How much do Croatian Physicians and Croatian Population Know about Risk Factor for Cadiovascular Diseases?

The results of two studies about knowledge and awareness of risk factors for cardiovascular diseases (CVD) of 1382 Croatian primary care physicians, internists and cardiologists as well as 882 citizens have been presented. The results show that although a great majority of physicians think that the guidelines for the prevention of CVD are useful, only more than a half of them use them in their daily work. Although more than four-fifths of physicians think that they provide good treatment to their patients suffering from dyslipidemia, only a half of them know what are the LDL target values in the patients with a high risk for CVD and which HDL concentration is risky for CVD. Although the population die because of CVD twice as much than of malignant disease, the respondents in the group of general population are much more afraid of malign diseases, although many of them know that CVD are the main cause of death. Only more than one fifth of patients have received advice from their physician in connection with lipid disorders as the CVD risk factor, while more than a half of respondents have received no instructions about the risk factors. We may conclude that physicians should know more about risk factors and guidelines for prevention of CVD and that the awareness of and knowledge about these factors in Croatian population should also be improved. The transfer of information about CVD risk factors between physicians and patients should be improved as well

The perception and knowledge of cardiovascular risk factors among medical students

Aim To assess perceptions, knowledge, and awareness of cardiovascular disease (CVD) risk factors among medical students (freshmen and graduating students). Methods A descriptive cross-sectional survey based on an anonymous self-administered questionnaire was conducted in 2008 on 443 medical students – 228 freshmen on their enrollment day and 214 students on the day of their final exam at the University of Zagreb School of Medicine, Croatia. Results The perception and knowledge of some CVD risk factors, eg, dyslipidemia, arterial hypertension, and metabolic syndrome as well as of lipid-lowering therapy important for CVD prevention was significantly better among graduating students but was still not sufficient. Only 66% of graduating students reported that they would prescribe lipid-lowering therapy to high risk patients. Disappointingly, many graduating students were smoking (30.4%) and had low-awareness of obesity as an important CVD risk factor. Conclusion These results suggest an urgent need to improve medical students’ knowledge of obesity and low physical activity as important CVD risk factors and of the methods for increasing low high-density lipoprotein-cholesterol and for smoking cessation. All this provides a rationale for modifying the university core curriculum to include more information concerning these issues

Prevention of Cardiovascular Diseases in the Elderly

Pučanstvo razvijenih zemalja, uključujući i Hrvatsku, postaje sve starije i danas su u ovim zemljama kardiovaskularne bolesti uzrokovane aterosklerozom postale ubojica broj jedan ne samo osoba srednje životne dobi, već i onih starijih. Ove bolesti i njihove posljedice uvelike utječu na smrtnost, ali i na kvalitetu života starijih osoba i značajno je pogoršavaju. Međutim, do relativno nedavno nije bilo jasno jesu li čimbenici rizika za kardiovaskularne bolesti kao što su hiperkolesterolemija, arterijska hipertenzija, nedostatak tjelesne aktivnosti i kretanja te psihosocijalni čimbenici – primjerice osamljenost, depresija i nedostatna društvena potpora, uistinu povezani s povećanim pomorom i pobolom u navedenoj dobnoj skupini kao što jesu u ljudi srednje dobi. Ova je povezanost dokazana u nekoliko istraživanja koja su podrobno prikazana u ovom članku, no ovime su potaknuta i pitanja o koristi liječenja statinima i antihipertenzivima u starijih osoba. Stoga je načinjeno nekoliko velikih prospektivnih istraživanja, rezultati kojih su također raspravljeni u ovom članku. Isti jasno ukazuju da u starijih osoba treba primijeniti jednak pristup prevenciji kardiovaskularnih bolesti koji je prihvaćen za osobe srednje životne dobi. Statini smanjuju rizik akutnog infarkta miokarda, nestabilne angine pektoris, ishemijskoga moždanog udara, kognitivnih tegoba i invalidnosti zbog ovih bolesti u starijih kojih već imaju (sekundarna prevencija) ili su u velikom riziku da obole (primarna prevencija) od kardiovaskularnih bolesti. Pokazano je također kako različiti antihipertenzivi podjednako djeluju u prevenciji pomora i pobola od kardiovaskularnih bolesti, što upućuje da je presudno smanjiti povećani arterijski tlak bez obzira na način kojim se ovo postiže.The population in developed countries, including Croatia, is steadily ageing and today cardiovascular diseases caused by atherosclerosis are the killer number one, not only in middle-aged people, but in the elderly as well. These diseases and their sequelae have a huge impact on mortality, but also on the quality of life of elderly people that they severely impair. However, until relatively recently it was not clear whether cardiovascular risk factors, such as hypercholesterolemia, hypertension, and lack of physical activity, as well as psychosocial factors, such as social isolation, depression and low perceived social support, are associated with increased morbidity and mortality in this age group as they are in middle-aged people. This association has been proved in several studies that are presented in detail in this review, and it also raised the question about the benefi ts of statins and antihypertensives in the elderly. Therefore, several prospective intervention studies have been conducted and their results are also discussed in this paper. They suggest that the strategy for cardiovascular risk management in middle-aged people should be also applied to the elderly. Statins reduce the risk of acute myocardial infarction, unstable angina, ischaemic stroke, cognitive decline, and disability in the elderly with existing cardiovascular diseases (secondary prevention) and in those at high risk of developing cardiovascular diseases (primary prevention). Various antihypertensives showed similar effi cacy in the prevention of cardiovascular mortality and major morbidity thus indicating that decrease in blood pressure is of major importance

