Lege Artis Medicinae

[Rosuvastatin for the treatment of diabetic dyslipidaemia]


SEPTEMBER 20, 2012

Lege Artis Medicinae - 2012;22(08-09)

[Cardiovascular disease is a leading cause of death. The incidence of type 2 diabetes is increasing worldwide as well as in Hungary. Diabetes mellitus is a high-risk state, and if associated with coronary disease, it is considered a very high-risk condition. According to the 5th Cardiovascular Consensus Conference and ESC/EAS, the target level of LDL-cholesterol should be <2.5 mmol/l in high-risk condition and <1.8 mmol/l in very high-risk condition. In diabetes, one of the main goals is to achieve target LDL-cholesterol levels, which require lifestyle changes as a first step, followed by statin treatment, in combination with with ezetimibe if necessary. Statins are also known to have diabetogenic effects, which are dose-dependent. The advantage of the preventive cardiovascular effects observed in nondiabetic patients substantially outweighs the risk of potentially developing diabetes mellitus, therefore, this risk should not hinder the use of statins. Statin treatment can substantially reduce cardiovascular events in patients with diabetes mellitus. The greatest reduction in LDL-cholesterol level can be achieved by the most efficient statin, rosuvastatin.]



Further articles in this publication

Lege Artis Medicinae

[Therapeutic potential and risks of ayahuasca]

BOKOR Petra, FRECSKA Ede, CSÁNYI Barbara, BRYS Zoltán

[Ayahuasca, which originates from the Amazon Basin, is a psychoactive brew of two components. Its active agents are betacarboline and tryptamine derivatives. Near the spring of the Amazon River this brew is still a central component of many healing and tribal rituals. During the past few decades, the substance has become known among both laymen and scientistss and nowadays its use is spreading all over in Europe. In the present paper we give an overview of the scientific research and describe ayahuasca's main features, the main questions raised over its use, the risk factors and potential benefits. A growing number of scientific results seem to support the psychotherapeutic potential of ayahuasca, which has a strong serotonergic effect, whereas studies on its effect on the immune system also raise the possibility that certain ethno-medical observations can be scientifically proved.]

Lege Artis Medicinae

[Stress load and health risk behaviour among medical, dental and pharmacy school students]

SIMA Ágnes, KOVÁCS Eszter, CSEH Károly, BALÁZS Péter

[INTRODUCTION - This study aims to analyse interrelations of stress load, mental state and work related symptoms with health risk behaviour of medical, dental and pharmacy school students. SAMPLE AND METHODS - 473 fourthyear students participated, 73.4% of medical, 10.1% of dental and 16.5% of pharmacy school. Measuring stress, we used the validated version of Anderson's questionnaire for mental, physical and work related divisions. Those with high level of stress on the score system entered the risk groups in the relevant divisions. Among health risks, tobacco smoking, alcohol consume, illegal drugs and psychoactive pharmaceuticals were measured. RESULTS - 15.2% of students perceived mental and 7.8% physical complaints. Work related symptoms were in 26.0% indicated. The overall prevalence of health risks were found to be 12.1% for smoking, 36.2% for drinking, 30.9% for drug use and 9.1% for taking pharmaceuticals. There was a significant (p<0.001) association between taking pharmaceuticals and all the three risk divisions. CONCLUSIONS - The prevalence of smoking is low in all student groups, but three out of ten students are regularly consuming alcohol and some kind of illegal drugs, yet there is no significant association between these health risks and the stress phenomena. Using pharmaceuticals is relatively less frequent, but it must be concerned that these drugs are taken primarily to manage stress related problems.]

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Clinical Neuroscience

[Personalised epilepsy treatment]


[Epilepsy is one of the most common chronic neurological disease in childhood. Patients with epilepsy – even with so-called benign epilepsy – need medication for years. During this time, children go through a very big change, not only gaining weight and height, but also changing hormonal and metabolic processes. Maturation processes in different brain areas also take place at different rates depending on age. All of these should be considered when preparing a therapeutic plan. In everyday practice after the diagnosis of epilepsy, the applied drug is most often selected based on the shape and type of seizure. However, a number of other factors need to be considered when designing a therapeutic strategy: 1. efficacy (form of epilepsy, type of seizure), 2. age, gender, 3. pharmacological properties of the drug, 4. adverse drug reaction profile, 5. lifestyle (community), figure (skinny, corpulent, obese), 6. other comorbidities (nutrition, behavioral and learning problems, circulatory disorders, kidney or liver disease), 7. expected interactions with other drugs already used, 8. genetics, 9. other aspects (drug registration and prescription rules). The purpose of this article is to help to decide which antiepileptic drugs are expected to have the least side effects in a particular child with different comorbidities and which medications should be avoided if possible.]

Clinical Neuroscience

[Diabetes, dementia, depression, distress]

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[The number of people living with diabetes continues to rise. Therefore neurologists or other health care practitioners may be increasingly faced with comorbid neuropsychiatric disorders commonly presented by diabetic patients. More recently there has been an increasing research interest not only in the interactions between diabetes and the nervous system, the fine structure and functional changes of the brain, but also in the cognitive aspects of antidiabetic treatments. Patients with both types of diabetes mellitus may show signs of cognitive decline, and depression. Comorbid insomnia, anxiety, and distress may also occur. The bi-directional relationships between all these phenomena as well as their connection with diabetes can lead to further health and quality of life deterioration. Therefore it is important that all practitioners involved in the care of diabetic patients recognize the presence of comorbid neuropsychiatric disturbances early on during the healthcare process. Identifying higher risk patients and early screening could improve the prognosis of diabetes and may prevent complications.]

Hypertension and nephrology

[Nonproteinuric diabetic kidney disease]


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LAM Extra for General Practicioners

[Similarities and differences in the renal effects of statins]


[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.]

LAM Extra for General Practicioners



[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.]