Učinkovitost i sigurnost kombinacije atorvastatina/amlodipina u jednoj tableti kod bolesnika s arterijskom hipertenzijom i dislipidemijom

The aim was to evaluate the efficacy of a single-pill combination of atorvastatin/amlodipine in patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk. This prospective study included 243 patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk, mean age 63.3±9.8 years. All patients were prescribed a treatment with one of the following doses of a single-pill combination of atorvastatin/amlodipine: 10/5, 10/10, 20/5 or 20/10 mg daily. The follow-up period was 3 months. The mean baseline values of the systolic and diastolic blood pressure were 155.7±16.2 and 92.0±9.2 mm Hg, respectively. At month 3, the respective mean systolic and diastolic blood pressure values were 136.9±26.9 and 80.6±5.1 mm Hg. The mean baseline values of total cholesterol and low-density lipoprotein cholesterol were 6.6±1.2 and 4.4±1.1 mmol/L, respectively. At month 3, the respective mean values of total cholesterol and low-density lipoprotein cholesterol were 5.1±0.9 and 2.9±1.0 mmol/L. Treatment was discontinued in 9 (3.7%) patients due to adverse events. In conclusion, treatment with the single-pill combination of atorvastatin/amlodipine was effective and well tolerated by the patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk.Cilj ovoga istraživanja je bio ocijeniti učinkovitost kombinacije atorvastatina/amlodipina u jednoj tableti kod bolesnika s arterijskom hipertenzijom, dislipidemijom i umjerenim do visokim kardiovaskularnim rizikom. Ovo prospektivno istraži­vanje obuhvatilo je 243 bolesnika s arterijskom hipertenzijom, dislipidemijom i umjerenim do visokim kardiovaskularnim rizikom, srednje dobi od 63,3±9,8 godina. Bolesnicima je propisana terapija jednim od sljedećih režima doziranja kombinacije atorvastatina/amlodipina u jednoj tableti: 10/5, 10/10, 20/5 ili 20/10 mg na dan. Razdoblje praćenja bilo je 3 mjeseca. Srednje početne vrijednosti sistoličkog i dijastoličkog tlaka bile su 155,7±16,2 i 92,0±92,0 mm Hg. Krajem 3. mjeseca vrijednosti sistoličkog i dijastoličkog tlaka bile su 136,9±26,9 i 80,6±5,0 mg Hg. Srednje početne vrijednosti ukupnog kolesterola i kolesterola niske gustoće bile su 6,6±1,2 i 4,4±1,1 mmol/L. Krajem 3. mjeseca vrijednosti ukupnog kolesterola i kolesterola niske gustoće bile su 5,1±0,9 i 2,9±1,0 mmol/L. Terapija analiziranom kombinacijom lijekova prekinuta je kod 9 (3,7%) bolesnika zbog neželjenih nuspojava. U zaključku, terapija kombinacijom atorvastatina/amlodipina u jednoj tableti visoko je učinkovita i dobro ju podnose bolesnici s arterijskom hipertenzijom, dislipidemijom i umjerenim do visokim kardiovaskularnim rizikom

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Anticoagulant prophylaxis and therapy in patients with COVID-19

В условията на пандемия от COVID-19 продължават проучванията на ранните и късните белодробни и сърдечно-съдови промени, нарушенията в коагулацията и риска от венозен тромбоемболизъм в хода на инфекцията. Особен интерес предизвикват публикуваните данни по тези теми и препоръките за антикоагулантна профилактика и лечение в клиничната практика. В този обзор са представени накратко отговори на някои от най-често задаваните въпроси за COVID-19: честота на тромбоемболични усложнения; необходимо ли е всички пациенти с COVID-19 да получават профилактична доза антикоагулант; кои антикоагуланти се препоръчват за приложение при пациенти, хоспитализирани в общо или интензивно отделение; с какви възможни лекарствени взаимодействия трябва да се съобразяваме при пациенти на антикоагулантна или антитромбоцитна терапия, които приемат и медикаменти за лечение на COVID-19; при кои пациенти с COVID-19 се препоръчва да се продължи антитромбозната профилактика и след изписването им от болница. Надяваме се тази информация да е полезна за всички медицински специалисти, лекуващи пациенти с COVID-19: интернисти, пулмолози, кардиолози, общопрактикуващи лекари During the COVID-19 pandemic, studies of the early and late pulmonary and cardiovascular changes, coagulation disorders and risk of venous thromboembolism in thе course of the infection are ongoing. Of particular interest are the published data on these topics and the recommendations for anticoagulant prophylaxis and treatment in the clinical practice. This review summarizes answers to some of the most commonly asked questions about COVID-19: incidence of thromboembolic complications; should all patients with COVID-19 receive a prophylactic dose of anticoagulant; which anticoagulants are recommended for use in patients hospitalized in a general ward or intensive care unit; what potential drug interactions should be considered in patients on anticoagulant or antiplatelets who are also taking COVID-19 therapies; which patients with COVID-19 are recommended to continue antithrombotic prophylaxis after their hospital discharge. We hope this information will be useful for all medical specialists who are dealing with COVID-19 patients: internists, pulmonologists, cardiologists, general practitioner

