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Lege Artis Medicinae

JULY 01, 2020

[Treatment of hypercholesterolemia in the elderly]

BARNA István

[The percentage of population aged ≥65 years is mounting worldwide, among them those over 75 years is also growing. Athe­ro­scle­rosis is one of the most important and common disorder in the elderly responsible primarily for premature death and cognitive declining and impaired quality of life. Adequate lipid lowering therapy can decrease the risk of cardiovascular events – the main cause behind mortality – can extend life expectancy and improve the quality of life of patients. Effect of dietary treatment on cardiovascular risk reduction is as beneficial as in the younger populations. Regular physical activity reduces the risk of cardiovascular and overall mortality by 26% in males and 20% in females aged ≥65 years. If the medical history is negative for vascu­lar disorders, statin administration as a primary prevention is indicated for patients 65>years. In the population aged 75≥years individual benefit/risk assessment is needed before statin administration. Larger risk reduction can be achieved between 65-75 years than in subjects over 75 years. Concerning secondary prevention, statin treatment is of pre-eminent significance, and its administration is evidence-based in the elderly. For achieving the lipid goals, combined therapy with statin and ezetimibe is recommended in the primary as well as secondary cardiovascular prevention. ]

Lege Artis Medicinae

MARCH 20, 2019

[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. ]

Hypertension and nephrology

FEBRUARY 20, 2019

[Statins for elderly people, in primary prevention?]

BAJNOK László

[In a recent, retrospective cohort study, statin usage in primary prevention was found being not beneficial for patients (i) without diabetes over 75 years of age, and (ii) with diabetes over 85 years of age (75-84 years total mortality of diabetics was also lower). These findings are in sharp contrast to the two outstanding, double-blind, placebo controlled, randomized, a primary prevention studies done with rosuvastatin. Of these, 50% reduction in LDL-C in JUPITER was associated with a 50% reduction in risk and 25% reduction in LDL-C in HOPE-3 with 25% reduction in risk. Furthermore, subgroup analyzes did not indicate lower efficacy for the elderly. The recommendation of the European Atherosclerosis Society for primary preventions of the elderlies recommending consideration of statin use in these cases (Class IIa) is particularly relevant, especially in the presence of other risk factors such as hypertension. In the primary prevention lipid treatment, we can see quite clearly till 75 years of age and hopefully, we will even further after learning about the results of STAREE, a study that is designed to elderly and in which 40 mg atorvastatin is applied.]

Lege Artis Medicinae

DECEMBER 10, 2018

[Modalities of the therapy of patients with high cardiovascular risk]

FARSANG Csaba

[International and Hungarian guidelines emphasize the need of the combinations in the therapy of hypertension. Single pill combinations (SPC) are preferred. The importance of the treatment reducing cardiovascular risk is underlined by the fact that in most hypertensive patients other cardiovascular risk factors, among them most frequently dyslipidemia is present. In addition to antihypertensive drugs these patients should be treated also with those decreasing plasma lipids. Adherence / persistence to therapy of patients is greatly improved by the use of single pill combinations. Today we also have SPCs decreasing both, blood pressure and plasma lipids. Among them there is the combination containing amlodipine and atorvastatin. Several international and Hungarian clinical studies have been conducted. Results of these investigations have been described in several publications. In this paper I summarise the most important results of some of these studies. ]

Hypertension and nephrology

APRIL 20, 2018

[Cholesterol-lowering is not the Holy Grail, but neither is the work of the devil]

BAJNOK László

[Cholesterol-lowering statins are the most tested medications in respect of the effects and side-effects. Based on these, we can safely claim that most of the negative opinions about cholesterol-lowering are not realistic. It is not a panacea, but it is proven that around a 30% of cardio- and cerebrovascular risk reducation can be achieved by their regular taking, while the incidence of side effects and risks are at least one order of magnitude lower in each patient groups. For cholesterol, there is no “normal” lab threshold or low level, only “target values”, since the mean value in the general population is high in regard of atherosclerosis (the values measured at birth and among natural people can be considered normal). Let us appreciate the cholesterol- lowering medications because we do not have a large armamentarium!]

Lege Artis Medicinae

AUGUST 20, 2016

[Defending the statins]

MÁRK László

[Taking into account the frequent occurrence of coronary heart disease and the mortality related to this, it is obvious that the primary and secondary prevention of cardiovascular events is nowadays a major challenge in medicine. The lipid lowering therapy has become the basic element of the prevention and the statins are first-choice drugs in this field. Despite the great amount of the evidences coming from studies based on the principles of the evidence based medicine, the statins are frequently in the crossfire of undeserved offensives. The unexplainable reluctance to statins is frequent not only among the misled patients but among doctors too. The attitude of the latter to the treatment determines the patients’ compliance. The change of this attitude is the aim of this paper. This potential change and the continuous education of the patients are the most common possibilities for the improvement of the bad statin persistence and adherence. ]

Lege Artis Medicinae

MARCH 20, 2016

[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. ]

Lege Artis Medicinae

NOVEMBER 03, 2015

[The evaluation of statin adherence in patients from the village of Méhkerék]

HANYECZ Vince, DANI Győző, MÁRK László

[INTRODUCTION - One of the basic elements of cardiovascular prevention is lipid lowering therapy, the quality of which is indicated by the increasing rate of lipid target values achieved during recent years. Further improvement is needed and for this the enhancement of patient adherence to statin treatment is a possible way. PATIENTS AND METHODS - The prescription habits in 81 patients taking statins (41 atorvastatin and 40 rosuvastatin) from 392 randomly selected ones for another study were analysed from the database of general practitioner in the village called Méhkerék in Békés County, Hungary. RESULTS - The statin adherence of the patients was evaluated in two different ways: the estimation by the general practitioner and the determination of prescribed drug boxes during one year. There was no significant difference between the two methods. Similarly, no significant difference was found between the atorvastatin or rosuvastatin adherence. The reduction of total cholesterol was significantly greater in patients taking rosuvastatin (p=0.03). A significant correlation was found between the prescribed box numbers and the decrease of LDL- and total cholesterol. CONCLUSIONS - The patients’ adherence seems to be independent from the type of statin. For the evaluation of patient adherence the GP's simple estimation and determination of prescribed drug boxes during one year are equally appropriate. This suggests, that the GP would be able to select those patients whose education needs longer time. ]

Lege Artis Medicinae

SEPTEMBER 20, 2015

[Pleiotrop effect of rosuvastatin: clinical revelance of decreasing the mean platelet volume]

PUKOLI Dániel, SEMJÉN Judit, SZÉKELY Anita, RAJDA Cecília

[INTRODUCTION -Activated platelets play a key role in the patomechanism of cardiovascular diseases. One biomarker of platelet activation is mean platelet volume (MPV). Increased MPV level is connected to higher cardiovascular risk. Statins are frequently used in vascular diseases. We examined the effect of rosuvastatin on platelets in serum. METHODS - The patient were divided in medium risk and high risk (suffering ischaemic stroke) groups. Altogether parameters (total-, HDL, LDL-cholesterol, MPV) of 66 patients were examined before and after rosuvastatin treatment. RESULTS - Rosuvastatin decreased the cholesterol and MPV levels in both groups. This effect was greater in the high risk group. DISCUSSION - According the our findings rosuvastatin decreases the MPV both in hypercholesterolaemic and ischaemic stroke patients. The high LDL level causes increased platelet activation leading to increased thrombosis. This cascade worsens the underlying pathways in cardiovascular diseases. We found that aspirin taken together with rosuvastatin has a greater effect on decreasing the MPV. This probably doubles the antithrombotic effect. ]