Anna Gdula-Dymek

Publications of Anna Gdula-Dymek

• The effect of bezafibrate and omega-3 fatty acids on lymphocyte cytokine release and systemic inflammation in patients with isolated hypertriglyceridemia.

  Authors: Robert Krysiak, Anna Gdula-Dymek, Boguslaw Okopien

  European journal of clinical pharmacology. 06/2011; 67(11):1109-17.

  The aim of this study was to compare the effects of fibrates and omega-3 fatty acids on lymphocyte secretory function and systemic inflammation in patients with isolated hypertriglyceridemia. TheThe aim of this study was to compare the effects of fibrates and omega-3 fatty acids on lymphocyte secretory function and systemic inflammation in patients with isolated hypertriglyceridemia. The study included 107 patients with isolated hypertriglyceridemia who received bezafibrate (200 mg twice daily), omega-3 fatty acids (1 g twice daily) or placebo for 12 weeks. The lipid profile, fasting and 2-h post-glucose load plasma glucose levels, homeostasis model assessment index (HOMA), plasma high-sensitivity C-reactive protein (hsCRP) levels and lymphocyte release of interleukin-2, interferon-γ and tumor necrosis factor-α were assessed at baseline, on the day of randomization, and after 4 and 12 weeks of treatment. Both bezafibrate and omega-3 fatty acids reduced plasma triglyceride levels. Bezafibrate additionally decreased total and low-density lipoprotein-cholesterol levels and the HOMA and insignificantly decreased post-glucose load plasma glucose, as well as increased high-density lipoprotein-cholesterol. Bezafibrate treatment was associated with a reduction in lymphocyte release of interleukin-2, interferon-γ and tumor necrosis factor-α, which was accompanied by a reduction in plasma hsCRP levels. Omega-3 fatty acid did not significantly reduce lymphocyte cytokine release and plasma hsCRP. The anti-inflammatory effects of both drugs did not correlate with their action on plasma lipids, but in the case of the former the effect was related to the improvement in insulin sensitivity. Our results indicate that bezafibrate is superior to omega-3 fatty acid in inhibiting systemic inflammation and lymphocyte secretory function.

• [Beta-adrenolitics in therapy of cardiovascular diseases in patients with type 2 diabetes mellitus].

  Authors: Joanna Krupej, Leszek Kedzierski, Anna Gdula-Dymek, Robert Krysiak, Bogusław Okopień

  Wiadomości lekarskie (Warsaw, Poland : 1960). 01/2011; 64(2):132-41.

  The recent years have brought about a marked increase in the number of people suffering from carbohydrate metabolism disturbances. This is primarily due to adverse changes in lifestyle, whichThe recent years have brought about a marked increase in the number of people suffering from carbohydrate metabolism disturbances. This is primarily due to adverse changes in lifestyle, which consists of an improper diet, rich in simple carbohydrates and fats, and low physical activity. An increasing number of patients with diabetes resulted in the growth of a number of individuals suffering from diabetes-related complications, including cardiovascular diseases. Although, the first line treatment of cardiovascular disorders are beta-blockers, for many years their use in diabetic patients was questioned to the extent that diabetes was one of the major contraindication to these agents. These concerns stemmed primarily from the proven negative impact of first generation beta-blockers on carbohydrate metabolism. The aim of this study was to summarize the possibility of beta-blocker applications in type 2 diabetic patients suffering from cardiovascular disorders, which, in a non-diabetic population, are commonly treated with these agents, taking into account the diversity between various classes of beta-blockers. On the basis of published clinical trials and meta-analyses we discuss the impact of this group of agents on the development of new-onset diabetes, worsening of existing diabetes control, and the development and progression of diabetes-induced complications.

• Monocyte-suppressing effect of bezafibrate but not omega-3 fatty acids in patients with isolated hypertriglyceridaemia.

  Authors: Robert Krysiak, Anna Gdula-Dymek, Boguslaw Okopien

  Basic & clinical pharmacology & toxicology. 01/2011; 109(1):23-9.

  Fibrates and omega-3 fatty acids have been used for many years in the treatment of increased triglyceride levels. Unfortunately, pleiotropic effects of these agents in patients with isolatedFibrates and omega-3 fatty acids have been used for many years in the treatment of increased triglyceride levels. Unfortunately, pleiotropic effects of these agents in patients with isolated hypertriglyceridaemia are poorly understood. The aim of this study was to compare the effect of bezafibrate and omega-3 fatty acids on monocyte cytokine release and systemic inflammation in this type of dyslipidaemia. The study included eighty-seven hypertriglyceridaemic subjects randomly allocated to one of three groups, treated respectively with bezafibrate (200 mg twice daily), omega-3 fatty acids (1 g twice daily) or placebo for 90 days. Eighty-three subjects completed the study. Apart from improvement in lipid profile, bezafibrate treatment reduced plasma high-sensitivity C-reactive protein (hsCRP) levels and inhibited monocyte release of interleukin-6, interleukin-1β, monocyte chemoattractant protein-1 and tumour necrosis factor-α. Bezafibrate action on plasma hsCRP and monocyte cytokine release was lipid-independent but correlated with drug-induced improvement in insulin sensitivity. Omega-3 fatty acids reduced plasma triglycerides, but did not induce any significant changes in monocyte secretory function and plasma hsCRP. Our study suggests that bezafibrate is superior to omega-3 fatty acids in reducing systemic inflammation and in producing monocyte-suppressing effects. Anti-inflammatory actions of bezafibrate may contribute to the clinical effectiveness of fibrates in the prevention and treatment of isolated hypertriglyceridaemia.

• Effect of simvastatin and fenofibrate on cytokine release and systemic inflammation in type 2 diabetes mellitus with mixed dyslipidemia.

  Authors: Robert Krysiak, Anna Gdula-Dymek, Bogusław Okopien

  The American journal of cardiology. 01/2011; 107(7):1010-1018.e1.

  The aim of our study was to compare the effect of simvastatin and fenofibrate treatment on the secretory function of human monocytes and lymphocytes and on systemic inflammation in type 2 diabetesThe aim of our study was to compare the effect of simvastatin and fenofibrate treatment on the secretory function of human monocytes and lymphocytes and on systemic inflammation in type 2 diabetes and to assess whether their coadministration is superior to treatment with only 1 of these drugs. One hundred ninety-six adult patients with recently diagnosed and previously untreated type 2 diabetes and mixed dyslipidemia, complying throughout the study with lifestyle intervention and treated with metformin, were randomized in a double-blind fashion to receive simvastatin (40 mg), fenofibrate (200 mg), simvastatin plus fenofibrate, or placebo for 90 days. Main outcome measurements were monocyte and lymphocyte release of proinflammatory cytokines and plasma levels of C-reactive protein. One hundred ninety patients completed the study. Simvastatin and fenofibrate decreased monocyte release of tumor necrosis factor-α, interleukin-1β, interleukin-6, and monocyte chemoattractant protein-1 and lymphocyte release of interleukin-2, interferon-γ, and tumor necrosis factor-α, which was accompanied by a decrease in plasma C-reactive protein levels. Anti-inflammatory effects of fenofibrate partly correlated with the improvement in insulin sensitivity. Lymphocyte-suppressing, but not monocyte-suppressing, effect was stronger if these 2 agents were administered together. In conclusion, simvastatin and fenofibrate exhibit a similar effect on the secretory function of human monocytes and lymphocytes and on systemic inflammation in type 2 diabetic subjects with mixed dyslipidemia. This effect may be clinically relevant in the prevention of vascular complications in metformin- and diet-treated subjects with newly diagnosed diabetic dyslipidemia.

• Anti-inflammatory and monocyte-suppressing effects of simvastatin in patients with impaired fasting glucose.

  Authors: Robert Krysiak, Anna Gdula-Dymek, Joanna Scieszka, Bogusław Okopień

  Basic & clinical pharmacology & toxicology. 10/2010; 108(2):131-7.

