• MeSH
• ateroskleróza * farmakoterapie   metabolismus   patofyziologie   prevence a kontrola   MeSH
• hypolipidemika farmakologie   terapeutické užití   MeSH
• lidé MeSH
• lipoproteiny * klasifikace   krev   metabolismus   škodlivé účinky   MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• tuhost cévní stěny MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that, with respect to low-density lipoprotein cholesterol (LDL-C), "lower is better for longer", and recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.

• MeSH
• akutní koronární syndrom * krev   farmakoterapie   etiologie   MeSH
• anticholesteremika terapeutické užití   MeSH
• ateroskleróza * krev   komplikace   farmakoterapie   MeSH
• hypolipidemika * terapeutické užití   MeSH
• LDL-cholesterol krev   MeSH
• lidé MeSH
• přehledová literatura jako téma MeSH
• statiny terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH

Úloha LDL-cholesterolu (LDL-C) v patogenéze aterosklerózy a v následnom zvýšení rizika aterosklerotického kardiovaskulárneho ochorenia (ASKVO) je nespochybniteľná. Predmetom odborných diskusií je len skutočnosť, ako výrazne a akým spôsobom je potrebné túto hladinu znížiť. Aj tu však vo všeobecnosti panuje zhoda, že by to malo byť podmienené úrovni kardiovaskulárneho (KV) rizika konkrétneho jednotlivca. Tu sa názory začínajú od seba líšiť v otázke, ktorí sú pacienti s najvyšším KV-rizikom a ktorí sú naopak tí, ktorých farmakologicky stačí liečiť menej intenzívne? Odlišnosti existujú aj v názoroch, ako skoro začať liečbu, ako dlho v nej pokračovať a akým spôsobom. Odporúčania odborných spoločností sa vo väčšine prípadov opierajú o medicínu založenú na dôkazoch (Evidence Based Medicine – EBM), ktorá stratifikuje jednotlivých kandidátov na liečbu podľa úrovne dôkazov a tried odporúčaní. Napriek tomu existuje v klinickej praxi mnoho situácií, v ktorých postup nemusí byť úplne presne vyšpecifikovaný v odporúčaniach. Cieľom tohto prehľadu je pomôcť zlepšiť situáciu v sekundárnej prevencii aterosklerózy poukázaním na úlohu nestatínových liekov a možnosti ich použitia vzhľadom ku doposiaľ preukázaným benefitom a existujúcim limitáciám ich použitia.

The role of LDL-cholesterol (LDL-C) in the pathogenesis of atherosclerosis and in the subsequent increase in the risk of atherosclerotic cardiovascular disease (ACVD) is unquestionable. The only subject of expert debate is how significantly and in what way this level needs to be reduced. However, there is also general agreement that this should be conditional on the level of cardiovascular (CV) risk of the individual. This is where opinions start to diverge – who are the patients with the highest CV risk, and who, conversely, are those who pharmacologically just need to be treated less intensively? Differences also exist in opinions about how early to start treatment, how long to continue it, and in what manner. In most cases, the recommendations of professional societies are based on Evidence Based Medicine (EBM), which stratifies individual candidates for treatment according to the level of evidence and classes of recommendations. Nevertheless, there are many situations in clinical practice in which management may not be completely specified in the recommendations. The aim of this review is to help improve the situation in the secondary prevention of atherosclerosis by highlighting the role of non-statin drugs and the potential for their use in light of the benefits demonstrated to date and the limitations of their use.

