How has the treatment of hypercholesterolemia in Poland changed over the last six years?

Background: To assess changes in the treatment of hypercholesterolemia in Polish ambulatory care over the last 6 years. Methods: Data were obtained from two separate questionnaire-based studies, conducted in 2009 and 2015. The analysis included only those patient visits, which were associated with modifications of previous hypercholesterolemia treatment (1924 visits from the year 2009 and 1888 visits from the year 2015). Results: In the present registry, there was a 19 mg/dL reduction in the level of total cholesterol and a 17 mg/dL reduction in the level of low-density lipoprotein compared to year 2009. In both registries, the most common reason for treatment modification was failure to achieve therapeutic goals. Compared to year 2009, there was an increase in the proportion of patients treated with atorvastatin and a reduction in the proportion of patients treated with simvastatin at baseline; additionally, in year 2015, 10% of patients received rosuvastatin. After therapy modification, there was a similar increase in the proportion of patients treated with a statin-fibrate combination in both registries. However, at present, ezetimibe was significantly less often added to previous therapy. In both registries, therapy modification led to an increase in the mean doses of the most commonly used statins, although presently, this increase was smaller than in 2009. Conclusions: The most favorable change in the treatment of hypercholesterolemia is an increase in the proportion of patients treated with strong statins. Unfavorable changes include a reduction in the frequency of polytherapy, especially with ezetimibe, and a tendency to prescribe lower, ineffective statin doses

Alternative methods for functional assessment of intermediate coronary lesions

Wire-based fractional flow reserve (FFR) is a diagnostic tool used to evaluate the ischemic burden of coronary lesions. Large-scale studies have shown that FFR-guided revascularization is associated with better clinical outcomes. However, wide adoption of this technology is limited due to the considerable cost, additional time needed for set-up and performance of the measurement as well as the invasiveness of the procedure which requires pressure wire placement across the lesion into the distal segment of the coronary artery. To overcome these limitations new, promising, and less-/non-invasive methods were developed. These methods are based on computational fluid dynamics analysis and three-dimensional lumen reconstruction. The aim of this paper is to review scientific evidence supporting the clinical safety and efficacy of these techniques, such as instantaneous wave-free ratio, quantitative flow ratio and FFR calculated from computed tomographic angiography

Inhibitory CETP — czy nowe leki mają szansę zrewolucjonizować farmakoterapię miażdżycy?

Diseases of the cardiovascular system are a major problem in modern medicine. Existing methods oftreatment are based on the reduction of plasma LDL-C levels , but the results are not fully satisfactory. Currently, there are high hopes for raising HDL plasma concentration as a factor reducing cardiovascularrisk. The article focuses on a new group of drugs — inhibitors of cholesterol ester transfer protein (CETP).Their main action is inhibition of functions of proteins transporting cholesterol esters from HDL to LDLand VLDL, which leads to an increase of HDL plasma concentration and, as a result, further reduces therisk of atherosclerosis.It is expected that CETP inhibitors will change lipid-lowering therapy. That is why they are very intensivelyresearched and several parallel studies are being performed. Published results allow to assessthe chances of a revolution in the treatment of atherosclerosis. The article attempts to demonstrate andorganize these results. The studies concerning four representatives of CETP inhibitors are presented.These are: torcetrapib, anacetrapib, dalcetrapib and evacetrapib. Clinical effects, adverse reactions andclinical usefulness are compared. Also, their effects on the lipid profile are analyzed. CETP inhibitors stillrequire a lot of research before they could be used in clinical practice. The initial enthusiasm associatedwith them was repeatedly cooled down due to necessity of early termination of several large studiesbecause of unsatisfactory effects. Currently obtained results, although inconclusive, suggest that thereis still a chance that the impact on the level of HDL by CETP inhibition will be effective in lipid-loweringtherapy, as an addition to already known drugs.Choroby układu sercowo-naczyniowego to ogromny problem współczesnej medycyny. Podstawą dotychczasstosowanych metod terapii jest obniżanie stężenia cholesterolu frakcji LDL w osoczu, ale efekty niesą w pełni satysfakcjonujące. Obecnie duże nadzieje są pokładane w zwiększaniu osoczowego stężeniacholesterolu frakcji HDL jako czynnika zmniejszającego ryzyko sercowo-naczyniowe. W artykule skupionosię na grupie nowych leków, tak zwanych inhibitorów białka transportującego estry cholesterolu(CETP). Ich główne działanie polega na zahamowaniu funkcji białka transportującego estry cholesteroluz HDL do LDL i VLDL, co ma prowadzić do zwiększenia stężenia HDL w osoczu i w rezultacie dodatkowozmniejszać ryzyko wystąpienia miażdżycy.Oczekuje się, że inhibitory CETP zmienią zasady terapii hipolipemizującej, dlatego są bardzo intensywniebadane. Jest prowadzonych wiele równoległych analiz oceniających je, a publikowane wyniki pozwalająrealnie oceniać szanse na rewolucję w leczeniu miażdżycy. W artykule starano się je przybliżyć i uporządkować.W pracy zaprezentowano przebieg badań nad 4 przedstawicielami inhibitorów CETP: torcetrapibu,anacetrapibu, dalcetrapibu i ewacetrapibu. Uwzględniono ich efekty kliniczne, działania niepożądaneoraz spodziewaną przydatność kliniczną, a także porównano ich działanie na profil lipidowy. Przed ewentualnymzastosowaniem w praktyce klinicznej inhibitory CETP nadal wymagają wielu badań. Pierwotnyentuzjazm z nimi związany wielokrotnie chłodziła konieczność przedwczesnego zakończenia kilku dużychbadań wobec niezadowalających efektów działania. Obecnie uzyskiwane wyniki, choć niejednoznaczne,nadal sugerują istnienie prawdopodobieństwa, że wpływ na stężenie cholesterolu frakcji HDL poprzezzahamowanie CETP będzie skuteczny w leczeniu hipolipemizującym, jako dodatek do znanych już leków