Lege Artis Medicinae

[Cardiovascular prevention 2021 – Guidelines of European Society of Cardiology 2021. Special considerations]

VÁLYI Péter1,2, KÉKES Ede3

NOVEMBER 30, 2021

Lege Artis Medicinae - 2021;31(11)

DOI: https://doi.org/10.33616/lam.31.035

Review

[On 31 August 2021, the European Society of Cardiology published its guideline “Prevention of cardiovascular disease in clinical practice”. This guideline provides a comprehensive review about risk factors of atherosclerotic cardiovascular disease, their assessment, potential modifiers, treatment and prevention of the cardiovascular dis­ease itself at societal and individual levels respectively. The previous guideline issued 2016, had to be updated due to the recent significant advances in risk prediction of cardiovascular disease on atherosclerotic background and due to the beneficial effects of treatment, emerging new drugs and therapeutic targets. The risk assessment system has undergone a major overhaul and now predicts the risk of fatal and non-fatal cardiovascular events together over a 10-year horizon and over a lifetime. In the new guideline, age plays a more important role in risk classification than before. The risk assessment and staged management of apparently healthy people or patients with established atherosclerotic cardiovascular disease, diabetes mellitus and other specific diseases or conditions are detailed. The positive impact of influencing risk factors, the years of life gained can recently be presented in a lifetime perspective, which will help to make an individually tailored decision on the extent of interventions, while taking into account also the patient’s preferences.]

AFFILIATIONS

  1. Érgondnok Rendelőház, Sopron
  2. VALYTERAPIA Egészségügyi és Szolgáltató Bt., Győr
  3. Pécsi Tudományegyetem, Klinikai Központ, Kardiológiai Tanszék

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[Stroke is one of the most frequent causes of death and the most important cause of permanent disability worldwide and also in Hungary. The Hungarian medical literature has mentioned this disease and has been giving recommendations for its treatment since 1690. Initially folk medicines, herbal preparations and phlebotomy were used as standard therapy. Later, cooling the head joined these methods. Pharmacy preparations emerged at the middle of the 19th century. From the middle of the 20th century, products of the pharmaceutical industry like blood flow enhancers and neuroprotective drugs were in the frontline of the acute care. Anti­hy­per­ten­sive, antithrombotic and lipid-lowering medications became part of stro­ke prevention. Imaging techniques – mainly computer tomography of the brain and ultrasound examination of the cervical large arteries – have radically changed the diagnostics of cerebrovascular diseases from the middle of the 1980s. Since the 1990s, diagnostic and therapeutic decisions are based on reliable evidence from good quality clinical trials. Since the beginning of the 21st century, reperfusion treatments (intravenous thrombolysis and mechanical thrombectomy) re­present the most effective emergency care. The current direction is the extension of the therapeutic time-window of reperfusion treatments based on sophisticated neruoimaging. This review provides a brief summary of the development of stroke care in the last three and a half centuries as reflected in the Hungarian medical literature. ]

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[Relationship of adolescents’ eating behavior and motivations with self-control and risk perception]

SZABÓ Katalin, PIKÓ Bettina

[Obesity and related diseases caused by unhealthy eating form a serious public health problem already in youth. In terms of prevention, it is essential to explore adolescents’ eating behaviors and factors influencing their diet. Our study aimed to explore adolescents’ eating behaviors, its motivations and their relation to self-control and risk perception related to eating behavior. Participants were 374 high school students (48% males; mean age: 16 years, S.D.=1.5) from Szeged and Bu­da­pest. Self-administered questionnaire was used for data collection which assessed socio-demographics, eating behaviors, mo­ti­vation, eating behavior related risk perception and self-control. Using factor analysis, we categorized eating behaviors (“junk food/drink consumption”; “health-oriented nutrition”; and “snacking and habit-oriented nutrition”), and eating motivations (“social, emotional and external motives”; “traditions and internal motives”; and “health motives”). According to correlation analysis, self-control was positively related to health-oriented nutrition and health motives and negatively to junk food/drink consumption and social, emotional and external motives. These two latter factors were associated with an increased risk perception as well. Our results draw the attention to strengthen self-control and explore the role of risk perception and eating motivations in school health education programs. ]

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[Lipoprotein(a) is a genetic trait, resembling the structure of low density lipoprotein (LDL). Due to its high atherogenicity it is an independent risk factor for atherosclerotic vascular diseases. External impacts (as dietary and lifestyle measurements) do not decrease its plasma level thus the primary and secondary cardiovascular prevention prefers primarily the drug therapy. How­ever, widely used lipid lowering agents do not have any impact on its plasma level. Recently, the PCSK9 inhibitor monoclonal antibodies (evolocumab and alirocumab), the small interfering mRNA inclisiran, and particularly the antisense oligonucleotide targeting the LPA mRNS, further the clinical use of pelacarsen produced significant lipoprotein(a) lowering effect. Beyond the atherosclerotic vascular diseases, lipoprotein(a) plays an important role in the pathogenesis of the calcific aortic valvular stenosis, as well. The usage of the above-men­tioned biological therapies in this condition is also promising. ]

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[Cardiovascular prevention 2021 – Guidelines of European Society of Cardiology 2021. General principles]

