Hyperlipidemias: Poland

Bobiński R. · Wydział Nauk o Zdrowiu, Akademia Techniczno-Humanistyczna w Bielsku-Białej. · Chir Narzadow Ruchu Ortop Pol. · Pubmed #18847012 No free full text.

Abstract: Dupuytren's contracture is a connective tissue disorder characterized by contractile palmar aponeurosis leading to shortening and progressive digital flexion deformity. Various investigators have proposed many theories and documented several findings regarding the aetiology of Dupuytren's contracture. However, none of them explains the causes well enough. Most studies have found relationships between the disorder and manual labor, previous hand injures, genetic susceptibility, diabetes mellitus, epilepsy, high cholesterol level profile and intake of either alcohol or tobacco. However, according to others, the evidence on risk factors associated with certain lifestyles has been conflicting. This article reviews the most common theories regarding the aetiology of Dupuytren's contracture such as genetic, microinjury, immunological, toxic and ischaemic theories.

Galus R, Zandecki Ł, Jóźwiak J, Włodarski K. · Warszawski Uniwrsytet Medyczny, Katedra i Zakład Histologii i Embriologii Centrum Biostruktury. · Pol Merkur Lekarski. · Pubmed #18702340 No free full text.

Abstract: Statins are well-established and effective drugs in the treatment of hyperlipidemias and coronary heart disease. However the effects of statins extend beyond their lipid-lowering actions, due to their capacity to inhibit prenylation of some intracellular regulatory proteins. Recent studies have shown that statins could modulate inflammantory response, improve endothelial function, exert antiarrhytmic properties, have beneficial effects on renal function and bone tissue. Statins may exert effect in the treament and prevention of dementia and some autoimmune disorders. Although statins therapy is generally well-tolerated, sometimes they lead to objective adverse effects, mainly in muscular system. Combination therapy with fibrates, coenzyme Q and other substances may increase and even extend therapeutic effects of statins. Further studies will help to clarify the clinical role of statins.

Otto-Buczkowska E, Dworzecki T, Mazur-Dworzecka U. · Upper Silesia Mother and Child Health Centre, Katowice. · Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw. · Pubmed #18577344 links to  free full text

Abstract: For many years chronic complications of diabetes in adolescent patients were linked mainly to microangiopathy. New, more and more accurate, diagnostic methods, making noninvasive diagnosis of very early lesions in the vascular wall possible, allowed to find out that microangiopathic lesions may be present even in very young patients. Maintenance of increased blood glucose levels initiates a number of mechanisms which lead to damage of blood vessels and nerves. Early detection and treatment of these abnormalities may help to prevent the natural progression of the disease. Effective early prevention of cardiovascular disease will involve the lifestyle modification.

Olczak A. · Klinika i Katedra Chorób Zakaźnych i Hepatologii CM UMK. · Przegl Epidemiol. · Pubmed #18572495 No free full text.

Abstract: HAART changed natural course of infection with HIV, reduced the morbidity and mortality of AIDS patients. The lipodystrophy syndrome is long-term complication of antiretroviral therapy characterized by changes in body fat redistribution changes and metabolic abnormalities: insulin resistance, hyperglycemia, diabetes type 2, hypertriglyceridemia and hyperlipidemia. The pathogenesis is multifactorial due to interplay of viral, host and drug related factors. The HIV protease inhibitors and NRTI may play a pathogenic role. The potential risk factors include treatment with PIs and NTRIs, increasing age, gender and genetic predispositions.

Rzewuska M. · Samodzielna Pracownia Farmakoterapii IPiN w Warszawie. · Psychiatr Pol. · Pubmed #18046977 No free full text.

Abstract: Compared with the general population, persons with schizophrenia are characterized with an increased prevalence of obesity, type 2 diabetes mellitus, and cardiovascular disease. Weight gain and increased adiposity is associated with decreases in insulin sensitivity, leading to an increased risk of hyperglycaemia and hyperlipidemia. Antipsychotic drugs can increase adiposity and the range of trials suggests that treatment with antipsychotic medications may be associated with an increased risk of acute (ketoacidosis), subacute (weight gain, glucose intolerance, insulin resistance, dyslipidemia), and chronic (diabetes, hypertension, coronary heart disease) metabolic complications. Conclusions regarding the relative effects of various antipsychotic agents on different components of the metabolic syndrome were reviewed, as well as recommendations for monitoring these effects were noted. Selection and management of the antipsychotic agent reflects a balance between optimizing therapeutic effectiveness, modifying diet and exercise, and avoiding excessive weight gain, dyslipidemia, and insulin resistance.

