Mildronate improves carotid baroreceptor reflex function in patients with chronic heart failure

Summary Objectives: The aim of the study was to compare the efficacy of combined treatment of chronic heart failure (CHF) patients with mildronate and ACEI (lisinopril) and the treatment with ACEI (lisinopril) used alone. One of the objectives was to assess the influence of both therapies on the reactivity of the carotid baroreceptor reflex. Design and Methods: The study was designed as a controlled, parallel-group, double-blind, randomised phase IV clinical trial. The study group comprised 57 patients (men and women; aged 30-80 years) with CHF (NYHA I-III) due to coronary heart disease (CHD). The first study group (ML20) received mildronate (M) 1000 mg and lisinopril (L) 20 mg daily; the second group (ML5) received M 1000 mg and L 5 mg, the third (control) group (L20) received L 20 mg daily. The treatment period lasted for 3 months. Results: Improvement of the main symptoms of CHF, NYHA class, peripheral circulation and contractility of the myocardium in the ML5 and ML20 groups was reported in our previous papers. In CHF patients receiving a prolonged treatment of cardioselective β-adrenergic blockers (metoprolol or bisoprolol), a three-month therapy of mildronate in combination with lisinopril has resulted in an increase of the amplitude of baroreflex bradycardic and hypotensive reactions. The effect was not found to be dependent upon the lisinopril dosage applied in this combination (within the range of the minimal-maximal dose). Besides, neither lisinopril by itself, nor the combination of mildronate with lisinopril were stated to be related with any changes in arterial pressure or the heart rate in CHF patients. Conclusions: This study has revealed the advantage of the combined treatment with "lisinopril 20 mg/daily and mildronate 1000 mg/daily" and "lisinopril 5 mg/daily and mildronate 1000 mg/daily" over the treatment with "lisinopril 20 mg/daily" on the reactivity of the carotid baroreceptor reflex in CHF patients. Seminars in Cardiovascular Medicine 2008; 13: 7 Keywords: mildronate, chronic heart failure, baroreflex reactivity Heart failure is a multifactorial disease with poor prognosis (about 50% mortality during the first 5 years of diagnosis) From the previous studies we have learned that patients with heart failure have an increased sympathetic nerve activity, which seems to be important to maintain the cardiac output and blood pressure. The sympathetic nervous system activity progressively increases from mild to severe heart failure. Some investigators have attributed the increase in sympathetic nervous system activity to a cardiopulmonary and baroreflex dys-* Corresponding address: Vilnis Dzerve, Institute of Cardiology, Pilsonu iela 13, Riga LV-1002, Latvia E-mail: [email protected] (V. Dzerve). function. Experimental studies have proved the changes in angiotensin II and noradrenaline levels to be related with the changed baroreflex control of the heart rate (HR) and the sympathetic nerve activit

Blood pressure control in treated hypertensive patients in daily practice of Latvian family physicians

Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background and Objective: The aim of this study was to evaluate blood pressure (BP) control level in treated hypertensive patients in Latvia and to compare their characteristics according to the adequacy of BP control. Materials and Methods: Family physicians collected information on demographic and clinical characteristics, and current antihypertensive treatment of 455 18-80-year-old patients with essential arterial hypertension treated for 1 or more years. Target BP was defined as values of <140/90 mm Hg for patients with low or moderate cardiovascular risk and <135/85-125/75 mm Hg for patients with high or very high risk. BP was measured in the office setting after a 5-minute rest in a sitting position using a calibrated aneroid sphygmomanometer. Results: Nearly half of patients (46.2%) attained their target BP. The proportion of patients with effective BP control was higher in the group of low and moderate added cardiovascular risk than in the high and very high added cardiovascular risk group (61.7% vs. 34.4%, P<0.0001). The majority of patients were given two-drug (26.2%) or three-drug (31.6%) combined antihypertensive therapy. Current pharmacological treatment was similar in the patients who attained target BP and in those who did not. Overall, physicians did not modify antihypertensive treatment in 37.9% of patients; such a recommendation was more common among patients with controlled BP. Very few patients (7.4%) who did not attain target BP did not receive recommendations to modify antihypertensive treatment. Conclusions: The rate of effective BP control was less than 50% and was even worse (34.4%) in patients with high or very high added cardiovascular risk in the present sample of treated hypertensive patients.publishersversionPeer reviewe

Decrease in annual incidence of acute coronary syndrome and restructuring of coronary care in Latvia