Risk Factors for Microvascular Atherosclerotic Changes in Patients with Type 2 Diabetes Mellitus

Diabetes mellitus is a metabolic disorder primarily characterized by elevated blood glucose levels and by microvas- cular and macrovascular complications which increase the morbidity and mortality.The aim of this study was to assess whether in high risk patients with type 2 diabetes mellitus whose blood pressure and lipid levels are well controlled still exist risk factors for microvascular changes and target organ damage (nephropathy and retinopathy). In this case con- trol retrospective study 326 patients (111 with nephropathy and/or retinopathy and 215 controls) were enrolled. Nephro- pathy or retinopathy was present in 10.1% and 26.9% cases, respectively. Only 71% of patients (no significant difference between cases and controls) were treated with antidiabetic drugs. Therefore their diabetes was not properly controlled (hemoglobin A1c was 7.96% in cases and 7.58% in controls). Patients with microvascular changes had significantly lon- ger diabetes than the controls (p < 0.05) but there were no significant differences between these two groups concerning lipids concentrations. Statins and fibrates were used by significantly less (p < 0.05) patients with microvascular compli- cations than by those without them (21.6% vs. 36.3% and 1.8% vs. 17.2% respectively). The results of this study suggest that the duration of the disease and adequate control of glycaemia in patients with type 2 diabetes mellitus are more im- portant for microvascular complications than the serum lipoproteins levels. Lipid-lowering treatment might have an im- pact on microvascular complications in patients with type 2 diabetes, irrespectively of their serum lipid levels

IS HYPERTRIGLYCERIDAEMIA A RISK FACTOR FOR CORONARY HEART DISEASE?