  The aim of our study was to compare the effect of simvastatin on systemic inflammation and monocyte secretory function between individuals with impaired fasting glucose (IFG) and patients withThe aim of our study was to compare the effect of simvastatin on systemic inflammation and monocyte secretory function between individuals with impaired fasting glucose (IFG) and patients with isolated hypercholesterolaemia. The study included 25 patients with IFG and 23 patients with hypercholesterolaemia. The lipid profile, fasting and 2-hr post-glucose load plasma glucose levels, homeostatic model assessment (HOMA) ratio, glycated haemoglobin, plasma high-sensitivity C-reactive protein (hsCRP) levels and monocyte release of TNF-α, interleukin-1β, interleukin-6 and MCP-1 were assessed at baseline, and after 30 and 90 days of simvastatin treatment (20 mg/daily). Compared to monocytes of the control patients (22 age-, sex- and weight-matched patients without lipid and glucose metabolism abnormalities), monocytes of the patients with hypercholesterolaemia and patients with IFG released greater amounts of all studied cytokines and exhibited higher plasma levels of hsCRP, with no difference between the two groups of patients. Although in both the patients with hypercholesterolaemia and the patients with IFG simvastatin treatment improved lipid profile, it exhibited no effect on glucose metabolism markers. The drug markedly reduced plasma hsCRP and monocyte secretion of TNF-α, interleukin-1β, interleukin-6 and MCP-1 in a lipid- and glucose-independent manner. Our results indicate that low-grade systemic inflammation and monocyte secretory function are disturbed to a similar degree in the patients with isolated hypercholesterolaemia and in the patients with IFG. They also show that simvastatin is an effective anti-inflammatory drug in patients with isolated early glucose metabolism abnormalities.

• Pleiotropic effects of atorvastatin and fenofibrate in metabolic syndrome and different types of pre-diabetes.

  Authors: Robert Krysiak, Anna Gdula-Dymek, Ryszard Bachowski, Boguslaw Okopien

  Diabetes care. 10/2010; 33(10):2266-70.

  To compare extra-lipid effects of statins and fibrates in relation to the baseline metabolic status of patients. The study involved a group of 242 metabolic syndrome patients with or withoutTo compare extra-lipid effects of statins and fibrates in relation to the baseline metabolic status of patients. The study involved a group of 242 metabolic syndrome patients with or without pre-diabetes and randomized to atorvastatin, fenofibrate, or placebo. Compared with matched healthy subjects, metabolic syndrome patients exhibited higher plasma levels/activities of high-sensitivity C-reactive protein (hs-CRP), fibrinogen, factor VII, plasminogen activator inhibitor 1, and enhanced monocyte cytokine release. These abnormalities were alleviated by both atorvastatin and fenofibrate treatment. CRP-lowering and monocyte-suppressing actions were more pronounced for atorvastatin in subjects with impaired fasting glucose and for fenofibrate in patients with impaired glucose tolerance. The presence of pre-diabetes potentiates metabolic syndrome-induced abnormalities in plasma markers of inflammation and hemostasis and in monocyte secretory function. Both atorvastatin and fenofibrate exhibit multidirectional pleiotropic effects in subjects with metabolic syndrome, the strength of which seem to be partially determined by the type of pre-diabetes.

• [Growth hormone therapy]

  Authors: Robert Krysiak, Bogusław Okopień, Anna Gdula-Dymek

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 05/2007; 22(130):305-11.

  Growth hormone (GH) is a polypeptide secreted by somatotropic cells of the anterior part of the hypophysis. Its usage was firstly restricted to children with growth hormone deficiency. Because ofGrowth hormone (GH) is a polypeptide secreted by somatotropic cells of the anterior part of the hypophysis. Its usage was firstly restricted to children with growth hormone deficiency. Because of molecular biology development and greater availability of GH, the range of its therapeutic applications has widened. Apart from supplementary management of GH deficiency in children and adults, nowadays it is commonly used as first-line therapy in many disorders associated with short height. The aim of this paper is to present the exact role of GH in contemporary pharmacotherapy and adverse effects of treatment with GH. We review both well-known and less-commonly known indications for this form of treatment. Suggested dosage and the time of the beginning and duration of therapy are also discussed.