Okopień B, Stachura-Kułach A, Kułach A, Krysiak R, Herman ZS. · Katedra Farmakologii, Zakład Farmakologii Klinicznej SI. AM. · Pol Merkur Lekarski. · Pubmed #17877135 No free full text.

Abstract: The role of Impaired Glucose Tolerance (IGT) in the pathogenesis of cardiovascular complications is still underestimated. Besides proven doubled risk of diabetes mellitus, IGT patients present wide range of atherogenic disturbances such as insulin resistance, proinflammatory and procoagulant state and proatherogenic lipid changes. This paper reviews lipid metabolism disorders, such as elevation of free fatty acids and triglycerides level, structural changes of LDL (high level of "small dense" and modified LDL), HDL particles and more, as well as visceral obesity often observed in patients with IGT. Untreated IGT leads to diabetes mellitus and cardiovascular complications, consequently increasing risk of myocardial infarction and stroke. This supports the need for treatment at the stadium of IGT The therapy of Impaired Glucose Tolerance should be focused on body mass reduction, improvement of insulin sensitivity and lipid disturbances correction. The most common approach for overweight persons is a balanced-calorie diet and lifestyle change. According to several surveys the drugs reducing insulin resistance, such as biguanides or thiazolidinediones, as well as those improving lipid disorders (fibrates) seem to be efficient, but it needs to be confirmed in randomized clinical trials.

Włodarek D. · Katedra Dietetyki, Szkoła Główna Gospodarstwa Wiejskiego w Warszawie, 02-776 Warszawa. · Rocz Panstw Zakl Hig. · Pubmed #17711090 No free full text.

Abstract: Daily cholesterol consumption in western countries reaches as much as 400 mg. According to the health recommendations the daily intake should not exceed 300 mg and in the case of people with cardiovascular disease it should be less than 200 mg. For 50 years it is known that phytosterols can decrease the level of cholesterol in blood. One of the mechanisms is based on the fact that phytosterols stop absorption of cholesterol in digestive tract, which results in the decrease of the concentration of cholesterol in blood. The second mechanism is based on the fact that cholesterol is pumped back out of enterocytes into the lumen of small intestine by ABC transporter and phytosterols increase this process. The above merftioned mechanisms are different than the way statins can lower cholesterol level and they are commonly used as hipocholesterolemic medicine. Because different mechanisms are implemented both statins and fitosterols can be used in therapy of hipercholeserolemia. The people taking statins who still have increased level of total cholesterol and LDL-cholesterol in blood can include phytosterols in their diet what can lead to the decrease of its level.

Swiderski F, Dabrowska M, Rusaczonek A, Waszkiewicz-Robak B. · Department of Functional Foods and Commodity Warsaw Agricultural University, 02-776 Warsaw, Nowoursynowska 159C, Poland. · Rocz Panstw Zakl Hig. · Pubmed #17711089 No free full text.

Abstract: Garlic is characterised by medicinal properties due to the content of over 2000 biologically active substances. Numerous commercially processed garlic forms, which differ in the content of bioactive compounds, especially sulphuric, are available on the market. The knowledge of the types of bioactive substances present in garlic and its products, their changes during treatment and pro-health influence is of crucial importance to the diet supplement producers, doctors, pharmacists and consumers. Therefore, this work has aimed to characterise the most important bioactive substances of garlic, its preparations and describe in detail the role of garlic in dietoprophylaxis and dietotherapy.

Naruszewicz M, Kozlowska-Wojciechowska M. · Department of Pharmacognosy and Molecular Basis of Phytotherapy, Faculty of Pharmacy Medical, University of Warsaw, Warsaw, Poland. · Br J Nutr. · Pubmed #17705890 No free full text.

This publication has no abstract.

Nagalski A, Bryła J. · Zakład Regulacji Metabolizmu, Instytut Biochemii, Wydział Biologii, Uniwersytet Warszawski, Warszawa, Poland. · Postepy Hig Med Dosw (Online). · Pubmed #17554232 links to  free full text

Abstract: Niacin (nicotinic acid and nicotinamide) is a vitamin used as a source of the NAD+ and NADP+ coenzymes required for many metabolic processes. Its low dietary levels induce the development of pellagra. Niacin has been used for decades in the treatment of patients with disturbed lipid and lipoprotein metabolism, this being the main cause of atherosclerotic changes in cardiovascular diseases. It is still the most efficacious drug in terms of its ability to increase HDL cholesterol content accompanied by a decrease in all atherogenic lipoproteins (VLDL, LDL, and L(a)) as well as fatty acids and triglycerides. Niacin also increases adiponectin level, which might result in additional atheroprotection. There are studies confirming the beneficial action of niacin against migraine and hyperphosphatemia associated with renal failure, ethanol-induced neurodegeneration, and loss of beta-cell function in type 1 diabetes. Moreover, it augments plasma tryptophan concentrations in HIV-infected patients and thyroid radiosensitivity to 131I. Inhibition of the invasion of hepatoma cells has also been proven. However, it is necessary to point out that the currently applied niacin preparations might exhibit such side effects as cutaneous flushing, gastrointestinal disturbances, and hepatotoxicity, particularly during treatment with sustained-release niacin preparations. The recent discovery of the G-protein-coupled receptor GPR109A, which mediates the antilipolytic effects induced by nicotinic acid in adipocytes as well as cutaneous vasodilation, allows the development of new agents interacting with this receptor. In view of these observations, niacin therapy must be accompanied by control of the choice of niacin preparation and its dose in order to eliminate or at least limit its side effects.

Broncel M, Balcerak M, Chojnowska-Jezierska J. · Department of Internal Diseases with Clinical Pharmacology and Therapy Monitoring Unit, Medical University of Łódź, Poland. · Pol Merkur Lekarski. · Pubmed #17477094 No free full text.

Abstract: It is very difficult to reach therapeutic goals of lipids concentrations n patients with very high and high risk development of coronary heart disease during statin monotherapy. Treatment with high doses of statins is associated with significantly increase of serious adverse events, especially rhabdomiolysis. Therefore are taken much more often trials of the combined hypolipemic therapy. In this article, we briefly review the clinical trial data on the efficacy, safety and influence on non-lipid atherosclerosis factors of combined therapy statin with fibrates, statin with nicotinic acid and statin with ezetimibe.

Lukjanowicz M, Trzcińska-Butkiewicz B, Brzosko M. · Klinika Reumatologii PAM w Szczecinie. · Pol Arch Med Wewn. · Pubmed #17278784 No free full text.

Abstract: Hypothyroidism is one of the common causes of the secondary hypercholesterolemia. The prevalence of hypothyroidism in the general population is estimated to be as high as about 1.5%. Frequency of the hypothyroidism in patients with hyperlipidemia is high, and can be observed in 4.2-10% in different populations. Most commonly, there is no need to treat the hypothyroid patients with the hypolipidemic drugs. Substitution treatment with the thyroid hormones usually results in either normalization or significant decreasing of the lipid levels. Hypothyroidism with symptoms of involvement of skeletal muscles is referred as to hypothyroid myopathy in English literature, and can be present in 30-80% patients with deficiency of the thyroid hormones. Hypothyroidism is a risk factor of developing of toxic injury of muscles, what is thought to be related to hypolipidemic drug intake. We report a case of a patient with undiagnosed hypothyroidism with muscle involvement manifestation, who was treated with fenofibrate due to accidentally diagnosed hypercholesterolemia. Hypolipidemic management resulted in rapid exacerbation of previously moderate myopathy. High concentrations of muscle enzymes and moderate increasing of creatinine concentration were detected. Improvement was observed after discontinuation of fenofibrate administration, but muscle symptoms and elevation of muscle enzymes and creatinine persisted. After administration of levothyroxin, muscle weakness and laboratory abnormalities were observed no longer. After several months of follow-up we believe that treatment with fenofibrate in our patient was complicated with muscle tissue damage and exacerbated symptoms of myopathy originally related to decompensated hypothyroidism.

