardiovascular diseases, prepared by the Board of the Czech Society for Atherosclerosis

Vladimír Soška, David Karásek, Vladimír Blaha, Renata Cífková, Tomáš Freiberger, Pavel Kraml, Jan Piťha, Hana Rosolová, Tomáš Štulc, Zuzana Urbanová, Michal Vrablík

Vnitr Lek 2018, 64(12):1124-1128  

This article summarised opinion of the European Society for Atherosclerosis on the causal relationship between low density lipoprotein (LDL) and the development of atherosclerosis. The fact that there is a clear causal relationship between the LDL concentration and the development of atherosclerotic cardiovascular disease (ASKVO) is evidenced by congenital lipid metabolism disorders and results of prospective epidemiological studies, Mendelian randomized trials, and randomized controlled trials. It is documented that the effect of LDL exposure on ASKVO development is cumulative; the additive effect of other risk factors is also discussed. In conclusion...

Inflammation and atherosclerosis

Rudolf Poledne, Ivana Králová Lesná

Vnitr Lek 2018, 64(12):1142-1146  

Although current treatment of hypertension and hypercholesterolemia is most effective, cardiovascular mortality still remains at 50 % in industrialized countries. This could be explained by the rather high contribution of the inflammatory process to atherogenesis development. Use of high-sensitivity C-reactive protein (hsCRP) determination in several large epidemiological studies has made it possible to document increased risk of myocardial infarction in individuals with slightly increased hsCRP concentrations, which could thus serve as a discriminatory factor in cardiovascular disease risk assessment. However, the situation is not that simple since...

Bilirubin: from an unimportant waste product to important myocardial infarction predictor

Jaroslav A. Hubáček, Libor Vítek

Vnitr Lek 2018, 64(12):1148-1152  

Bilirubin is the major catabolic product of heme degradation. It has long been regarded as an unimportant waste product. However, within the last twenty-five years, it has been demonstrated to play a very important role in maintaining the body's redox equilibrium. Disturbances of this equilibrium - increased oxidative stress - are currently considered one of the major risk factors for the development of non-communicable diseases. Although the exact mechanism is not known, a number of human studies have proved a reduced incidence of a number of (especially cardiovascular but also cancer) diseases in individuals with mildly elevated bilirubin concentrations.

"The higher the better" seems to be no longer true for HDL-cholesterol

Hana Rosolová

Vnitr Lek 2018, 64(12):1153-1155  

It is very well known from the old epidemiological population studies, that HDL-cholesterol (HDL-C) was in a negative association with coronary events risk. New studies have occurred during the last 10 years that the mentioned association has in fact the U-shaped curve, i.e. lower and higher levels of HDL-C then the optimal one are in an exponential increasing risk. The association of high HDL-C levels with cardiovascular risk is not explained clearly. There might be a hypothesis concerning a change of function of large HDL particles riched of cholesterol esters, which become to be cholesterol donors for the arteries.

Current views on metabolic syndrome

Štěpán Svačina

Vnitr Lek 2018, 64(12):1156-1159  

The theory of metabolic syndrome originated 30 years ago. Several definitions try to explain the frequent common incidence of the risk factors for atherosclerosis. At first the syndrome of insulin resistance was involved. It was only later that the relation of the metabolic syndrome was described to what is known as systemic inflammation arising in adipose tissue and inflammatory diseases such as chronic bronchitis or psoriasis, or to degenerative diseases such as Alzheimer's disease. The views on the metabolic syndrome are thus constantly changing.

Lipoprotein(a) - the cardiovascular risk factor: significance and therapeutic possibilities

Vladimír Blaha

Vnitr Lek 2018, 64(12):1160-1168  

About 20 % of the population has raised Lp(a) concentrations and evidence suggests that high levels of Lp(a) are an independent cardiovascular risk factor. Both the European Society of Cardiology and the European Atherosclerosis Society recommend measuring Lp(a) values in intermediate to high-risk patients for risk stratification, as well as in patients already under statin treatment and with recurrent clinical events as a residual risk factor that calls for lipid-lowering therapy intensification. Strategies used to lower Lp(a) concentrations have either been partially disappointing in the past or lack cardiovascular outcome data. Therefore, Lp(a)...