• MeSH
• hypercholesterolemie farmakoterapie   prevence a kontrola   MeSH
• hypolipidemika aplikace a dávkování   farmakologie   klasifikace   MeSH
• klinická studie jako téma MeSH
• klinické rozhodování MeSH
• kombinovaná farmakoterapie MeSH
• LDL-cholesterol * analýza   účinky léků   MeSH
• lidé MeSH
• rizikové faktory kardiovaskulárních chorob * MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• statiny aplikace a dávkování   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Úvod: Aj napriek výrazným pokrokom v manažmente kardiovaskulárnych ochorení (KVO), predstavuje celosvetovo táto skupina ochorení najčastejšiu príčinu morbidity a mortality. Redukcia hladín LDL-cholesterolu (LDL-C) je základným pilierom primárnej, ako aj sekundárnej prevencie KVO. Cieľom tejto práce bolo sledovať koncentrácie LDL-C u pacientov vo veľmi vysokom kardiovaskulárnom (KV) riziku a popísať aká časť týchto pacientov dosahuje cieľové hodnoty LDL-C. Metodika: Táto štúdia prebiehala vo forme retrospektívnej analýzy anonymizovaných hodnôt LDL-C z rokov 2017–2019 z dát spolupracujúceho laboratória s celoslovenskou pôsobnosťou. Celkovo boli zaradení pacienti s diagnózou akútneho koronárneho syndrómu (AKS), cievnej mozgovej príhody (CMP) a všeobecne pacienti s veľmi vysokým KV-rizikom. Cieľové hodnoty LDL-C boli hodnotené na základe toho času platných odporučení ESC/EAS 2016. Výsledky: Celkovo sa spracovalo 220 657 záznamov vyšetrení LDL-C od 72 039 pacientov. U pacientov s diagnózou AKS dosahovali cieľové hodnoty LDL-C len 8–9 % pacientov v jednotlivých rokoch sledovania. Až 6–9 % pacientov malo hladiny LDL-C na úrovni ≥ 4,9 mmol/l. V prípade pacientov s diagnózou CMP dosahovalo cieľové hodnoty LDL-C len 9–10 % pacientov a 7–8 % malo hladiny ≥ 4,9 mmol/l. V skupine s veľmi vysokým KV-rizikom dosahovalo cieľové hladiny len 7 % pacientov a 7–8 % malo extrémne vysoké hodnoty LDL-C ≥ 4,9 mmol/l. V prípade uplatnenia najnovších odporučení ESC/EAS 2019 dosahovali cieľové hladiny len 2–3 % pacientov v jednotlivých skupinách a rokoch. Záver: Na základe výsledkov analýzy sme zistili, že až vyše 90 % pacientov vo veľmi vysokom KV-riziku nedosahuje cieľové hodnoty LDL-C. Títo pacienti sú naďalej vo vysokom riziku následnej KV-príhody a mali by významný benefit z intenzifikovanej hypolipemickej terapie.

Introduction: Despite significant progress in the management of cardiovascular (CV) diseases, they represent the most common cause of morbidity and mortality. LDL-cholesterol (LDL-C) reduction is a basic pillar of primary as well as secondary prevention of heart disease. The Aim of this study was to monitor LDL-C concentrations in patients at very high CV risk and to determine the prevalence of patients reaching the LDL-C target values. Methodology: This project took place in the form of a retrospective analysis of anonymized LDL-C values from 2017–2019 from the data of cooperating laboratory with nationwide operations. Overall, patients with a diagnosis of an acute coronary syndrome (ACS), stroke and a general patient with a very high CV risk were included. The LDL-C target values were evaluated based on the then valid ESC/EAS 2016 recommendations. Results: A total of 220,657 LDL-C results from 72,039 patients were obtained. In patients with ACS, LDL-C target values were achieved by only 8–9 % of patients in each year of follow-up. Up to 6–9 % of patients have LDL-C levels ≥ 4.9 mmol/L. In the case of patients with stroke, only 9–10 % of patients achieved target values and 7–8 % had levels ≥ 4.9 mmol/L. In the group with very high CV risk, only 7 % of patients reached the target levels and 7–8 % had extremely high LDL-C values ≥ 4.9 mmol/L. In the case of the application of the new ESC/EAS 2019 recommendations, the target levels were reached by only 2–3 % of patients. Conclusion: Based on the results of the analysis, we found that up to 90 % of patients at very high CV risk do not reach the target LDL-C values. These patients remain at high risk for further CV events and would benefit significantly from intensified hypolipidemic therapy.