Abnormal myocardial performance index in M-mode color tissue Doppler-echocardiography

Индексът на миокардна производителност (myocardial performance index, MPI) е показател, използван за оценка на глобалната систолно-диастолна левокамерна функция и прогнозата при пациентите със сърдечни заболявания, даващ възможност за преценка на моментното състояние на пациента и проследяване на развитието на заболяването. Класическият метод за изчисляването му е пулсовата Doppler-ехокардиография (ЕхоКГ). Целта на проучването е да се оцени корелацията на индекса на миокардна производителност с класическите показатели на систолната и диастолната функция на лявата камера и да се направи преценка на граничните стойности на индекса на миокардна производителност при 1Р цветна тъканна Doppler-ЕхоКГ през аортната и митралната клапа, предсказващи патологичен MPI от пулсова Doppler-ЕхоКГ. Изследвани са 105 лица (30 здрави контроли, 45 човека с артериална хипертония и 30 - с ИБС. При изследваните пациенти е изчислен MPI с помощта на пулсова Doppler-ЕхоКГ (MPIPW) и едноразмерна цветна тъканна Doppler-ЕхоКГ през аортната (MPIAO1 и MPIAO2) и митралната (MPIMV) клапа. Индексът на миокардна производителност за всички изследвани лица показа ниска до умерена негативна корелация с левокамерната фракция на изтласкване, а установената корелация с изследваните показатели на диастолната функция е умерена до висока. При здравите лица установените корелации при почти всички сравнения не са зна-чими. Получените стойности на MPIAO1, MPIAO2 и MPIMV, предсказващи патологичен MPI от пулсов Doppler (MPIPW ≥ 0,50), са MPIAO1 ≥ 0,578, MPIAO2 ≥ 0,446 и MPIMV ≥ 0,552. Получените гранични стойности за MPI при едноразмерна цветна тъканна Doppler-ЕхоКГ през аортната и митралната клапа могат да се използват при оценката на глобалната левокамерна функция на пациентите със сърдечни заболявания. Необходими са по-нататъшни проучвания върху по-голям брой пациенти за преценка на прогностичната стойност на установените параметри. The myocardial performance index (MPI) is used for global systolic-diastolic left ventricular function and prognosis assessment in patients with heart disease, allowing assessment of the patient‘s current condition and disease development follow-up. The classic method of calculation is pulsed Doppler echocardiography. The aim of the study was to evaluate the correlation of myocardial performance index with established left ventricular systolic and diastolic function indices and to determine cut-off values of the myocardial performance index in M-mode color tissue Doppler echocardiography through the aortic and mitral valves predicting abnormal myocardial performance index by pulsed Doppler echocardiography. One hundred and fi ve subjects were studied, including 30 healthy controls, 45 hypertensive patients, and 30 patients with CHD. MPI was calculated using pulsed Doppler (MPIPW) and M-mode color tissue Doppler echocardiography through the aortic (MPIAO1 and MPIAO2) and mitral (MPIMV) valves. In all patients, the myocardial performance index showed a low to moderatenegative correlation with the left ventricular ejection fraction, and the correlation with the diastolic function indices was moderate to high. In healthy persons, the correlations were not signifi cant in almost all comparisons. The MPIAO1, MPIAO2,and MPIMV values predicting abnormal MPI by pulsed Doppler (MPIPW ≥ 0.50) are MPIAO1 ≥ 0.578, MPIAO2 ≥ 0.446, and MPIMV ≥ 0.552. The cut-off values of MPI by M-mode color tissue Doppler echocardiography through the aortic and mitral valve obtained can be used for global left ventricular function assessment in patients with heart disease. Further studies, on a larger number of patients, are necessary to estimate the predictive value of the parameters established

Physicians’ Perceptions of Their Patients’ Attitude and Knowledge of Long-Term Oral Anticoagulant Therapy in Bulgaria

Background and Objectives: Oral anticoagulation (OAC) is widely used in daily clinical practice worldwide for various indications. We aimed to explore the perception of Bulgarian clinicians about their patients’ attitude and knowledge of long-term OAC, prescribed for atrial fibrillation (AF) and/or known deep venous thrombosis (DVT)/pulmonary embolism (PE). Materials and Methods: We performed a cross-sectional study that involved 226 specialists: 187 (82.7%) cardiologists, 23 (10.2%) neurologists, and 16 (7.1%) vascular surgeons. They filled in a questionnaire, specially designed for our study, answering various questions regarding OAC treatment in their daily clinical practice. Results: The mean prescription rate of OACs in AF patients was 80.3% and in DVT/PE—88.6%. One hundred and eighty-seven (82.7%) of the participants stated they see their patients on OAC at least once per month. According to more than one-third of the inquired clinicians, the patients did not understand well enough the provided information concerning net clinical benefit of OAC treatment. About 68% of the clinicians declared that their patients would prefer a “mutual” approach, discussing with the physician the OAC options and taking together the final decision, whereas according to 43 (19.0%), the patients preferred the physician to take a decision for them. Patients’ OAC treatment had been interrupted at least once within the last year due to a physician’s decision by 178 (78.8%) of the participants and the most common reason was elective surgery. The most influential factors for a patient’s choice of OAC were the need of a specific diet to be kept, intake frequency, and possible adverse reactions. Conclusions: Our results suggest that a clinician’s continuous medical education, shared decision-making, and appropriate local strategies for improved awareness of AF/DVT/PE patients are key factors for improvement of OAC management

