[The role of dyslipidaemia in the patomechanism of obstructive sleep apnoea ]
MÉSZÁROS Martina, BIKOV András
MÉSZÁROS Martina, BIKOV András
[Obstructive sleep apnoea (OSA) is the most recent sleep-breathing disorder, which is characterised by repetitive collapses of the upper airways. Chronic intermittent hypoxia, sleep fragmentation and systemic inflammation play pre-eminent role in the pathogenesis of OSA and its comorbidities, such as dyslipidaemia. The triple impaired lipid metabolism results in OSA by dysregulated lipid synthesis of the liver, insufficient lipoprotein clearance and increased lypolysis. Several previous studies examined the association between dyslipidaemia and OSA with various outcomes. The aim of this review is to present the pathomechanism of dyslipidemia in the OSA. ]
Lege Artis Medicinae
[The comprehensive screening program of Hungary (MAESZ) 2010-2020-2030 is a unique initiative in Hungary and worldwide too. This largest humanitarian program provides by the latest technology free screening tests for all residents in Hungary. The program developed by 76 professional organizations offers 38 screening tests to every participants free of charge, in a special designed screening truck. Screening program performed by MAESZ includes cardiovascular, ophthalmologic, dermatologic, gynecologic, and neurologic investigations, lab tests, audiometry, blood pressure and arterial stiffness measurements, and venous Doppler ultrasound examinations. Moreover, screening tests for lactose intolerance, colon malignancy, inflammatory bowel disease, reflux disease, urine incontinency, prostatic cancer and physical activity level were evaluated. Starting 2020, a dental screening station will be added to the mobile unit for early detection of oral cancers. Beyond screening tests, special attention is paid to assess health threatening risk factors, such as smoking, alcohol consumption, physical inactivity, unhealthy nutrition, and obesity. The program demonstrates the key elements of first aid from reanimation to bandage of burns in cooperation with professional and civil organisations. Furthermore, during the waiting time, participants get lifestyle recommendations and a health booklet with a bar code enabling the immediate computer analysis of test outcomes. Since the 2018/2019 school year the official prevention program for children entitled “Travel around the Empire of Health” was started. During its 10 years, the MAESZ performed 7 million free of charge screening tests on 1,886 scenes, enrolled 560,000 participants, invested 16,000 hours for prevention, handed out 1,200,000 health booklets and 391,000 prevention info packages to thousands of families. More than 20,000 health professionals (GPs, nurses, dietetics, health development agents, public health government officials, Accident Prevention Committee of National Police Headquarters, General Directorate of Social Affairs and Child Protection and non-governmental organizations) have been participated. The program designed to improve social health aims to help more and more Hungarian citizens to be informed about their health status and to reminds them of the importance of prevention. ]
Lege Artis Medicinae
Lege Artis Medicinae
[In 2019 the European Atherosclerosis Society (EAS) and European Society of Cardiology (ESC) renewed their dyslipidaemia guidelines. The new version is more progressive than the previous ones. Thus, in the low-risk, not severely hypercholesterolaemic population cholesterol-lowering medication is also suggested. Except this low-risk group, atherogenic target values, e.g. for LDL-cholesterol, were reduced by an entire category, in some cases to the lowest one. If these goals cannot be achieved with statin-monotherapy, combined treatment is recommended generally by the cholesterol inhibitor ezetimib, and in some very high-risk cases also by innovative cholesterol lowering so-called PCSK9 inhibitor. ]
Lege Artis Medicinae
[BACKGROUND - When treating very elderly and frail hypertensive patients, there have to be taken in account the general health condition and frailty of patients, the present cardiovascular diseases (CVD) and values of the systolic blood pressure (SBP). Goals - In a clinical study performed in 29 countries, we aimed to analyse differences in practical antihypertensive therapy of family doctors among patients older than 80 years; further we sought to answer how much was influenced their therapeutic choice by frailty of the old age. The other goal of our study was to compare Hungarian versus international outcomes. Methodology - As part of an online survey, family practitioners had to decide about necessity of starting antihypertensive treatment among very elderly patients according to different patterns of frailty, SBP and CVD. The ratio of specific cases with positive treatment decision of family practitioners was compared in all 29 countries. We used a logistic mixed model analysis to multivariately model the role of frailty. Results - 2543 family practitioners participated in the cross-national study; 52% were female; 51% practised in urban environment. In 61% of practices, there was the ratio higher than 10% of very elderly patients. Hungary participated with 247 family practitioners in the study; 52.3% were female; 63.1% practised in urban environment. In 48.8% of practices the ratio of very elderly patients was higher than 10%. In 24 out of the 29 