Atherosclerotic cardiovascular disease (ASCVD) is accelerated in people with diabetes. Dyslipidemia, hyperglycemia, oxidative stress, and inflammation play a role via a variety of mechanisms operative in the artery wall. In addition, some unique features predispose people with type 1 diabetes to accelerated atherosclerosis. Various organizations have created guidelines that provide advice regarding screening, risk assessment, and roadmaps for treatment to prevent ASCVD in diabetes. Management of dyslipidemia, especially with statins, has proven to be of immense benefit in the prevention of clinical CVD. However, since many patients fail to attain the low levels of low-density lipoproteins (LDL) recommended in these guidelines, supplemental therapy, such as the addition of ezetimibe, bempedoic acid or PCSK9 inhibitors, is often required to reach LDL goals. As a result, the upfront use of combination therapies, particularly a statin plus ezetimibe, is a rational initial approach. The addition to statins of drugs that specifically lower triglyceride levels has not proven beneficial, although the addition of icosapent-ethyl has been shown to be of value, likely by mechanisms independent of triglyceride lowering. Newer treatments in development, including apoC-III and ANGPTL3 inhibitors, seem promising in further reducing apoB-containing lipoproteins.

• MeSH
• anticholesteremika terapeutické užití   MeSH
• ateroskleróza farmakoterapie   krev   prevence a kontrola   MeSH
• biologické markery krev   MeSH
• diabetes mellitus 1. typu farmakoterapie   diagnóza   krev   komplikace   MeSH
• dyslipidemie * farmakoterapie   krev   diagnóza   MeSH
• ezetimib terapeutické užití   MeSH
• hypolipidemika terapeutické užití   MeSH
• kombinovaná farmakoterapie MeSH
• lidé MeSH
• statiny terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• anticholesteremika MeSH
• biologické markery MeSH
• ezetimib MeSH
• hypolipidemika MeSH
• statiny MeSH

Dyslipidemia (DLP) is the most important risk factor for atherosclerotic cardiovascular disease (ASCVD) and, in the context of severe hypertriglyceridemia (TG > 10 mmol/l), a risk factor for the development of acute pancreatitis. The prevalence of DLP is very high, but their control, especially among the patients at highest risk, is often inadequate. When diagnosing DLP, we should always exclude its possible secondary aetiology (e.g. DLP in the context of hypothyroidism, diabetes, ...). Based on the assessment of the overall CV risk (according to SCORE2/SCORE2-OP or according to the comorbidities of the individual), target values for blood lipids, especially LDL-cholesterol, are determined according to the risk category. The basis of the management of DLP in the prevention of ASCVD is dietary and regimen measures, followed by adequate lipid-lowering therapy in indicated cases. As of April 2023, the portfolio of lipid-lowering medication has been expanded to include inclisiran (small interfering RNA against proprotein convertase subtilisin/kexin type 9 (PCSK9)), which is administered directly in cardiologists' and internists' outpatient clinics, ensuring 100% adherence. In severe hypertriglyceridaemia, fibrate monotherapy may be indicated in addition to dietary and regimen measures; if this treatment fails, some patients may be offered lomitapide, volanesorsen or evinacumab as part of clinical trials or specific treatment programmes if very strict indication criteria are met.

• Klíčová slova
• acute pancreatitis, acute pancreatits, atherosclerotic cardiovascular disease, cardiovascular risk, combination therapy, dyslipidemia, inclisiran,
• MeSH
• akutní nemoc MeSH
• anticholesteremika * terapeutické užití   MeSH
• ateroskleróza * farmakoterapie   MeSH
• dyslipidemie * komplikace   diagnóza   epidemiologie   MeSH
• hyperlipidemie * farmakoterapie   MeSH
• kardiovaskulární nemoci * prevence a kontrola   MeSH
• lidé MeSH
• lipidy terapeutické užití   MeSH
• pankreatitida * MeSH
• proproteinkonvertasa subtilisin/kexin typu 9 terapeutické užití   MeSH
• statiny * terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• anticholesteremika * MeSH
• lipidy MeSH
• PCSK9 protein, human MeSH Prohlížeč
• proproteinkonvertasa subtilisin/kexin typu 9 MeSH
• statiny * 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
• Názvy látek
• LDL-cholesterol MeSH
• statiny * MeSH

