Lege Artis Medicinae

[Lifesaving statins]

CSÁSZÁR Albert

SEPTEMBER 10, 2001

Lege Artis Medicinae - 2001;11(08-09)

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Lege Artis Medicinae

[Anti-atherosclerotic effects of Ca-antagonists in the light of new clinical data]

ALFÖLDI Sándor

[Based on in vitro and animal research, it has been found that calcium antagonist drugs are capable of inhibiting directly the atherosclerotic process. In spite of their advantegous antiatherosclerotic effect, the fast-release, first-generation dihydropyridines had an unfortunate effect on the number of newly developed myocardial infarctions and on cardiovascular mortality. New, controlled clinical studies have found long acting calcium antagonists to decrease significantly the progression of the atherosclerosis in the carotid artery - verified with B-mode ultrasound scans - and the appearance of cardiovascular clinical events, when either proven coronary sclerosis (PREVENT, CAPARES studies) or hypertension (INSIGHT, ELSA, VHAS) was present. If further clinical trials (CAMELOT, NORMALISE - now under way) justify these promising clinical data, then long-acting calcium channel blockers may become new and significant tools in the prevention of the progression and clinical complications of atherosclerotic disease.]

Lege Artis Medicinae

[Congress of ASH, 2001.]

ALFÖLDI Sándor

Lege Artis Medicinae

[Endothel dysfunction and hypertension]

KELEMEN Judit, BLASKÓ György

[In the past two decade numerous data has been collected about the role of endothelium in the development of several cardiovascular disorders i.e. hypertension, congestive heart failure and atherosclerosis. Endothelial cells had been thought to be passive barriers only, but it turned out that through paracrine and autocrine hormone secretion they take part in modulating and regulating the vasodilator and vasoconstrictor effects being directed to vascular smooth muscle cells. The intact endothelium prevents the adhesion of platelets and monocytes, the platelet aggregation, as well as the migration and proliferation of vascular smooth muscle cells. It has been shown that both in experimental and human hypertension the endothelial function i.e. the so-called endothel-dependent vasodilatation is damaged, being the main feature of endothelial dysfunction. In spite of extensive research it is not clear whether endothelial dysfunction is a cause or a consequence of hypertension, with exact pathomechanism being also unclear. Methods, by which this important parameter could be precisely measured are under development. Researchers also examine whether recently used antihypertensive agents could improve or eliminate endothelial dysfunction and whether this effect may offer benefit to patients in terms of morbidity and mortality. This article attempts to summarize the most up-to-date information about the endothelial dysfunction research.]

Lege Artis Medicinae

[Risk to the fetus in the light of new data]

BODA Domokos

[Extensive research efforts based on principles of evidence-based medicine have helped lately to accumulate large amount of information on the risks to the fetus during pregnancy. As a result, the standpoints concerning risks to the fetus have become more precise in many respects. A number of earlier assumptions have been proven to be exaggerated or unfounded and the range of cases at risk has been narrowed down. This paper presents the most important data on potential risks to the fetus originating from hereditary factors, infections, maternal diseases, drugs, irradiation and special gestational anomalies. The data presented highlight the necessity of identifying the fetal damage during the pregnancy unequivocally, based exclusively on evidence of probative force and with realistic appraisal of the danger of any existent fetal damage.]

Lege Artis Medicinae

[Wegener’s granulomatosis: diagnostic questions]

CSISZÉR Eszter, SOLTÉSZ Ibolya, FÜZESI Katalin

[INTRODUCTION - Wegener’s granulomatosis is a disease of unknown origin classified as an immune vasculitis. The main pathologic feature is necrotising granulomatous small vessel vasculitis. Clinically the upper and/or lower airways are affected most often as well as the kidneys in the generalised form. The highly specific antineutrophil cytoplasmic antibodies have diagnostic significance beside the pathology and clinical symptoms. PATIENTS AND METHODS - We have studied the clinical and diagnostic characteristics of 15 cases diagnosed in our centre from the last 25 years. All patients had pulmonary manifestation. We analysed the organ involvement, clinical signs indicating the diagnosis, chest radiography, chances for biopsies of diagnostic significance and the difficulties of differential diagnostics. RESULTS - The diagnosis was made based on histological samples from the upper airways in three cases and from the lower airways in six cases (in four cases the bronchoscopic biopsies were diagnostic, in two patients thoracotomy was necessary). In six cases, clinical signs and typical organ manifestations were the basis of the diagnosis. CONCLUSION - This very rarely occurring disease which is difficult to recognise requires pulmonological examination due to the involvement of lungs. If this diagnosis comes to mind - based on findings of bilateral, multiplex, round pulmonal shadows with cavitation - the pulmonologist should search for other organ manifestations and involve respective specialists. Ideally, diagnosis is established by histopathology or by positive cytoplasmic antineutrophil cytoplasmic antibodies.]