countries (83%), frailty was associated with GPs’ negative decision about starting treatment even after adjustment for SBP, CVD, and GP characteristics (odds ratio [OR 0.53]), 95% CI: 0.48-0.59; ORs per country 0.11-1.78). The lowest treatment ratio was in the Netherlands (34.2%; 95% CI: 32.0-36.5%) and the highest one in Ukraine (88.3%; 95% CI: 85.3-90.9%). In Hungary’s treatment ratio ranged 50-59%. This country ranked on the 27th place since Hungarian family practitioners chose rather to start antihypertensive treatment despite the frailty of the patient (OR=1.16; 95% CI: 0.85-1.59). Hungarian family practitioners started pharmacotherapy of elderly patients more frequently if they were males (OR= 1.45; 95% CI: 0.81-2.61), were working in their practice for less than 5 years (OR=2.41; 94% CI: 0.51-11.38), and if they had many patients aged over 80 years in their practice (OR=2.18; 95% CI: 0.70-6.80), however these differences were statistically not significant. Among Hungarian family practitioners starting therapy was significantly influenced by cardiovascular disease (OR=3.71; 95% CI: 2.64-5.23) and a SBP over 160 mmHg (OR=190.39; 95% CI: 106.83-339.28). Conclusions - In our study, there was significant difference between countries in starting antihypertensive treatment for very elderly patients. However, Hungary was among the countries where family practitioners preferred to treat their frail patients. The patients’ frailty did not have any impact on starting the therapy; rather cardiovascular disease and a SBP over 160 mmHg decided. It is an important message of the study that there is continuous need to educate family practitioners and trainees about the treatment of frail, elderly hypertensive patients.]
Hypertension and nephrology
[Summary – Chronic kidney disease (CKD), which affects 10-14% of the population, dramatically increases the incidence and severity of cardiovascular (CV) disease, leading to death in the majority of patients before kidney replacement therapy. The current CV risk scorecards in CKD significantly underestimate the real risk and are therefore not applicable. For CV risk assessment it is recommended to use the combined GFR/proteinuria table also, which is used for CKD classification, was also adopted by the Hungarian CV Consensus Conference last year. The benefit of cholesterol- lowering treatment has also been demonstrated in CKD, and a 1 mmol/l reduction in LDL-c, as in the general population, reduces the incidence of major CV events by 20%. Recent clinical trials have clearly indicated that the lower the LDL-c values achieved, the lower the risk of future CV events, and therefore the new recommendations have tightened the LDL-c values to be achieved. ]
Lege Artis Medicinae
[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. ]
Hypertension and nephrology
[Accelerated cardiovascular disease is a frequent complication of chronic kidney disease. Chronic kidney disease promotes hypertension and dyslipidaemia, which in turn can contribute to the progression of renal failure. Diabetic nephropathy is a leading cause of renal failure. Hypertension, dyslipidaemia and diabetes together are the major risk factors of the development of endothelial dysfunction and progression of atherosclerosis. Inflammatory mediators are often elevated and the renin-angiotensin system is frequently activated in chronic kidney disease. Promoters of calcification are increased and inhibitors are reduced, which favors vascular calcification, an important cause of vascular injury associated with end-stage renal disease. Accelerated atherosclerosis will then lead to increased prevalence of coronary artery disease, heart failure, stroke and peripheral arterial disease.]
Lege Artis Medicinae
[Dyslipidaemia is one of the known main risk factors of atherosclerosis by causing endothelial dysfunction that initiates and promotes vascular remodelling. Recent data from experimental and clinical studies suggest the existence of lipoprotein- neurohormonal interactions that may adversely affect vascular structure and function. Elevated lipid levels enhance the activation of the renin-angiotensin system, and, on the other hand, activation of the renin-angiotensin system leads to increased LDL cholesterol biosynthesis and oxidized-LDL uptake. These findings may explain the synergistic effect on cardiovascular risk observed in patients with coexisting hypertension and dyslipidaemia. The combined use of cholesterol-lowering drugs and inhibition of the tissue renin-angiotensin system may be more efficient in reducing cardiovascular risk.]
Lege Artis Medicinae
[In total 50 patients with hypertension and dyslipidaemia received combined antihypertensive and antilipid treatment. The main component of therapy was a fixed combination of amlodipine/ atorvastatin in different dose variations. The goal of the observation was to achieve optimal target blood pressure and lipid profile. During the six- month therapy, the baseline average blood pressure value was 161/90 mmHg and it decreased to 133/84 mmHg. The lipid profile also changed successfully. The average value of total cholesterol decreased from 5.9 mmol/l to 4.76 mmol/l. Over the six month period, amlodipine/ ator vastatin usage not only decreased the number of the heart and vascular system events, but increased the patients medicine compliance and therapy loyalty.]
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