Rosuvastatin i ezetimib za učinkovitu prevenciju aterosklerotskih kardiovaskularnih bolesti

SUMMARY Atherosclerotic cardiovascular diseases (ASCVD) present a global public health challenge with potentially fatal consequences. The key factor in the prevention of ASCVD is the control of LDL cholesterol (LDL-C) levels. Herein we present two important agents for the reduction of elevated LDL-C levels: rosuvastatin and ezetimibe. Rosuvastatin is a potent HMG-CoA reductase inhibitor that considerably lowers LDL-C, increases HDL cholesterol, and reduces triglyceride levels. Ezetimibe, on the other hand, inhibits the intestinal absorption of cholesterol. The combination of these drugs enables achieving target cholesterol levels. Although statins are the cornerstone therapy for LDL-C reduction, they often need to be combined with ezetimibe, especially in high-risk patients. Research shows that this combination can significantly reduce the risk of cardiovascular events. Despite the guidelines, achieving target LDL-C levels is often challenging in practice. A statin/ezetimibe combination may be key to achieving set targets and improving cardiac health. Control of LDL-C levels is key in the prevention of ASCVD. An integrated approach, including healthy diet, exercise, and pharmacotherapy, is crucial in fighting this global public health challenge.SAŽETAK Aterosklerotske kardiovaskularne bolesti (ASCVD) globalan su javnozdravstveni izazov s potencijalno fatalnim posljedicama. Ključni čimbenik u prevenciji ASCVD-a jest kontrola razine LDL kolesterola (LDL-C). Prikazujemo dva važna lijeka za snizivanje povišenih vrijednosti LDL-C-a: rosuvastatin i ezetimib. Rosuvastatin je snažan inhibitor HMG-CoA reduktaze koji znatno smanjuje LDL-C, povećava HDL kolesterol i smanjuje vrijednost triglicerida. Ezetimib, s druge strane, inhibira apsorpciju kolesterola u crijevima. Kombinacija tih lijekova omogućuje postizanje ciljanih razina kolesterola. Iako su statini temeljna terapija za snizivanje LDL-C-a, često je potrebna kombinacija s ezetimibom, osobito u bolesnika s visokim rizikom. Istraživanja pokazuju da takva kombinacija može znatno smanjiti rizik od kardiovaskularnih događaja. Unatoč smjernicama, postizanje ciljanih razina LDL-C-a u praksi je često izazovno. Kombinacija statina i ezetimiba može biti ključna u postizanju ciljeva i poboljšanju zdravlja srca. Kontrola razine LDL-C-a ključna je u prevenciji ASCVD-a. Integrirani pristup, koji uključuje pravilnu prehranu, tjelesnu aktivnost i farmakološku terapiju, ključan je za borbu protiv ovoga globalnoga javnozdravstvenog izazova

Relapsing mitral valve endocarditis – patient preference meets guidelines

Introduction: Endocarditis is a devastating infection often leading to significant valvular disfunction. Prolonged antibiotic therapy remains a mainstay of treatment but one third of patients require surgery in course of disease. Classic indications are severe valvular disfunction causing heart failure, septic embolization, difficult to control and local propagation of infection.1,2 Case report: Our patient has had a mitral valve endocarditis 20 years ago leaving behind presumably moderate mitral regurgitation. Last 3 months she had relapsing fever, anorexia and polyarthralgia which were attributed to her osteoporosis. Transthoracic echocardiography showed deformation and thickening of posterior mitral cusp causing severe mitral regurgitation (MR) described in previous exams, but transesophageal study (TEE) also showed a fresh vegetation on anterior mitral cusp. Streptococcus viridans was repeatedly isolated from blood cultures supporting diagnosis of odontogenic subacute endocarditis. There were no signs of heart failure or peripheral embolization. Patient a priori refused any form of surgical treatment. Vancomycin was administered for 4 weeks (due to penicillin allergy) leading to complete clinical recovery, sterilization of blood cultures and disappearance of anterior mitral cusp vegetation on TEE. After regaining full mobility patient still had no symptoms correlated with a MR. Discussion and Conclusion: Severe primary MR after endocarditis in the era of valve reparation seems like straightforward surgical indication. We were surprised to find out that the patient’s reluctance to surgery was justified by her complete recovery from endocarditis and guidelines. Although MR remained severe, left ventricle is mildly dilated (EDD 56mm/ESD 27 mm), hyperdynamic (EF 66%), pulmonary hypertension is mild (sPAP 45 mmHg), and the patient is still in sinus rhythm. Question remains is she truly asymptomatic because recent polyarthritis limited her mobility. Patient was discharged and scheduled for follow up in 3 months