• MeSH
• dyslipidemie diagnóza   patologie   prevence a kontrola   MeSH
• kardiovaskulární nemoci prevence a kontrola   MeSH
• LDL-cholesterol * krev   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Slovenská republika MeSH

Manažment dyslipidémií ostáva výzvou napriek objemu kvalitných dát a dostupnosti liečebných modalít. Epidémia aterosklerotického kardiovaskulárneho ochorenia je dominantnou príčinou chorobnosti a úmrtnosti vo vyspelom svete. Prienik Odporúčaní pre manažment dyslipidémií do ostatných dokumentov dokazuje význam tejto problematiky. Nové poznatky vedú k sprísneniu cieľových hodnôt pre LDL-cholesterol podľa stupňa kardiovaskulárneho rizika. Ročná mortalita po akútnom koronárnom syndróme v porovnaní s vyspelejšími krajinami neúmerne rastie. Analýza príčin poukazuje na zlý manažment rizikových faktorov po prepustení z hospitalizácie. Možnosti zlepšenia okrem iného smerujú k zmene indikačných obmedzení pre PCSK9-inhibítory.

The management of dyslipidemia remains a challenge despite the volume of EBM data and the availability of treatment modalities. The ASCVD epidemic is the dominant cause of morbidity and mortality in the developed world. The integration of the Guidelines for the Management of Dyslipidemias into other documents demonstrates the importance of this issue. New findings lead to the tightening of LDL-C target values according to CV risk levels. Annual mortality after ACS in Slovakia is rising disproportionately compared to more developed countries. The root cause analysis points to poor management of risk factors after hospital discharge. Opportunities for improvement include, inter alia, the changing of the indication restrictions for PCSK9 inhibitors.

• MeSH
• akutní koronární syndrom * patologie   MeSH
• dyslipidemie * farmakoterapie   MeSH
• LDL-cholesterol krev   škodlivé účinky   MeSH
• lidé MeSH
• management nemoci MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• Slovenská republika MeSH

• Klíčová slova
• studie FOURIER, inhibitory PCSK9, evolocumab,
• MeSH
• anticholesteremika terapeutické užití   MeSH
• hypolipidemika terapeutické užití   MeSH
• kardiovaskulární nemoci * epidemiologie   mortalita   prevence a kontrola   MeSH
• LDL-cholesterol * účinky léků   MeSH
• lidé MeSH
• monoklonální protilátky terapeutické užití   MeSH
• PCSK9 inhibitory MeSH
• proproteinkonvertasa subtilisin/kexin typu 9 * MeSH
• randomizované kontrolované studie jako téma MeSH
• sekundární prevence MeSH
• statiny terapeutické užití   MeSH
• Check Tag
• lidé MeSH

In recent years, there has been growing interest in the possible use of nutraceuticals to improve and optimize dyslipidemia control and therapy. Based on the data from available studies, nutraceuticals might help patients obtain theraputic lipid goals and reduce cardiovascular residual risk. Some nutraceuticals have essential lipid-lowering properties confirmed in studies; some might also have possible positive effects on nonlipid cardiovascular risk factors and have been shown to improve early markers of vascular health such as endothelial function and pulse wave velocity. However, the clinical evidence supporting the use of a single lipid-lowering nutraceutical or a combination of them is largely variable and, for many of the nutraceuticals, the evidence is very limited and, therefore, often debatable. The purpose of this position paper is to provide consensus-based recommendations for the optimal use of lipid-lowering nutraceuticals to manage dyslipidemia in patients who are still not on statin therapy, patients who are on statin or combination therapy but have not achieved lipid goals, and patients with statin intolerance. This statement is intended for physicians and other healthcare professionals engaged in the diagnosis and management of patients with lipid disorders, especially in the primary care setting.