Funding Information: No financial support was provided for the conduct of the research and the preparation of this article. Copyright: Copyright 2014 Elsevier B.V., All rights reserved.Introduction Improvement in coronary heart disease prevention and treatment, as well as availability of coronary care facilities, is important for the reduction of acute coronary syndrome (ACS) incidence. Centralized acute coronary care system is crucial to provide optimal hospitalization and management algorithm for ACS patients. Aim The aim of the current report was to assess the annual incidence of ACS and the quality of acute coronary care in Latvia. Methods The Data from The Latvian Registry of Acute Coronary Syndromes were analyzed covering the time period from 2005 to 2010. Results Since the year 2005 the annual incidence of hospitalization due to ACS decreased significantly in Latvia. The annual incidence of non-ST-elevation ACS (NSTE-ACS) decreased from 8019 to 4613 in absolute numbers based on the registry data during six years. Improvement in the use of guidelines based therapy and early invasive strategy in ACS patients was observed. Increase in primary percutaneous coronary intervention was achieved from 7.9% in 2005 to 57.0% in 2010, contributing to reduction in the proportion of STEMI patients without any reperfusion (from 45% in 2005 to 21% in 2010). Conclusions The annual incidence of hospitalized ACS, especially NSTE-ACS, decreased and guidelines based management of ACS improved from 2005 to 2010 in Latvia.publishersversionPeer reviewe

A population-based cross-sectional study of cardiovascular risk factor in Latvia

Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background and Objective: To date, the epidemiological studies of noncommunicable diseases in Latvia were more episodic and covered only selected areas. The first national crosssectional population-based survey of cardiovascular risk factors after regaining independence was carried out to provide reliable information on the cardiovascular risk factor profile in adults. Material and Methods: Computerized random sampling from the Registry of Latvian population was carried out. A total of 6000 enrolled subjects aged 25-74 years were divided into 10 age subgroups. The data of 3807 respondents (63.5% of all) were included into the final analysis. Results: The mean number of cardiovascular risk factors was 2.99±0.026 per subject: 3.45±0.043 and 2.72±0.030 for men and women, respectively. Of all the respondents, 75.2% had an increased total cholesterol level. Hypercholesterolemia was found in almost 56% of men and 41% of women in the age group of 25-34 years. Hyperglycemia was documented in 34.1% of the respondents (41.6% of men and 29.8% of women). More than two-thirds (67.8%) of the persons were overweight, while obesity was found in 25.6% of men and 32.6% of women. Arterial hypertension was identified in 44.8% of the respondents; its prevalence was higher in men than women (52.9% vs. 40.2%). There were more current smokers among men than women (30.5% vs. 11.4%). Conclusions: The levels of cardiovascular risk factors in Latvia were found to be relatively high. The data can be utilized as baseline characteristics that can be compared down the road including the monitoring of health prevention activities.publishersversionPeer reviewe

Prevalence estimation of celiac disease in the general adult population of Latvia using serology and HLA genotyping

BACKGROUND: Prevalence estimates for celiac disease (CD) depend on the method used. The role of deamidated gliadin peptide (DGP) and genetic testing in epidemiological studies and diagnostic settings of celiac disease (CD) has still to be established. OBJECTIVES: The objective of this article is to assess the prevalence of CD in Latvia by combining serological tests with DQ2.5/DQ8 testing. METHODS: A total of 1444 adults from a randomly selected cross-sectional general population sample were tested by ELISA for tTG IgA, DGP IgA and IgG antibodies (QUANTA Lite®, Inova Diagnostics Inc). Samples with tTG IgA ≥20U were tested for EMA IgA by indirect immunofluorescence assay, and all specimens with tTG IgA ≥15U were tested by QUANTA-Flash® chemiluminescent assays (CIA) (Inova Diagnostics Inc) for tTG IgA, DGP IgA and IgG. DQ2.5/8 was detected in individuals with any positive ELISA test and a subgroup of controls. RESULTS: Forty-three individuals (2.98%; 95% CI: 2.10–3.86%) tested positive by at least one ELISA test; 41.86% of the serology-positive individuals (any test above the cutoff) were DQ positive. Six individuals (0.42%; 95% CI: 0.09–0.75%) were triple ELISA positive, and DQ2.5 or DQ8 was positive in all; 0.35% (95% CI: 0.05–0.65%) were tTG IgA and EMA positive. Two tTG IgA-negative cases were both DGP IgG and IgA positive, both being DQ positive; including them in the “serology-positive” group would increase the prevalence to 0.49% (95% CI: 0.13–0.85%). CIA tests revealed 2 tTG IgA-positive and EMA-negative cases with a positive genotype. DQ2.5 or DQ8 genotype was positive in 28.6% of the serology-negative population. CONCLUSIONS: Estimates of the prevalence of CD in Latvia based on the serogenetic testing approach range from 0.35% to 0.49% depending on the criteria used. There is a rationale for combining serological tests and DQ2.5/8 genotyping

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants

Background: Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories. Methods: We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment. Findings: In 2022, an estimated 828 million (95% credible interval [CrI] 757-908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554-713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401-496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait). Interpretation: In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes