Hypercholesterolemia: Soska V

Vaverková H, Soska V, Rosolová H, Ceska R, Cífková R, Freiberger T, Pit'ha J, Poledne R, Stulc T, Urbanová Z, Vráblík M, Czech Atherosclerosis Society. · III. interní klinika LF UP a FN, Olomouc. · Cas Lek Cesk. · Pubmed #17650596 No free full text.

Abstract: The present guidelines are based on the recommendations published in 2005 entitled "Prevention of Cardiovascular Diseases in Adulthood" summarizing the conclusions of nine Czech medical societies and agree with them in the assessment of individual risk of mortality from cardiovascular disease (CVD) according to SCORE tables. They reflect new research data in pathophysiology of dyslipidemias (DLP) and particularly the results of recent clinical trials of lipid-lowering therapy and their meta-analyses. They establish priorities for the screening and management of DLP, present suitable diagnostic methods, additional investigations of potential use in risk assessment, including some emerging risk factors and detection of sub-clinical atherosclerosis in persons in a moderate-risk category. Major changes include a lower LDL-cholesterol treatment target (< 2.0 mmol/L for all CVD individuals) and a possible use of apolipoprotein B as a secondary target in selected persons (< 0.9 g/L in high risk without CVD, < 0.8 g/L for CVD patients) and nonHDL-cholesterol (< 3.3 mmol/L in high risk without CVD, < 2.8 mmol/L for CVD patients). Therapy of individual DLP phenotypes (monotherapy and combination therapy) as well as basic principles for control examination at lipid-lowering medication are described. Recommended therapeutic lifestyle changes are shown. Enclosed are five annexes: DLP diagnosis; causes of secondary DLP; additional investiga- tions of potential use in risk stratification; familial hypercholesterolemia; list of recommended foods; two variants of SCORE tables for risk assessment for the Czech Republic; the scheme of recommended procedures and treatment algorithm in DLP asymptomatic individuals.

Vaverková H, Soska V, Rosolová H, Ceska R, Cífková R, Freiberger T, Pit'ha J, Poledne R, Stulc T, Urbanová Z, Vráblík M, Anonymous00126. · III. interní klinika Lékarské fakulty UP a FN Olomouc. · Vnitr Lek. · Pubmed #17419181 No free full text.

Abstract: The present guidelines are based on the recommendations published in 2005 entitled "Prevention of Cardiovascular Diseases in Adulthood" summarizing the conclusions of nine Czech medical societies and agree with them in the assessment of individual risks of mortality from cardiovascular disease (CVD) according to SCORE tables. They reflect new research data in pathophysiology of dyslipidemias (DLP) and particularly the results of recent clinical trials of lipid-lowering therapy and their meta-analyses. They establish priorities for the screening and management of DLP, present suitable diagnostic methods, additional investigations of potential use in risk assessment, including some emerging risk factors and detection of sub-clinical atherosclerosis in persons in a moderate-risk category. Major changes include a lower LDL-cholesterol treatment target (< 2.0 mmol/L for all CVD individuals) and a possible use of apolipoprotein B as a secondary target in selected persons (< 0.9 g/L in high risk without CVD, < 0.8 g/L for CVD patients) and nonHDL-cholesterol (< 3.3 mmol/L in high risk without CVD, < 2.8 mmol/L for CVD patients). Therapy of individual DLP phenotypes (monotherapy and combination therapy) as well as basic principles for control examination at lipid-lowering medication are described. Recommended therapeutic lifestyle changes are shown. Enclosed are five annexes: DLP diagnosis; causes of secondary DLP; additional investigations of potential use in risk stratification; familial hypercholesterolemia; list of recommended foods; two variants of SCORE tables for risk assessment for the Czech Republic; the scheme of recommended procedures and treatment algorithm in DLP asymptomatic individuals.

Olsson AG, Pauciullo P, Soska V, Luley C, Pieters RE, Broda G, Palacios B, Anonymous00213. · Hälsouniversitet Institutionen för Internmedicin, Linköping, Sweden. · Clin Ther. · Pubmed #11219479 No free full text.

Abstract: BACKGROUND: A new extended-release (ER) formulation of fluvastatin 80 mg has been developed for once-daily treatment of primary hypercholesterolemia. OBJECTIVE: The purpose of this study was to compare the lipid-lowering efficacy and tolerability of fluvastatin ER (80 mg once daily) versus fluvastatin immediate-release (IR) (40 mg once or twice daily). METHODS: Following a 4-week placebo/dietary run-in period, patients with primary hypercholesterolemia type IIa or IIb (low-density lipoprotein cholesterol ILDL-C] > or = 160 mg/dL and triglycerides [TG] < or = 400 mg/dL) were randomized (2:1:1) to receive fluvastatin ER 80 mg once daily at bedtime (QPM), fluvastatin IR 40 mg QPM, or fluvastatin IR 40 mg BID for 24 weeks. Patients who had homozygous familial hypercholesterolemia; type I, III, IV, V, or secondary hyperlipoproteinemia; diabetes; or evidence of liver or renal impairment were excluded. At weeks 0, 2, 4, 8, 12, 16, 20, and 24 of the active-treatment period, levels of LDL-C, high-density lipoprotein cholesterol (HDL-C), TG, and total cholesterol (TC) were measured. RESULTS: Of the 1183 patients enrolled, 695 were randomly assigned to treatment--346 to fluvastatin ER 80 mg QPM, 174 to fluvastatin IR 40 mg QPM, and 175 to fluvastatin IR 40 mg BID. Patients were well matched between groups, with a mean age of approximately 56 years and body mass index of 27 kg/m2; 56.0% of patients (389/695) were female and 97.7% (679/695) were white. Fluvastatin ER 80 mg QPM lowered LDL-C levels significantly more than did fluvastatin IR 40 mg QPM (33.7% vs 24.4%; P < 0.001) and as effectively as fluvastatin IR 40 mg BID (33.9%). More than half of the patients administered fluvastatin ER 80 mg QPM and IR 40 mg BID achieved reductions in LDL-C levels of > or = 35%; more than half of those administered fluvastatin IR 40 mg QPM experienced reductions in LDL-C levels of > or = 25%. The mean reductions in LDL:HDL ratio, TC, and apolipoprotein B levels in the fluvastatin ER 80 mg QPM group were significantly greater than the reductions in the IR 40 mg QPM group (P < 0.001). In patients with mixed dyslipidemia, fluvastatin ER 80 mg reduced triglycerides by 21.8% (median 28%) and increased HDL-C by 14.5%. Fluvastatin ER 80 mg QPM was well tolerated, with incidences of clinically notable elevations in alanine aminotransferase, aspartate aminotransferase, and creatine kinase levels and musculoskeletal adverse events comparable to those in the IR 40 mg QPM group. CONCLUSION: The ER 80-mg formulation of fluvastatin is effective and well tolerated as a once-daily starting and maintenance treatment for primary hypercholesterolemia.

Soska V. · Centrum pro diagnostilku a lécbu dyslipidemií, Oddelení klinického komplementu FN u sv. Anny, Brno. · Vnitr Lek. · Pubmed #15651145 No free full text.

Abstract: Treatment of dyslipidaemia is one of the most important factors that decreases cardiovascular mortality and morbidity. Although we know lipid levels goals, we are not very successful in achiving them. The number of hypolipidemic substances is increasing and we have got guidelines for treatment dyslipidaemic patients. It is very important to implement this guidelines in the clinical practice. Another problem is rather poor patients's compliance both for dyslipidaemia treatment and for lifestyle changes. Pharmacologic treatment of dyslipidaemia may be limited due to its high expense. Pharmacologic treatment thus should be target to the high risk population: patients with coronary heart disease, patients with diabetes mellitus and with familial hypercholesterolaemia. In primary prevention only persons with high risk of cardiovascular event should be treated with hypolipidemic drugs.

Grombiríková H, Freiberger T, Kuhrová V, Soska V, Nedomová K. · Výzkumný ústav zdraví dítĕte, Brno. · Cas Lek Cesk. · Pubmed #11242979 No free full text.

Abstract: BACKGROUND: Familial defective apolipoprotein (apo) B-100 (FDB) is a common inherited metabolic disorder. Reduced binding of the apo B-100, the major protein of LDL particles, to LDL receptor results in marked hypercholesterolemia. FDB is caused particularly by an arginine to glutamine substitution at the codon for amino acid 3500 of the apo B-100. The aim of this study was to determine mutations potentially responsible for hypercholesterolemia in the apo B gene and to estimate their frequency in the group of Czech hyperlipidemic patients. METHODS AND RESULTS: The groups of 169 unrelated patients with primary isolated hypercholesterolemia (total cholesterol > or = 6.5 mmol/l, triglycerides < or = 2.3 mmol/l) and 58 unrelated patients with combined hyperlipoproteinemia (total cholesterol > or = 6.5 mmol/l, triglycerides > 2.3 mmol/l) were screened for mutations in codon 3500 region of the apolipoprotein B gene by denaturing gradient gel electrophoresis. Mutation R3500Q was detected in 20 patients with isolated hypercholesterolemia (11.8%) and in 2 patients with combined hyperlipoproteinemia (3.4%). No other mutations were found. CONCLUSION: The frequency of FDB in our group of patients with primary isolated hypercholesterolemia is high when compared with data published in other countries. We suggest that all patients with primary isolated hypercholesterolemia (total cholesterol > or = 6.5 mmol/l) in the Czech Republic should be analysed for the presence of mutation R3500Q in the apo B gene.

Soska V. · Oddĕlení klinické biochemie FN U sv. Anny, Brno. · Vnitr Lek. · Pubmed #10953659 No free full text.

Abstract: Familial hypercholesterolaemia is a serious inborn disease of lipoprotein metabolism with a high risk of early cardiovascular complications. The cause of the disease is a congenital defect of LDL receptors. In adults with familial hypercholesterolaemia practically always pharmacotherapy with hypolipaemic agents is indicated. The prerequisite for starting lifelong medication in primary prevention of ischaemic heart disease is a correct diagnosis of this disease. The latter involves in addition to clinical and genealogical examinations, above all correct interpretation of blood lipids in relation to age and the relationship of probands in the affected family. At present the diagnostic process is improved greatly by DNA analysis. The author mentions also exact clinical and laboratory criteria for classification of patients with familial hypercholesterolaemia into groups.

Meluzín J, Soska V, Petrikovits E, Seménka J. · I. interní-kardioangiologická klinika, FN U sv. Anny, Brno. · Vnitr Lek. · Pubmed #10951875 No free full text.

Abstract: In 18 patients with hypercholesterolaemia (total cholesterol > or = 6.7 mmol/l or LDL > or = 4.0 mmol/l a standard and Doppler echocardiographic examination was made before and after 27 +/- 7 months hypolipidaemic treatment leading to a drop of the cholesterol levels of at least > or = 1 mmol/l. Except for hypercholesterolaemia these patients did not suffer from any diseases with an impact on cardiac activity. Doppler echocardiography was used to measure parameters of diastolic left ventricular filling at rest and during 2-4 minutes of an isometric load. Lipid lowering therapy led to a significant drop of the deceleration half-time of early diastolic filling of the left ventricle at rest (from 88 +/- 16 ms to 74 +/- 15 ms, p < 0.01) as well as during an isometric load (from 83 +/- 31 ms to 61 +/- 31 ms, p < 0.05). The authors observed an insignificant increase of the rate of early diastolic left ventricular filling at rest (from 53 +/- 10 cm/s to 60 +/- 10 cm/s, p = ns) and during an isometric load (from 52 +/- 11 cm/s to 56 +/- 18 cm/s, p = ns). Similarly there was also an insignificant increase of the ratio of the velocity of left ventricular filling in early diastole to the rate of filling during atrial contraction (from 1.02 +/- 0.27 to 1.10 +/- 0.33 at rest and from 0.91 +/- 0.25 to 0.93 +/- 0.41 during a load, both p = ns). It may be concluded that long-term hypolipidaemic treatment in patients with hypercholesterolaemia contributes to better diastolic filling of the left ventricle.

Freiberger T, Soska V, Kuhrová V, Stejskal J. · Výzkumný ústav zdraví dítĕte, Brno. · Cas Lek Cesk. · Pubmed #10916204 No free full text.

Abstract: The authors present an international MedPed project (Make early diagnoses to prevent early deaths in medical pedigrees) the task of which is to increase the number of patients with familial lipid disorders identified and adequately treated all over the world. This will lead to significant decrease of premature deaths from coronary artery disease. Primary effort has been focused on familial hypercholesterolemia. The realization of MedPed program in Czech Republic is described.