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Lege Artis Medicinae

[Lipid lowering therapy during COVID-19 pandemic]

MÁRK László

[The COVID-19 pandemic posed significant challenges to all healthcare systems of the world as created a new situations above the large number of people infected, solutions of which were lacking any previous patterns. Former experiences were specifically needed among physicians who practised usually with therapies supported by evidence based clinical experiences thus they were working along the principles of Evidence-Based Medicine. The new observations and recommendations for treating infected patients increased gradually, however they were not always well-founded by the general urgency. In this situation, physicians faced often problems of the patient’s former medications since they had to focus on the therapy of the prevalent life-threatening condition. In such cases, therapy as lipid lowering, which is inherently inimically and lightly taken, may be omitted even more often. Basic drugs of lipid lowering are statins. They are used to reduce cholesterol levels and the risk of cardiovascular events, but they have also been described as having beneficial effect on the new viral infection. In this effect, the statins beyond the well-known anti-inflammatory impact and increasing the expression of angiotensin-converting enzyme-2 further mechanisms can take part as well. These may include among others the promoted breakdown of lipid rafts, which directly inhibits the entry of coronavirus into the cell through the S protein by decreasing the level of cholesterol required for this proceeding. In a group of more than 1200 statin treated and SARS-COV-2 infected patients the overall mortality rate by the 28th day was 48% lower than among the non-statin-users. According to a meta-analysis of nearly nine thousand COVID-19-infected statin users, they had 30% lower mortality rate or serious complications. Up to date observational studies suggest that statin therapy and the administration of other lipid lowering drugs should be continued or initiated according to the guidelines also during the COVID-19 infection.]

LAM Extra for General Practicioners

[Similarities and differences in the renal effects of statins]

ÁBRAHÁM György

[By efficiently reducing serum cholesterol level, statins significantly decrease both cardiovascular morbidity and mortality. Decreasing LDL-cholesterol level by 1% reduces coronary mortality risk by 1%, whereas increasing HDL-cholesterol level by 1% reduces the risk by 3%. At the same time, renal failure significantly increases cardiovascular events and/or mortality compared with the population mean. It is an exciting question whether statins are able to prevent and decelerate the deterioration of kidney function deterioration, preserve GFR and decrease albuminuria. Depending on the strength of their effect, statins have different cholesterol-lowering capacity (rosuvastatin and atorvastatin are especially effective). An important question is whether these differences can be detected in the renal function as well. The results of experimental data and major clinical trials (e.g. AURORA, PLANET I-II, SHARP) are often controversial. Nevertheless, statin therapy has advantages for patients with kidney diseases, although to a lesser extent than it has in the normal population.]

Hypertension and nephrology

[Cholesterol-lowering is not the Holy Grail, but neither is the work of the devil]

BAJNOK László

[Cholesterol-lowering statins are the most tested medications in respect of the effects and side-effects. Based on these, we can safely claim that most of the negative opinions about cholesterol-lowering are not realistic. It is not a panacea, but it is proven that around a 30% of cardio- and cerebrovascular risk reducation can be achieved by their regular taking, while the incidence of side effects and risks are at least one order of magnitude lower in each patient groups. For cholesterol, there is no “normal” lab threshold or low level, only “target values”, since the mean value in the general population is high in regard of atherosclerosis (the values measured at birth and among natural people can be considered normal). Let us appreciate the cholesterol- lowering medications because we do not have a large armamentarium!]

LAM Extra for General Practicioners

[NEW POTENTIAL PERSPECTIVES OF STATIN THERAPY]

CSÁSZÁR Albert

[Statins have become crucial components of the therapy of cardiovascular diseases. Beyond their cholesterol-lowering effect, statins turned out to have further beneficial effects on various vascular mechanisms. One of the best known effects is antithrombotic capacity, which is related partly to platelet function and partly to the coagulation cascade. Besides experimental observations, interventional clinical trials have also demonstrated that statins have an antithrombotic effect both in arterial and venous thrombosis. Regarding the effects of statins on dementia, previous studies with relatively small sample sizes had controversial results. Recently, two observational studies of tens of thousands of elderly patients reported that statins reduce the incidence of nonvascular dementia. Evaluation of the data revealed that statins have pleiotropic effects in this case, too. The results discussed here shed light on new benefits of statin therapy used for reducing cardiovascular mortality, namely the prevention of thrombotic events and dementia. These benefits are related to the antithrombotic and anti-inflammatoric capacity of statins.]

Hypertension and nephrology

[Statin therapy and hyperuricemia in hyperlipidemia - the clinical importance of atorvastatin]

CSIKY Botond

[Population based studies have proven that serum level of uric acid is a cardiovascular risk factor. Uric acid is produced in the human body as a result of the degradation of endogenous and exogenous purin nucleotids. It is eliminated mainly by the kidneys and in a small amount through the gastrointestinal tract. Serum uric acid can be decreased by some medical therapies. It has been demonstrated that atorvastatin treatment can decrease significantly uric acid level in patients with hyperlipidemia. Other statins do not seem to have such an effect. The uric acid lowering effect of atorvastatin is dose-dependent, and it most likely acts by increasing the renal elimination. The cholesterol, trgiglycerid and uric acid lowering effect of atorvastatin may have an important role in decreasing cardiovascular risk.]