The Role of Sartans in Cardiovascular Prevention

Primjena blokatora angiotenzinskih receptora (AT1) u kardiovaskularnoj prevenciji temelji se na liječenju arterijske hipertenzije. Telmisartan, u grupi sartana kojima pripada, povrh antihipertenzivnoga djelovanja, zaslužuje posebno mjesto zbog dokazanih pleiotropinih, metaboličkih, biohumoralnih, antiproliferativnih i vaskularnih učinaka, temeljnih procesa vaskularnoga starenja, ali i nastanka; progresije ateroskleroze čije još uvijek česte fatalne posljedice zahtijevaju rano prepoznavanje rizika i sveobuhvatnu primarnu i sekundarnu kardiovaskularnu prevenciju. Na temelju stručno-znanstvenih dokaza telmisartan se dokazao lijekom s dobrom podnošljivošću, dobrim antihipertenzivnim učinkom tijekom 24 sata, a indiciran je u prevenciji kardiovaskularnih bolesti.The application of angiotensin receptor blockers (AT1) in cardiovascular prevention is based on the treatment of arterial hypertension. Telmisartan, a medication from the sartan group, has not only an antihypertensive effect but proven pleiotropic, metabolic, biohumoral, antiproliferative, and vascular effects – the basic processes of vascular aging as well as the progression of atherosclerosis, a disease with a high mortality that requires early risk recognition and comprehensive primary and secondary cardiovascular prevention. Based on scientific evidence, telmisartan has been proven to provide a well tolerated antihypertensive effect over 24 hours, and is indicated in the prevention of cardiovascular diseases

Peripheral artery disease of lower extremities – review of the European Society of Cardiology guidelines.

Periferna arterijska bolest (PAB) donjih ekstremiteta prepoznata je kao ozbiljan kardiovaskularni poremećaj. Simptomatska i asimptomatska PAB prediktor je infarkta miokarda, moždanog udara i kardiovaskularnog mortaliteta. 2011. godine objavljene su prve smjernice Europskog kardiološkog društva o dijagnostici i liječenju PAB. Smjernice obuhvaćaju aterosklerotsku bolest svih nekoronarnih vaskularnih područja, a značajan dio smjernica posvećen je upravo okluzivnoj bolesti arterija donjih ekstremiteta. Osnovni dijagnostički test jest mjerenje omjera sistoličkog tlaka na gležnju i ruci (engl. ancle-brachial index, ABI), koji osim potvrde dijagnoze ukazuje i na težinu bolesti. Vrijednosti ABI <0,9 su patološke, dok ABI <0,5 nosi visok rizik od amputacije. Kombinacija ABI i dupleks ultrazvuka dovoljna je za donošenje optimalne odluke o načinu liječenja većine bolesnika. Digitalna subtrakcijska angiografija danas se primjenjuje uglavnom samo kada je planirana endovaskularna intervencija. Opće preporuke u liječenju PAB podrazumjevaju prestanak pušenja, poticanje svakodnevne tjelesne aktivnosti, redukciju prekomjerene tjelesne težine te favoriziranje mediteranske prehrane. Antihipertenzivi, statini i antitrombocitni lijekovi okosnica su farmakoterapije. Bolesnici s intermitentnim klaudikacijama