Premda još nije potpuno jasno dokazano jesu li povišeni trigliceridi izravno aterogeni ili nisu, rezultati mnogih istraživanja upućuju na to da su oni nedvojbeno važan čimbenik rizika i/ili biljeg koronarne bolesti srca (KBS). Stoga u osoba koje imaju velik rizik od KBS-a treba liječiti hipertrigliceridemiju. Povišeni su trigliceridi često udruženi sa sniženom koncentracijom HDL-kolesterola, osobito u bolesnika s dijabetesom tipa 2 i/ili metaboličkim sindromom koji imaju velik rizik od KBS-a. Takav se poremećaj lipida naziva aterogena dislipidemija i ima sve veću prevalenciju. Liječenje hipertrigliceridemije ponajprije se mora temeljiti na intenzivnoj promjeni nezdravog načina života (smanjenje tjelesne težine u debelih, smanjenje unosa alkohola te šećera, fruktoze i transmasnih kiselina, redovita aerobna tjelesna aktivnost) čime se trigliceridi mogu sniziti za čak do 50%. Osobe s velikim rizikom od KBS-a koje ne mogu promjenom načina života dovoljno smanjiti hipertrigliceridemiju moraju se liječiti lijekovima. U ovom času od lijekova za taj poremećaj imamo fibrate, nijacin i pripravke omega 3-masnih kiselina koji su registrirani kao lijekovi. Ako je istodobno povišen i LDL-kolesterol, bolesnici trebaju uzimati kombiniranu terapiju. Na temelju rezultata najnovijih istraživanja takvim se bolesnicima preporučuje uzimanje statina uz fenofibrat i/ili omega 3-masne kiseline.Although it is still not clear whether elevated serum triglycerides are directly atherogenic or not, the results of many studies indicate that they are undoubtedly an important risk factor /biomarker for coronary heart disease (CHD). Therefore, targeting hypertriglyceridaemia should be beneficial for subjects at high risk for CHD. Elevated triglycerides are often accompanied with low HDL cholesterol, particularly in high risk patients with diabetes type 2 and/or metabolic syndrome. Such a disturbance is called atherogenic dyslipidaemia and has an increasing prevalence. The treatment of hypertriglyceridaemia has to be focused primarily on intensive lifestyle changes (weight reduction in obesity, reduction of alcohol consumption as well as reduction of added sugars, fructose and trans-fatty acids, regular aerobic physical activity) by which reduction of up to 50% in triglycerides can be achieved. Subjects with high CHD risk who cannot lower hypertriglyceridaemia by lifestyle measures should be treated with pharmacological therapy. The available medications include fibrates, niacin and prescription omega-3 polyunsaturated fatty acids. If LDL cholesterol is elevated too, combination therapy is needed. Based upon recent studies in such patients a combination of a statin with fenofibrate and/or omega-3 fatty acids can be recommended

LOW HDL-CHOLESTEROL – AN IMPORTANT RISK FACTOR FOR CARDIOVASCULAR DISEASES

Već je odavno poznato da je koncentracija HDL-kolesterola u krvi obrnuto razmjerna riziku od kardiovaskularnih bolesti (KVB) te da je sniženi HDL-kolesterol neovisni čimbenik rizika od KVB. Svrha je ovoga preglednog članka razjasniti ulogu HDL-čestica i važnost HDL-kolesterola. Podrobno su raspravljene glavne protuaterosklerotske uloge HDL-čestica – obrnuti prijenos kolesterola, njihova protuoksidacijska, protuupalna, protutrombotska i protuapoptotska svojstva, ali i uloga u poboljšanju funkcije endotela. Objašnjena je uloga promjene nezdravog načina života u povišenju koncentracije HDL-kolesterola, poglavito važnost redovite tjelesne aktivnosti i aerobne tjelovježbe, prestanka pušenja, smanjenja tjelesne težine u onih u kojih je prekomjerna, kao i prehrane, ali i umjerenog unosa alkohola s naglaskom na činjenicu da su HDL-čestice alkoholičara izmijenjene funkcije, tj. ne djeluju protuaterogeno. To valja naglasiti stoga što je dokazano da nije važna samo količina HDL-čestica, pa onda i HDL-kolesterola u krvi, već da je važna i njihova funkcija, osobito ako je izmijenjena. HDL-čestice u bolesnika s dijabetesom također gube neka protuaterogena svojstva, a u bolesnika s dijabetesom tipa 2 česta je pojava upravo aterogena dislipidemija obilježena smanjenom količinom HDL-kolesterola i povišenim trigliceridima u krvi. Bolesnici s dijabetesom koji imaju takvu dislipidemiju imaju posebno velik rizik od KVB, a rezultati novijih ispitivanja kao što je primjerice ACCORD-Lipid, upućuju da bi liječenje takvog poremećaja lipida u njih bilo osobito korisno. Na temelju objavljenih rezultata kliničkih ispitivanja raspravljaju se mogućnosti liječenja fibratima, posebice fenofibratom, ali i nijacinom te kombinacijama tih lijekova i drugih lijekova za dislipidemije.It has been known for quite a long time that the concentration of HDL-cholesterol correlates inversely with cardiovascular disease (CVD) risk and that low HDL-cholesterol is an independent CVD risk factor. This review aims to highlight evidence on several topics concerning the role of HDL particles and the importance of HDL-cholesterol. The main antiatherogenic functions of HDL particles are presented in details – reverse cholesterol transport, but also their anti-oxidant, anti-inflammatory, anti-thrombotic and anti-apoptotic properties as well as endothelial stabilizing and repair properties. Lifestyle management of low HDL-cholesterol is explained, particularly physical activity and aerobic exercise, smoking cessation, weight reduction in the overweight individuals and composition of the diet but also moderate alcohol consumption stressing the fact that HDL particles from alcoholics are dysfunctional. This is important since it has been shown that it is not only the quantity of HDL particles, and thus HDL-cholesterol level in plasma, that matters, but their quality and impaired functionality as well. HDL from diabetic subjects also lose some of their antiatherogenic properties but a common feature of patients with diabetes type 2 is atherogenic dyslipidemia which is characterized exactly by low HDL-cholesterol and high triglycerides. Diabetic patients with such dyslipidemia are at particularly high CVD risk and the results of recent studies such as ACCORD-Lipid suggest that in them treatment of these lipid abnormalities may be beneficial. Treatment options with fibrates, particularly fenofibrate, and niacin are discussed based upon published trials, as well as combination therapy with these medicines and other lipid-lowering drugs

Kombinirano liječenje makularnog edema uzrokovanog okluzijom mrežnične vene bevacizumabom i triamcinolon acetonidom

The purpose of this study was to determine the efficacy of combined intravitreal bevacizumab and triamcinolone in the treatment of macular edema due to retinal vein occlusion. A prospective randomized trial was conducted in the Department of Ophthalmology, Osijek University Hospital Centre in Osijek including 51 patients divided into three groups depending on the drug received. The first group received 1.25 mg intravitreal bevacizumab, the second group received 1 mg intravitreal triamcinolone, and the third group received a combination of 1.25 mg bevacizumab and 1 mg intravitreal triamcinolone on the same day. Changes in the central macular thickness, intraocular pressure and visual acuity were monitored during the follow up period. The retinal perfusion status was evaluated by fluorescein angiography. The group that received combined treatment had better outcome in terms of reduction of macular thickness. There was no statistically significant intraocular pressure elevation among the three treatment groups or within each group of patients. A positive trend regarding visual improvement was observed in the group receiving combined treatment in spite of the lowest initial visual acuity, highest value of macular thickness and longest mean duration of symptoms. In conclusion, combined treatment with bevacizumab and triamcinolone for the treatment of retinal vein occlusion is more potent, safe, efficient and cost-effective. It can also be recommended because fewer injections are needed in patients undergoing treatment for macular edema.Cilj rada bio je utvrditi učinkovitost kombinirane intravitrealne terapije bevacizumabom i triamcinolonom kod makularnog edema nastalog kao posljedica okluzije mrežnične vene. Prospektivno randomizirano ispitivanje provedeno je na Odjelu za očne bolesti Kliničkoga bolničkog centra Osijek. U ispitivanje je bio uključen 51 ispitanik, koji su podijeljeni u tri skupine ovisno o vrsti lijeka koji su primali. Bolesnici u prvoj skupini primali su 1,25 mg bevacizumaba intravitrealno, druga skupina ispitanika je primala 1 mg triamcinolona intravitrealno, a treća skupina je primala kombinaciju 1,25 mg bevacizumaba i 1 mg triamcinolona intravitrealno u istom posjetu. Tijekom razdoblja praćenja promatrane su promjene u centralnoj makularnoj debljini, vidnoj oštrini, kao i vrijednosti intraokularnog tlaka. Fluoresceinska angiografija primijenjena je za procjenu perfuzijskog statusa retine. Skupina koja je primila kombiniranu terapiju s oba lijeka imala je bolji ishod u vidu smanjenja makularne debljine. Nije bilo značajnijeg povišenja očnog tlaka unutar skupina, kao ni usporedbom među skupinama. U skupini ispitanika koji su primili kombinaciju oba lijeka zabilježen je pozitivan trend u oporavku vidne oštrine, iako su imali najniže ulazne vrijednosti vidne oštrine, najveću vrijednost centralne makularne debljine mjerenu optičkom koherentnom tomografijom i najduže prosječno trajanje okluzije u odnosu na ostale skupine ispitanika. Zaključno, smanjenje broja injekcija kod primjene kombinacije oba lijeka predstavlja ekonomičniji pristup liječenju okluzije mrežnične vene, a također djeluje potentnije na sniženje centralne makularne debljine u odnosu na pojedinačnu primjenu svakog lijeka

