Lege Artis Medicinae

[Anti-atherosclerotic effect of pioglitazone - The first evidence of the role of triglyceride/HDL ratio]


FEBRUARY 20, 2011

Lege Artis Medicinae - 2011;21(02)

[The presence of multiple risk factors can multiply exponentially the risk of cardiovascular events, thus cardiovascular diseases are more severe in diabetes mellitus. One of the challenges we face today is the application of drugs that, besides improving glucose homeostasis, also have antiatherosclerotic effect. Such candidates are glitazones, which have pleiotropic efficiency beyond their main effect: they improve distribution of adipose tissue, blood pressure and endothelial function and also have anti-inflammatory and anti-coagulation capacity. Regarding the effects on lipid metabolism, there are differences between various glitazones: improvements are mainly achieved by pioglitazone, which markedly reduces triglyceride levels, and also elevates HDL levels and decreases the ratio of small, dense LDL-particles. Studies on clinical outcomes also show the superiority of pioglitazone. Imaging of blood vessels (carotis-IMT, intracoronary ultrasound technique) also suggest a greater efficiency of pioglitazone. According to the latest analysis of the PERISCOPE study, the stability of the coronary plaque was associated only with the triglyceride/ HDL ratio in case of pioglitazone. The newest data also revealed that pioglitazone uniquely increases the cholesterol-efflux attributed to HDL-related macrophages. On the basis of the latest results, pioglitazone not only improves glucose homeostasis, but also has a remarkable anti-atherosclerotic effect, which is primarily due to its favourable lipid metabolism profile.]



Further articles in this publication

Lege Artis Medicinae

[Myocardial infarction in systemic lupus erythematosus]

BOLF Zsuzsanna, KOVÁCS Mónika, LUPKOVICS Géza

[Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with relatively common cardiovascular morbidity and mortality. We present a case of a 56-year-old woman treated for SLE, who had an infection of the upper respiratory tract and fever followed by multiple cardiac symptoms: pericarditis, endocarditis and finally acute myocardial infarction (AMI), which was attributed to coronaritis. Acute PCI resulted in revascularisation and combined drug therapy also reduced the patient’s inflammatory symptoms. Our case draws attention to the fact that SLE, as well as diabetes, is a condition equivalent with ischaemic heart disease.]

Lege Artis Medicinae

[The significance of generic valsartan in the treatment of patients]


[The renin-angiotensin-aldosterone system (RAAS) is involved in the regulation of electrolyte and water balance primarily; however, it also influences vascular function and increases blood pressure - especially under pathological conditions. Hypertension, post-myocardial infarction state, and heart failure are, for example, associated with excessive systemic and/or local activation of the RAAS. Angiotensin II (AT-II) generated by the latter contributes - along with additional factors and through its deleterious effects (vasoconstriction, endothelial dysfunction, atherosclerosis, prothrombotic state, fibrosis, etc.) - to damage to the target organs involved in the sequence of cardiovascular events. Inhibiting the RAAS at different levels is of therapeutic importance - its purpose is to delay disease progression, to prevent end organ damage, and to achieve a better outcome. As AT-II acts on several (AT1 and AT2) receptors, using angiotensin receptor blocking (ARB) agents with a high selectivity for the AT1 receptor is the rational choice. In view of its favourable therapeutic properties and efficacy demonstrated by morbidity and mortality studies, a generic formulation of appropriate quality, containing valsartan as active substance could prove to be the ideal treatment for patients with hypertension and other cardiovascular disorders.]

Lege Artis Medicinae

[Leaving Paradise – Or the Hidden Curative Effects of Pomegranate]

BECHER Péter, PATAI Árpád, MÁJER Katalin

Lege Artis Medicinae

[Cardiovascular safety of non-steroidal anti-inflammatory drugs]

ROJKOVICH Bernadette, INOTAI András

Lege Artis Medicinae

[The Loves of Abe Moyra – Pictures of a Posthumous Exhibition ]


All articles in the issue

Related contents

Hypertension and nephrology

[The prevalence of type 2 diabetes mellitus in the Hungarian population with hypertension]

KÉKES Ede, PÁL László, SCHANBERG Zsolt, KISS István

[Authors had found diabetes mellitus type 2 in 30% of 38 886 hypertensive patients (stadium I-III). Diabetes was more frequent in case of women under 30 years. Subsequently all age groups (from 40 to 80 years) incidence was more frequently (p<0.01-0.001) in men, above 80 years again a higher ratio was in women. Presence of diabetes was correlated to rate of BMI value and systolic, diastolic pressure as well. In women - above 140 mmHg systolic pressure - the elevation was exponential. We have found a significant correlation between fasting glucose and waist. Reaching the target blood pressure is not a simply task in hypertensive patients with diabetes. The 140/90 mmHg was reached in 34.2%, 90 mmHg diastolic blood pressure in 62.3%, but the required 80 mmHg only in 16.4% of cases. Achieve the target value was quite different in the different region of our country. The major cardiovascular complications (stroke, renal disease, myocardial infarction, peripheral artery disease) have suffered a higher rate in the hypertensives with diabetes compered to hypertensives without diabetes.]

