A new approach to the treatment of dyslipidemia

During the last decade, the evidence of beneficial effects of cholesterol lowering in patients with coronary heart disease has been proven in many clinical trials. The National Cholesterol Education Program (NCEP) released 2004 update to the Adult Treatment Panel III (ATP III) guidelines. The new guidelines of European Society of Cardiology announced in 2007 support more intensive LDL-C lowering in patients at high risk of cardiovascular diseases. For patients at the highest risk of cardiovascular diseases (diabetic patients with coronary heart disease), the recommended LDL-C goal is <1.8 mmol/L. In very high-, high-, and moderately high-risk patients, statin therapy should be considered with a treatment targeting an LDL-C reduction of 30– 40%. Clinical studies have shown that statin therapy alone is not always effective, especially in patients with primary hypercholesterolemia. Furthermore, high doses of statins can increase the possibility of adverse events. The combination of statins with intestinal cholesterol absorption inhibitors is more effective than statin monotherapy in LDL-C lowering and is well tolerated

Atmospheric, cosmic, solar variations and hospitalization for cardiovascular diseases

Environment and Health - Bridging South, North, East and West, 19-23 August 2013 in Basel, Switzerland : Abstracts of the 2013 Conference of the International Society of Environmental Epidemiology (ISEE), the International Society of Exposure Science (ISES), and the International Society of Indoor Air Quality and Climate (ISIAQ)Background. Recent investigations have shown that hospitalizations for cardiovascular diseases might be associated with environmental factors. Aim. To evaluate the associations between seasonal, meteorological, heliophysical factors and the risk of hospitalizations due to acute myocardial infarction (AMI) and stroke. Methods. The study comprised 1115 patients with AMI and 801 patients with stroke hospitalized in Lithuanian University of Health Sciences Cardiology and Neurology Clinics in the year 2010. National Geophysical Data Centre data was used to evaluate solar activity, geomagnetic activity and cosmic radiation activity. Kaunas Meteorological station data was used to evaluate meteorological conditions. SPSS 15.0 for Windows was used in the statistical analysis. Results. The mean of hospitalized patients with AMI per day in June and July was 2.40±0.18, in other months 3.18±0.18, p=0.004. When a day before hospitalization wind speed was ≤ 1.3 m/s, AMI mean was 3.06±0.179. When wind speed was ≥2.7 m/s, AMI mean was 3.17±0.19. When atmosphere pressure a day before hospitalization was lower than 995 mmHg, AMI relative risk was RR=1.23, 95% CI 1.08-1.41. When relative humidity a day before hospitalization was lower than 88%, AMI relative risk RR=1.18, 95% CI 1.03-1.34. When geomagnetic index Ap≥16, AMI and stroke means were higher than when Ap<16. When geomagnetic activity was low (Ap<4) and cosmic ray activity was high (≥9500 imp/min), AMI mean was 3.7. When geomagnetic activity was low (Ap<4) and cosmic radiation activity was lower than 9500 imp/min, AMI mean was 2.88, p<0.05. Conclusions. In summer AMI frequency was lower than in other seasons. There were tendencies for stroke risk to be higher when geomagnetic activity was high. AMI risk was associated with wind speed, atmosphere pressure, relative humidity, geomagnetic activity and cosmic radiation activityLietuvos sveikatos mokslų universitetasLietuvos sveikatos mokslų universiteto Medicinos akademijos Kardiologijos institutasLietuvos sveikatos mokslų universiteto Medicinos akademijos Kardiologijos klinik

The association between geomagnetic storms, solar particle events and hospital admissions for first myocardial infarction

Lietuvos sveikatos mokslų universiteta

The association between solar particle events, geomagnetic storms, and hospital admissions for myocardial infarction

Aplinkotyros katedraLietuvos sveikatos mokslų universitetasVytauto Didžiojo universiteta

Incidentally Diagnosed Malignant Coronary Artery Anomaly: A Clinical Case

The incidence of congenital coronary artery anomalies is estimated to range between 1% and 2% in the general population. The separate types of coronary artery anomalies are even rarer – the left main coronary artery arising from the right coronary sinus and passing between the thoracic aorta and the pulmonary artery is one of them. In this case, the segment of the artery that courses between the aorta and the pulmonary artery is prone to compression, especially during heavy exercise. Outcomes may be fatal due to myocardial hypoperfusion, which is associated with sudden cardiac death especially among children, young adults, and athletes. Nowadays, innate coronary artery anomalies may be incidentally diagnosed in older age using new investigation methods such as computed tomography angiography