• MeSH
• dyslipidemie krev   farmakoterapie   epidemiologie   MeSH
• fytonutrienty aplikace a dávkování   krev   farmakokinetika   MeSH
• HDL-cholesterol krev   MeSH
• intestinální absorpce účinky léků   MeSH
• játra účinky léků   metabolismus   MeSH
• kardiovaskulární nemoci krev   farmakoterapie   epidemiologie   MeSH
• LDL-cholesterol krev   MeSH
• lékové interakce MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• metaanalýza jako téma MeSH
• nenasycené mastné kyseliny aplikace a dávkování   krev   farmakokinetika   MeSH
• potravní doplňky * MeSH
• pozorovací studie jako téma MeSH
• probiotika aplikace a dávkování   farmakokinetika   MeSH
• randomizované kontrolované studie jako téma MeSH
• rizikové faktory MeSH
• statiny terapeutické užití   MeSH
• triglyceridy krev   MeSH
• životní styl MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: The metabolic syndrome (MS) is a clustering of cardiovascular risk. The high prevalence of metabolic syndrome among populations of lower socioeconomic status is a cause of concern and calls for an effective public health response. OBJECTIVES: The aim of this study was to determine the prevalence of metabolic syndrome in the Roma population compared with the non-Roma population in the eastern part of Slovakia and to determine the parameter which has the strongest association with metabolic syndrome. RESULTS: 123 Roma and 79 non-Roma patients with metabolic syndrome were evaluated. In the subgroup of Roma men, we found that waist circumference conferred the highest chance of MS (more than 12-times), followed by triglycerides (TG) (3.670-times). In the subgroup of non-Roma men, we found that waist circumference conferred the highest chance of MS (more than 16-times), followed by high-density lipoprotein (HDL) (4.348-times increased risk per one unit decrease in HDL). In the subgroup of Roma women as well as non-Roma women, we found that serum TG conferred the highest chance of MS, followed by waist circumference for Roma women. Comparing non-classical risk factors for MS we found that only age (with OR 1.977) and high-sensitivity C-reactive protein (hsCRP) (OR 1.887) were significant and independent predictors of MS in Roma men. Among Roma women apolipoprotein B100 was also found to be an independent predictor of MS, besides age and hsCRP. CONCLUSION: Our study confirmed that the prevalence of metabolic syndrome is strongly associated with hypertriglyceridemic waist, besides other risk factors, a marker of the atherogenic metabolic triad among younger Roma population, which may be the reason for the increased cardiovascular (CV) morbidity and mortality in elderly Roma compared with non-Roma. In light of these results, better prevention of CV events for Roma minority settlements in Slovakia should be provided.

• MeSH
• apolipoprotein B-100 krev   MeSH
• biologické markery krev   MeSH
• C-reaktivní protein MeSH
• charakteristiky bydlení statistika a číselné údaje   MeSH
• dospělí MeSH
• index tělesné hmotnosti MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipidy krev   MeSH
• lipoproteiny HDL krev   MeSH
• metabolický syndrom krev   etnologie   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• obezita krev   etnologie   MeSH
• obvod pasu etnologie   fyziologie   MeSH
• odds ratio MeSH
• prevalence MeSH
• rizikové faktory MeSH
• Romové etnologie   statistika a číselné údaje   MeSH
• rozložení podle pohlaví MeSH
• triglyceridy krev   MeSH
• věkové rozložení MeSH
• venkovské obyvatelstvo statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Slovenská republika MeSH

BACKGROUND: The simultaneous presence of chronic hepatitis B (CHB) and metabolic syndrome (MS) in the high-risk Roma community constitutes a high risk for liver cirrhosis and potentially hepatocellular carcinoma. This study aims to explore the relationship between MS and CHB. METHODS: Data from the cross-sectional HepaMeta Study conducted in Slovakia in 2011 among Roma living in rural communities were used. Participants were tested for the presence of MS, and lipid levels--total cholesterol, high density lipoproteins (HDL), low density lipoproteins (LDL), triglycerides (TG), apolipoprotein B100, and CHB HBsAg and anti-HBc IgG were also monitored. Viral load was measured in HBsAg-positive patients. RESULTS: A total of 452 patients were screened; MS was diagnosed in 29.6% of patients, and 12.5% had CHB. Anti-HBc IgG antibodies were present in 52.8% of patients. CHB patients had lower levels of total cholesterol (5.45 +/-1.21 vs. 4.71 +/- 1.23 mmol/l; p = 0.035), LDL cholesterol (median 2.2 mmol/l, interquartile range 0.88 mmol/l vs. 2.5 mmol/l, interquartile range 0.9 mmol/l; p = 0.01) and apolipoprotein B100 (median 0.66 mmol/l, interquartile range 0.26 mmol/l vs. 0.74 mmol/l, interquartile range 0.29 mmol/l; p = 0.025). Patients diagnosed with MS had a higher HBV DNA load than patients without MS (1,728.2 +/- 14.33 IU/ml vs. 12,779.1 +/- 20.9 IU/ml; p = 0.037). CHB patients with TC and apolipoprotein B100 within the reference range had a lower hepatitis B DNA (HBV DNA) load than patients with high or low values of TC or apolipoprotein B100. CONCLUSION: The prevalence of chronic hepatitis B and simultaneous presence of MS was high among Roma. HBsAg-positive patients had lower levels of total and LDL cholesterol along with decreased apolipoprotein B100. The viral load of chronic hepatitis B patients with MS was higher than in patients without MS.

