[Cardiovascular diseases are still leading cause of death in developed countries. A possible background, atherosclerosis, might appear even in childhood, and deteriorate during the years without any symptoms. The cardiovascular prevention is a complex activity, which can be observed in population or/and in individual level. The conventional screening means the assessment of higher cholesterol level, blood pressure or other risk factors in healthy population without symptoms. The point of clinical risk evaluation is to find patient with high cardiovascular risk and consequentially with the necessity of intensive preventive strategy. For the right cardiovascular screening and adequate evaluation of the risk, it is needed that the doctors who frequently meet with the population execute the above-mentioned risk assessment. Therefore doctors, nurses, and education for preventive aspect would is needed, as education is important to decrease cardiovascular mortality for those patients that were categorized as a high-risk group.]

[INTRODUCTION - Shift workers have an impaired circadian rhythm, which might have an adverse effect on their health. In order to assess cardiometabolic risk in shift workers, a cross-sectional study was performed among active workers (aged 25-66 years, with a minimal shift working experience of 5 years). METHODS - In total 481 workers (121 men, 360 women) registered by the occupational health service were enrolled in our study. Most participants worked in the light industry (58.2%) or in public service (23.9%). Following questionnaire-based data recording, anthropometric measurements and physical examination were performed and fasting venous blood sample was taken for measuring laboratory parameters. Data from shift workers (n=234, 54 men and 180 women, age: 43.9±8.1 years) were compared with those of day workers (n=247, 67 men and 180 women, age: 42.8±8.5 years). RESULTS - Compared with day workers, shift workers had bigger weight (76.6±16.1 vs 73.9±17.6 kg; p<0.05), higher BMI index (27.5±5.3 vs 26.0±4.9 kg/m2; p<0.01) and systolic blood pressure (123±19 vs 119±16 mmHg, p<0.01), and higher prevalence rate of diabetes (4.3 vs 1.2 %; p<0.05) and cardiovascular diseases (3.8 vs 0.8 %; p<0.05). In addition, the proportion of participants who performed regular physical activity was lower (20.6 vs 38.7 %; p<0.001) and that of current smokers were higher (35.0 % vs 19.5 %; p<0.001) in shift workers than in day workers. In laboratory findings, only one difference has been found: HDL-cholesterol level was lower among women (shift workers versus workers: 1.56±0.32 vs 1.68±0.36 mmol/l; p<0.01). CONCLUSION - Long-term shift work (day-night) results in a less healthy lifestyle and worse cardiometabolic risk factors compared with day work. Thus, our study highlights the importance of measures for preventing cardiovascular diseases in shift workers.]

[Angiotensin converting enzyme inhibitors have long been basic drugs in the treatment of heart failure. In the preventive treatment of ischaemic heart disease, however, their mortality-reducing effect has only been proved recently. The HOPE was the first trial that showed a beneficial effect of the angiotensin converting enzyme inhibitor ramipril in patients at high risk for cardiovascular diseases. The EUROPA trial showed a positive role of perindopril in the reduction of hard clinical endpoints in relatively low risk patients with known coronary artery disease. The PEACE trial was designed to show a possible group effect of angiotensin converting enzyme inhibitors, but it failed to demonstrate a beneficial effect of trandolapril in patients with coronary artery disease. The latest data from the EUROPA trial and results from three new prevention trials with perindopril or amlodipine plus perindopril combination and with quinapril have been presented recently. Perindopril was administered in patients over 65 years with previous myocardial infarction and with good left ventricle function in the PREAMI study. By the end of the study period, the combined end point and remodelling had decreased significantly. The ASCOT-BPLA trial (amlodipine plus perindopril versus beta-blocker plus diuretic) showed a reduction in all coronary events, in the risk of stroke and in the prevalence of new-onset diabetes mellitus. Quinapril was used in the IMAGINE trial in patients after coronary bypass surgery; the results did not support the hypothesis that early treatment with angiotensin converting enzyme inhibitors improves clinical outcome. Based on these new results, the indication of perindopril has been extended to the reduction of cardiovascular risk in patients with stable coronary artery disease after myocardial infarction or revascularization.]

[10 years of experience following the millennium has confirmed again that data on long term cardiovascular morbidity and mortality can be influenced by effective prevention most substantially. Growing body of knowledge and experience in the field of modern cardiovascular prevention is available, but novel and novel milestone studies have been published leading to updating of guidelines, however, we cannot be satisfied with the results. Evidence suggest that despite recent efforts, Hungarian cardiovascular morbidity and mortality has not been reduced significantly and except for some success - acute ST elevation myocardial infarction care in accordance with the European standard - we are behind the other EU countries in cardiovascular mortality of the active (age 30-65 years) age group. Recently several interesting contradiction has been published in the field of prevention, like the effectiveness of aspirin as primer prevention, which changes our common prevention conception. Data have to be also addressed, which can explain the controversial results from a different point of view. Now we are talking about the results of REALITY study, which highlight not only the noncompliance of the patient but that of the physician as well.]

[The pathobiological aim of treatment with angiotensin converting enzyme inhibitor is to restore the balance between nitrogen-monoxide and angiotensin II due to inhibition of blood and tissue angiotensin converting enzyme. The clinical consquences of the inhibition of tissue angiotensin converting enzyme in patients with additionally high (HOPE) and low (EUROPA) cardiovascular risk without left ventricular dysfunction has already been demonstrated. Ramipril and the perindopril reduce the risk of combined end-point of these trials such as cardiovascular mortality, reinfarction and resuscitated sudden cardiac death. However, pharmacological and genetic differences in blocking of tissue angiotensin converting enzyme may influence the cardioprotective effect of various angiotensin converting enzyme inhibitors. Thus new, well-designed, controlled clinical trials are needed to determine the role of angiotensin converting enzyme inhibitor with different tissue angiotensin converting enzyme affinity in cardiovascular disease.]