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[On 31 August 2021, the European Society of Cardiology published its guideline “Prevention of cardiovascular disease in clinical practice”. This guideline provides a comprehensive review about risk factors of atherosclerotic cardiovascular disease, their assessment, potential modifiers, treatment and prevention of the cardiovascular disease itself at societal and individual levels respectively. The previous guideline issued 2016, had to be updated due to the recent significant advances in risk prediction of cardiovascular disease on atherosclerotic background and due to the beneficial effects of treatment, emerging new drugs and therapeutic targets. The risk assessment system has undergone a major overhaul and now predicts the risk of fatal and non-fatal cardiovascular events together over a 10-year horizon and over a lifetime. In the new guideline, age plays a more important role in risk classification than before. The risk assessment and staged management of apparently healthy people or patients with established atherosclerotic cardiovascular disease, diabetes mellitus and other specific diseases or conditions are detailed. The positive impact of influencing risk factors, the years of life gained can recently be presented in a lifetime perspective, which will help to make an individually tailored decision on the extent of interventions, taking into account also the patient'’s preferences.]

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Comparison of hospitalized acute stroke patients’ characteristics using two large central-eastern european databases

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Objectives – Stroke is the third leading cause of death in the European region. In spite of a decreasing trend, stroke related mortality remains higher in Hungary and Romania when compared to the EU average. This might be due to higher incidence, increased severity or even less effective care. Methods – In this study we used two large, hospital based databases from Targu Mures (Romania) and Debrecen (Hungary) to compare not only the demographic characteristics of stroke patients from these countries but also the risk factors, as well as stroke severity and short term outcome. Results – The gender related distribution of patients was similar to those found in the European Survey, whereas the mean age of patients at stroke onset was similar in the two countries but lower by four years. Although the length of hospital stay was significantly different in the two countries it was still much shorter (about half) than in most reports from western European countries. The overall fatality rate in both databases, regardless of gender was comparable to averages from Europe and other countries. In both countries we found a high number of risk factors, frequently overlapping. The prevalence of risk factors (hypertension, smoking, hyperlipidaemia) was higher than those reported in other countries, which can explain the high ratio of recurring stroke. Discussion – In summary, the comparatively analyzed data from the two large databases showed several similarities, especially regarding the high number of modifiable risk factors, and as such further effort is needed regarding primary prevention.

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[In August 2021, the European Society of Cardiology (ESC) published its practical guidelines for cardiovascular prevention. In Part 1 of our publication, we discussed cardiovascular risk factors, risk assessment, cardiovascular risk assessment in presumably healthy individuals of different ages, people with proven atherosclerotic cardiovascular disease, people with diabetes mellitus, and factors influencing risk. In Part 2, conditions that influence cardiovascular risk were detailed. In the current Part 3 of this publication, we review personalised cardiovascular prevention, non-pharmaceutical and pharmaceutical treatment of specific risk factors, emerging treatment options, and par­ticipation in cardiovascular rehabilita­tion and prevention programmes based on ESC guidelines.]

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[Cardiovascular prevention 2021 – Guidelines of European Society of Cardiology 2021. Prevention at the population level And Disease specific cardiovascular prevention]

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[In our four-part publication we review the current state of cardiovascular prevention based on the European Society of Car­dio­logy Guidelines 2021. In part 1 we reviewed the risk factors, risk assessment, age-specificities, the influencing factors, including diabetes mellitus and chronic kidney disease. In part 2 we concerned comorbidities affecting the cardiovascular risk. In part 3 we reviewed the personalised cardiovascular prevention and the management of specific risk factors, including optimisation of life style factors, management of lipid levels and high blood pressure and anti­thrombotic therapy. This part 4, we review the community level preventive measures (physical activity, diet, smoking habits and alcohol consumption) and the importance of governmental and non-governmental interventions. We provide a brief summary about the principles of cardiovascular prevention in individuals with coronary artery disaese, heart failure, cerebrovascular dis­eases, lower extremity artery disaese, chronic kidney disease, atrial fibrillation, and in multimorbid patients.]

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Risk factors for ischemic stroke and stroke subtypes in patients with chronic kidney disease

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Background - The aim of this study was to compare ischemic stroke subtypes with the effects of risk factors, the relationship between grades of kidney disease and the severity of stroke subtypes. Methods - The current study was designed retrospectively and performed with data of patients who were hospitalised due to ischemic stroke. We included 198 subjects who were diagnosed with ischemic stroke of Grade 3 and above with chronic kidney disease. Results - In our study were reported advanced age, coronary artery disease, moderate kidney disease as the most frequent risk factors for cardioembolic etiology. Hypertension, hyperlipidemia, smoking and alcohol consumption were the most frequent risk factors for large-artery disease. Female sex and anaemia were the most frequent risk factors for small-vessel disease. Dialysis and severe kidney disease were the most frequent risk factors in unknown etiologies, while male sex, diabetes mellitus, prior stroke and mild kidney disease were the most frequent risk factors for other etiologies. National Institute of Health Stroke Scale (NIHSS) scores were lower for small-vessel disease compared with other etiologies. This relation was statistically significant (p=0.002). Conclusion - In order to improve the prognosis in ischemic stroke with chronic kidney disease, the risk factors have to be recognised and the treatment options must be modified according to those risk factors.