Implementation of international transtelephonic ECG platform for patients with ischemic heart disease

Ischemic heart disease in European countries over decades causes up to 55% of all cases of sudden death and also has a high rate of mortality, morbidity, and hospital admission. Patients with such chronic diseases also require intensive home care facilities from community nurses. The aim was to establish international multilingual platform for transtelephonic ECG system as an alternative solution for home care and assess its performance. Methods. During this pilot study, the international toll-free line between Lithuania and Germany was established, and practical applicability of the tele-ECG device was tested. Transtelephonic ECG system was implemented between Telemedicine Center in Bad Segeberg (Bad Segeberg Clinic, Germany), the Call Center in Kaunas at the Hospital of Kaunas University of Medicine, and a patient residence. Results. Over a 6-month follow-up period, 34 patients were recruited. Following the ECG transmission, 86 teleconsultations were done. During the study, a total of 329 ECGs were sent by the patients; out of them, 14 ECGs were with clinical changes. Technical problems due to insufficient patient training, telecommunication systems, acoustic data transmission, and device itself were reported. Up to 23% of ECGs sent by patients were unreadable and not applicable for further clinical analysis. Conclusions. Our study showed the potential of telemedicine facilities to overcome the problems of access that makes the technique so potentially useful, but for telemonitoring application at patient homes in a wider population, it needs to be improved in terms of technical performance, transmission and analysis automatization

The Association between phenomena on the Sun, geomagnetic activity, meteorological variables, and cardiovascular characteristic of patients with myocardial infarction

It has been found that solar and geomagnetic activity affects the cardiovascular system. Some evidence has been reported on the increase in the rate of myocardial infarction, stroke and myocardial infarction related deaths during geomagnetic storms. We investigated the association between cardiovascular characteristics of patients, admitted for myocardial infarction with ST elevation (STEMI), and geomagnetic activity (GMA), solar proton events (SPE), solar flares, and meteorological variables during admission. The data of 1,979 patients hospitalized at the Hospital of Lithuanian University of Health Sciences (Kaunas) were analyzed. We evaluated the association between environmental variables and patient's characteristics by multivariate logistic regression, controlling patient's gender and age. Two days after geomagnetic storms the risk of STEMI was over 1.5 times increased in patients who had a medical history of myocardial infarction, stable angina, renal or pulmonary diseases. The dose-response association between GMA level and STEMI risk for patients with renal diseases in history was observed. Two days after SPE the risk of STEMI in patients with stable angina in anamnesis was increased over 1.5 times, adjusting by GMA level. The SPE were associated with an increase of risk for patients with renal diseases in history. This study confirms the strongest effect of phenomena in the Sun in high risk patientsAplinkotyros katedraLietuvos sveikatos mokslų universitetasVytauto Didžiojo universiteta

Image quality of 16-slice computed tomography coronary angiography in patients with complete left bundle branch block

Objective. Noninvasive diagnosis of coronary artery disease in patients with left bundle branch block is challenging. Multislice computed tomography can be useful in this population; however, quality of images depends on the patterns of myocardial contractions. We investigated the influence of left bundle branch block on image quality of multislice computed tomography coronary angiography. Materials and methods. Multislice computed tomography coronary angiography was performed in 30 patients with left bundle branch block and 30 patients without conduction disturbances. Image quality of each coronary segment was visually assessed and rated on a five-point scale (1=highest quality). Results. Average image quality score in the best cardiac cycle phase did not differ significantly between groups (1.71±0.59 in the left bundle branch block group vs. 1.60±0.57 in the control group, P=0.46). In the left bundle branch block group, a significantly lower image quality score was observed in end-systolic cardiac phase (2.67±0.6 vs. 2.22±0.65 in the control group, P=0.007), whereas no difference was demonstrated in mid-diastolic phase (1.73±0.6 vs. 1.69±0.66 in the control group, P=0.81). After image assessment in multiple cardiac phases, an increase in image quality score was higher in the left bundle branch block than in the control group (0.2±0.17 vs. 0.11±0.14, P=0.003). A negative correlation was observed between image quality score and both the heart rate and heart rate variability in both groups (P&lt;0.001). Conclusion. A nonsignificantly lower overall image quality of multislice computed tomography coronary angiography was demonstrated in the left bundle branch block group. In the presence of left bundle branch block, image quality in the end-systolic phase was significantly lower. Image assessment in multiple phases increased overall image quality and is therefore advisable in patients with left bundle branch block. Increased heart rate and heart rate variability worsened image quality in both groups