Efficacy and Safety of a Single-Pill Combination of Atorvastatin/Amlodipine in Patients with Arterial Hypertension and Dyslipidemia

The aim was to evaluate the efficacy of a single-pill combination of atorvastatin/amlodipine in patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk. This prospective study included 243 patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk, mean age 63.3±9.8 years. All patients were prescribed a treatment with one of the following doses of a single-pill combination of atorvastatin/amlodipine: 10/5, 10/10, 20/5 or 20/10 mg daily. The follow-up period was 3 months. The mean baseline values of the systolic and diastolic blood pressure were 155.7±16.2 and 92.0±9.2 mm Hg, respectively. At month 3, the respective mean systolic and diastolic blood pressure values were 136.9±26.9 and 80.6±5.1 mm Hg. The mean baseline values of total cholesterol and low-density lipoprotein cholesterol were 6.6±1.2 and 4.4±1.1 mmol/L, respectively. At month 3, the respective mean values of total cholesterol and low-density lipoprotein cholesterol were 5.1±0.9 and 2.9±1.0 mmol/L. Treatment was discontinued in 9 (3.7%) patients due to adverse events. In conclusion, treatment with the single-pill combination of atorvastatin/amlodipine was effective and well tolerated by the patients with arterial hypertension, dyslipidemia and moderate to high cardiovascular risk

The Coexistence of Systemic Lupus Erythematosus and Thyrotoxicosis: The Diagnostic Value of Antihistone Antibodies

We report four female patients with Graves' disease with positive ANA antibodies and possibility for development of systemic lupus erythematosus. All four patients have been treated with antithyroid drugs. SLE symptoms have appeared from 4 to 12 months after the beginning of therapy with methysol in two of them. The third patient had no symptoms for SLE, but her ANA, anti-DNA, and antihistone antibodies had been positive at the time of the onset of thyrotoxicosis. The fourth patient had alopecia areata with positive ANA and antihistone antibodies

Pericardial Effusion in Obstructive Sleep Apnea without Pulmonary Arterial Hypertension and Daily Hypoxemia - is it Unusual?

Background: Pericardial effusion in chronic hypoxemic lung diseases, such as Obstructive Sleep Apnea syndrome, usually occurs after the development of severe pulmonary arterial hypertension. However, data about the frequency of pericardial effusions in Obstructive Sleep Apnea syndrome without pulmonary arterial hypertension and/or daytime hypoxemia are still scarce, and their pathogenesis is unclear. Aims: To assess the prevalence of pericardial effusions and their volume and location in patients with obesity and Obstructive Sleep Apnea syndrome without pulmonary arterial hypertension and/or hypoxemia. Study Design: Cross-sectional study. Methods: We included 279 consecutive patients (162 males) with newly diagnosed Obstructive Sleep Apnea syndrome having a mean age of 42.8±12.4 years and a mean body mass index of 37.3±7.8 kg/m2. Obstructive Sleep Apnea syndrome was confirmed by polysomnography. Main exclusion criteria were concomitant inflammatory diseases, thyroid dysfunction, daytime hypoxemia, nephrotic syndrome, left ventricular systolic dysfunction and pulmonary arterial hypertension. Results: Pericardial effusion was found in 102 (36.56%) -all of them with moderate to severe obstructive Sleep Apnea syndrome. The mean effusion volume was mild to moderate (up to 250 mL). In 36 patients (35.3%) the pericardial effusion was diffuse, in 42 (41.2%), the pericardial effusion was located in front of the right atrium and the right ventricle, and in 24 (23.5%) the pericardial effusion was situated in front of the right cardiac cavities and the left atrium. We found a significant positive correlation between the presence of pericardial effusion and apnea-hypopnea index (r=0.374, p<0.001), body mass index (r=0.473, p<0.001), and desaturation time during sleep (r=0.289, p<0.001). Conclusion: Pericardial effusion in patients with obesity and moderate to severe Obstructive Sleep Apnea syndrome without daily hypoxemia and/or pulmonary hypertension is a relatively common finding. The occurrence of pericardial effusions is dependent mostly on the grade of Obstructive Sleep Apnea syndrome, degree of obesity, and duration of sleep desaturation