Lege Artis Medicinae

[Lixisenatide: a new GLP-1-receptor agonist with mainly prandial effect for the treatment of patients with type 2 diabetes]


[Recently, lixisenatide, a new incretin mimetic GLP-1-receptor agonist with a mainly prandial effect has been registered for the treatment of patients with type 2 diabetes mellitus. The amino acid sequence of lixisenatide and that of human native GLP-1 is 50% identical. Due to its altered amino acid sequence and conformation, lixisenatide is resistant to inactivation by DPP-4. Lixisenatide is a specific agonist of GLP-1- receptors and its binding has a pharmacologic GLP-1-agonist effect. Lixisenatide is used subcutaneously, its normal daily dose is 1×20 μg. It is mostly used in combination with metformin, but it can be also used to supplement sulfanylurea or basal insulin therapy. Clinical efficiency of lixisenatide has been investigated in the phase-III GetGoal trials. In these trials, adequate glycaemic control and a marked decrease in postprandial blood glucose values were observed. During lixisenatide therapy, a decrease in body weight and no substantial increase in the risk of hypoglycaemia were observed, whereas transient gastrointestinal side effects might occur after initiation of treatment. Lixisenatide as an add-on treatment to basal insulin should be considered as a new treatment approach in the management of type 2 diabetes.]

Lege Artis Medicinae

[What does the „whole”-ness of patients with diabetes mellitus mean?]


[Diabetes mellitus is a chronic, progressive disease, characterized by elevated levels of blood glucose, can lead to many complications and can increase the overall risk of early disability and dying prematurely. The newest guidelines on management of patients with diabetes mellitus give a full description of diagnostic criteria, prevention, lifestyle and pharmacological treatment, complications, age-related characteristics. However, in everyday care of patients with diabetes mellitus little attention is paid to severity of anatomical and functional impairment related to disease, how and in what extent those limit everyday activities, restricts filling the social role, the importance of interrelationship of a human being and environment, to personal factors. The aims of this publication is: to present how diabetes mellitus influences the entirety, the “whole”-ness of a human; to show tools of objective estimation of impairments and changes of functionality; to call attention to importance of development of residual abilities, of shaping supportive environment, of assessment of needs, of positive influences of personal characteristics; to demonstrate how all these measures improve quality of life and compliance of patient with diabetes mellitus. The holistic approach of “human’s whole-ness” can contribute to success of preventive, curative and rehabilitative measures in patients with diabetes mellitus.]

Lege Artis Medicinae

[Investigation of skin microcirculation in diabetes mellitus by laser Doppler flowmetry]


[The prognosis of patients with diabetes mellitus is mainly influenced by vascular complications which is partly due to the deterioration of the microcirculation. Laser Doppler flowmetry is a suitable method to investigate the complex disturbance that characteristic for diabetic microcirculation. This review gives a summary of the anatomical, physiological and theoretical backgrounds and the possibilities in diagnosis given by Laser Doppler flowmetry.]

Lege Artis Medicinae


WITTMANN István, WAGNER László, WAGNER Zoltán, MOLNÁR Gergő Attila, TAMASKÓ Mónika, LACZY Boglárka, MARKÓ Lajos, MOHÁS Márton, NAGY Judit

[The stages of abnormal albuminuria are microand macroalbuminuria. The isolated abnormal albuminuria is a special form of proteinuria. For the detection of abnormal albuminuria one can use immunological or liquid chromatographic methods. The latter seems to be more appropriate than the immunological methods for the measurement of albuminuria in normo- and microalbuminuric diabetic patients. In diabetes mellitus, the circulating glycated and oxidized albumin is degraded and eliminated in the kidney. Decrease of the glomerular filtration rate is a valuable measure of renal insufficiency and this loss of kidney function is followed by the decrease of albuminuria as a sign of the glomerular closure. Albuminuria is an important cardiovascular risk factor and the decrease of the abnormal albuminuria is associated with a diminishing cardiovascular risk. Thus, albuminuria is a cardiovascular therapeutic target, as well. Therefore, the major points of the management of diabetic albuminuria are the achievement of euglycaemia, the use of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers.]