AIMS: To assess differences in estimated cardiovascular disease (CVD) risk among rheumatoid arthritis (RA) patients from different world regions and to evaluate the management and goal attainment of lipids and blood pressure (BP). METHODS AND RESULTS: The survey of CVD risk factors in patients with RA was conducted in 14 503 patients from 19 countries during 2014-19. The treatment goal for BP was <140/90 mmHg. CVD risk prediction and lipid goals were according to the 2016 European guidelines. Overall, 21% had a very high estimated risk of CVD, ranging from 5% in Mexico, 15% in Asia, 19% in Northern Europe, to 31% in Central and Eastern Europe and 30% in North America. Of the 52% with indication for lipid-lowering treatment (LLT), 44% were using LLT. The lipid goal attainment was 45% and 18% in the high and very high risk groups, respectively. Use of statins in monotherapy was 24%, while 1% used statins in combination with other LLT. Sixty-two per cent had hypertension and approximately half of these patients were at BP goal. The majority of the patients used antihypertensive treatment in monotherapy (24%), while 10% and 5% as a two- or three-drug combination. CONCLUSION: We revealed considerable geographical differences in estimated CVD risk and preventive treatment. Low goal attainment for LLT was observed, and only half the patients obtained BP goal. Despite a high focus on the increased CVD risk in RA patients over the last decade, there is still substantial potential for improvement in CVD preventive measures.

• Klíčová slova
• Audit, Blood pressure, Lipids, Prevention, Rheumatoid arthritis, Statins,
• MeSH
• dyslipidemie * diagnóza   farmakoterapie   epidemiologie   MeSH
• hypertenze * diagnóza   farmakoterapie   epidemiologie   MeSH
• kardiovaskulární nemoci * diagnóza   epidemiologie   prevence a kontrola   MeSH
• lidé MeSH
• lipidy MeSH
• revmatoidní artritida * diagnóza   farmakoterapie   epidemiologie   MeSH
• rizikové faktory MeSH
• statiny * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• lipidy MeSH
• statiny * MeSH

The concentration of total cholesterol has so far been part of the SCORE tables for estimating the risk of cardiovascular events; in the new SCORE2 tables, it has already been replaced by non-HDL-cholesterol. Total cholesterol continues to serve as a guide for the presence of dyslipoproteinemia and is necessary for the calculation of LDL-cholesterol and non-HDL-cholesterol. The importance of HDL-cholesterol as a separate risk factor is already limited, but it is necessary for the calculation of non-HDL-cholesterol and LDL-cholesterol. LDL-cholesterol remains an essential indicator of risk, it is needed for decision making and control of hypolipidemic therapy. Non HDL-cholesterol can be used as a therapy target instead of LDL-cholesterol. Triglycerides remain necessary for residual risk assessment, for the calculation of LDL-cholesterol and for the diagnosis of certain types of dyslipoproteinemias.

• Klíčová slova
• HDL‑ cholesterol, LDL‑ cholesterol, atherosclerotic cardiovascular diseases, non HDL‑ cholesterol, total cholesterol, triglyceride, triglycerides,
• MeSH
• cholesterol MeSH
• dyslipidemie * diagnóza   MeSH
• HDL-cholesterol MeSH
• kardiovaskulární nemoci * diagnóza   MeSH
• LDL-cholesterol MeSH
• lidé MeSH
• lipoproteiny MeSH
• rizikové faktory MeSH
• triglyceridy MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• cholesterol MeSH
• HDL-cholesterol MeSH
• LDL-cholesterol MeSH
• lipoproteiny MeSH
• triglyceridy MeSH

BACKGROUND AND AIMS: Central and Eastern Europe (CEE) is a largely understudied region, despite having the highest cardiovascular disease mortality in Europe. This analysis aimed to assess the proportion of patients in CEE who achieved their LDL-C goals based on individual cardiovascular risk recommended by the 2016 and 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines. METHODS: The DA VINCI study was a cross-sectional observational study of primary and secondary prevention patients receiving lipid-lowering therapy across Europe between June 2017 and November 2018. RESULTS: In total, 2154 patients were enrolled from the Czech Republic (n = 509), Hungary (n = 319), Poland (n = 460), Romania (n = 259), Slovakia (n = 123) and Ukraine (n = 484). At LDL-C measurement, most patients were on either moderate- or high-intensity statin monotherapy (53% and 32%, respectively). Despite this, only 44% of patients achieved risk-based LDL-C goals recommended by the 2016 ESC/EAS guidelines, ranging from 21% in Ukraine to 50% in Hungary and Romania. Only 24% of patients overall achieved the risk-based LDL-C goals recommended by the 2019 ESC/EAS guidelines, ranging from 11% in Ukraine to 32% in Poland. CONCLUSIONS: Among patients receiving lipid-lowering therapy, more than half did not achieve their 2016 LDL-C goals. In one of the first comparative analyses evaluating 2019 risk-based goal attainment among countries in CEE, three-quarters of patients did not meet their 2019 LDL-C goals, highlighting a significant gap between guidelines and clinical practice for lipid management in CEE.

