How much do Croatian Physicians and Croatian Population Know about Risk Factor for Cadiovascular Diseases?

The results of two studies about knowledge and awareness of risk factors for cardiovascular diseases (CVD) of 1382 Croatian primary care physicians, internists and cardiologists as well as 882 citizens have been presented. The results show that although a great majority of physicians think that the guidelines for the prevention of CVD are useful, only more than a half of them use them in their daily work. Although more than four-fifths of physicians think that they provide good treatment to their patients suffering from dyslipidemia, only a half of them know what are the LDL target values in the patients with a high risk for CVD and which HDL concentration is risky for CVD. Although the population die because of CVD twice as much than of malignant disease, the respondents in the group of general population are much more afraid of malign diseases, although many of them know that CVD are the main cause of death. Only more than one fifth of patients have received advice from their physician in connection with lipid disorders as the CVD risk factor, while more than a half of respondents have received no instructions about the risk factors. We may conclude that physicians should know more about risk factors and guidelines for prevention of CVD and that the awareness of and knowledge about these factors in Croatian population should also be improved. The transfer of information about CVD risk factors between physicians and patients should be improved as well

The perception and knowledge of cardiovascular risk factors among medical students

Aim To assess perceptions, knowledge, and awareness of cardiovascular disease (CVD) risk factors among medical students (freshmen and graduating students). Methods A descriptive cross-sectional survey based on an anonymous self-administered questionnaire was conducted in 2008 on 443 medical students – 228 freshmen on their enrollment day and 214 students on the day of their final exam at the University of Zagreb School of Medicine, Croatia. Results The perception and knowledge of some CVD risk factors, eg, dyslipidemia, arterial hypertension, and metabolic syndrome as well as of lipid-lowering therapy important for CVD prevention was significantly better among graduating students but was still not sufficient. Only 66% of graduating students reported that they would prescribe lipid-lowering therapy to high risk patients. Disappointingly, many graduating students were smoking (30.4%) and had low-awareness of obesity as an important CVD risk factor. Conclusion These results suggest an urgent need to improve medical students’ knowledge of obesity and low physical activity as important CVD risk factors and of the methods for increasing low high-density lipoprotein-cholesterol and for smoking cessation. All this provides a rationale for modifying the university core curriculum to include more information concerning these issues

METABOLIC SYNDROME, MORBIDITY AND MORTLITY IN THE ERA OF COVID-19 PANDEMIC

The prevalence of obesity, diabetes, arterial hypertension and cardiovascular and cerebrovascular diseases is increasing worldwide. Nowdays we are witnessing a pandemic of metabolic syndrome and obesity and an epidemic of these diseases in Croatia as well. Moreover, every second Croatian citizen dies because of cardiovascular diseases. Visceral obesity, diabetes, dyslipidemia and arterial hypertension tend to cluster forming a syndrome that we call metabolic syndrome. The concept of metabolic syndrome was defined several decades ago as visceral type of obesity, hypertriglyceridemia, low HDL-cholesterol, arterial hypertension and diabetes mellitus (insulin resistance). Most widely used definition is the one by National Education Cholesterol Program, NCEP - Adult treatment Panel III - ATP III . Therefore, visceral obesity is considered as one of the greatest risks for mortality worldwide. COVID pandemia increased the risk od deaths especially among patients with metabolic syndrome. Pandemia perpetuated several other socio-economical risk factors (stress, depression, physical inactivity, devian strongly influence cardiovascular health. Unfortunately, SARS-COV-2 virus enters the host (human) cell using signaling pathways (ANG II Rc) known very well from the metabolic syndrome research and connecting those two entities predesponing these patients for a much worse prognosis when infected with SARS-COV-2 virus. To conclude - chronic obesity pandemia goes hand by hand with novel COVID-19 pandemia dramatiacally increasing the risk of severe morbidity and mortality

Porodična hiperkolesterolemija - mislimo li dovoljno o ovoj teškoj bolesti? [Familial hypercholesterolemia - do we think enough about this severe disease?]

Familial hypercholesterolemia is the most common genetic metabolic disorder and is associated with significant morbidity and mortality from cardiovascular disease, in particular coronary heart disease (CHD). Gene mutations for LDL receptor, APOB or PCSK9 are the main causes of the disease. The incidence of homozygous form of disease is 1:1000000 and ofheterozygous 1:500. Some of the patients have clinical signs like xanthomas, xanthelasmas and corneal arcus. More predictive for the diagnosis are elevated serum LDL cholesterol values and positive family history of early CHD. Identification of the causative mutation provides definitive diagnosis. Diet, statins, combined therapy (statins and ezetimibe) are the first line of treatment, mostly in high doses. LDL apheresis is the procedure of mechanical removal of LDL particles from plasma and has to be performed in patients with homozygous or severe heterozygous form of the disease together with drug treatment. There is a need to increase the awareness of this disease in Croatia but also worldwide with one main goal: to early diagnose and prevent cardiovascular morbidity and mortality