moraju biti upoznati s važnošću redovitih vježbi hodanja koje signifikantno produžavaju hodnu prugu. Revaskularizacija u asimptomatskih bolesnika se ne preporuča. U mnogim centrima danas se kao prva revaskularizacijska metoda preferira perkutana angioplastika (PTA), a kirurška revaskularizacija u slučaju neuspjeha PTA. Pokušaj revaskularizacije obavezan je kod kritične ishemije. Revaskularizacija je opravdana kod aortoilijačne bolesti te u svih bolesnika koji unatoč tromjesečnoj konzervativnoj terapiji i dalje imaju klaudikacije koje im značajno narušavaju kvalitetu života. Liječenje bolesnika s PAB često zahtijeva multidisciplinarni pristup. Primjena smjernica u svakodnevnoj praksi pruža dodatnu sigurnost u odluci o optimalnom načinu liječenja svakog pojedinog bolesnika.Peripheral artery disease (PAD) of the lower extremities has been recognized as a serious cardiovascular disorder. Symptomatic and asymptomatic PAD is a predictor of myocardial infarction, stroke and cardiovascular mortality. In 2011 the first European Society of Cardiology guidelines on PAD diagnostics and treatment were published. The guidelines include atherosclerotic disease of all non-coronary vascular areas, and a great part of the guidelines covers occlusive artery disease of lower extremities. The main diagnostic test is the ankle-brachial index measurement (ABI), which in addition to confirmation of the diagnosis indicates the severity of the disease. ABI values <0.9 are pathological, while ABI <0.5 carries a high risk of amputation. The combination of ABI and duplex ultrasound is sufficient for making an optimal treatment decision for most of the patients. Digital subtraction angiography is today used mainly when the endovascular intervention is planned. General recommendations for treatment of PAD include giving up smoking, encouraging daily physical activity, overweight reduction and opting for Mediterranean diet. Antihypertensive drugs, statins and antiplatelet drugs are the basic drugs in pharmacotherapy. Patients with intermittent claudications must be familiar with the importance of regular walking exercises that significantly prolong the walking distance. Revascularization in asymptomatic patients is not recommended. In many centers today, percutaneous transluminal angioplasty (PTA) is preferred as the first revascularization method, while the surgical revascularization is preferred in case of failure of PTA. The attempt of revascularization is mandatory in the event of for critical ischemia. Revascularization is justified in case of aortoiliac disease and in all patients that despite a three-month conservative therapy still have claudications which severely impair their quality of life. Treatment of patients with PAD often requires a multidisciplinary approach. Application of guidelines in daily practice provides additional safety in making the decision on optimal method of treatment for each patient

