Lege Artis Medicinae

[Cardiovascular risk factors and risk assessment]


NOVEMBER 20, 2013

Lege Artis Medicinae - 2013;23(10-11)

[The author summarises the most important cardiovascular risk factors. Concerning public health, the three most important synergistic factors are smoking, hypertension and abnormal cholesterol. Abnormal total lipid profile, visceral obesity, elevated glucose and uric acid levels and hypertonia all contribute to the global cardiometabolic risk. A number of studies and metaanalyses have confirmed the correlations of the risk factors and cardiovascular events (organ damage, clinical events, mortality). The concomitant occurance of risk factors increases the rate of risk. Risk estimation methods have been designed on the basis of proven correlations and they have been continuously improved and made more reliable owing to the assessment of more and more factors.]



Further articles in this publication

Lege Artis Medicinae

[The possibilities and practice of immunoglobulin replacement in adults with antibody deficiency]

KRIVÁN Gergely

[Primary antibody deficiencies can occur at any age, but in a significant number of patients the correct diagnosis has not been established yet and thus their treatment has not been initiated. In patients with primary antibody deficiency, lifelong immunoglobulin replacement therapy has no alternatives. Immunoglobulin replacement therapy applied at adequate doses can prevent infections and provide a good quality of life for patients. In addition to intravenous preparations that have been used for decades, new preparations for subcutaneous administration are available now in Hungary as well. Subcutaneous preparations have fewer systemic side effects, can be used at home and, with weekly infusions, can provide more constant IgG levels, which can be beneficial in preventing infections.]

Lege Artis Medicinae

[BOMM Report – The Hungarian Working Group for the Education of Bioethics (BOMM) ]

KAKUK Péter, BODNÁR János Kristóf

Lege Artis Medicinae


HAJDU Mária, KRUTSAY Miklós, MAKKAI Erzsébet

Lege Artis Medicinae

[A General Practitioner and Diary Writer Around Leo Tolstoy ]


Lege Artis Medicinae

[Who are the happy female physicians in Hungary?]


[BACKGROUND - The female Physicians’ well-being and happiness has become the latest researching field of the “Physicians studies”. In Hungary the researches haven't focused on this subject. Our aim was to examine the subjective well-being of the Hungarian female Physicians. METHODS - Representative, cross-sectional, quantitative survey on a representative sample of female Physicians (N=408). Modified version of WHO Well- Being Index was performed to measure of subjective Well-Being. RESULTS - We have found that the key to the Hungarian female Physicians’ wellbeing is the “time”. Significantly higher rate of well-being is associated with reduced work-hours (8 hour or less, p=0.000), and duty hours (p=0.042), having one hour free time daily (p=0.021) and they satisfied with the time of doctor-patient interaction (p=0.021). The higher rate of Well-Being scores haven't associated with age, marital status, number of children and the speciality. CONCLUSION - Similarly to the national trends, the Hungarian female Physicians' well-being is depending on the work and the satisfaction with work. The satisfied healer is the key of the health system therefore the future studies and the prevention and intervention have to focus on the Physicians’ well-being.]

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Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]


[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Clinical Neuroscience

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

GÜLER Siber, NAKUS Engin, UTKU Ufuk

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.

Lege Artis Medicinae

[Hypertension in the elderly - critical review of diagnostic-therapeutic guidelines and their background]


[In the majority of old and very old hypertensive patients, the reduction of abnormally high blood pressure has been proved to provide a strategic defense of target organs. In patients younger than 80 years, both initial and target blood pressure (BP) values are similar to those of younger age groups. In those older than 80 years, a a systolic blood pressure level >160 mmHg is the threshold of indication for antihypertensive treatment and the therapeutic target value is<150 mmHg. Both values are evidence- based (HYVET). The latest ACCF/AHA guidelines (USA 2011) advise to achieve a BP below 140 mmHg if the use of one or two antihypertensive agents result in sufficient BP reduction. However, this strategy is not yet supported by unequivocal evidence regarding complications in target organs. It is not recommended to aim for target levels lower than the above values (especially the value defined by the ESH guidelines) even in elderly hypertensive patients at high cardiovascular risk, as the results of several studies suggest a J-curve effect. In multimorbid elderly patients it is highly important to adapt antihypertensive treatment to individual needs, rather than to use schematic approaches. The number and progression of comorbid diseases can greatly influence, in certain cases attenuate the aimed BP reduction. A similar medical decision should be made if the target BP level could only be achieved by the combination of multiple antihypertensive medications, which can remarkably impair quality of life in elderly patients. Among non-comorbid elderly patients with hypertension, there seems to be no convincing difference in the efficiency of target organ protection between antihypertensive treatments that have different target sites but can achieve similar target levels. However, the majority of elderly hypertensive patients have comorbidities with variable rates of progression. In those at even low cardiometabolic risk the use of beta-receptor blockers (BRB) and especially a combination of BRB+diuretic (DIU) is not recommended. The adequate therapeutic tactic includes the use of only moderate drug-doses and their early combination. This approach has been convincingly proved mainly with early combinations of RAS inhibitors+CCB-s and RAS inhibitors+small doses of DIU-s. It is very important to monitor the treated patients, as the BP and circulatory response to the same antihypertensive treatment can markedly change in elderly patients when either the enviromental conditions change or a new pathologic process develops and/or is treated. Strict control is also necessary because it occurs quite often that the earlier optimal compliance of elderly patients in taking antihypertensive medicines rapidly deteriorates. The efficiency of statins and acetylsalicylic acid decreases over 80 years of age, but this does not indicate that the previously efficient approach should be suspended.]

Hypertension and nephrology

[Hyperuricemia as a cardiovascular risk factor: novelties in therapeutic guidelines]


Lege Artis Medicinae



[Obesity, particularly intra-abdominal (visceral) obesity, is a leading cause of cardiovascular disease, insulin resistance, type 2 diabetes, dyslipidaemia, and thrombosis. There is a growing consensus that abdominal obesity, measured by wait circumference, is a better predictor of coronary artery disease, diabetes and metabolic syndrome than body mass index. Although the primary function of adipocytes is storage and release of energy, several factors secreted by adipocytes have regulatory roles in metabolism and exert vascular effects. The pro-inflammatory adipokines, for example, play a causal role in the development of insulin resistance, type 2 diabetes and cardiovascular disease. Clinical studies provide growing evidence that adipous tissue is biologically highly active and possesses a range of metabolic and endocrine functions. The aim of this review is to explore the pathophysiological connections between abdominal obesity and the development of cardiovascular diseases.]