Why not to interfere with LDL-cholesterol freefall and why not to talk badly about statins

Jan Piťha

Vnitr Lek 2018, 64(12):1169-1175  

Thanks to new drugs and treatments it is now possible, and therefore also advisable, to achieve very low LDL-cholesterol levels. This is primarily the inhibition of the proproteinconvertase subtilisin kexin 9 and LDL apheresis. Despite these new procedures, they remain the main antagonist of atherosclerosis and atherogenic dyslipidemia of statins. Statins are the basis of treatment always. If they are not enough or if they actually cause uncontrollable difficulties, they can be supplemented or replaced by other medications or treatments that reduce values of LDL-cholesterol. Often, however, their full potential is not fully exploited, and there are...

Combined lipid-lowering therapy

David Karásek

Vnitr Lek 2018, 64(12):1177-1184  

Dyslipidemia belongs to the main risk factors for atherosclerosis. To achieve current blood lipid targets, it is often necessary to use intensive hypolipidemic therapy including a combination of individual hypolipidemic drugs. In terms of cardiovascular risk reduction, it is important that the patient is treated with the highest tolerated dose of statin. In the next step, we decide to co-administer ezetimibe and/or fibrate, and for high-risk patients an additional treatment with proprotein convertase subtilisin kexin 9 inhibitors should be considered. The manuscript provides an overview of the individual combinations effectiveness to influence lipid...

PCSK9 inhibitors and diabetes mellitus

Branislav Vohnout, Jana Lisičanová, Andrea Havranová

Vnitr Lek 2018, 64(12):1186-1189  

Proproteinconvertase subtilisin kexin 9 (PCSK9) is a key regulator of low-density lipoprotein receptor (LDLR) expression. Anti-PCSK9 monoclonal antibody (MAb) therapy reduces LDL-cholesterol (LDL-C) by ~60 % and reduces also the risk of major adverse cardiovascular events. Mendelian randomisation studies showed that patients carrying loss-of-function PCSK9 genetic variants display lower LDL-C and have an increased risk of developing type 2 diabetes (T2DM). Randomized controlled trials with anti-PCSK9 MAbs however showed no effect on the risk. A possible explanation of the discrepancy is that the deficiency of locally but not circulating PCSK9 is responsible...

Consensus statement of professional associations on prescribing of PCSK9-inhibitors

Richard Češka, Miloš Táborský, Michal Vrablík

Vnitr Lek 2018, 64(12):1131-1136  

A new class of drugs known as PCSK9 inhibitors (PCSK9i) provide biological treatment for hypercholesterolemia. These drugs are administered using a subcutaneous injection once in two or four weeks. PCSK9i are not a replacement of the existing hypolipidemics, they just expand the therapeutic spectrum for the critically ill and those who cannot use the standard therapy and do not reach satisfactory target values. There are essentially two indications: (1) hypercholesterolemie and mixed dyslipidemia and (2) secondary prevention of cardiovascular diseases (CVD). Statin intolerance is not the only indication for treatment. However as its presence sometimes...

Comments on the most important and recent studies involving PCSK9i

Richard Češka

Vnitr Lek 2018, 64(12):1137-1141  

The paper provides a brief overview of the key studies focused on PCSK9 inhibitors. It mainly examines positive results of the FOURIER studies on evolocumab, the SPIRE study on boccocizumab and the ODYSSEY Outcomes study on alirocumab. All these studies have not only shown a significant decrease in LDL-cholesterol levels, but also the reduction of cardiovascular events just correlating with these levels. The treatment leading to a dramatic drop in LDL-cholesterol levels was safe and well tolerated by patients. All the studies provided with comments demonstrate a positive impact of biological treatment of hypercholesterolemia on cardiovascular disease...