Stable Angina Pectoris - Conservative or Intervention Treatment

Današnja terapija acetilsalicilnom kiselinom i statinima smanjuje mortalitet i morbiditet bolesnika i pobolj- šava preživljenje bolesnika s kroničnom stabilnom anginom pektoris i očuvanom funkcijom lijeve klijetke. Druga antianginalna terapija (nitrati dugotrajnog djelovanja, beta-blokatori, antagonisti kalcijevih kanala) smanjuje ili prevenira anginalne simptome, ali nije dokazano da poboljšava preživljenje. U bolesnika s oslabljenom funkcijom lijeve klijetke nakon preboljelog infarkta srca liječenje beta-blokatorima i ACE-inhibitorima smanjuje mortalitet i rizik od ponovnog infarkta. Intervencijsko liječenje kronične stabilne angine pektoris, kako invazivno kardiološko tako i kardiokirurško, značajno smanjuju simptomatologiju angine pektoris, prorjeđuju učestalost reinfarkta i potrebu za ponovnom hospitalizacijom, ali ne utječu na produljenje života.The current medicament therapy with acetylsalicylic acid and statins lowers the mortality and morbidity of patients and improves survival of patients with chronic stabile angina pectoris and preserved function of the left ventricle. The other anti-anginal medicament therapy (long activity nitrates, beta-blockers, calcium channel antagonists) diminishes or prevents anginal symptoms, but it has not been proven that such therapy improves survival. In patients with weakened left ventricle function after myocardial infarction treatment with beta-blockers and ACE inhibitors reduces mortality and the risk of repeated infarction. The intervention treatment of chronic stable angina pectoris, both invasive cardiological and cardiosurgical, significantly lessen the symptomatology of angina pectoris, reduce the frequency of new infarctions and the need for repeated hospitalization, but do not influence the prolongation of life

Antiaggregational Therapy

Patofiziološko obrazloženje značenja antiagregacijske terapije leži u središnjoj ulozi trombocita pri aterotrombotskoj bolesti koja se nalazi u osnovi akutne i kronične koronarne bolesti, bolesti perifernih arterija i arterija mozga. Danas su dostupni brojni lijekovi kojima se mogu različitim mehanizmima mijenjati svojstva trombocita. Postoje brojna klinička istraživanja u kojima je dokazana učinkovitost antiagregacijske terapije pri različitim aterotrombotskim bolestima, premda neka pitanja ostaju još neodgovorena. U ovom pregledu antiagregacijske terapije bit će ukratko opisana dosadašnja saznanja o acetilsalicilnoj kiselini, tienopiridinima (tiklopidin, klopidogrel, prasugrel, tikagrelor), antagonistima glikoproteinskih receptora IIb/IIIa i kombinacijskom liječenju.Pathophysiological explanation of the antiplatelet therapy importance lies in the central role of platelets in atherothrombotic disease, which is in the very foundations of both acute and chronic coronary artery disease, peripheral arterial disease and cerebral arteries disease. Today, many medications are available that change the properties of platelets using different mechanisms. Numerous clinical trials have demonstrated the effectiveness of antiplatelet therapy in various atherothrombotic diseases, although some questions still remain unanswered. This review of antiplatelet therapy will briefly describe current knowledge about acetylsalicylic acid, thienopyridines (ticlopidine, clopidogrel, prasugrel, ticagrelor), glycoprotein IIb/IIIa receptor antagonists and the combination treatment

Antiaggregational Therapy

Patofiziološko obrazloženje značenja antiagregacijske terapije leži u središnjoj ulozi trombocita pri aterotrombotskoj bolesti koja se nalazi u osnovi akutne i kronične koronarne bolesti, bolesti perifernih arterija i arterija mozga. Danas su dostupni brojni lijekovi kojima se mogu različitim mehanizmima mijenjati svojstva trombocita. Postoje brojna klinička istraživanja u kojima je dokazana učinkovitost antiagregacijske terapije pri različitim aterotrombotskim bolestima, premda neka pitanja ostaju još neodgovorena. U ovom pregledu antiagregacijske terapije bit će ukratko opisana dosadašnja saznanja o acetilsalicilnoj kiselini, tienopiridinima (tiklopidin, klopidogrel, prasugrel, tikagrelor), antagonistima glikoproteinskih receptora IIb/IIIa i kombinacijskom liječenju.Pathophysiological explanation of the antiplatelet therapy importance lies in the central role of platelets in atherothrombotic disease, which is in the very foundations of both acute and chronic coronary artery disease, peripheral arterial disease and cerebral arteries disease. Today, many medications are available that change the properties of platelets using different mechanisms. Numerous clinical trials have demonstrated the effectiveness of antiplatelet therapy in various atherothrombotic diseases, although some questions still remain unanswered. This review of antiplatelet therapy will briefly describe current knowledge about acetylsalicylic acid, thienopyridines (ticlopidine, clopidogrel, prasugrel, ticagrelor), glycoprotein IIb/IIIa receptor antagonists and the combination treatment

EUROPEAN GUIDELINES ON THE DIAGNOSIS AND MANAGEMENT OF PULMONARY EMBOLISM

Suglasnost ispitanika za sudjelovanje u medicinskim istraživanjima standard je zaštite svih sudionika u biomedicinskim istraživanjima koji je potvrđen i u međunarodnim dokumentima vezanim uz područje istraživanja na ljudima i u hrvatskom zakonodavstvu. Neka pitanja međutim ostaju otvorena. Jedno od njih, s kojim se susreću brojna etička povjerenstva u svijetu i Republici Hrvatskoj, jest i je li potrebno tražiti suglasnost pacijenata kod istraživanja u kojima se rabe pohranjeni biološki materijali pacijenata i njihovi medicinski podatci dobiveni tijekom dijagnostičkih i/ili terapijskih zahvata. U radu je dan pregled hrvatskih i međunarodnih pravnih dokumenata i smjernica te znanstvenih istraživanja koja se bave ovim pitanjem. Budući da za sada ne postoji zakonska regulativa u Hrvatskoj vezana uz ovaj tip istraživanja, autori ovog rada daju preporuke za istraživače i etička povjerenstva kako postupati u takvim slučajevima. Njihovo prihvaćanje olakšalo bi znanstvena istraživanja i međunarodnu suradnju hrvatskih znanstvenih institucija.Informed consent represents the standard for adequate protection of all participants in biomedical research. This standard is affirmed in international legal documents concerning biomedical research, as well as in Croatian legislation. However, some questions regarding informed consent remain open. One of such questions that research ethics committees around the world and in the Republic of Croatia often deal with, is the question of whether to obtain informed consent for the research on archived material or previously collected research data taken from the patients during diagnostic or therapeutic procedures. This contribution provides an overview of both Croatian and international legal documents and guidelines that deal with this issue, together with an overview of the literature concerning this issue. Since in the Republic of Croatia there are no regulations regarding this type of research, the authors of this contribution are presenting conduct guidelines for researchers and ethics committees in such cases. The implementation of the proposed guidelines would facilitate scientific research and international cooperation for Croatian scientific institutions

EUROPEAN GUIDELINES ON THE DIAGNOSIS AND MANAGEMENT OF PULMONARY EMBOLISM

Suglasnost ispitanika za sudjelovanje u medicinskim istraživanjima standard je zaštite svih sudionika u biomedicinskim istraživanjima koji je potvrđen i u međunarodnim dokumentima vezanim uz područje istraživanja na ljudima i u hrvatskom zakonodavstvu. Neka pitanja međutim ostaju otvorena. Jedno od njih, s kojim se susreću brojna etička povjerenstva u svijetu i Republici Hrvatskoj, jest i je li potrebno tražiti suglasnost pacijenata kod istraživanja u kojima se rabe pohranjeni biološki materijali pacijenata i njihovi medicinski podatci dobiveni tijekom dijagnostičkih i/ili terapijskih zahvata. U radu je dan pregled hrvatskih i međunarodnih pravnih dokumenata i smjernica te znanstvenih istraživanja koja se bave ovim pitanjem. Budući da za sada ne postoji zakonska regulativa u Hrvatskoj vezana uz ovaj tip istraživanja, autori ovog rada daju preporuke za istraživače i etička povjerenstva kako postupati u takvim slučajevima. Njihovo prihvaćanje olakšalo bi znanstvena istraživanja i međunarodnu suradnju hrvatskih znanstvenih institucija.Informed consent represents the standard for adequate protection of all participants in biomedical research. This standard is affirmed in international legal documents concerning biomedical research, as well as in Croatian legislation. However, some questions regarding informed consent remain open. One of such questions that research ethics committees around the world and in the Republic of Croatia often deal with, is the question of whether to obtain informed consent for the research on archived material or previously collected research data taken from the patients during diagnostic or therapeutic procedures. This contribution provides an overview of both Croatian and international legal documents and guidelines that deal with this issue, together with an overview of the literature concerning this issue. Since in the Republic of Croatia there are no regulations regarding this type of research, the authors of this contribution are presenting conduct guidelines for researchers and ethics committees in such cases. The implementation of the proposed guidelines would facilitate scientific research and international cooperation for Croatian scientific institutions

The prevalence of smoking among Croatian hospitalized coronary heart disease patients [Prevalencija pušenja u hospitaliziranih bolesnika u Hrvatskoj]

The aim of this paper was to investigate the prevalence of smoking using selected anthropometric variables in a sample of hospitalized coronary heart disease (CHD) patients in Croatia (N = 1,298). A total of 444 subjects (34.6%) were non-smokers, 548 (42.6%) were smokers and 293 (22.8%) were ex-smokers. Men, on average, smoked more cigarettes per day than women (22.62 vs. 19.84 cigarettes, p < 0.001) and they also had bigger index "pack-years" than women (36.96 vs. 33.91, p = 0.024). Men were more often smokers and ex-smokers than women (47.4% vs. 30.8% for smokers and 25.0% vs. 22.8% for ex-smokers, p < 0.001). In this study a high prevalence of smoking was found among CHD patients in Croatia. Unless it is decreased, it can be expected that CHD patients in Croatia will continue to experience adverse effects more often than other CHD patients in the rest of Europe

Abnormal Systolic Blood Pressure during Treadmill Test and Brachial Artery Flow – Mediated Vasodilatation Impairment

The aim of the study was to assess the relationship between systolic blood pressure during maximal treadmill test (SBPmtt) and flow-mediated vasodilation (FMD). Abnormal rise of SBPmtt is the phenomenon more frequent in hypertensive persons but it could be found in normotensive subjects too. 199 subjects referred to treadmill test were enrolled in the study. Four groups were formed: hypertensives with abnormal SBPmtt (group A), hypertensives with normal SBPmtt (group B), normotensives with abnormal SBPmtt (group C) and normotensives with normal SBPmtt (group D). Rise of SBPmtt above 200 mmHg was considered abnormal reaction. Simple linear regression analysis showed significant inverse relationship between SBPmtt and FMD (F=20.2036, p<0.001, R2=0.0956). Mean FMD index was worst in hypertensive subjects with abnormal SBPmtt (group A), followed by normotensives with abnormal SBPmtt (group C), hypertensives with normal SBPmtt (group B) and the best was in normotensives with normal SBPmtt (3.56±5.17, 4.19±5.14, 6.81±8.43 and 10.92±7.48%, respectively). In multivariate regression analysis FMD showed significant association with abnormal SBPmtt (p<0.001) along with brachial artery diameter (p<0.001), male gender (p<0.001), but not with hypertension (p=0.073), BMI (p=0.137) and total cholesterol (p=0.23) (coefficients: –0.26, –0.40, –0.27, –0.13, –0.11 and –0.07, respectively). There was a significant inverse relationship between SBPmtt and FMD. An impairment of FMD exists in normotensive subjects with abnormal SBPmtt. In hypertensives with abnormal SBPmtt an additional impairment of FMD exists when compared to hypertensives with normal SBPmtt. Abnormal SBPmtt should be taken into account in global cardiovascular risk assessment

The Prevalence of Hypertension among Croatian Hospitalized Coronary Heart Disease Patients

The aim of this article was to investigate the prevalence of hypertension with selected anthropometric variables in a sample of hospitalized coronary heart disease (CHD) patients in Croatia. This study investigated patients hospitalized in the period of October 1st 2007 until January 7th 2010 because of acute or chronic CHD in various hospitals in Croatia (N=1,298). Prevalence of hypertension in surveyed patient population was high: 70.1% of participants had raised blood pressure (BP) or previously diagnosed hypertension. Men had statistically significantly higher mean diastolic BP values than women (78.91±8.97 vs. 77.12±10.61 mmHg, p=0.011). Prevalence of hypertension was statistically significantly more frequent in women (80.6% vs. 65.8%, p<0.001). Hypertension still represents an important problem among hospitalized Croatian CHD patients. Its prevalence, unfortunately, continues to increase in this population, suggesting that there is still great potential for improvement of preventive cardiology standards and measures that have already been undertaken

The Prevalence of Overweight and Obesity among Croatian Hospitalized Coronary Heart Disease Patients

The aim of this article was to investigate the prevalence of overweight and obesity using selected anthropometric variables in a sample of hospitalized coronary heart disease (CHD) patients in Croatia (N=1,298). Prevalence of overweight and obesity in surveyed patient population was high: 48.2% of participants were overweight and 28.6% were obese according to their body mass index; measured through waist-to-hip ratio 54.5% of participants were centrally obese. These data on prevalences of overweight, obesity and central obesity show that although there are some reassuring trends, there is still considerable amount of work to be done if the prevalence of this cardiovascular risk factor is to be reduced further among Croatian CHD patients. While the prevalence of obesity seems to be on the decline, the prevalence of overweight is rising, which may be just an early warning sign of an incoming wave of obesity epidemic in future years

The Prevalence of Smoking among Croatian Hospitalized Coronary Heart Disease Patients

The aim of this paper was to investigate the prevalence of smoking using selected anthropometric variables in a sample of hospitalized coronary heart disease (CHD) patients in Croatia (N=1,298). A total of 444 subjects (34.6%) were non-smokers, 548 (42.6%) were smokers and 293 (22.8%) were ex-smokers. Men, on average, smoked more cigarettes per day than women (22.62 vs. 19.84 cigarettes, p<0.001) and they also had bigger index »pack-years« than women (36.96 vs. 33.91, p=0.024). Men were more often smokers and ex-smokers than women (47.4% vs. 30.8% for smokers and 25.0% vs. 22.8% for ex-smokers, p<0.001). In this study a high prevalence of smoking was found among CHD patients in Croatia. Unless it is decreased, it can be expected that CHD patients in Croatia will continue to experience adverse effects more often than other CHD patients in the rest of Europe