Hyperlipidemias: Bláha V

Bláha V, Mistrík E. · Klinika gerontologická a metabolická Lékarské fakulty UK a FN Hradec Králové. · Vnitr Lek. · Pubmed #19449750 No free full text.

Abstract: Diabetes mellitus associates with high cardiovascular risk. The absolute values of cardiovascular risk tend to be even higher than as calculated from the SCORE tables. Recent randomized clinical trials have shown evidence of benefit and safety of more intensive LDL-cholesterol lowering in patients with diabetes and established cardiovascular disease supporting guidelines for a more intensive LDL goal of therapy. A recent meta-analysis has confirmed benefit on major coronary events and ischaemic stroke in many diabetic patient subgroups, including those with type 1 disease. The pathological combination of several lipoprotein metabolism abnormalities and the need to reach lipoprotein goals need combination therapy of hypolipidemic drugs with different mechanisms of action. Despite statin treatment, cardiovascular disease residual risk remains high. After LDL the next lipoprotein goal is to increase HDL. Although there has been disappointment with the first cholesteryl-ester-transfer-protein-inhibitor, there is encouraging evidence that increasing HDL with the peroxisome-proliferator-activator-receptor (PPAR) gamma agonist, pioglitazone and nicotinic acid derivatives may contribute beyond statin therapy.

Ceska R, Kvasnicka T, Bláha V, Pit'ha J, Soska V. · III. interni klinika 1. lékafské fakulty UK a VFN, Praha. · Vnitr Lek. · Pubmed #16737147 No free full text.

Abstract: BACKGROUND: Treatment of hyperlipoproteinaemias (HLP) is a basic step in prevention and treatment of atherosclerosis and its complications. Simvastatin is among hypolipidaemic agents a preparation for which at present there is most evidence from intervention trials. On the Czech market are at present in addition to the original one also some other preparations of simvastatin. In the submitted paper the authors present results achieved with the preparation Simvor (Rambaxy, distribution in CR Interchemia), tablets containing 20 mg simvastatin. CHARACTERISTIC OF GROUP AND METHODS: In 15 departments in the CR a total of 185 patients with HLP were examined, 98 men and 87 women, mean age 55.8 years. The patients were treated after a minimal 4-week period of non-pharmacological treatment with simvastatin 20 mg for a period of 6 weeks. The patients were subjected at the onset and end of treatment to a complete medical examination, basic parameters of lipid metabolism were assessed and a safety laboratory was involved. Facultatively in some departments additional examinations were made. RESULTS: The total cholesterol level 7.26 +/- 1.01 mmol/l declined on average by 1.64 mmol/l i.e. to 5.62 mmol/l, LDL-cholesterol declined from the original value of almost 5 mmol/l to 3.55 mmol/l. The baseline triglyceride concentration 3.07 declined by 1 mmol/l to 2.09 mmol/l, and HDL-cholesterol which was in a normal range already at the onset of treatment did not change significantly, i.e. its slight increase did not reach statistical significance. Treatment was well tolerated and in the safety laboratory no significant deviations from normal were recorded. DISCUSSION: The results achieved in our patients are as far as the investigated parameters are concerned, comparable with or even better than the results presented in the ample literature. The safety and tolerance of treatment of the investigated preparation is also very good. Unfortunately we did not have an opportunity during our short-term follow up to evaluate the influence of the investigated preparation on the incidence of cardiovascular diseases or mortality. In this respect we can only refer to positive results assembled with simvastatin in large statin intervention "megatrials". CONCLUSION: Treatment with decline of total and LDL-cholesterol and triglycerides. Treatment was well tolerated by the patients, in the safety laboratory no significant deviations were detected.

Bláha M, Krejsek J, Bláha V, Andrýs J, Vokurková D, Malý J, Blazek M, Skorepová M. · Department Hematology, Institute of Clinical Immunology and Allergology, Faculty Hospital, Charles University, Hradec Králové, Czech Republic. · Physiol Res. · Pubmed #15209534 links to  free full text

Abstract: The role of adhesive selectin molecules in the process of atherogenesis is an open question. These molecules are known as markers of atherosclerosis activity, however, only some biological mechanisms are known up to now. In this study we examined the levels of soluble forms of E-, P-selectin and monocyte chemotactic protein (MCP-1) in the process of extracorporeal cholesterol elimination by LDL-apheresis. We measured the levels of sE-, sP-selectin and MCP-1 in the plasma before and after LDL-apheresis and in the washout solution from immunoabsorption columns Lipopak. Eighty measurements were performed repeatedly in 6 patients with severe familial hypercholesterolemia (FH) on long-term LDL-apheresis treatment. Before the procedure P-selectin levels were 204+/-179 ng/ml, E-selectin 32.1+/-33.7 ng/ml, MCP-1 323.8+/-121 pg/l, whereas after the procedure we found P-selectin levels 131.6+/-34 ng/ml, E-selectin 33.1+/-51 ng/ml, and MCP-1 200.4+/-15 pg/l. Levels of P-selectin were increased in the blood of patients with FH in spite of long-term intensive extracorporeal LDL-elimination, documenting thus the activity of atherosclerosis. The levels of P-selectin and MCP-1 decreased significantly after the hypolidemic procedure and could be used as another marker showing the effectivity of the extracorporeal LDL-cholesterol elimination (immediately after the procedure), and, after further verification, may serve as a marker for controlling the therapy efficacy.

Bláha M, Cermanová M, Bláha V, Blazek M, Malý J, Siroký O, Solichová D, Filip S, Rehácek V. · Department of Haematology, IInd Internal Clinic, Charles University, Hiradec Králové, Czech Republic. · Ther Apher Dial. · Pubmed #17309569 No free full text.

Abstract: The aim of this work is to arbitrate the incidence of side effects and tolerability of long lasting LDL-apheresis in familial hyperlipoproteinemia. 1200 procedures were performed and the last 463 of them were evaluated. An immunoadsorption method of LDL-apheresis was used (continuous blood cell separator Cobe Spectra; secondary device: automated adsorption-desorption ADA, Medicap; absorption columns: Lipopak). As a whole, 6.26% adverse events were found and subsequently resolved by standard symptomatic therapy. Vaso-vagal reactions (symptoms of neurovegetative lability) were the most common adverse effects, presented as malaise, weakness, slight and short-term drop in blood pressure or other general signs. They were all well controlled by symptomatic therapy. We conclude that LDL-apheresis in the hands of experienced personnel is a safe procedure. An acceptable procedure duration limit, balancing the possibility to achieve a targeted cholesterol level while still maintaining an acceptable patient tolerance, was confirmed to be 4 hours.

Bláha V, Solichová D, Zadák Z. · Klinika gerontologická a metabolická Fakultní nemocnice UK, Hradec Králové. · Vnitr Lek. · Pubmed #11344651 No free full text.

Abstract: Dyslipoproteinaemia as one among classical risk factors of atherosclerotic cardiovascular diseases has been involved also in the aged. The predictive value of total cholesterol, LDL-cholesterol, HDL-cholesterol, triacylglycerols and lipoprotein (a) is preserved. There are several objective data from post-hoc analyses of prospective clinical studies AFCAPS/TexCAPS, 4S, CARE, LIPID a WOSCOPS, which addressed the need of treatment of dyslipoproteinaemia in the aged. The guidelines are not unique, but they stress an individual approach. We usually continue to treat genetic forms of dyslipidaemia. Candidates of treatment are also patients with diagnose of coronary heart disease (CHD) and sublinic form of CHD, where the treatment has been effective within two years and lead to decrease of CHD risk up to 45%. The individuals with CHD and other CHD risk factors absent would be treated less often. The diet is an basic treatment option of hypolipidemic intervention in the elderly. We do not omit exercise. The pharmacotherapy of dyslipidaemia is used for the individuals with high risk. We usually start with lower dose of fibrates or statins and monitor for adverse effects of such therapy.

Zadák Z, Bláha V, Hyspler R, Zd'ánský P. · Klinika gerontologická a metabolická Fakultní nemocnice UK, Hradec Králové. · Vnitr Lek. · Pubmed #11344642 No free full text.

Abstract: The article deals with contemporary views on the impact of different nutritional substrates important for the construction of diets for patients with primary and secondary hyperlipoproteinaemia, explanation of different provisions and instructions according to which the physician or dietitian can prepare individual diets for normosthenic and obese patients, incl. calculation of the energy value of the diet. The author emphasizes also some new aspects of nutritional pharmacology useful not only for the treatment of hyperlipoproteinaemia but also for prevention of thrombogenic complications and adverse vasomotor reactions in patients with affections of the cardiovascular system.