PURPOSE: Low-density lipoprotein cholesterol (LDL-C) recommendations differ between the 2018 American College of Cardiology/American Heart Association (ACC/AHA) and 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) (< 70 vs. < 55 mg/dl, respectively). In the DA VINCI study, residual cardiovascular risk was predicted in ASCVD patients. The extent to which relative and absolute risk might be lowered by achieving ACC/AHA versus ESC/EAS LDL-C recommended approaches was simulated. METHODS: DA VINCI was a cross-sectional observational study of patients prescribed lipid-lowering therapy (LLT) across 18 European countries. Ten-year cardiovascular risk (CVR) was predicted among ASCVD patients receiving stabilized LLT. For patients with LDL-C ≥ 70 mg/dl, the absolute LDL-C reduction required to achieve an LDL-C of < 70 or < 55 mg/dl (LDL-C of 69 or 54 mg/dl, respectively) was calculated. Relative and absolute risk reductions (RRRs and ARRs) were simulated. RESULTS: Of the 2039 patients, 61% did not achieve LDL-C < 70 mg/dl. For patients with LDL-C ≥ 70 mg/dl, median (interquartile range) baseline LDL-C and 10-year CVR were 93 (81-115) mg/dl and 32% (25-43%), respectively. Median LDL-C reductions of 24 (12-46) and 39 (27-91) mg/dl were needed to achieve an LDL-C of 69 and 54 mg/dl, respectively. Attaining ACC/AHA or ESC/EAS goals resulted in simulated RRRs of 14% (7-25%) and 22% (15-32%), respectively, and ARRs of 4% (2-7%) and 6% (4-9%), respectively. CONCLUSION: In ASCVD patients, achieving ESC/EAS LDL-C goals could result in a 2% additional ARR over 10 years versus the ACC/AHA approach.

• MeSH
• ateroskleróza * diagnóza   farmakoterapie   epidemiologie   MeSH
• chování snižující riziko MeSH
• kardiovaskulární nemoci * diagnóza   epidemiologie   prevence a kontrola   MeSH
• LDL-cholesterol MeSH
• lidé MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• statiny * terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Spojené státy americké MeSH

Onemocnění kardiovaskulárního systému patří celosvětově k předním příčinám morbidity a mortality. Prvním identifikovaným rizikovým faktorem kardiovaskulárních onemocnění je hypertenze, následně pak byla identifikována celá řada rizikových faktorů, na základě kterých byly provedeny velké populační studie se vznikem celé řady skórovacích systémů. U nás je nejpoužívanější skórovací systém SCORE přizpůsobený přímo pro českou populaci. Skórovací systémy nám pomáhají ve vyhledávání jak dosud asymptomatických pacientů, tak pacientů s již známým onemocněním kardiovaskulárního systému. Na stratifikaci kardiovaskulárního rizika je založena jak primární, tak sekundární prevence fatálních i nefatálních kardiovaskulárních příhod. Klíčová slova: kardiovaskulární onemocnění – prevence – rizikové faktory – odhad rizika

Cardiovascular diseases are a common cause of morbidity and mortality all over the world. Currently, cardiovascular diseases are a direct cause of death in one out of two or three patients. Hypertension as a cardiovascular risk factor was first mentioned almost 60 years ago. Since that time, multiple risk factors have been identified. Based on these factors, large population studies have been performed leading to the development of scoring systems; with the Framingham risk score being at the top. However, in our region the SCORE system is the most commonly used scoring system. Scoring systems help in finding asymptomatic patients and contribute in the management of patients with a known cardiovascular disease. Both primary and secondary prevention of fatal and non‑fatal cardiovascular events is based on cardiovascular risk stratification. Keywords: cardiovascular diseases – prevention – risk factors – risk estimation

• Klíčová slova
• AHA- ACC- ASCVD skóre, Framinghamské skóre, Reynoldsovo skóre, skórovací systém SCORE,
• MeSH
• hodnocení rizik * metody   MeSH
• kardiovaskulární nemoci * prevence a kontrola   MeSH
• lidé MeSH
• primární prevence MeSH
• prognóza MeSH
• rizikové faktory * MeSH
• sekundární prevence MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