Wójcik K, Piekarska A. · Klinika Chorób Zakaźnych i Hepatologii UM w Lodzi. · Pol Arch Med Wewn. · Pubmed #17274475 No free full text.

This publication has no abstract.

Skałba P, Dabkowska-Huć A. · Gynaecological Endocrinology Department, Medical University of Silesia, Katowice, Poland. · Endokrynol Pol. · Pubmed #16821219 No free full text.

Abstract: Polycystic ovarian syndrome (PCOS) is considered to be the main reason of hyperandrogenism in reproductive women. There are often metabolic disorders connected with carbohydrate and adipose metabolism in the patients with PCOS. However, presence of metabolic disorders does not influence the diagnosis of the syndrome. The investigations demonstrated that the changes in lifestyle and use of proper medications could normalize endocrine system and metabolism through insulin-sensitivity increase and in the result it could restore the menses and ovulations. This paper introduces present knowledge concerning metabolic disorders associated with PCOS.

Chudzik W, Kaczorowska B, Chmielewski H, Przybyła M, Gałka M. · Klinika Neurologii i Neurorehabilitacji z Oddzialem Udarowym Uniwersyteckiego Szpitala Klinicznego nr 2 w Lodzi. · Pol Merkur Lekarski. · Pubmed #16379334 No free full text.

Abstract: The occurrence of stroke increases with age, particularly affecting the older elderly, a population also at higher risk for coronary heart disease (CHD). Epidemiological and observational studies have not shown a clear association between cholesterol levels and all causes of stroke. Nevertheless, large, long-term statin trials in patients with established CHD or et high risk for CHD (diabetes, hypertension) have shown that statins decrease stroke incidence in these populations even with a normal baseline cholesterol concentration. In patients with previous stroke statins reduce the incidence of coronary events, but whether they actually reduce the incidence of recurrent strokes in secondary prevention is unproved. In this review we discuss the potential reason for the effects of statins on stroke and the mechanisms of action. Statins probably reduce stroke by a variety of mechanisms. Several studies indicate that statins have multiple effects beyond lowering the cholesterol level. There is evidence that statins have neuroprotective properties for the acute ischaemic brain. Statins interfere with platelet aggregation and have anti-inflammatory and antioxidative properties. Also statins promote stabilisation of atherosclerotic plaques and improve blood flow to the ischaemic brain. The protective effects of statins might be due to their direct effect on endothelial cells leading to improved nitric oxide (NO) bioavailability. However further studies are needed to understand the full role of statins in the prevention of stroke in patients without established cardiovascular disease, representative of the typical stroke population.

Jedrzejuk D, Milewicz A. · Department of Endocrinology, Diabetology and Isotope Therapy, Wroclaw Medical University, Poland. · Gynecol Endocrinol. · Pubmed #16373247 No free full text.

Abstract: Human life was prolonged by 30 years in the past century, with the result that about 40% of a woman's life falls within the postmenopausal period. The consequences, both early and remote, in the form of cardiovascular disease, osteoporosis and neoplastic disease are most pronounced in women suffering from one of the most common diseases, i.e., diabetes mellitus and the metabolic syndrome preceding it. These patients are problematic for physicians, and for this reason a study of diagnostic and therapeutic management was undertaken on the basis of our own experience as well as examination based on evidence-based medicine. Prior to making therapeutic decisions it is necessary to determine cardiovascular, thromboembolic and breast cancer risk factors. Hormonal therapy may be helpful in young postmenopausal women who are free of risk factors, and its composition and route of administration are significant considerations. Women with risk factors and who are more than 10 years after menopause should be administered alternative therapy depending on the diagnosed pathology.

Szczeklik A, Musiał J, Undas A, Sanak M. · Department of Medicine, Jagiellonian University School of Medicine, Cracow, Poland. · J Thromb Haemost. · Pubmed #16102031 No free full text.

Abstract: Treatment failures occur with any drug and aspirin is no exception. Evidence is growing to indicate that there are subpopulations that do not respond to antithrombotic action of aspirin. The term 'aspirin resistance' has been used to describe a number of different phenomena, including inability of aspirin to: (i) protect against cardiovascular events despite its regular intake; (ii) to affect various laboratory tests, reflecting platelet activity. Research on aspirin resistance yielded interesting results in clinical pharmacology and pharmacogenetics. Future studies will show whether genotyping for polymorphisms might be of value in everyday clinical use of aspirin. Present data indicate that in survivors of recent myocardial infarction or unstable angina, patients receiving coronary artery bypass grafts, as well as in subjects with hypercholesterolemia, aspirin resistance has to be considered when implementing antithrombotic therapy. However, in individual patients the available laboratory tests are of no particular use to predict reliably the clinical outcome or to guide in making therapeutic decision. Prospective clinical trials seem necessary to reach such conclusions.

Piechowski-Jóźwiak B, Bogousslavsky J. · Department of Neurology, CHUV, Lausanne, Switzerland. · Acta Neurol Belg. · Pubmed #16076057 No free full text.

Abstract: Diabetes mellitus, arterial hypertension, smoking are major stroke risk factors. The role of hypercholesterolemia in stroke has not been established yet. In patients with type 2 diabetes mellitus there is evidence that intensive glucose lowering therapy diminishes the risk of microvascular complications. In all patients with stroke or transient ischemic attack (TIA), blood pressure should be lowered irrespectively of the baseline level with either diuretics, angiotensin converting enzyme (ACE) inhibitors, beta-blockers, or calcium antagonists. The role of angiotensin II (AT2) receptor blockers has not been established so far. In general terms a global approach to management of patients with vascular risk factors should be developed. An extended follow-up of randomised trials on preventive therapy should be completed. Controlled trials comparing angiotensin receptor blockers with ACE inhibitors should be started. Further research may focus on the new lipid lowering agents, and on the comparison of single lipid lowering agent vs. combinations in stroke prevention. These efforts should help in finding the best vasoprotective strategy in stroke prevention.

Watala C. · Department of Haemostasis and Haemostatic Disorders, Medical University of Lodz, Poland. · Curr Pharm Des. · Pubmed #16022671 No free full text.

Abstract: Blood platelets play a crucial role in physiological haemostasis and in pathology of prothrombotic states, including atherosclerosis. In this paper, we review major factors underlying altered platelet reactivity, with special attention paid to abnormalities in platelet function in people with diabetes mellitus (DM). The overall picture of platelet abnormalities in DM, including altered adhesion and aggregation, is hypersensitivity of diabetic platelets to agonists. "Primed" diabetic platelets respond more frequently even to subthreshold stimuli, sooner become exhausted, consumed and finally hyposensitive, thus contributing to accelerated thrombopoiesis and release of 'fresh' hyperreactive platelets. In diabetes disturbed carbohydrate and lipid metabolism may lead to physicochemical changes in cell membrane dynamics, and consequently result in altered exposure of surface membrane receptors. These phenomena, together with increased fibrinogen binding, prostanoid metabolism, phosphoinositide turnover and calcium mobilisation often present in diabetic patients, contribute to enhanced risk of small vessel occlusions and accelerated development of atherothrombotic disease of coronary, cerebral and other vessels in diabetes. As platelet hypersensitivity in DM makes a major contribution to enhanced risk of thromboembolic macroangiopathy, and consequently enhanced morbidity and mortality, it validates use of antiplatelet agents in diabetic individuals. Platelet hyperreactivity may be cured with various antiplatelet drugs to a considerably large extent notwithstanding, evidence gathered from clinical and experimental surveys shows that this approach may not always be equally efficient in people with diabetes. Observations from clinical studies rather support the use of multifactorial strategy under such circumstances, like a combined therapy of aspirin plus either purinoreceptor blocker or GPIIb-IIIa antagonist.

Piechota G, Małkiewicz J, Karwat ID. · Katedra i Zakład Epidemiologii Akademii Medycznej im. Prof. F Skubiszewskiego w Lublinie. · Przegl Epidemiol. · Pubmed #16013421 No free full text.

