Lege Artis Medicinae

[The modern therapy of lipid disorders in the daily practice ]

REIBER István1

MARCH 20, 2019

Lege Artis Medicinae - 2019;29(03)

DOI: https://doi.org/10.33616/lam.29.014

[Elevated LDL-C and/or triglycerides and decreased HDL-C levels contribute to development of vascular lesions. In the absence of detectable vascular disease the lipid values of providing vascular protection preferably with a healthy diet, regular physical activity and by trying to get out of harmful passions. If the healthy lifestyle is not effective enough, lipid-lowering medication may also be necessary in primary prevention. In the cases of inherited lipid disorders and in patients with high or very high cardiovascular risk it is necessary to take lipid lowering medications in effective dose. The Hun­ga­rian and the international guidelines have been formulated the targets of lipid values for vascular protection. The paper is trying to help for everyday medical practice, how to treat the dyslipidemic patients with the application of widely available lipid parameters and lipid lowering medications effectively. ]

AFFILIATIONS

  1. Fejér Megyei Szent György Egyetemi Oktató Kórház

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[The atherosclerosis can not only be prevented, but also can be cured ]

MÁRK László

[The process of atherosclerosis nowadays plays an important role in the health care not just as a major cause of the most common cardiovascular diseases which lead to death, but also as a major factor in the loss of age-related elasticity in the blood vessels. Over the past two decades, large studies have shown that the treatment of high cholesterol levels can reduce the frequency of cardiovascular events and death and have confirmed the ability to reduce the already existing atherosclerotic plaque, which is almost unique in pharmacotherapy. Using lipid lowering therapy, if we do it properly, we can not only prevent vascular events, but can also cure atherosclerosis. Currently there are three drug groups (statins, ezetimibe and PCSK9- inhibitors), which have complete evidence that their use can reduce the number of cardiovascular events and plaque regression can be achieved. Despite many convincing clinical trials, lipid-lowering therapy is on the cardiovascular prevention palette in the just tolerated or forced applied category. In order to take advantage of its potentials at an appropriate level, as doctors, we have to approach to it by considering its importance. We should communicate to our patients that it’s about a life-long treatment, which not only can reduce the possibility of cardiovascular events, but also can slow down the aging process of the arteries. ]

Lege Artis Medicinae

[Is it necessary? - Opinions and experiences about a first aid programme for children - pilot study]

BÁNFAI Bálint, PANDUR Attila, SCHISZLER Bence, RADNAI Balázs, BÁNFAI-CSONKA Henrietta, BETLEHEM József

[INTRODUCTION - Starting first aid education in early childhood can be an effective method of knowledge transfer. AIM - Our aim was to examine first aid education related opinions of kindergarten- and primary school children, educators, and parents. MATERIALS AND METHODS - 871 people (children, educators, parents) were involved in our study. Opinions were measured with self-administered questionnaires, containing mainly open questions. RESULTS - General opinion of parents and educators on first aid education in childhood were mainly positive, but they also gave negative ones. The majority of participants had a positive opinion about our completed program. Based on the opinions of parents and educators first aid education is recommended by health care professionals. Opinions were independent from gender, age, lenght of time of working with children in all cases (p>0.05). CONCLUSIONS - General opinion of parents and educators was varied, but it was generally positive concerning our program. Based on this results opinions can be changed with concrete activities. ]

Lege Artis Medicinae

[Antibiotics from the rood nodules]

KOVÁCS Ferenc

Lege Artis Medicinae

[Long-term CPAP compliance among Sleep Apnea Patients at the Sleep Laboratory of the Hungarian Defense Forces Medical Center ]

DOMBOVÁRI Magdolna, BERNÁT István, TERRAY-HORVÁTH Attila, CSATLÓS Dalma, HARGITTAY Csenge, TORZSA Péter

[Obstructive sleep apnea syndrome (OSAS) is the most common sleep disorder, with a prevalence of 2-4% in the overall popula­tion. It is a risk factor for cardiovascular diseases and its daytime symptoms significantly impair the patients’ quality of life and increase the risk of work and road accidents. Its first-line treatment is the CPAP device (Continuous Positive Airway Pres­sure) the effectiveness of which is significantly determined by the compliance of the patient. Although the issue of compliance in such treatment is a very important factor, long-term studies including a large number of patients have not been published yet, and there are no known data about it in Hungary. OBJECTIVE - Examining the long-term compliance of CPAP among OSAS patients in a sleep laboratory in Hungary. METHOD - 3403 OSAS patients were selected for our study between January 1, 2007, and September 30, 2017. The diagnosis and titration of effective CPAP pressure were determined by polysomnography. Patients were controlled after 2 months of therapy and then every 6 and 12 months. During the care, their compliance value was determined by data downloaded from their device's memory card. RESULTS - The mean age (± SD) of patients was 59.0 (± 10.5) years, most of them were male, 2676 (78.6%), their average body mass index (BMI) was 32.6 (± 5.25) kg/m2, their average Epworth Sleepiness Scale score was 11.4 (± 5.0), their average Apnea-Hypopnoe index was 51.0 (± 19.5) events/hour. The average usage time of the CPAP device was 5.0 (± 1.9) hours. 72.3% of the patients used the device for over 4 hours and 27.7% used it for less than 4 hours. 34.7% of the patients used the device for more than 6 hours. The Epworth Sleepiness Score showed a significant and dose-dependent improvement over CPAP treatment, with a greater improvement among patients who used the machine for longer hours. The highest score improvement was achieved by users who used CPAP between 6-7 hours, averaging 7.3 (± 3.2) points (p <0.001). CONCLUSIONS - Our present study shows that high average compliance can be achie­ved among well-adjusted and well-maintained patients. ]

Lege Artis Medicinae

[From disease-centrism to P4 medicine - a route to a health system placing the human “wholeness” into the center]

VÁLYI Péter

All articles in the issue

Related contents

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[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.]

LAM Extra for General Practicioners

[THE RISK OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS]

FARSANG Csaba, BEDROS J. Róbert, ALFÖLDI Sándor

[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used medicines all over the world. In the year 2012 in the LAM, we summarized data on cardiovascular (CV) safety of these drugs. We emphasized that all NSAIDs may potentially be harmful on the CV system, as they can increase the blood pressure, the risk of coronary events (angina, myocardial infarction), and that of stroke, as well as they may deteriorate renal functions. We also outlined that in this respect there are substantial differences between different compounds, and the CV risk does not depend on the ratio of COX- 1/COX-2 selectivity. The newly available data of original papers and metaanalyses shed light on further details. Even naproxen which drug was previously considered the less harmful on CV system can increase the risk of blood pressure, stroke, and gastrointestinal (GI) complications. We have to emphasize that the most important risk of NSAIDs is still the GI bleeding. This adverse effect is significantly less for drugs which are more selective for COX-2 than COX-1 enzyme, but other, pleiotropic effects can also beneficially modify the GI as well as the CV risk. E.g. the aceclofenac was found to be among NSAIDs with the less adverse effects on GI system and is also among those having the less CV risk.]

Lege Artis Medicinae

[Experiences with rosuvastatine therapy]

MEZŐ Izabella

[A relative cardiovascular risk reduction of 25-35% has been reported in patients with high cardiovascular risk that have started statins directly after the cardiovascular events. A lot of patients fail to consistently take these medications as directed. In order to obtain further success, it is very important to improve the actual routine, especially because in the field of lipid-lowering we have new data and guidelines that strongly support our efforts in the right direc­tion. We report the results of our ten patients treated with rosuvastatin after myocardial infarction from our ALADDIN Study. In the period of six month of treatment with 40 mg rosuvastatin LDL-cholesterol decreased 55% (from 3.55±1.1 to 1.58±0.6 mmol/l, p<0.01), non-HDL-cholesterol decreased 52% (from 4.15±1.23 to 2.0±0.8 mmol/l, p<0.01), triglycerides -26% (from 1.63± 0.41 to 1.2±0.4 mmol/l) and hsCRP level decreased 61% (from 5.47±3.8 to 2.1±1.0 mg/l, p<0.01). The two years persistence in these patients were 100%. Our experience confirms that the daily use of a highly-efficient statin (rosuvastatin) has a beneficial effect on lipid parameters and also facilitates the attainment of target lipid levels and significant cardiovascular risk reduction. ]

Hypertension and nephrology

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

ALFÖLDI Sándor

Lege Artis Medicinae

[Antidiabetic therapy of patients with type 2 diabetes - The place of administration of acarbose]

KEMPLER Péter

[Administration of the alpha-glucosidase enzyme inhibitor acarbose leads to a prolonged absorption of carbohydrates, which has a smoothing effect on blood glucose excursions, and results in a more even daily blood glucose profile. The glucose lowering effect is mainly due to the reduction of postprandial blood glucose levels. Non-glycaemic effects of acarbose, including those on blood pressure, lipids and the coagulation system are also clearly beneficial. According to the available data, the preparation also reduces cardiovascular risk. If used as a monotherapy, acarbose does not cause hypoglycaemia. Flatulence and diaorrhea represent the main side effects. From a professional point of view, acarbose should be given if postprandial blood glucose excursions exceed 2.2 mmol/l.]