V rokoch 2017 a 2018 boli publikované výsledky dvoch veľkých kardiovaskulárnych štúdií s inhibítormi pro-proteín konvertázy subtilizín-kexín typu 9 (PCSK9i), ktoré potvrdili klinické výhody ich použitia u pacientov s vysokým rizikom rozvoja kardiovaskulárnych ochorení podmienených aterosklerózou (Atherosclerosis-related Cardio-Vascular Disease - ASCVD). Súhrnná analýza výsledkov štúdie FOURIER (Further cardiovascular OUtcomes Research with PCSK9 Inhibition in subjects with Elevated Risk) s evolokumabom bola publikovaná v NEJM [1]. V marci 2018 po čas kongresu ACC (American College of Cardiology) v Orlande boli prezentované výsledky štúdie ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes after an Acute Coronary Syndrome during Treatment with Alirocumab) s alirokumabom [2,3]. Aj keď existuje množstvo otvorených otázok, výsledky obidvoch štúdií potvrdzujú, že ďalšie znižovanie LDL-cholesterolu (LDL-C) vedie k zníženiu reziduálneho rizika ASCVD u vysokorizikových pacientov a doslova menia hypotézu týkajúcu sa LDL-C "čím nižšie tým lepšie" na realitu a potrebu každodenného života. V klinickej praxi však pridanie PCSK9i musíme vždy dôkladne zvážiť. V sekundárnej prevencii v prvej línii ostáva intenzívna statínová liečba s ezetimibom súčasne so zmenou životného štýlu. PCSK9i pridávame pacientom, u ktorých pretrváva LDL-C ≥1,8 mmol/l.

In the years 2017 and 2018, the results of two large cardiovascular trials with inhibitors of pro-protein convertase subtilisin-kexin type 9 (PCSK9i) were published and confirmed the clinical benefits of their use in patients at high risk of developing atherosclerosis-related cardiovascular disease (ASCVD). A summary analysis of FOURIER (Evolutionary Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk) study was published in NEJM [1]. In March 2018, during the ACC Congress in Orlando, the results of the ODYSSEY Outcomes Study (Assessment of Cardiovascular Outcomes after an Acute Coronary Syndrome during Treatment with Alirocumab) were presented [2,3]. Although there are a number of open questions, the results of the trials confirm that further reduction of LDL-C leads to a reduction in the residual risk of ASCVD in high-risk patients and changes the hypothesis on LDL-C "the lower is better" to reality and the need for everyday life. In clinical practice, however, we must always carefully consider adding PCSK9i. In secondary prevention in the first line intensive statin treatment with ezetimibe and lifestyle changes remains. PCSK9i is added to patients with LDL-C ≥ 1.8 mmol/l.

• Klíčová slova
• studie FOURIER, studie ODYSSEY OUTCOMES,
• MeSH
• ezetimib aplikace a dávkování   terapeutické užití   MeSH
• kardiovaskulární nemoci farmakoterapie   MeSH
• klinické zkoušky jako téma MeSH
• lidé MeSH
• PCSK9 inhibitory MeSH
• proproteinkonvertasa subtilisin/kexin typu 9 aplikace a dávkování   terapeutické užití   MeSH
• statiny MeSH
• Check Tag
• lidé MeSH

The inverse relationship between low plasma high-density lipoprotein cholesterol (HDL-C) concentrations and increased risk of Atherosclerotic Cardiovascular Disease (ASCVD) is well-known. However, plasma HDL-C concentrations are highly variable in subjects with ASCVD. In clinical outcome trials, pharmacotherapies that increase HDL-C concentrations are not associated with a reduction in ASCVD events. A causal relationship between HDL-C and ASCVD has also been questioned by Mendelian randomization studies and genome-wide association studies of genetic variants associated with plasma HDL-C concentrations. The U-shaped association between plasma HDL-C concentrations and mortality observed in several epidemiological studies implicates both low and very high plasma HDL-C concentrations in the etiology of ASCVD and non- ASCVD mortality. These data do not collectively support a causal association between HDL-C and ASCVD risk. Therefore, the hypothesis concerning the association between HDL and ASCVD has shifted from focus on plasma concentrations to the concept of functionality, in particular cellular cholesterol efflux and HDL holoparticle transport. In this review, we focus on these new concepts and provide a new framework for understanding and testing the role of HDL in ASCVD.

• MeSH
• ateroskleróza * MeSH
• celogenomová asociační studie MeSH
• cholesterol MeSH
• HDL-cholesterol MeSH
• kardiovaskulární nemoci * MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