Echocardiographic Assessment of Revascularization Completeness Impact on Diastolic Dysfunction in Ischemic Heart Disease

Diastolic dysfunction indicates a functional abnormality of diastolic relaxation, filling, or distensibility of the left ventricle (LV), regardless of whether the LVEF is normal or abnormal. Diastolic dysfunction is practically always pro- gressive and connected with higher morbidity and mortality rates, and, if not treated may lead to a diastolic heart fail- ure. The golden standard for evaluation of diastolic function is echocardiography. One of the most important causes of diastolic dysfunction is ischemic heart disease. The revascularization of chronic myocardial ischemia can be partial (in- complete) or complete. Previous data have shown that the completeness of revascularization could have influence on clin- ical outcomes. The aim of this study was to asses, by means of echocardiography, the impact of completeness of revascula- rization on diastolic dysfunction in ischemic heart disease. This study included 65 consecutive patients with previously recognized diastolic dysfunction that met criteria for PCI revascularization. Two groups of patients were identified; one with complete revascularization achieved and another one with incomplete one. There were no statistical differences be- tween two groups considering gender, age, arterial hypertension, hyperlipoproteinaemia, previous CABG and left ventricle systolic function. In the incomplete revascularization group, the proportion of patients that had diabetes mellitus, previ- ous myocardial infarction and previous PCI procedure were statistically higher (p<0.05). The diastolic function recovery was statistically significant in both groups (p<0.001), and there was no statistically significant difference in recovery be- tween the two groups. Lack of recovery was registered in 18.2% patients with incomplete revascularization achieved, and 15.6% in the complete group, which was not significant, but shows a trend. The causes of somewhat worse recovery in the incomplete revascularization group could be attributed to the higher proportion of diabetics, to the somewhat older popu- lation and ultimately to the incomplete revascularization. The E/A ratio on diastolic transmitral flow as well as the E/E lat ratio on tissue doppler were found as the best echocardiographic parameters in diastolic function evaluation. In fol- low up recovery after complete or incomplete revascularization the tissue doppler (E/E lat) was recognized as the best parameter. In conclusion, we found that echocardiographic assessment of diastolic function recovery was a safe method, and our results showed that even in incomplete revascularization group of patients the recovery of diastolic function could be as good as in the complete one, if the indication for revascularization was correct

Percutaneous closure of paravalvular leak — case report on first procedure in Croatia

Klinički značajna paravalvularna regurgitacija (PVL) nakon implantacije proteze valvule je rijetka, ali moguća ozbiljna komplikacija. Reoperacija je povezana sa značajnim rizicima i mogućim neuspjehom, budući da prvobitni uzrok regurgitacije nije uvijek moguće korigirati. Perkutano zatvaranje PVL uvedeno je kao važna alternativa s dokumentiranim dobrim kratkoročnim i dugoročnim rezultatima. Prikazujemo slučaj zatvaranja PVL kod mladog bolesnika pomoću naprave Amplatzer Vascular plug III, vođenog periproceduralnom transezofagijskom ehokardiografijom. Dokumentiran je kratkoročan i srednjoročni rezultat. Obzirom na značajan broj implantacija valvularnih proteteza u Hrvatskoj, tijekom godina se može očekivati porast potrebe za ovom vrstom intervencije.Clinically significant paravalvular leak (PVL) after prosthetic valve implantation is a rare, but potentially serious complication. Repeat surgery is associated with significant risks and may fail, because the original cause of leak is not always amenable to correction. Percutaneous PVL closure has been introduced as an important alternative with documented good immediate and late results. We present a case of PVL closure in a young patient using the Amplatzer Vascular plug III device, guided by periprocedural transesophageal echocardiography. Immediate success and mid-term result could be documented. In view of the significant number of prosthetic valve implantations in Croatia, an increase in the need for this type of intervention can be expected each year

