Lege Artis Medicinae

[New possibilities in treating hyperlipidemia]

CSÁSZÁR Albert

FEBRUARY 22, 2013

Lege Artis Medicinae - 2013;23(02)

[In the fight against atherosclerosis, statin therapy is one of the most important elements. On the basis of data from the past few years the clinical introduction of a more effective statin is not expected, however, in order to improve cardiovascular prevention further development of agents that reduce LDL-cholesterol levels more effectively than currently used statins is warranted. The need for the development of new cholesterol-lowering therapeutic options is also supported by the existence of statin intolerance. The currently available combination therapies do not provide additional mortality benefits compared with statin monotherapy. The new solutions include fourth-generation statin molecules that primarily aim to enhance the NO-donor capacity of statins, and to reduce their muscle toxicity. Certain compounds that affect cholesterol synthesis (squalene synthase inhibitors, MTP inhibitors, ACAT inhibitors) need to be further analysed because of the risk of side effects. The use of an antisense oligonucleotid that blocks the mRNA of apoB, the main protein on the LDL-particle and antibodies that inhibit the protein PCSK9 that promotes the intracellular breakdown of the LDL-receptor seems to be much more promising. Besides the lowering of LDLcholesterol level, studies have focused on the benefits of increasing HDL-cholesterol levels. Unfortunately, recently completed analyses show that new forms of the strong HDL-C increasing nicotinic acid have not provided any additional benefit when added to statin therapy. Similarly, the adverse effects associated with the promising CETP inhibitors and the lack of additional benefit when combined with statins question the significance of this drug class. The necessity for an absolute increase of HDL-cholesterol levels needs to be revised on the basis of new data, in other words, the exact role of the HDL particle in atherosclerosis needs to be further investigated.]

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Lege Artis Medicinae

[Fulvestrant and bisphosphonate therapy of breast cancer with osseal metastases]

KLINKÓ Tímea, GALLER Zoltán, LANDHERR László

Lege Artis Medicinae

[LETTER OF THE EDITORS IN CHIEF]

FARSANG Csaba, KAPÓCS Gábor

Lege Artis Medicinae

[“I can’t do it alone.” Household workload and division of labour among Hungarian female physicians]

GYŐRFFY Zsuzsa

[BACKGROUND - Mental and somatic morbidity and role conflict among female physicians has become an issue of growing interest in the Hungarian and international literature. Among the potential backgrounds factor, the household labour is a less studied field. METHODS - A qualitative, pilot study (N=36) was conducted among female physicians in Hungary. The structured interview was focused on amount and division of household labour, the attitudes of household labour division and the harmonization of professional workload and household work. RESULTS - About of 66% of interviewed female physicians do the household work alone. About 33% is supported by partner in the household labour, and in one case the male partner does the household work alone. The responders are not satisfied with the division of household labour, and they want the amount of professional workload and household work both to be reduced. CONCLUSIONS - Our study is a pilot for further quantitative research. Our findings suggest that the Hungarian female physicians have traditional household labour division. The lack of the division is important to understand the problem of role conflict and the morbidity.]

Lege Artis Medicinae

[Public health care prevention in Hungary: are we doing what we should?]

KISS István, DANKOVICS Gergely, BARNA István, DAIKI Tenno, KÉKES Ede

[Primary prevention means health protection and disease prevention in the population, whereas secondary prevention includes early diagnosis and treatment to prevent the progression of diseases and the development of complications. Both ways of prevention are present in public health programs, but primary prevention measures are usually less substantial. METHODS - The “Comprehensive Health Protection Screening Program of Hungary 2010-2020” was organised in 2010 as part of the National Cardiovascular Program. In this program, a mobile screening station (set up on a truck) tours the country and provides a complex health status and risk assessment at village fairs as well as at offices. RESULTS - In the past three years, this station provided complex screening for 65267 individuals and lifestyle counseling and health education for 132964 people at 528 locations, touring 58807 km. The aim of the Program is to provide a comprehensive overview of the health status of the Hungarian population, and to make it possible to measure and record the long-term changes of the health status of the Hungarian population. Another goal is to inform those being screened about their health status and to highlight the importance of health protection and disease prevention. On the basis of the results, in the past three years the Program has been able to achieve its targets, which provides a good basis for its continuation.]

Lege Artis Medicinae

[Necrotising autoimmune myopathy showing dermatomyositis symptoms during persistent statin treatment]

TIHANYI László, SÜTŐ Gábor, VERESS Gábor

[INTRODUCTION - Dermatomyositis is an idiopathic autoimmune disease. Diagnosis has to be confirmed by biopsy, because clinical symptoms can be similar to those in other myopathies. CASE REPORT - The authors describe the development of dermatomyositis in a 59- year-old man. The patient had a heart attack in 1988. He had been taking simvastatin for three years and atorvastatin since 2002. In June 2008 he complained of myalgia and weakness, became physically very inactive but visited our specialist only half a year later. Laboratory examinations showed a substantial increase of CK, CKMB, LDH and HBDH with troponin T positivity (troponin I was negative). A subsequent biopsy confirmed dermatomyositis. Treatment with azatioprine and methylprednisolone and suspending statin therapy resulted in the regression of his clinical symptoms, his muscles gradually became stronger and his laboratory values normalised. CONCLUSION - During statin treatment in 5% of the cases myopathy can occur, which might develop into amore severe inflammatory disorder.]

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Lege Artis Medicinae

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[Based on animal and human research data, it is likely that renin-angiotensin-aldosteron system has an important role in the pathogenesis and progression of atherosclerosis. It has been demonstrated in several large clinical trials that ACE inhibitors reduce the risk of ischemic events in patients with left ventricular dysfunction. Whereas some benefits of ACE inhibitors may be related to the lowering of blood pressure, other specific effects on vasculature have also been proposed. ACE inhibitors appear to possess unique cardioprotective and vasculoprotective properties even for patients without hypertension or left ventricular dysfunction. Recent data suggest that most patient with atherosclerotic cardiovascular disease should be considered for ACE inhibitor therapy, unless they are intolerant or have contraindication for the drug. The goal of this article is to review the data from clinical trials that support the anti-atherosclerotic and antiischemic effects of ACE inhibitors.]