• Klíčová slova
• Atherosclerosis, Cardiovascular, Dyslipidaemia, Low-density lipoprotein cholesterol,
• MeSH
• dyslipidemie * diagnóza   farmakoterapie   epidemiologie   MeSH
• kardiovaskulární nemoci * diagnóza   farmakoterapie   prevence a kontrola   MeSH
• lidé MeSH
• lipidy MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• sekundární péče MeSH
• statiny * terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH
• Polsko MeSH
• Názvy látek
• lipidy MeSH
• statiny * MeSH

Coronary risk evaluation by conventional factors (age, gender, smoking, blood pressure and cholesterol) may further be specified by facets of the metabolic syndrome, namely insulin resistance, hypertriglyceridemia and obesity. Although obesity is usually defined as elevated body mass index (BMI), recent data indicate a superior role of waist circumference or hypertri-glyceridemic waist (HTGW) over BMI in the assessment of cardiometabolic risk. In dyslipidemic patients, the specific contributions of risky waist, HTGW or BMI have not been evaluated as yet. 686 dyslipidemic subjects (322 males and 364 females) were enrolled into a cross-sectional study. In each subject basic antropometry (i.e. waist circumference, HTGW, BMI) and laboratory parameters of lipid profile and insulin resistance were determined. Cardiometabolic risk was given by fulfilling the criteria (harmonized definition) of metabolic syndrome. The significance of risky waist, HTGW and BMI were assessed by comparing the respective predictive values for the presence of metabolic syndrome. Dyslipidemic patients with risky waist, HTGW or high BMI have a more atherogenic lipid profile and higher insulin resistance compared to those without risky waist, HTGW or high BMI. Risky waist is stronger predictor of metabolic syndrome (PPV 66 %, NPV 90 %) and thus posesa greater cardiometabolic risk than higher BMI per se does (PPV 42 %, NPV 97 %). The contribution of triglycerides (i.e. HTGW) to these predictive values is marginal (PPV 66 %, NPV 92 %). The present results highlight the superior role of waist circumference as a screening tool over BMI for the evaluation of cardiometabolic risk in dyslipidemic subjects. HTGW brings little additional benefit in risk stratification. Lower BMI proved to be optimal for identifying the subjects with inferior risk.

• MeSH
• dospělí MeSH
• dyslipidemie krev   diagnóza   epidemiologie   MeSH
• index tělesné hmotnosti * MeSH
• kardiovaskulární nemoci krev   diagnóza   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metabolický syndrom krev   diagnóza   epidemiologie   MeSH
• mladý dospělý MeSH
• obvod pasu fyziologie   MeSH
• prediktivní hodnota testů MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• Apolipoprotein B, Cholesterol;, Dyslipidaemias, Familial hypercholesterolaemia, Guidelines, High-density lipoproteins, Lipoprotein remnants, Lipoprotein(a), Low-density lipoproteins, Total cardiovascular risk, Treatment (adherence), Treatment (drugs), Treatment (lifestyle), Triglycerides, Very low-density lipoproteins,
• MeSH
• biologické markery krev   MeSH
• chování snižující riziko MeSH
• dospělí MeSH
• dyslipidemie krev   diagnóza   farmakoterapie   epidemiologie   MeSH
• hodnocení rizik MeSH
• hypolipidemika škodlivé účinky   terapeutické užití   MeSH
• kardiovaskulární nemoci diagnóza   epidemiologie   prevence a kontrola   MeSH
• kombinovaná farmakoterapie MeSH
• konsensus MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipidy krev   MeSH
• rizikové faktory MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH
• Názvy látek
• biologické markery MeSH
• hypolipidemika MeSH
• lipidy MeSH

