METABOLIC SYNDROME, MORBIDITY AND MORTLITY IN THE ERA OF COVID-19 PANDEMIC

The prevalence of obesity, diabetes, arterial hypertension and cardiovascular and cerebrovascular diseases is increasing worldwide. Nowdays we are witnessing a pandemic of metabolic syndrome and obesity and an epidemic of these diseases in Croatia as well. Moreover, every second Croatian citizen dies because of cardiovascular diseases. Visceral obesity, diabetes, dyslipidemia and arterial hypertension tend to cluster forming a syndrome that we call metabolic syndrome. The concept of metabolic syndrome was defined several decades ago as visceral type of obesity, hypertriglyceridemia, low HDL-cholesterol, arterial hypertension and diabetes mellitus (insulin resistance). Most widely used definition is the one by National Education Cholesterol Program, NCEP - Adult treatment Panel III - ATP III . Therefore, visceral obesity is considered as one of the greatest risks for mortality worldwide. COVID pandemia increased the risk od deaths especially among patients with metabolic syndrome. Pandemia perpetuated several other socio-economical risk factors (stress, depression, physical inactivity, devian strongly influence cardiovascular health. Unfortunately, SARS-COV-2 virus enters the host (human) cell using signaling pathways (ANG II Rc) known very well from the metabolic syndrome research and connecting those two entities predesponing these patients for a much worse prognosis when infected with SARS-COV-2 virus. To conclude - chronic obesity pandemia goes hand by hand with novel COVID-19 pandemia dramatiacally increasing the risk of severe morbidity and mortality

NOT EVERY RESPIRATORY FAILURE NOWDAYS IS COVID. POMPE DISEASE

Pompe disease, also known as glycogen storage disease type II, is an autosomal recessive disorder caused by deficiency of the lysosomal enzyme acid-α-glucosidase. It is a chronic and progressive disease characterized by storage of glycogen mostly in muscles. Late onset cases typically present with proximal muscle weakness and respiratory insufficiency or exertional dyspnea. Treatment is now available with intravenous infusion of recombinant acid α-glucosidase

Porodična hiperkolesterolemija - mislimo li dovoljno o ovoj teškoj bolesti? [Familial hypercholesterolemia - do we think enough about this severe disease?]

Familial hypercholesterolemia is the most common genetic metabolic disorder and is associated with significant morbidity and mortality from cardiovascular disease, in particular coronary heart disease (CHD). Gene mutations for LDL receptor, APOB or PCSK9 are the main causes of the disease. The incidence of homozygous form of disease is 1:1000000 and ofheterozygous 1:500. Some of the patients have clinical signs like xanthomas, xanthelasmas and corneal arcus. More predictive for the diagnosis are elevated serum LDL cholesterol values and positive family history of early CHD. Identification of the causative mutation provides definitive diagnosis. Diet, statins, combined therapy (statins and ezetimibe) are the first line of treatment, mostly in high doses. LDL apheresis is the procedure of mechanical removal of LDL particles from plasma and has to be performed in patients with homozygous or severe heterozygous form of the disease together with drug treatment. There is a need to increase the awareness of this disease in Croatia but also worldwide with one main goal: to early diagnose and prevent cardiovascular morbidity and mortality

Unos soli, metabolički sindrom i pretilost (Hrvatska Nacionalna Kampanja za Smanjenje Unosa Kuhinjske Soli (CRASH))

Dobro je poznato kako je visok unos kuhinjske soli važan faktor rizika za bubrežne i kardiovaskularne bolesti. No svjesnost o navedenom nije još dosegla željenu razinu kako u općoj populaciji tako i u bolesnika koji boluju od navedenih bolesti. Metabolički sindrom i komponente koje ga čine (arterijska hipertenzija, intolerancija glukoze, dislipidemija, pretilost) važan je faktor rizika za nastanak kardiovaskularnih bolesti. Rezultati nekih recentnijih studija ukazuju kako su prekomjerna konzumacija kuhinjske soli i metabolički sindrom usko povezani. S obzirom na navedeno, ovom pilot studijom, koja je dio Nacionalnog programa za smanjenje unosa kuhinjske soli (CRASH-Croatian Action on Salt and Health), pokušali smo istražiti koliko je okviran unos soli u ispitivanoj populaciji te odrediti povezanost između unosa soli i metaboličkog sindroma

Epidemiologija arterijske hipertenzije u Hrvatskoj i svijetu

Arterijska hipertenzija (AH) jedan je od najvažnijih sprečivih (preventabilnih) uzroka prijevremenog umiranja i jedan od najvećih javnozdrastvenih problema današnjice u svijetu. Prevalencija AH je veća nego ranije i kreće se oko 40% u odraslim populacijama europskih zemalja, dok je u Sjedinjenim Američkim Državama značajno niža. Prema rezultatima studije “Epidemiologija arterijske hipertenzije u Hrvatskoj (EH-UH)” prevalencija AH u Hrvatskoj je 37,5%. AH je učestalija u žena nego u muškaraca, što se podudara s većinom drugih zemalja diljem svijeta, uključujući SAD u kojem se bilježi značajniji porast prevalencije AH u žena, kao i u zemljama bivših socijalističkih ekonomija. Žene u Hrvatskoj svjesnije su od muškaraca, češće se liječe i u većem broju postižu kontrolu AT-a unatoč prosječno nižem stupnju obrazovanja, višem ITM-u i nižim mjesečnim primanjima. U Hrvatskoj se liječi nešto više hipertoničara od europskog prosjeka, ali manje nego u SAD-u i Kanadi. Kontrola AH u Hrvatskoj je iznad europskog prosjeka, izuzev nešto bolje kontrole u Španjolskoj i Engleskoj. Kao i u većine europskih zemalja, Hrvatska ima sličnu distribuciju AT-a i AH uz lošije rezultate u usporedbi sa SAD-om i Kanadom koji su iako daleko ispred nas, i dalje u velikoj mjeri ugroženi visokim brojem radno onesposobljenih ljudi zbog posljedica koje nosi AH u obliku povećane kardiovaskularne smrtnosti i pobola. Stoga su osvješćivanje problema, rano otkrivanje AH osobito u određenim segmentima populacije, prihvaćanje zdravih životnih navika te redovito uzimanje terapije ključni u postizanju bolje kontrole AT-a, a time i boljeg i dužeg života

FAMILIAL HYPERCHOLESTEROLEMIA – DO WE THINK ENOUGH ABOUT THIS SEVERE DISEASE?

Porodična hiperkolesterolemija je najčešći genetski metabolički poremećaj koji je povezan sa značajnim pobolom i smrtnosti od kardiovaskularnih bolesti. Glavni uzrok bolesti su mutacije gena za LDL-receptor, molekulu APOB ili enzim PCSK9. Postoji homozigotni oblik bolesti s incidencijom 1:1 000 000 te heterozigotni oblik s 1:500. U kliničkom statusu bolesnika nalazimo ksantome, ksantelazme i arcus corneae senilis. U postavljanju dijagnoze pomaže nam iscrpna anamneza (podatak o preboljelim srčanim bolestima te klinički znakovi koronarne bolesti srca, pozitivna obiteljska anamneza o ranoj smrti zbog srca), povišena koncentracija LDL-kolesterola te neka fenotipska obilježja. Konačna pouzdana dijagnoza u bolesnika koji se prema kliničkoj slici i razini LDL-kolesterola uklapaju u definiciju porodične hiperkolesterolemije postavlja se jedino analizom DNK. Pronalazak mutacije otvara mogućnost retrogradnog probira u obitelji s ciljem otkrivanja srodnika koji također nose mutaciju i imaju znatan rizik da preuranjeno obole od koronarne bolesti ili infarkta miokarda pa podlegnu ovoj opasnoj bolesti. Dijeta, statini, kombinirana terapija (statini i ezetimib) prva su linija liječenja, i to uglavnom u visokim dozama. Često ovakav terapijski pristup nije dovoljan pa je uz davanje lijekova potrebno provoditi postupak afereze – mehaničkog uklanjanja LDL-čestica iz krvi. Taj je postupak katkad jedina opcija u bolesnika koji su homozigoti jer je još i sad konzervativniji nego što je to transplantacija jetre. Projektima koji uključuju podizanje svijesti o ovoj bolesti, boljim probirom te omogućavanjem genske analize bolesnika s porodičnom hiperkolesterolemijom postiže se ranija dijagnoza, bolje liječenje te u skladu s time prevencija pobola i smrtnosti od kardiovaskularne bolesti i u svijetu i u Hrvatskoj.Familial hypercholesterolemia is the most common genetic metabolic disorder and is associated with significant morbidity and mortality from cardiovascular disease, in particular coronary heart disease (CHD). Gene mutations for LDL receptor, APOB or PCSK9 are the main causes of the disease. The incidence of homozygous form of disease is 1:1 000 000 and of heterozygous 1:500. Some of the patients have clinical signs like xanthomas, xanthelasmas and corneal arcus. More predictive for the diagnosis are elevated serum LDL cholesterol values and positive family history of early CHD. Identification of the causative mutation provides definitive diagnosis. Diet, statins, combined therapy (statins and ezetimibe) are the first line of treatment, mostly in high doses. LDL apheresis is the procedure of mechanical removal of LDL particles from plasma and has to be performed in patients with homozygous or severe heterozygous form of the disease together with drug treatment. There is a need to increase the awareness of this disease in Croatia but also worldwide with one main goal: to early diagnose and prevent cardiovascular morbidity and mortality

Fabryjeva bolest - smjernice za dijagnozu i liječenje odraslih bolesnika [Fabry disease - guidelines for diagnosis and management of adult patients]

Early diagnosis and management of patients with Fabry disease (FD) requires a multidisciplinary approach of several different experts. The aim of this document is to provide health care professionals with guidelines for management of adult patients with Fabry disease. These guidelines were produced by the staff of the Division of Metabolic Diseases, Department of Internal Medicine, University Hospital Center Zagreb, which is the Referral Expert Center for Rare and Metabolic Diseases of the Ministry of Health, Republic of Croatia. The first guidelines ever published in Croatia concerning a rare metabolic disease are presented. This document provides a short summary on Fabry disease, how to diagnose Fabry disease, management of patients with this disease, follow-up of the patients, and gives recommendations on therapy and genetic testing

A Pilot Croatian Survey of Risk Factor (CRO-SURF) Management in Patients with Cardiovascular Disease

A pilot survey was performed to determine the presence of known risk factors for cardiovascular disease in Croatian patients with diagnosed coronary heart disease (CHD) using a new questionnaire. The idea was to test this new and very simple questionnaire but also to compare the data collected in this pilot survey with the results of the last Croatian national survey (TASPIC-CRO V) and so to obtain the information whether secondary prevention has improved between 2003 and 2010. 122 patients with established CHD (88 men, 34 women, mean age 66.3 years) treated in Zagreb University Hospital Center were included. Data collection was based on filling the SURF questionnaire right after the clinical exam or later using review of medical records. Patients were hospitalized because of CABG (1%), PCI (8%), ACS (35%) or chronic stable angina (56%). The history of arterial hypertension had 95% patients (however, on admission mean systolic pressure was 130.1 mmHg, diastolic 76.8 mmHg), 90% had dyslipidaemia ( total cholesterol <4.5 mmol/L had 43%; 1.2 mmol/L (women) or >1.0 mmol/L (men) had 67%), 25% had diabetes which was poorly regulated (mean HbA1c 8.2%), 18% were active smokers. After discharge only 24% performed cardiac rehabilitation. Mean body mass index of the patients was 28.3 kg/m2 (32% were obese, 72% overweight). Compared to TASPIC-CRO V there was lower usage of aspirin than recommended on discharge. This was also true for statin therapy. More patients were taking beta blockers, calcium antagonists and diuretics than 7 years ago. This pilot survey showed that CRO-SURF questionnaire is short, quick, effective and simple to use. It is a good and cost effective tool to collect data on CVD risk factors and their management. The results obtained by using it indicate that there is still a high prevalence of modifiable risk factors in Croatian patients with CHD

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

Unos soli u seoskoj populaciji u Hrvatskoj – procjena korištenjem jednokratno skupljenog uzorka mokraće

Prekomjeran unos soli važan je i značajan čimbenik rizika za arterijsku hipertenziju, moždani udar, hipertrofiju lijeve klijetke, mikroalbuminuriju, bronhalnu astmu, osteoporozu, nefrolitijazu, i neke zloćudne tumore, kao što su rak želuca i nazofarinksa (1-12). Velik broj epidemioloških studija je pokazao da je unos soli danas u svijetu nekoliko puta viši od preporučenih 5 g dnevno prema trenutno važećim smjernicama Svjetske Zdrastvne Organizacije (SZO) (13). Iz navedenog se nameće potreba za nekim jednostanim, brzim i jefitinim metodama kojima bi se moglo procjeniti trenutno stanje unosa soli u nekoj populaciji. Dvadesetčetiri satni (24h) urin zlatni je standard za određivanje unosa soli (5,13,14). Međutim, ova je metoda nepraktična i teško izvodiva u javnozdrastvenim i velikim epidemiološkim istraživanjima, kao i javnozdravstvenim aktivnostima usmjerenim na sniženje arterijskog tlaka u zajednici. Stoga su Tanaka i sur. (14) utvrdili metodu procjene dnevnog unosa natrija (soli) iz jednokratno skupljenog uzorka urina. Cilj ovog istraživanja je bio procijena unosa soli u seoskoj populaciji kontinentalne Hrvatske pomoću Tanaka-Kawasakijeve metode