The Role of Rosuvastatin in Primary and Secondary Prevention of Cardiovascular Events and Influence on Patient Compliance

Kardiovaskularne su bolesti vodeći uzrok smrtnosti u svijetu, a povišene masnoće u krvi jedan su od najvažnijih čimbenika rizika za njihov nastanak. U tome je smislu učinkovito smanjenje lipida bitan napredak u smanjenju pobola i smrtnosti od neželjenih kardiovaskularnih događaja, što dokazuju i mnogobrojne studije. Za smanjenje masnoća vrlo su učinkoviti antilipemici, a među njima statini zauzimaju središnje mjesto. Kao statin „nove generacije” ističe se rosuvastatin. To je sintetski statin koji inhibira enzim 3-hidroksi-3-metilglutaril koenzim A reduktazu te na taj način smanjuje sintezu endogenog kolesterola. Dominantni učinak rosuvastatina jest snizivanje LDL kolesterola i ukupnog kolesterola u krvi te je on jedini statin koji je pokazao pozitivan učinak u povećanju koncentracije HDL kolesterola, i to do 15 %. U literaturi su opisani i protuupalni, antioksidativni i antitrombotski učinci ovoga lijeka, koji dodatno smanjuju rizik od kardiovaskularnog pobola i smrtnosti, a ne mogu se pripisati isključivo smanjivanju razine ukupnog kolesterola. Najčešća nuspojava ovog lijeka jest mijalgija koja je jedan od najvažnijih razloga zašto bolesnici odustaju od statinske terapije i pribjegavaju „alternativnim“, često neučinkovitim rješenjima. Kako je liječenje hiperlipidemije od ključne važnosti za smanjenje kardiovaskularnog rizika, potrebno je naglasak staviti na redovito uzimanje lijeka i na nalaženje adekvatnog načina da bolesnik ostane na terapiji statinima. U tome smislu širok raspon jačine rosuvastatina u 6 različitih doza od 5 do 40 mg omogućuje da količinu lijeka prilagodimo potrebama bolesnika kako bi liječenje bilo učinkovito, a eventualne neželjene nuspojave lijeka svedene na minimum.Cardiovascular diseases are the leading cause of death in the world with hyperlipidemia being one of the most important risk factors in their development. Therefore, numerous randomized controlled trials conducted, showed decrease morbidity and mortality from adverse cardiovascular events by effective lipid reduction. Statins are the most effective medications used in treatment of hyperlipidemia. Rosuvastatin represents a “new generation” statin. It is a synthetic statin that inhibits the enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase, and therefore reducing the synthesis of endogenous cholesterol. The major effect of rosuvastatin is the reduction of LDL-cholesterol, and total cholesterol in the blood. It is the only statin that has been shown to increase the levels of HDL-cholesterol up to 15%. The anti-inflammatory, anti-oxidative, and anti-thrombotic effects of the drug were demonstrated in various studies, causing further decrease in cardiovascular morbidity and mortality, that effect is beyond the one described only by the reduction in total cholesterol levels. The most common side-effect of statin treatment is myalgia, causing the non-adherence and discontinuation of the medication, leading to “alternative” drug treatment. However, the approach of alternative drug treatment often showed itself to be ineffective solution. Since treating hyperlipidemia is crucial in reducing cardiovascular risk, the importance of adherence to treatment, and achieving patient compliance to statin therapy must be emphasized. Rosuvastatin is available in 6 different doses from 5 to 40 mg, allowing the physician to adjust the dose of medication according to the patient’s needs, to maintain highest treatment effect while reducing unwanted side-effects at the minimum