Statins in Primary and Secondary Prevention of Coronary Heart Disease

Iako je općeprihvaćena opravdanost davanja inhibitora HMG-CoA reduktaze (statina) radi smanjenja ukupnog i LDL-kolesterola u serumu bolesnika s koronarnom bolešću srca (KBS) i onih koji zbog hiperlipidemije imaju povećani rizik, donedavno nije bilo tako jasno treba li statine davati i osobama s manje izraženim rizikom. Rezultati novijih velikih kliničkih ispitivanja i gotovo dva desetljeća kliničkih iskustava sa statinima pokazuju da su oni vrlo djelotvorni u smanjenju rizika za KBS i u primarnoj i u sekundarnoj prevenciji, i to bez češćih i značajnijih neželjenih nuspojava. Korisni učinci statina nadmašuju one postignute u ranijim ispitivanjima s drugim antilipemicima i pojavljuju se prerano da bi se mogli pripisati samo snižavanju koncentracije lipida u serumu. Stoga se smatra da do toga ne dolazi samo zbog jačeg smanjenja lipida u serumu, već zbog tzv. pleiotropnih protuaterosklerotskih učinaka statina. Novija klinička ispitivanja jasno su pokazala da se davanjem statina ne postiže samo liječenje hiperlipidemije, već uistinu smanjenje pobola i pomora od KBS-a u osoba s povećanim rizikom. Međutim, u nekoliko je ispitivanja uočeno da mnogi bolesnici s KBS-om (a još više onih koji samo imaju velik rizik) ili uopće ne dobivaju statin, ili se u njih zbog preniske doze statina ne postižu ciljne, odnosno preporučene vrijednosti lipida. Budući da je hipodoziranje statina važan problem, osobito u nas, tomu valja posvetiti posebnu pozornost.Although treatment with HMG-CoA reductase inhibitors (statins) to reduce total and LDL-cholesterol is clearly indicated in patients with coronary heart disease (CHD) and those with increased risk due to hyperlipidemia, the requirements of patients with lower risk were until recently less straightforward. The results of recent large clinical trials with statins and almost two decades of clinical experience have shown that statins are effective and well tolerated in reducing CHD risk for both primary and secondary prevention. The beneficial effects of statins outweigh those seen in earlier trials with other hypolipemic drugs and occur too early in treatment to be due to lipid lowering mechanism alone. Therefore this happens presumably not only because of the greater reduction in lipids but because of their so-called “pleiotropic” antiatherogenic effects. Recent clinical trials have proved that lipid lowering therapy with statins is no longer just a matter of hyperlipidemia treatment but rather a way of lowering risk of CHD morbidity and mortality in a large number of individuals at high risk. However, the data from several studies have shown that many CHD patients (and even more individuals at high risk) either receive no treatment at all, or are not treated to recommended lipid goals. Since undertreatment is a big problem, particularly in Croatia, this issue should be strongly addressed

Atherosclerosis – the Cause of Every Second Death in Croatia

Ateroskleroza je bolest kod koje dolazi do lokalnih zadebljanja stijenke arterija koje se nazivaju ateromi ili plakovi (od franc. plaque – ploča, jer na stijenci žile aterosklerotične naslage često izgledaju kao masne ploče). Ateroskleroza je najčešće oštećenje arterija, pa su ona i bolesti koje nastaju kao njena posljedica, a to su bolesti srca i krvnih žila, vodeći uzroci smrti i velik javnozdravstveni problem ne samo u Hrvatskoj već i u većini zemalja svijeta. Bolesti srca i krvnih žila uzrokovane poglavito aterosklerozom bolesti su koje osobito često pogađaju muškarce, pa je tako od 26.019 muškaraca umrlih 2009. godine s prebivalištem u Hrvatskoj 4.885 umrlo od ishemijske bolesti srca, a 3.268 od cerebrovaskularne bolesti. Glavni je cilj u borbi protiv bolesti srca i krvnih žila spriječiti da uopće nastane aterosklerotička nakupina, što se postiže suzbijanjem i liječenjem čimbenika rizika. Pri tome se osim na čimbenike rizika koji su već odavno poznati, kao što je povećani ukupni i LDL kolesterol u krvi, u zadnje vrijeme sve veća pozornost posvećuje i drugima, primjerice poremećaju masnoća u krvi obilježenom povećanim trigliceridima i smanjenoj količini zaštitnog HDL kolesterola u krvi.Atherosclerosis is a disease manifested through local artery wall thickenings called atheroma or plaques (French plaque – plate, since arteriosclerotic layers on the arterial wall often resemble fatty plates). In the majority of cases, atherosclerosis develops from damage to the arteries, so that together with cardiac and cardiovascular diseases, which occur as its effects, it remains the leading cause of death and a major problem for public health, not only in Croatia, but also in the majority of the countries worldwide. Cardiac and cardiovascular diseases caused mostly by atherosclerosis are diseases from which men suffer more frequently than women; out of 26,019 male Croatian residents, who died in 2009, 4,885 died of ischemic cardiac diseases, while 3,268 died of cerebrovascular diseases. The main objective in fighting cardiac and cardiovascular diseases is to prevent the occurrence of arteriosclerotic layers, which may be achieved by preventing and curing risk factors. Apart from the already well-known risk factors, such as increased total and LDL cholesterol, recently the attention has ever more been paid to others, such as blood fat disorder marked by increased triglycerides and reduced protective HDL cholesterol

Changing People’s Habits-Main Factor in the Treatment of Hyperlipidemias

U sklopu strategije primarne i sekundarne prevencije koronarne bolesti srca od ključne je važnosti promjena načina života. Osobito je važno djelovati na hiperkolesterolemiju koja je jedan od najvažnijih čimbenika rizika za koronarnu bolest. Na koronarnu bolest može se utjecati promjenom načina prehrane, prestankom pušenja, poticanjem tjelesne aktivnosti, smanjenjem pretjeranog konzumiranja alkohola i smanjenjem prekomjerne tjelesne težine te liječenjem povišenoga krvnog tlaka i šećerne bolesti. Promjena načina prehrane treba se temeljiti na smanjenju unosa masti, posebno zasićenih masnih kiselina i kolesterola, uz relativno povećanje unosa višestruko i jednostruko nezasićenih masnih kiselina te povećanje unosa prehrambenih vlakana i antioksidanata biljnog ili mineralnog podrijetla. U ovom se preglednom članku podrobno razmatraju učinci dijete na serumske lipide, a posebna pozornost posvećena je učincima trans-masnih kiselina, omega-3 višestruko nezasićenih masnih kiselina, dijetnim vlaknima, vitaminima E i C, flavonoidima, češnjaku, alkoholu, čaju, kavi i orašastom voću. Daju se i detaljne upute o tjelesnoj aktivnosti kojom se može utjecati na hiperlipidemiju.Intervention strategies for coronary heart disease (CHD) must include attention to life-style factors and changing people\u27s habits. Since hypercholesterolemia is one of the most important risk factors for CHD, the modification of this risk factor including dietary factors, cessation of smoking, improving exercise, sensible drinking, attainment of ideal body weight as well as control of hypertension and diabetes is essential. The dietary changes should include reduction in intake of total fat, saturated fat and cholesterol, relative increase in intake of poly- and monounsaturated fats, and an increase in intake of dietary fibre, vitamin and mineral antioxidants. In this review article the effect of diet on serum lipids is discussed and particular attention is payed on trans fatty acids, omega-3 polyunsaturated fatty acids, dietary fibre, vitamins E and C, flavonoids, garlic, alcohol, tee, coffee and nuts. The recommendations concerning an exercise regime are also presented

Uloga prehrane u prevenciji i terapiji kardiovaskularnih bolesti

Zdrava se prehrana već odavno povezuje s manjim rizikom od kardiovaskularnih bolesti izazvanih aterosklerozom, poglavito rizikom od koronarne bolesti i infarkta miokarda. Tijekom posljednjih se desetljeća povećalo zanimanje za takve učinke hrane i u literaturi se danas može naći niz podataka o sastojcima različitih namirnica i pića, kao i epidemiološki podaci o njihovim mogućim učincima. Rijetka su, međutim, velika dobro kontrolirana klinička ispitivanja djelovanja pojedinih namirnica u dobro defi niranih skupina ispitanika pa stoga i nema nedvojbenih dokaza o koristi većine namirnica u prevenciji kardiovaskularnih bolesti osim za omega-3 masne kiseline iz riba i mediteransku prehranu. Dapače, rezultati nekih ispitivanja su razočarali, kao primjerice oni o djelovanju protuoksidacijskih vitamina E, A i C. Kako se ipak konzumiranje nekih vrsta hrane može povezati s povoljnim, ali i nepovoljnim učincima na kardiovaskularne bolesti, u ovom su preglednom članku u sažetu obliku prikazane suvremene spoznaje o učincima različitih masnih kiselina, topljivih prehrambenih vlakana uključujući psilijum, beta-glukan, pektin i guar, likopena – karotenoida iz rajčice, antioksidacijskih vitamina, češnjaka, oraha i kikirikija, bjelančevina iz soje i fitosterola, polikozanola, čaja, kakaa i kave te alkohola i kuhinjske soli. Poseban je naglasak dan na protuoksidacijske i protudislipidemičke učinke različitih namirnica te one u smislu popravljanja disfunkcije endotela i utjecaja na arterijski tlak, što sve pridonosi prevenciji kardiovaskularnih bolesti, uz navođenje niza praktičnih podataka važnih za kliničare