Abstract: The aim of the review is to determine complex relations between obesity and disability. Obesity is defined as an abnormal, pathologic increase in body fat. This disease results from environmental factors, like: low level of physical activity, excessive intake of high energy food and genetic predisposition to storage of fat. The health consequences of obesity are chronic diseases: diabetes mellitus type 2, dyslipidemia, coronary heart disease, gallbladder disease, osteoarthritis, sleep apnea, certain types of cancers and also psychosocial problems, which together have an adverse effect on quality of life. The consequences of this comorbidities and conditions are also higher rates of disability in this group of people. Limitations in everyday functioning of the overweight and obese people are the consequence of comorbidities, for example: diseases of the circulatory system and late diabetic complications. The leading cause of disability (especially in functional area) is impairement of the musculoskeletal system, caused by excessive weight, for ex. chronic back pain. In this case the mechanism of "vicious cycle" is observed where sedentary lifestyle contributes to obesity and obesity exacerbates disability. The role of physical inactivity in the development of weight gain emphasises the fact that among people with disabling conditions rates of obesity are significantly higher.

Lisowska A, Musiał WJ. · Department of Cardiology, Medical University of Białystok, Poland. · Rocz Akad Med Bialymst. · Pubmed #15631334 No free full text.

Abstract: Heart failure is highly prevalent in the population with chronic kidney disease. Upon starting dialysis, 37% of patients will have had a previous episode of heart failure, doubling the risk of death. Both systolic and/or diastolic function may be impaired. 15% of patients starting dialysis therapy have systolic dysfunction of the left ventricle. The prevalence of diastolic dysfunction at dialysis inception is unknown, but is likely to be high. Either systolic or diastolic dysfunction can lead to clinically evident congestive heart failure. Hypertension and coronary heart disease are important causes of myocardial dysfunction in end-stage renal disease. Individuals with chronic kidney disease are at a very high risk for the development and progression of cardiovascular disease. The increased risk of cardiovascular disease is due to a higher prevalence of both traditional risk factors as well as nontraditional "uremia-related" risk factors. The prevalence of coronary artery disease (CAD) approaches 40% among patients starting dialysis. About 70-80% of these patients have hypertension. Anaemia is a known risk factor for left ventricular hypertrophy (LVH) and dilatation, heart failure and death. The diagnosis and treatment of heart failure in the patients with chronic kidney disease (CKD) are similar to that recommended for patients without CKD. The potent drugs like ACE-I, AT-1 antagonists, beta-receptor antagonists are the main tools in nowadays treatment of CHF. New therapeutic regiments using natriuretic peptides are being evaluated in clinical settings.

Rutkowski B, Chmielewski M. · Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Poland. · Rocz Akad Med Bialymst. · Pubmed #15631330 No free full text.

Abstract: Lipid disturbances are a constant feature of chronic renal failure (CRF). They compose a significant risk factor for vascular complications, leading to increased morbidity and mortality in this patients group. The major lipid abnormality in the course of CRF is hypertriglyceridemia, but increased cholesterol level is also common. Numerous studies, including these from our Centre, point to the conclusion that hypertriglyceridemia is a consequence of both, increased TG production and impaired TG removal. In contrast hypercholesterolemia is mainly due to enhanced cholesterol biosynthesis. HMG-CoA reductase inhibitors (statins) compose the most promising group of drugs to treat lipid abnormalities in CRF. Apart from their lipid-lowering abilities they possess non-lipid, so called pleiotropic activities, which make them especially useful in proliferative and inflammatory kidney diseases.

Wolszakiewicz J, Bilińska M. · Klinika i Zakład Rehabilitacji Kardiologicznej i Elektrokardiologii Nieinwazyjnej Instytutu Kardiologii w Warszawie. · Pol Merkur Lekarski. · Pubmed #15518430 No free full text.

Abstract: Hypercholesterolemia is a common disorder after heart transplantation and my be associated with the development of transplant coronary artery disease. 3-hydroxy 3-methylglutaryl coenzyme A reductase inhibitors (HMG CoA) are the most effective drugs to lower cholesterol level in transplant patients. However, interaction of immunosuppressants with HMG CoA inhibitors, which are metabolized by cytochrome P 450, increase incidence of skeletal muscle myopathy and rhabdomyolysis.

Lubiszewska B, Ruzyłło W. · I Klinika Choroby Wieńcowej, Instytutu Kardiologii w Warszawie. · Pol Arch Med Wewn. · Pubmed #15508815 No free full text.

This publication has no abstract.

Małecki R. · Oddział Wewnetrzny o Profilu Nefrologicznym SPZOZ Centralnego Szpitala Kolejowego w Warszawie. · Pol Arch Med Wewn. · Pubmed #14699681 No free full text.

This publication has no abstract.