Resistant Hypertension

The most common causes of therapeutic failure in hypertensive control are undiscovered secondary causes of hypertension and lack of patient/doctor compliance. In about 10% of cases, it can be attributed to resistant hypertension caused by a hyperactivity of the sympathetic nervous system, condition with a high cardiovascular risk to the patient. Resistant hypertension is failure to diminish blood pressure values to <140/90 mmHg (<140/85 mmHg for diabetic patients) with a lifestyle method and prescription of least three antihypertensive drugs in optimal doses, including a diuretic, or when patients use four or more antihypertensive drugs regardless of blood pressure control. Patients with resistant hypertension are typically presented with a long-standing history of poorly controlled hypertension. Early diagnosis and adequate treatment are needed to avoid end organ damage and to prevent cardiorenovascular remodeling. Cardiorenovascular morbidity and mortality are significantly higher in resistant hypertensive population. The need for the individualization of therapy and the use of the management strategies are also given weight in the treatment of resistant hypertension patients, including optional, innovative therapies, like a renal denervation or baroreflex activation. New innovative device therapies create an additional novel pathway of blood pressure-lowering procedures and should be prescribed by a specialist hypertension clinic

Inbreeding and osteoporosis in Croatian island isolates

The aim of this study was to investigate a recessive genetic component in susceptibility to osteoporosis (OP) by comparing its prevalence in isolated villages of three Croatian islands: Brač, Hvar and Korčula with different levels of inbreeding. A random sample of 20-30% adults from 14 villages was obtained, including a total of 1, 389 examinees. The average inbreeding coefficient (F) of examinees from each village population was estimated using Wright's path method (based on genealogical information), isonymy data and average deviation from Hardy-Weinberg expectations for classic set of serogenetic polymorphisms. The variation in environmental, cultural and socio-economic factors between villages was investigated and shown to be minimal. The morphometry of the metacarpal bones was performed on hand-wrist radiographs of both hands in all examinees. OP was defined as values of cortical index smaller than 2 standard deviations based on distribution of values in examinees of the same sex under 45 years of age. Mean values of cortical index (CI) and prevalence of OP (both standardized by age and weighted for the sample size) in each village were correlated to the mean inbreeding coefficient (F). The coefficient of correlation (r) between F values and CI was -0.28 in males (p=0.08) and -0.42 in females (p=0.005), and between F and OP prevalence 0.32 in males (p<0.001) and 0.43 in females (p<0.001). These results indicate a trend of increased susceptibility to osteoporosis with increasing level of inbreeding in isolated communities of Croatian islands

Lutembacher’s syndrome: a case report

Lutembacherov sindrom je kombinacija kongenitalnog atrijskog septalnog defekta (ASD) i stečene mitralne stenoze (MS). Prvi put ga je opisao francuski liječnik Lutembacher 1916. godine. Ovaj sindrom je vrlo rijedak i smatra se da mu je incidencija 0.001/10,00000. Hemodinamski efekti ovog sindroma posljedica su relativnog utjecaja težine MS i veličine ASD. Prikazujemo 54-godišnju pacijenticu kojoj je bio indiciran transtorakalni ehokardiografski pregled (TTE) zbog evaluacije prijašnjeg nalaza srednje teške MS u sklopu progresije zaduhe unatrag mjesec dana. Prije dvije godine prilikom hospitalizacije uslijed srčanog popuštanja, primjenom TTE registrirana je srednje teška MS uz urednu sistoličku funkciju lijeve klijetke. Sada se primjenom TTE i transezofagijske ehokardiografije registrira srednje teška MS te ASD koji nije bio opisan u prijašnjim ultazvučnim nalazima pa je postavljena dijagnoza Lutembacherova sindroma. Ovaj prikaz slučaja pokazuje kako je ehokardiografija nezaobilazna dijagnostička metoda u otkrivanju mnogih kardioloških entiteta uključujući i ovaj rijetko prisutan sindrom.Lutembacher’s syndrome refers to a con- genital atrial septal defect (ASD) complicated by aquired mitral stenosis (MS). It was first described by Lutembacher, a French physician, in 1916. This syndrome is a very rare disease, it is found that the incidence of Lutembacher’s syndrome is 0.001/10,00000. The hemodynamic effects of this syndrome are a result of the inter- play between the relative effects of the ASD and MS. We present a 54-year-old female referred to hospital for echocardiographic evaluation of previously diagnosed mild MS. She reported progression of dyspnea over the last month. Two years ago, she was admitted to another hospital because of heart failure and transthoracic echo- cardiography (TTE) revealed moderate MS with perserved left ventricular systolic function. We performed TTE and transesophageal echocardiogram and found severe MS with ASD that was previously unrecognised. The diagnosis of Lutembacher’s syndrome was established. This case demonstrates the presence of this rare disease in our population, but we would also like to stress the importance of the role of echocardiography in identifying many clinical syndromes including this one

Interactions Between Genetic Variants in Glucose Transporter Type 9 (SLC2A9) and Dietary Habits in Serum Uric Acid Regulation

Aim To investigate possible interactions between genetic variants in glucose transporter type 9 (SLC2A9) gene and dietary habits in serum uric acid regulation. Methods Participants for this study were recruited from two isolated Croatian island communities of Vis (n = 918) and Korčula (n = 898). Three single nucleotide polymorphisms (SNP) from the SLC2A9 gene (rs1014290, rs6449213, rs737267) were correlated with dietary habits and uric acid. Results A significant decrease in uric acid levels was recorded with increasing consumption of milk, sour cream, duck and turkey, and eggs. The only significant interaction was found between potato consumption and rs737267 and a near-significant interaction was found between soft drinks and rs1014290 (interaction P = 0.068). Increased consumption of soft drinks interacting with the TT genotype at rs1014290 increased serum uric acid. No significant interactions were observed between food products consumption and rs6449213. Conclusion There is a certain extent of interaction between SLC2A9 and dietary patterns in serum uric acid determination. The metabolic effect of soft drinks seems to be determined by the underlying genotype of rs1014290

Holistic anthropological research of Hvar islanders, Croatia: from parish registries to DNA studies in 33 years

The complexity of interactions between hereditary, environmental and cultural factors in determining human phenotypes is often underestimated in biomedical research. It can be most clearly demonstrated when a well-defined human isolate population is considered and multiple measurements of phenotypes, genetic characteristics and studies of environmental and cultural determinants are performed and analysed. Even in such small communities, where decreased variability in all those factors is presumed, it is often apparent how difficult it is to disentangle the effects of separate interacting factors and explain most of the variance in phenotypes of interest. In this paper, we present 33 years of holistic anthropological research that was being conducted since 1971 in the island of Hvar, Croatia. During this period, detailed characterisation of migrations, demography, isonymy, linguistic differences, anthropometric traits (head and body dimensions), physiological (cardiorespiratory) properties, quantitative and qualitative dermatoglyphic traits, radiogrammetric metacarpal bone dimensions and genetic traits (erythrocyte antigens, HLA diversity, DNA short tandem repeat (STR), mitochondrial DNA and Y-chromosome polymorphysms) was performed. The analysis of this large collection of data using both model-bound and model-free approaches showed that the complexity underlying human biological traits may be considerably greater than generally assumed, which has important implications for design of future studies into genetic determinants of complex traits

Apical hypertrophic cardiomyopathy: a case report.

Apical hypertrophic cardiomyopathy (AHC) is a rare variant of hypertrophic cardiomyopathy characterized by thickening of the most distal part of the left ventricular (LV) wall. It was first described by Sakamoto in 1976 in Japanese patients. AHC was reported as a stri- king electrocardiographic pattern of giant negative T-waves and angiographic feature of end diastolic LV cavity configuration resembling an ace of spade by Yamaguchi et al. Although AHC is more common in Asia and it accounts for about 13% to 25% of all cases of hypertrophic cardiomyopathy, it is much less prevalent in the western population. Diagnostic modalities include ECG, echocardiography, ventriculography, nuclear myocardial perfusion studies and cardiac magnetic resonance imaging. We present a 58-year-old man with AHC that was unre- cognized for the previous 10 years. In conclusion, this rare disease could be found in the Croatian population too, whereas the appropriate interpretation of the ECG and echocardiography is crucial in recognizing this rare, but important form of hypertrophic cardiomyopathy