The treatment of lipid disorders begins with lifestyle therapy to improve nutrition, physical activity, weight, and other factors that affect lipids. Secondary causes of lipid disorders should be addressed, and pharmacologic therapy initiated based on a patient's risk for atherosclerotic cardiovascular disease (ASCVD). Patients at extreme ASCVD risk should be treated with high-intensity statin therapy to achieve a goal low-density lipoprotein cholesterol (LDL-C) of <55 mg/dL, and those at very high ASCVD risk should be treated to achieve LDL-C <70 mg/dL. Treatment for moderate and high ASCVD risk patients may begin with a moderate-intensity statin to achieve an LDL-C <100 mg/dL, while the LDL-C goal is <130 mg/dL for those at low risk. In all cases, treatment should be intensified, including the addition of other LDL-C-lowering agents (i.e., proprotein convertase subtilisin/kexin type 9 inhibitors, ezetimibe, colesevelam, or bempedoic acid) as needed to achieve treatment goals. When targeting triglyceride levels, the desirable goal is <150 mg/dL. Statin therapy should be combined with a fibrate, prescription-grade omega-3 fatty acid, and/or niacin to reduce triglycerides in all patients with triglycerides ≥500 mg/dL, and icosapent ethyl should be added to a statin in any patient with established ASCVD or diabetes with ≥2 ASCVD risk factors and triglycerides between 135 and 499 mg/dL to prevent ASCVD events. Management of additional risk factors such as elevated lipoprotein(a) and statin intolerance is also described.

• MeSH
• algoritmy MeSH
• anticholesteremika * MeSH
• dyslipidemie * farmakoterapie   epidemiologie   MeSH
• endokrinologové MeSH
• kardiovaskulární nemoci * epidemiologie   prevence a kontrola   MeSH
• konsensus MeSH
• lidé MeSH
• rizikové faktory MeSH
• statiny * terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Spojené státy americké MeSH

Introduction: Patients with familial hypercholesterolemia (FH) are at increased risk of premature atherosclerotic cardiovascular disease (ASCVD). Aim of study: To perform a retrospective analysis of data to assess the effects of individual lipoproteins and other risk factors (RFs) on the development of ASCVD and to compare these parameters in individuals with versus without ASCVD. Patients and methods: Our study group included a total of 1,236 patients with FH (395 men and 841 women with a mean age of 44.8 ± 16.7 years) attending a single lipid clinic. The diagnosis of FH was established using the Dutch Lipid Clinic Network score (DLCN). Among the 1236 FH patients, 1,008 of them [854 suspected with LDL receptor-mediated FH and 154 with familial defective apolipoprotein B-100 (FDB)] were genetically analysed. Their RFs were assessed based on the patients' clinical characteristics. Results: While patients with ASCVD had higher baseline LDL-C, TC, TG and Lp(a) compared with patients without this diagnosis, this ratio was just the opposite by the follow-up. The highest statistically significant differences were seen in the baseline levels of Lp(a) and, quite surprisingly, TG. Except for Lp(a), the levels of all lipid parameters declined significantly over time. While the incidence of diabetes and arterial hypertension was not higher in our group compared with the general population, these patients were at a more significant risk of ASCVD. Conclusion: Familial hypercholesterolemia is a major RF for the development of ASCVD. While our analysis confirmed the important role of LDL-C, it also corroborated a strong correlation between ASCVD and other lipid parameters, and Lp(a) and TG in particular. Familial hypercholesterolemia is not the only RF and, to reduce cardiovascular risk of their patients, physicians have to search for other potential RFs. Patients diagnosed to have FH benefit from attending a specialized lipid clinic perse.

• Publikační typ
• časopisecké články MeSH

BACKGROUND: The highest mortality and morbidity worldwide is associated with atherosclerotic cardiovascular disease (ASCVD), which has in background both environmental and genetic risk factors. Apolipoprotein L1 (APOL1) variability influences the risk of ASCVD in Africans, but little is known about the APOL1 and ASCVD in other ethnic groups. METHODS: To investigate the role of APOL1 and ASCVD, we have genotyped four (rs13056427, rs136147, rs10854688 and rs9610473) APOL1 polymorphisms in a group of 1541 male patients with acute coronary syndrome (ACS) and 1338 male controls. RESULTS: Individual APOL1 polymorphisms were not associated with traditional CVD risk factors such as smoking, hypertension or diabetes prevalence, with BMI values or plasma lipid levels. Neither individual polymorphisms nor haplotypes were associated with an increased risk of ACS nor did they predict total or cardiovascular mortality over the 10.2 ± 3.9 years of follow-up. CONCLUSIONS: We conclude that APOL1 genetic variability has no major effect on risk of ACS in Caucasians.

• MeSH
• akutní koronární syndrom * genetika   MeSH
• apolipoprotein L1 * genetika   MeSH
• apolipoproteiny genetika   MeSH
• běloši genetika   MeSH
• genetická predispozice k nemoci MeSH
• haplotypy MeSH
• jednonukleotidový polymorfismus MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipoproteiny HDL genetika   MeSH
• rizikové faktory MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