Ūminio širdies nepakankamumo sąsajos su širdies ir kraujagyslių sistemos ligų baigtimis

Tyrimo tikslas. Nustatyti ūminių išeminių sindromų ir ūminio širdies nepakankamumo sąsajas su mirtimi nuo širdies ir kraujagyslių sistemos ligų stacionare bei mirtimi nuo širdies ir kraujagyslių sistemos ligų ir lėtiniu širdies nepakankamumu vienerių metų laikotarpiu. Tirtųjų kontingentas ir tyrimo metodika. Tirtųjų kontingentą sudarė nuoseklios imties 1554 ligoniai, susirgę ūminiais išeminiais sindromais (Q bangos miokardo infarktu – 607, miokardo infarktu be Q bangos – 441, nestabiliąja krūtinės angina – 500), 2005 m. gydyti Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų (buvusiose Kauno medicinos universiteto klinikose) Kardiologijos klinikoje. Ligonių būklei stacionariniu laikotarpiu įvertinti naudoti Lietuvos sveikatos mokslų universiteto Širdies centro informacinės bazės duomenys. Ligonių būklė stebėta vienerius metus nuo hospitalizavimo dienos. Rezultatai. Ūminis širdies nepakankamumas stacionare diagnozuotas trečdaliui (32,3 proc.) ligonių, postacionariniu vienerių metų laikotarpiu lėtinis širdies nepakankamumas – beveik penktadaliui (17,0 proc.) ligonių. Miokardo revaskulizacija atlikta 70,8 proc. ligonių, kuriems vainikinių arterijų stenozė buvo ≥70 proc. Lėtinis širdies nepakankamumas po vienerių metų įvertintas 1039 ligoniams ir nustatytas tris kartus dažniau nei ligoniams be stacionare nustatyto ūminio širdies nepakankamumo (31,4 ir 11,6 proc., p&lt;0,05). Mirtis nuo širdies ir kraujagyslių sistemos ligų stacionariniu ir postacionariniu laikotarpiu reikšmingai dažniau ištiko ligonius, kuriems buvo ūminis širdies nepakankamumas palyginti su ligoniais, kuriems nebuvo ūminio širdies nepakankamumo (11,5 ir 1,9 proc., p&lt;0,001; 7,7 ir 2,3 proc., p&lt;0,001). Išvada. Ištikus ūminiams išeminiams sindromams, atsiradęs ūminis širdies nepakankamumas reikšmingai didina lėtinio širdies nepakankamumo dažnumą postacionariniu vienerių metų laikotarpiu bei mirties nuo širdies ir kraujagyslių sistemos ligų dažnumą stacionare ir vienerių metų laikotarpiu

Admission hyperglycemia and abnormal glucose tolerance at discharge in patients with acute myocardial infarction and no previous history of diabetes mellitus

The objective of this study was to determine frequency of admission hyperglycemia and abnormal glucose tolerance at discharge in patients with acute myocardial infarction and no previous history of diabetes mellitus. Methods and results. Data on 1522 patients with acute myocardial infarction and no previous history of diabetes mellitus were analyzed. Before discharge from hospital, standardized oral glucose tolerance test was performed in 197 patients with admission hyperglycemia. Results. Admission hyperglycemia (≥6.1 mmol/L) was determined in half of the patients with acute myocardial infarction: glucose concentration of 6.1–6.99 mmol/L was in 21.5% and ≥7.0 mmol/L in 30.1% of the patients. By using glucose tolerance test, normal glucose metabolism was noted in 57.9% of the patients with admission hyperglycemia; abnormal glucose tolerance was diagnosed newly in more than one-third and glucose concentration of ≥11.1 mmol/L in 10.1% of the patients. Conclusions. Abnormal glucose tolerance is a frequent feature in nondiabetic patients with admission hyperglycemia during acute myocardial infarction, and glucose tolerance test should be considered in all patients with ischemic heart disease for early modification of this risk factor