Analysis of the Qualitative Dermatoglyphics of the Digito-Palmar Complex in Patients with Primary Open Angle Glaucoma

The primary open-angle glaucomas are a group of diseases that have in common characteristic morphological changes at the optic nerve head and retinal nerve fiber layer, progressive retinal ganglion cells death and characteristic visual field loss. The risk for primary open angle glaucoma rises continuously with the level of the intraocular pressure. The disease advances slowly and there are no symptoms. Primary open angle glaucoma is caused by abnormal aqueous humour outflow in the trabecular meshwork in the open angle. Etiopathogenesis of primary open angle glaucoma is unclear. The increased risk of glaucoma in relatives has long been recognized. Frequency for manifestation of the disease is 10–30% in family members. The discovery of the specific gene loci responsible for the manifestation of glaucoma has helped us to understand its mechanism of origin and definitely confirmed the hereditary nature of this disease. Digito- -palmar dermatoglyphs were already used to determine hereditary base of many diseases and it was the reason for investigation of their qualitative patterns in patients with glaucoma (22 males and 23 females), their immediate relatives (19 males and 23 females) in comparison to a group of phenotypically healthy population (52 males and 56 females). The results pointed a connection with the dermatoglyphic traits of the digito-palmar complex between patients with glaucoma and their immediate relatives. There is a possible discrimination of patients and their immediate relatives from phenotypically healthy population, too

Risk Factors for Microvascular Atherosclerotic Changes in Patients with Type 2 Diabetes Mellitus

A B S T R A C T Diabetes mellitus is a metabolic disorder primarily characterized by elevated blood glucose levels and by microvas

Analysis of the Quantitative Dermatoglyphic Traits of the Digito-Palmar Complex in Patients with Primary Open Angle Glaucoma

Patient with primary open angle glaucoma (PAOG), which is known to have a genetic predisposition, and their immediate relatives unaffected with PAOG, may have some changes in dermatoglyphic traits of the digito-palmar complex, since the trabecular meshwork develops at the same time and with the same hereditary base like dermatoglyphs, which have high genetic transmission. The objective of this study is to determine whether differences in quantitative dermatoglyphic traits of the digito-palmar complex exist between patients with glaucoma and the phenotipically healthy population and whether their family members have the same dermatoglyphic changes. The quantitative dermatoglyphic traits in patients suffering from glaucoma, first-degree members of their family and the phenotypically healthy population have been screened in this study. Descriptive statistics, univariate analysis of variance (ANOVA) and post hoc (Tukey HSD) method have been used. The results have shown that there is a link between the quantitative dermatoglyphic traits of the digito-palmar complex in patients affected by glaucoma and a first-degree healthy member of their family, as well as the difference between patients with glaucoma and their first-degree relatives, which may discriminate them from the phenotypically healthy population. The results of the study mostly affirm the existence of genetic predisposition for the development of primary open-angle glaucoma, thus emphasizing the relevance of hereditary factors in the etiopathogenesis of this disease