AIM: The objective was to examine the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its risk factors among patients with RA with diabetes mellitus (RA-DM) and patients with RA without diabetes mellitus (RAwoDM), and to evaluate lipid and blood pressure (BP) goal attainment in RA-DM and RAwoDM in primary and secondary prevention. METHODS: The cohort was derived from the Survey of Cardiovascular Disease Risk Factors in Patients with Rheumatoid Arthritis from 53 centres/19 countries/3 continents during 2014-2019. We evaluated the prevalence of cardiovascular disease (CVD) among RA-DM and RAwoDM. The study population was divided into those with and without ASCVD, and within these groups we compared risk factors and CVD preventive treatment between RA-DM and RAwoDM. RESULTS: The study population comprised of 10 543 patients with RA, of whom 1381 (13%) had DM. ASCVD was present in 26.7% in RA-DM compared with 11.6% RAwoDM (p<0.001). The proportion of patients with a diagnosis of hypertension, hyperlipidaemia and use of lipid-lowering or antihypertensive agents was higher among RA-DM than RAwoDM (p<0.001 for all). The majority of patients with ASCVD did not reach the lipid goal of low-density lipoprotein cholesterol <1.8 mmol/L. The lipid goal attainment was statistically and clinically significantly higher in RA-DM compared with RAwoDM both for patients with and without ASCVD. The systolic BP target of <140 mm Hg was reached by the majority of patients, and there were no statistically nor clinically significant differences in attainment of BP targets between RA-DM and RAwoDM. CONCLUSION: CVD preventive medication use and prevalence of ASCVD were higher in RA-DM than in RAwoDM, and lipid goals were also more frequently obtained in RA-DM. Lessons may be learnt from CVD prevention programmes in DM to clinically benefit patients with RA .

• MeSH
• diabetes mellitus * farmakoterapie   epidemiologie   MeSH
• kardiovaskulární nemoci * epidemiologie   etiologie   prevence a kontrola   MeSH
• lidé MeSH
• revmatoidní artritida * komplikace   farmakoterapie   epidemiologie   MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide. Despite the clinical long-term and near-term benefits of lowering cholesterol in, respectively, primary and secondary prevention of ASCVD, cholesterol levels remain under-treated, with many patients not achieving their recommended targets. The present article will review the latest updates on lipid management with emphases on the different classes of cholesterol-lowering agents and their clinical uses.

• MeSH
• anticholesteremika škodlivé účinky   terapeutické užití   MeSH
• ateroskleróza krev   diagnóza   farmakoterapie   mortalita   MeSH
• biologické markery krev   MeSH
• cholesterol krev   MeSH
• chování snižující riziko MeSH
• cvičení MeSH
• dyslipidemie krev   diagnóza   farmakoterapie   mortalita   MeSH
• lidé MeSH
• ochranné faktory MeSH
• rizikové faktory MeSH
• triglyceridy krev   MeSH
• výsledek terapie MeSH
• zdravá strava MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Dyslipidemias are defined as a wide range of abnormalities of the lipid profile. Treatment guidelines recommend aiming at lowering LDL-C. We investigated the adherence of Czech cardiologists to the dyslipidaemia treatment guidelines, especially in the management of patients with high and very high cardiovascular risk. In this retrospective cross-sectional multicentric study data from medical records of 450 adults with ASCVD, enrolled between June 2021 and January 2022, were analysed. Demographics, clinical outcomes, medical history, LLT treatment and other medications were collected. The physicians were to include patients at a very high risk of ASCVD and to complete a general questionnaire on their personal therapeutic preferences. Objectively assessed, only 80% of total patients (N = 450) enrolled in the study were at very high risk of ASCVD, and 12.7% of patients were at high risk of ASCVD, respectively. In total, 55 (13.1%) patients were diagnosed with familial hypercholesterolemia, and 39.1% of them had a positive family history of ASCVD. Generally, only 20.5% of patients reached the 2019 LDL-C goals- 19.4% of very high risk patients and 28.1% of high risk patients, respectively. 61% of the physicians preferred a slow and careful up-titration of the dose, which is contradictory to the guidelines. Only 17% of the physicians increased the statin dose or added/combined/changed the treatment to achieve the LDL-C goals as soon as possible. Surprisingly, in up to 61.5% of patients at very high risk who did not meet the LDL-C goals, their physicians stated subjective satisfaction with the treatment and considered no change needed. Among very high and high risk patients receiving lipid-lowering therapy, with high treatment adherence, the LDL-C goal attainment is very low and LLT utilization is rather sub-optimal. Improving observance of the guidelines by physicians bears a substantial potential for LDL-C goal attainment and thus improving overall benefit for patients for no additional costs.

• MeSH
• cíle MeSH
• dospělí MeSH
• dyslipidemie * farmakoterapie   diagnóza   MeSH
• hypolipoproteinemie * MeSH
• kardiovaskulární nemoci * prevence a kontrola   farmakoterapie   MeSH
• LDL-cholesterol MeSH
• lidé MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• rizikové faktory MeSH
• statiny * terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH