PURPOSE OF REVIEW: An evidence for lipid lowering therapy in heart failure is briefly summarized in this review. RECENT FINDINGS: Heart failure therapy is based on recent guidelines for diagnosis and treatment of acute and chronic heart failure. The question of the importance of hypolipidemic treatment in heart failure remains insufficiently answered. We still rely only on results of two randomized controlled trials that did not show significant benefit of statins on mortality in these patients. In contrast, some meta-analysis, prospective or retrospective cohorts, found some positive effects of this therapy. Recently, the role of inflammation and the possibility of its influence by hypolipidemics have been discussed. PCSK9 inhibitors, new lipid lowering drugs, are very effective in LDL-cholesterol lowering and atherosclerotic cardiovascular diseases prevention. The role of PCSK9 inhibitors in heart failure treatment is investigated. Based on current knowledge, hypolipidemics are not generally recommended in heart failure therapy, unless there is another indication for their use.

• Klíčová slova
• Dyslipidemia, Heart failure, Lipid lowering therapy, Statins, PCSK9 inhibitors,
• MeSH
• LDL-cholesterol MeSH
• lidé MeSH
• PCSK9 inhibitory MeSH
• proproteinkonvertasa subtilisin/kexin typu 9 * MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• srdeční selhání * farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• LDL-cholesterol MeSH
• PCSK9 inhibitory MeSH
• PCSK9 protein, human MeSH Prohlížeč
• proproteinkonvertasa subtilisin/kexin typu 9 * MeSH

PURPOSE OF REVIEW: Chronic kidney disease (CKD) is associated with a significantly increased risk of cardiovascular disease (CVD). This review summarizes known risk factors, pathophysiological mechanisms, and current therapeutic possibilities, focusing on lipid-lowering therapy in CKD. RECENT FINDINGS: Novel data on lipid-lowering therapy in CKD mainly stem from clinical trials and clinical studies. In addition to traditional CVD risk factors, patients with CKD often present with non-traditional risk factors that include, e.g., anemia, proteinuria, or calcium-phosphate imbalance. Dyslipidemia remains an important contributing CVD risk factor in CKD, although the mechanisms involved differ from the general population. While statins are the most commonly used lipid-lowering therapy in CKD patients, some statins may require dose reduction. Importantly, statins showed diminished beneficial effect on cardiovascular events in patients with severe CKD and hypercholesterolemia despite high CVD risk and effective reduction of LDL cholesterol. Ezetimibe enables the reduction of the dose of statins and their putative toxicity and, in combination with statins, reduces CVD endpoints in CKD patients. The use of novel drugs such as PCSK9 inhibitors is safe in CKD, but their potential to reduce cardiovascular events in CKD needs to be elucidated in future studies.

• Klíčová slova
• Cardiovascular Disease, Chronic Kidney Disease, Dyslipidemia, Lipid-lowering Drugs, Vascular Pathology,
• MeSH
• anticholesteremika * terapeutické užití   MeSH
• chronická renální insuficience * komplikace   epidemiologie   MeSH
• kardiovaskulární nemoci * epidemiologie   etiologie   prevence a kontrola   MeSH
• LDL-cholesterol MeSH
• lidé MeSH
• proproteinkonvertasa subtilisin/kexin typu 9 MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• rizikové faktory MeSH
• statiny * terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• anticholesteremika * MeSH
• LDL-cholesterol MeSH
• PCSK9 protein, human MeSH Prohlížeč
• proproteinkonvertasa subtilisin/kexin typu 9 MeSH
• statiny * MeSH

Antiplatelet therapy, and low-dose acetylsalicylic acid (ASA) in particular, is recommended in hypertensive patients with previous cardiovascular events and is considered in hypertensive patients with reduced renal function or a high cardiovascular (CV) risk, provided blood pressure is well-controlled. Acetylsalicylic acid is not recommended in low-to-moderate risk hypertensive patients in whom absolute benefit and harm are equivalent. Further trials evaluating antithrombotic therapy including newer agents in hypertension are needed. Women at high and moderate risk of pre-eclampsia are advised to take a low dose of ASA daily from 12 weeks of gestation until delivery. In addition to their lipid-lowering effects, statins induce a small blood pressure reduction. The 2013 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) guidelines recommend using statin therapy in hypertensive patients at moderate-to-high CV risk to achieve the target low-density lipoprotein (LDL) cholesterol value <3 mmol/l (115 mg/dl). For individuals with manifest CV disease or at very high CV risk, a more aggressive LDL target of <1.8 mmol/l (70 mg/dl) is recommended.

• Klíčová slova
• ASCOT, Acetylsalicylic acid, HOT study, LDL cholesterol, bleeds, cardiovascular mortality, chronic kidney disease, pre-eclampsia, statins, target LDL cholesterol, target blood pressure,
• Publikační typ
• časopisecké články MeSH
• přehledy 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.

• Klíčová slova
• dyslipidemia, lipid, nutraceuticals, position paper, recommendations,
• 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
• Názvy látek
• fytonutrienty MeSH
• HDL-cholesterol MeSH
• LDL-cholesterol MeSH
• nenasycené mastné kyseliny MeSH
• statiny MeSH
• triglyceridy MeSH

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

OBJECTIVE: To assess the discrepancies between LDL-cholesterol and apo B targets in patients at risk for vascular disease; namely, those with diabetes or hypertriglyceridemia and those with triglycerides <1.7 mmol/L and normal glucose homeostasis. METHODS: Lipid clinic patients were divided into two groups: Group 1 consisted of 182 patients whose triglyceride levels were >1.7 mmol/L or who had impaired fasting glucose or type 2 diabetes. In Group 2, there were 42 patients with triglycerides <1.7 mmol/L and normal glucose homeostasis. LDL-cholesterol and apo B were estimated during lipid clinic visits with patients on appropriate lipid lowering therapy. RESULTS: 46% of the patients in Group 1 who reached the high risk LDL-cholesterol target of <2.5 mmol/L did not reach apo B target of <0.9 g/L, while in Group 2, only 19% of those who reached the LDL-cholesterol target had apo B >0.9 g/L. CONCLUSION: Our findings demonstrate that a large percentage of patients with hypertriglyceridemia or impaired glucose tolerance, treated with lipid lowering agents, reach the LDL-cholesterol but not the apo B treatment targets.

• MeSH
• apolipoproteiny B krev   MeSH
• diabetes mellitus 2. typu krev   komplikace   terapie   MeSH
• dospělí MeSH
• glukózový toleranční test MeSH
• hypertriglyceridemie krev   farmakoterapie   etiologie   MeSH
• hypolipidemika terapeutické užití   MeSH
• krevní glukóza analýza   metabolismus   MeSH
• LDL-cholesterol krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• omezení příjmu potravy krev   MeSH
• porucha glukózové tolerance MeSH
• senioři MeSH
• triglyceridy krev   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• apolipoproteiny B MeSH
• hypolipidemika MeSH
• krevní glukóza MeSH
• LDL-cholesterol MeSH
• triglyceridy MeSH

Impaired NO-dependent vasodilation of resistance vessels is an early marker of an increased risk of atherosclerosis; utility of the examination of microcirculation, however, is far less established. We have therefore tested the hypothesis that hypercholesterolemia is associated with an impaired microvascular reactivity and that this defect is at least partially reversible by lipid-lowering treatment. Twenty-seven otherwise healthy patients with severe hypercholesterolemia (HLP) were examined at rest and then after 10 weeks of atorvastatin treatment (20 mg/day). Skin microvascular reactivity (MVR) was examined by laser-Doppler flowmetry. Baseline MVR values of the studied group were compared to healthy control subjects, HLP patients with coronary artery disease (CAD) and diabetic patients with and without diabetic retinopathy. MVR was normal in HLP subjects without CAD. On the contrary, MVR was impaired in HLP patients with CAD. There was no effect of atorvastatin on MVR, despite the profound reduction of serum lipids. MVR values did not correlate with cholesterol levels. In diabetic subjects, the MVR was substantially impaired only in patients with retinopathy. In the subjects without retinopathy, MVR was either normal (type I diabetes) or moderately impaired (type II diabetes). MVR was thus normal in HLP patients without manifest vascular disease and was not influenced by lipid lowering therapy. Impairment in the MVR was only evident in subjects with HLP and severe CAD. These results suggest that microcirculation is not involved in the early vascular dysfunction induced by HLP and that MVR rather reflects changes which appear later in the course of the atherosclerotic disease.

• MeSH
• anticholesteremika terapeutické užití   MeSH
• atorvastatin MeSH
• diabetes mellitus farmakoterapie   mikrobiologie   MeSH
• dospělí MeSH
• hypercholesterolemie farmakoterapie   patofyziologie   MeSH
• hyperemie patofyziologie   MeSH
• kůže krevní zásobení   MeSH
• kyseliny heptylové terapeutické užití   MeSH
• laser doppler flowmetrie MeSH
• LDL-cholesterol krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrocirkulace účinky léků   fyziologie   MeSH
• nemoci koronárních tepen patofyziologie   MeSH
• pilotní projekty MeSH
• pyrroly terapeutické užití   MeSH
• separace krevních složek MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• anticholesteremika MeSH
• atorvastatin MeSH
• kyseliny heptylové MeSH
• LDL-cholesterol MeSH
• pyrroly MeSH

PURPOSE: The objective was to analyse the exposure to lipid lowering agents (LLA) using the databases of health insurance companies and to appraise its concordance with the findings of evidence based medicine. METHODS: Three health insurance companies' prescription based databases were analysed in the years 1997-2000. All inhabitants in the Czech Republic (CR) have to be insured. The insured person with a recorded prescription for LLA in the year of interest was defined as a patient, the insured person with a recorded prescription for LLA in the years bordering the year of interest was defined as a chronically treated patient. In the year of interest the percentage of chronically treated patients without LLA medication, with 'very low' (<122 defined daily doses (DDD)/year), 'low' (122-243 DDD/year) and 'adequate' (>243 DDD/year) consumption was determined. RESULTS: During the observed period the total consumption of LLA increased among 450 000 inhabitants twice (by 109.6%) to 24.8 DDD/1000 inhabitants/day. In 2000 the rate of the consumption of statins and fibrates represented 34.2 and 65.6% respectively. In 1998 33.5% and in 1999 41.0% of the chronically treated patients occurred in the 'adequate' consumption group. CONCLUSIONS: The signals of inappropriate drug treatment such as the preferred use of fibrates and low doses of LLA prescribed to the Czech population were identified. Conversely, the increasing proportion of the chronically treated patients belonging to the group with the 'adequate' consumption could be considered as a positive signal.

• MeSH
• časové faktory MeSH
• farmakoepidemiologie metody   statistika a číselné údaje   trendy   MeSH
• hodnocení spotřeby léčiv metody   statistika a číselné údaje   MeSH
• hypolipidemika klasifikace   farmakologie   terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• medicína založená na důkazech metody   MeSH
• rozvrh dávkování léků * MeSH
• sběr dat metody   MeSH
• sexuální faktory MeSH
• věkové faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• hypolipidemika MeSH

The aim of this study was to evaluate the changes in fasting lipoproteins levels before and after a dietary advice among the patients attending for a lipid-lowering treatment. In total 286 patients attending for reimbursement of a lipid-lowering drug were recorded at two regional health insurance offices. Lipid levels measured at least three months after the dietary advice were compared with those before the dietary advice. The mean age of the included patients was 61 years. The average fasting total cholesterol (TC) was 7.4 mmol/l before the dietary advice as well as after the dietary advice. Fasting TC did not decrease with the dietary advice in 51% of the included patients. In the logistic regression not one of the studied factors was correlated with a successful dietary advice. Half of the patients receiving lipid-lowering drugs in Belgium were not able to decrease their TC with dietary advice before the initiation of the treatment.

• MeSH
• cholesterol krev   MeSH
• dospělí MeSH
• hodnocení výsledků zdravotní péče * MeSH
• hyperlipidemie dietoterapie   farmakoterapie   MeSH
• hypolipidemika aplikace a dávkování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lipoproteiny krev   MeSH
• omezení příjmu potravy MeSH
• poradenství metody   MeSH
• primární prevence metody   MeSH
• programy národního zdraví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• triglyceridy krev   MeSH
• úhrada zdravotního pojištění MeSH
• vzdělávání pacientů jako téma metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Geografické názvy
• Belgie MeSH
• Názvy látek
• cholesterol MeSH
• hypolipidemika MeSH
• lipoproteiny MeSH
• triglyceridy MeSH

• Publikační typ
• časopisecké články MeSH