Lipid-lowering treatment is a part of prevention and treatment of vascular diseases caused by atherosclerosis. We need new strategies for modifying plasma lipoprotein levels in the light of new findings that reduce target lipid levels further lower, as well as the growing population of patients for whom existing treatments cannot be offered. The spectrum of existing drugs (new statins) is widening, pharmacological treatments (recombinant lipoproteins-bound statins), improved forms of established drugs (selective PPARα receptor modulators) are coming. The new procedures include fixed combinations of established drugs improving adherence and intensifying lipid modifying effects (statin + ezetimibe). The portfolio of lipid-lowering therapies today also includes monoclonal antibodies against PCSK9 (PCSK9 inhibitors). The main direction of future development is biotechnology using the principle of so-called antisense therapy, i.e. the use of specific oligonucleotide sequences blocking the translation of the selected protein. These novel therapies targeting, for example, apolipoprotein B, apolipoprotein CIII, or lipoprotein(a) are in various stages of clinical trials. A simi-lar (but not identical) principle is the use of RNA silencing - interference with gene expression using short sequences of double-stranded RNA (e.g. inclisiran siRNA against PCSK9). Innovations in the field of hypolipidemic pharmacotherapy in our country may also be inhibitors of microsomal triglyceride transfer protein (approved for use in homozygotes for familial hypercholesterolemia and experimentally also for familial chylomicronemia). The small molecule ATP citrate lyase inhibitor, bempedoic acid, decreases LDL-C by a further 20 % over and above the reduction achievable by a statin. In a broader sense, the novelty of hypolipidemic pharmacotherapy includes treatment options for some rare metabolic diseases (eg. enzyme replacement therapy for acid lysosomal lipase deficiency) manifested by lipoprotein metabolism abnormalities. All these new directions must aim at the common main goal of reducing the incidence of cardiovascular and gastrointestinal complications of dyslipidemia. Clinical research also aims to prove these effects.

• Klíčová slova
• PCSK9 inhibitors, antisense therapy, bempedoic acid, combination therapy, new lipid lowering drugs,
• MeSH
• dvouvláknová RNA MeSH
• dyslipidemie * diagnóza   farmakoterapie   genetika   MeSH
• hyperlipoproteinemie typ II * MeSH
• lidé MeSH
• proproteinkonvertasa subtilisin/kexin typu 9 MeSH
• statiny * terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• dvouvláknová RNA MeSH
• PCSK9 protein, human MeSH Prohlížeč
• proproteinkonvertasa subtilisin/kexin typu 9 MeSH
• statiny * MeSH

In the era of precision medicine, treatments that target specific modifiable characteristics of high-risk patients have the potential to lower further the residual risk of atherosclerotic cardiovascular events. Correction of atherogenic dyslipidemia, however, remains a major unmet clinical need. Elevated plasma triglycerides, with or without low levels of high-density lipoprotein cholesterol (HDL-C), offer a key modifiable component of this common dyslipidemia, especially in insulin resistant conditions such as type 2 diabetes mellitus. The development of selective peroxisome proliferator-activated receptor alpha modulators (SPPARMα) offers an approach to address this treatment gap. This Joint Consensus Panel appraised evidence for the first SPPARMα agonist and concluded that this agent represents a novel therapeutic class, distinct from fibrates, based on pharmacological activity, and, importantly, a safe hepatic and renal profile. The ongoing PROMINENT cardiovascular outcomes trial is testing in 10,000 patients with type 2 diabetes mellitus, elevated triglycerides, and low levels of HDL-C whether treatment with this SPPARMα agonist safely reduces residual cardiovascular risk.

• Klíčová slova
• Atherogenic dyslipidemia, Diabetes, Inflammation, PROMINENT, Pemafibrate (K-877), Remnant cholesterol, Residual cardiovascular risk, SPPARMalpha, Selective peroxisome proliferator-activated receptor alpha modulator, Triglycerides, Visceral obesity,
• MeSH
• benzoxazoly škodlivé účinky   terapeutické užití   MeSH
• bezpečnost pacientů MeSH
• biologické markery krev   MeSH
• butyráty škodlivé účinky   terapeutické užití   MeSH
• cílená molekulární terapie MeSH
• dyslipidemie krev   diagnóza   farmakoterapie   MeSH
• hodnocení rizik MeSH
• hypolipidemika škodlivé účinky   terapeutické užití   MeSH
• kardiovaskulární nemoci krev   diagnóza   prevence a kontrola   MeSH
• konsensus MeSH
• lidé MeSH
• lipidy krev   MeSH
• PPAR alfa agonisté   metabolismus   MeSH
• rizikové faktory MeSH
• signální transdukce MeSH
• výsledek terapie MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• (R)-2-(3-((benzoxazol-2-yl-d4 (3-(4-methoxyphenoxy-d7)propyl)amino)methyl)phenoxy) butanoic acid MeSH Prohlížeč
• benzoxazoly MeSH
• biologické markery MeSH
• butyráty MeSH
• hypolipidemika MeSH
• lipidy MeSH
• PPAR alfa MeSH
• PPARA protein, human MeSH Prohlížeč