Peripheral artery disease of lower extremities – review of the European Society of Cardiology guidelines.

Periferna arterijska bolest (PAB) donjih ekstremiteta prepoznata je kao ozbiljan kardiovaskularni poremećaj. Simptomatska i asimptomatska PAB prediktor je infarkta miokarda, moždanog udara i kardiovaskularnog mortaliteta. 2011. godine objavljene su prve smjernice Europskog kardiološkog društva o dijagnostici i liječenju PAB. Smjernice obuhvaćaju aterosklerotsku bolest svih nekoronarnih vaskularnih područja, a značajan dio smjernica posvećen je upravo okluzivnoj bolesti arterija donjih ekstremiteta. Osnovni dijagnostički test jest mjerenje omjera sistoličkog tlaka na gležnju i ruci (engl. ancle-brachial index, ABI), koji osim potvrde dijagnoze ukazuje i na težinu bolesti. Vrijednosti ABI <0,9 su patološke, dok ABI <0,5 nosi visok rizik od amputacije. Kombinacija ABI i dupleks ultrazvuka dovoljna je za donošenje optimalne odluke o načinu liječenja većine bolesnika. Digitalna subtrakcijska angiografija danas se primjenjuje uglavnom samo kada je planirana endovaskularna intervencija. Opće preporuke u liječenju PAB podrazumjevaju prestanak pušenja, poticanje svakodnevne tjelesne aktivnosti, redukciju prekomjerene tjelesne težine te favoriziranje mediteranske prehrane. Antihipertenzivi, statini i antitrombocitni lijekovi okosnica su farmakoterapije. Bolesnici s intermitentnim klaudikacijama moraju biti upoznati s važnošću redovitih vježbi hodanja koje signifikantno produžavaju hodnu prugu. Revaskularizacija u asimptomatskih bolesnika se ne preporuča. U mnogim centrima danas se kao prva revaskularizacijska metoda preferira perkutana angioplastika (PTA), a kirurška revaskularizacija u slučaju neuspjeha PTA. Pokušaj revaskularizacije obavezan je kod kritične ishemije. Revaskularizacija je opravdana kod aortoilijačne bolesti te u svih bolesnika koji unatoč tromjesečnoj konzervativnoj terapiji i dalje imaju klaudikacije koje im značajno narušavaju kvalitetu života. Liječenje bolesnika s PAB često zahtijeva multidisciplinarni pristup. Primjena smjernica u svakodnevnoj praksi pruža dodatnu sigurnost u odluci o optimalnom načinu liječenja svakog pojedinog bolesnika.Peripheral artery disease (PAD) of the lower extremities has been recognized as a serious cardiovascular disorder. Symptomatic and asymptomatic PAD is a predictor of myocardial infarction, stroke and cardiovascular mortality. In 2011 the first European Society of Cardiology guidelines on PAD diagnostics and treatment were published. The guidelines include atherosclerotic disease of all non-coronary vascular areas, and a great part of the guidelines covers occlusive artery disease of lower extremities. The main diagnostic test is the ankle-brachial index measurement (ABI), which in addition to confirmation of the diagnosis indicates the severity of the disease. ABI values <0.9 are pathological, while ABI <0.5 carries a high risk of amputation. The combination of ABI and duplex ultrasound is sufficient for making an optimal treatment decision for most of the patients. Digital subtraction angiography is today used mainly when the endovascular intervention is planned. General recommendations for treatment of PAD include giving up smoking, encouraging daily physical activity, overweight reduction and opting for Mediterranean diet. Antihypertensive drugs, statins and antiplatelet drugs are the basic drugs in pharmacotherapy. Patients with intermittent claudications must be familiar with the importance of regular walking exercises that significantly prolong the walking distance. Revascularization in asymptomatic patients is not recommended. In many centers today, percutaneous transluminal angioplasty (PTA) is preferred as the first revascularization method, while the surgical revascularization is preferred in case of failure of PTA. The attempt of revascularization is mandatory in the event of for critical ischemia. Revascularization is justified in case of aortoiliac disease and in all patients that despite a three-month conservative therapy still have claudications which severely impair their quality of life. Treatment of patients with PAD often requires a multidisciplinary approach. Application of guidelines in daily practice provides additional safety in making the decision on optimal method of treatment for each patient

Interactions of MinK and e-NOS Gene Polymorphisms Appear to Be Inconsistent Predictors of Atrial Fibrillation Propensity, but Long Alleles of ESR1 Promoter TA Repeat May Be a Promising Marker

Interactions of MinK and e-NOS Gene Polymorphisms Appear to Be Inconsistent Predictors of Atrial Fibrillation Propensity, but Long Alleles of ESR1 Promoter TA Repeat May Be a Promising Marker. We analyzed minK, e-NOS and ESR1 gene polymorphisms in 40 patients with atrial fibrillation (AF) without major structural heart disease compared to 35 healthy controls. A missense polymorphism in the minK gene with A/G substitution at nucleotide 112 causing serine (S) to glycine (G) change, 786 T/C polymorphism in the 5’ flanking region of e-NOS gene and TA polymorphism in the regulatory region of estrogen receptor ESR1 gene with long (ł19 TA repeats) and short alleles were examined. Only a slight increase in minK G allele frequency, but with marked excess in AG/TT combination of minK and e-NOS polymorphisms was found in the AF group. The interpretation remains tentative due to small groups precluding statistical significance of differences, possible lab flaws and inconsistencies with earlier data. However, ESR1 long allele homozygotes were strikingly more frequent in the AF than in control group, reaching statistical significance surprisingly in males (p<0.02). Functional activity of estrogen receptors may be more critical in males than in females with abundance of circulating estrogen. Contrasting the intricate complexity of genetic polymorphisms influencing cardiac rhythm with our modest research, we would limit the conclusion to the plea for further research of ESR1 role in AF