• MeSH
• apolipoprotein B-100 krev   MeSH
• biologické markery krev   MeSH
• cholesterol krev   MeSH
• dospělí MeSH
• hepatitida B krev   etnologie   MeSH
• komorbidita MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipidy krev   MeSH
• metabolický syndrom krev   etnologie   MeSH
• mladiství MeSH
• průřezové studie MeSH
• Romové etnologie   statistika a číselné údaje   MeSH
• triglyceridy krev   MeSH
• venkovské obyvatelstvo statistika a číselné údaje   MeSH
• zdravotnické přehledy metody   statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Slovenská republika MeSH

Statíny sú najúčinnejšími liekmi na znižovanie LDL-cholesterolu a zároveň disponujú silnou medicínou založenou na dôkazoch dokumentujúcou signifikantné zníženie kardiovaskulárnych príhod v rôznorodých skupinách pacientov. Napriek tejto skutočnosti je ich používanie v bežnej klinickej praxi stále nižšie oproti predpokladom. Mnohí lekári sa obávajú potenciálnych vedľajších účinkov statínov, najmä závažnej svalovej toxicity, ktorá sa tak stáva prekážkou adekvátneho užívania statínov. Klinické prejavy myopatie zahŕňajú svalové bolesti, slabosť, únavnosť, kŕče a/ alebo zvýšenie kreatínkinázy (CK). Pretože hypercholesterolémia je zvyčajne asymptomatická, každý neželaný efekt použitého lieku môže závažne narušiť adherenciu k terapii. Preto je veľmi dôležité posúdenie závažnosti myopatie, jej včasný, racionálny individuálny manažment a čo možno najskoršie znovunasadenie lipidy znižujúcej liečby s prihliadnutím na jej druh, dávku a konkomitantnú liečbu.

Statins are the most effective drugs for reducing LDL-cholesterol and have strong evidence based medicine documented by significant reduction of cardiovascular events in wide variety of patients. Despite this fact, they are still underused in common clinical practice. Many physicians have expressed concern about potential adverse effects, particularly severe muscle toxicity, which is an impediment to appropriate statin use. The clinical symptoms of statin myopathy include myalgia or muscle weakness, tiredness, cramps and/or creatinkinase activity increases (CK). Because hypercholesterolaemia is usually asymptomatic, any unwanted effect of drug used for its management can undermine adherence. Therefore it is very important to evaluate myopathy magnitude, prompt and rational individual management, and if applicable, restart of lipid-lowering therapy as soon as possible with regard to its type, dose and concomitant treatment.

• MeSH
• bolest etiologie   MeSH
• hypercholesterolemie farmakoterapie   komplikace   MeSH
• kreatinkinasa izolace a purifikace   metabolismus   MeSH
• LDL-cholesterol účinky léků   MeSH
• lékové interakce MeSH
• lidé MeSH
• myozitida diagnóza   etiologie   komplikace   MeSH
• nemoci svalů diagnóza   etiologie   metabolismus   MeSH
• nežádoucí účinky léčiv MeSH
• rhabdomyolýza diagnóza   etiologie   komplikace   MeSH
• rizikové faktory MeSH
• statiny škodlivé účinky   terapeutické užití   MeSH
• svalová únava účinky léků   MeSH
• svalové křeče metabolismus   MeSH
• ubichinon analogy a deriváty   terapeutické užití   MeSH
• Check Tag
• lidé MeSH