Detection of milk fat in dairy products — an alternative approach

Milk fat is a highly valuable product, which is why accurate determination of its content in milk and milk products is very important. The use of the GC-FID method in our study proved to be very precise, as in the case of other authors, which signifies the importance of using this method to quantify milk fat. A total of 51 samples of dairy products were analyzed for fatty acid composition with particular attention to butyric acid. Butyric acid contents were in the range from 3.4 ± 0.73 in yogurt to 4.60 ± 0.08 in butter. Milk fat was in the range from 98.5 ± 4.77 in yogurt to 115.0 ± 1.73 in butter. Our results were in accordance with those of many other authors. Development of butyric acid and milk fat analyses in dairy products by GC-FID is essential for laboratories that must conduct analyses for food production, quality control during production, and inspection tasks for the import and export of these food products

The effects of dietary Selenium-yeast level on glutathione peroxidase activity, tissue Selenium content, growth performance, and carcass and meat quality of broilers

The present study was conducted to assess effects of selenium (Se)-yeast supplementation on glutathione peroxidase activity, Se levels in tissues, growth performance, carcass, and meat composition in broilers. A total of 275 one-d-old Cobb 500 broilers of both sexes were randomly allotted to 1 of 5 treatments during a 42-d period. The 5 treatments differed only in Se content: group 1 had no additional Se (background only); groups 2, 3, and 4 received 0.3 mg/kg of added Se from the beginning of the trial until d 21, whereas in the second half of the study (from d 22 to 42), these groups received 0.3, 0.6, and 0.9 mg/kg of added Se, respectively; and group 5 received 0.9 mg/kg of Se for the entire experimental period. At the end of the study, the control group showed significantly lower (P < 0.01) glutathione peroxidase activity in blood plasma compared to Se-supplemented groups. Regarding Se concentration in various tissues, the groups receiving Se yeast showed higher plasma, feces, and meat Se contents than the control group (P < 0.01). Supplementation of Se improved broilers body weight, weight gain and feed conversion ratio (P < 0.01). Dressing percentage was lower in the control group and the group with 0.3 mg/kg of added Se compared to other experimental groups (0.6 and 0.9 mg/kg of dietary Se). The proportion of less valuable carcass parts (wings and legs) was higher (P < 0.01) in the group fed the basal diet compared to groups supplemented with 0.9 mg/kg of Se. Initial and ultimate pH values differed among experimental groups (P < 0.05). Supplementation of Se improved the broilers antioxidative resistance, growth performance, carcass quality, and chemical composition of meat

Effects of n–3 Supplementation on Plasma and Liver Phospholipid Fatty Acids Profile in Aged Wistar Rats

The effects of fish oil supplementation in Wistar rats are focused on cardiovascular, endocrine, metabolic and antioxidant status changes. We determined plasma and liver phospholipid fatty acids (FAs) status and plasma lipid concentrations in aged Wistar rats. Our results showed differences in plasma and liver FAs profiles as well as plasma chlolesterol (CHOL), triglicerides (TG), high density lipoproteins (HDL), low density lipoproteins (LDL), CHOL/HDL ratio (risk factor for atherosclerosis) and LDL/HDL ratio (risk for cardiovascular diseases) between treated and control group of animals. In fish oil treated group there were statistically significant changes in FAs profile in increasing linoleic acid (LA), dihomo-. linoleic acid, eicopentanoic acid (EPA) and docosapentaenoic acid (DPA) and decreasing in arachidonic acid (AA) concentration. Also, liver phospholipids FAs results showed increasing concentrations of vascenic acid, LA, EPA, and DPA and decreasing concentration of AA after supplementation of fish oil compared to control group. However, concentrations of CHOL, LDL and non HDL concentrations decreased while HDL increased in fish oil group. CHOL/HDL, LDL/HDL ratios decreased. These findings suggest that long term treatment of fish oil in aged Wistar rats can be beneficial in decreasing LDL, and decreasing risk factors for developing atherosclerosis and cardiovascular diseases. (doi: 10.5562/cca1751