• [The testosterone therapy in patients with andropause]

  Authors: Robert Krysiak, Bogusław Okopień, Anna Gdula-Dymek

  Wiadomości lekarskie (Warsaw, Poland : 1960). 02/2007; 60(7-8):356-64.

  Andropause affects millions of men worldwide. The importance of this condition results not only from the aging process in contemporary societies, but also from raising awareness concerning its causesAndropause affects millions of men worldwide. The importance of this condition results not only from the aging process in contemporary societies, but also from raising awareness concerning its causes and symptoms. In recent years, the pathogenesis, diagnosis and treatment of andropause have been better known. The huge progress made in better understanding of this condition has thrown a new light on the management of patients with andropause. Unfortunately, the results of so far conducted studies are incoherent what makes it difficult to establish indications for the therapy and the time of beginning of testosterone supplementation. Apart from providing the reader with the scheme of treatment, the paper is aimed to discuss potentially beneficial and harmful effects of testosterone supplementation on various organs and life functions altered by age-related changes.

• Growth hormone therapy in children and adults.

  Authors: Robert Krysiak, Anna Gdula-Dymek, Anna Bednarska-Czerwińska, Bogusław Okopień

  Pharmacological reports : PR. 59(5):500-16.

  Growth hormone (GH) is a polypeptide hormone, secreted by somatotropic cells of the anterior part of the hypophysis. Its application in therapy, first limited to GH deficient children, has now beenGrowth hormone (GH) is a polypeptide hormone, secreted by somatotropic cells of the anterior part of the hypophysis. Its application in therapy, first limited to GH deficient children, has now been widened to various other clinical conditions, not necessarily related to short stature. Clinical trials conducted in recent years have proved the safety of its administration in both children and adults. The efficacy of this form of therapy varies, according to different authors, from enthusiastic data to very critical opinions. For many pediatric diseases, such as GH deficiency or Turner syndrome, GH is regarded by many experts, despite the high costs of the therapy, as the first-line treatment. Mounting evidence suggests that GH is safe and effective also in children with chronic renal failure and cystic fibrosis. Recently, it has also been administered to adults with GH deficiency and short bowel syndrome. The aim of this paper is to summarize the current data on GH administration in modern pharmacotherapy. In this paper we have included the results of the recently published studies and discussed not commonly known indications for GH therapy, as well as its experimental administration in both children and adults.

• Hemostatic effects of bezafibrate and ω-3 fatty acids in isolated hypertriglyceridemic patients.

  Authors: Robert Krysiak, Anna Gdula-Dymek, Bogusław Okopień

  Pharmacological reports : PR. 63(3):763-71.

  This study aimed to compare the effects of ω-3 fatty acids and fibrate treatment on plasma levels and activities of hemostatic risk factors on glucose and lipid metabolism in subjects with isolatedThis study aimed to compare the effects of ω-3 fatty acids and fibrate treatment on plasma levels and activities of hemostatic risk factors on glucose and lipid metabolism in subjects with isolated hypertriglyceridemia. Seventy-three subjects with elevated triglyceride levels were allocated into one of the following treatment options: bezafibrate (200 mg twice daily), ω-3 fatty acids (1 g twice daily) or placebo. Plasma lipids, glucose homeostasis markers (fasting and 2-h post-glucose load plasma glucose levels and HOMA), as well as plasma levels/activities of fibrinogen, factor VII and PAI-1 were determined at baseline, on the day of randomization, and after 4 and 12 weeks of the treatment. Not only did bezafibrate improve plasma lipids, but it also increased glucose sensitivity and tended to reduce post-glucose loads of plasma glucose. Except for the reduction in plasma triglycerides, ω-3 fatty acids produced no effect on the lipid profile and insulin sensitivity. Both treatment options reduced, to similar extents, plasma levels of fibrinogen and PAI-1 and factor VII coagulant activity. Our study indicates that, although fibrates exhibit more-pronounced metabolic effects than do ω-3 fatty acids, both these treatment options are equipotent in producing a complex beneficial effect on hemostasis in isolated hypertriglyceridemic subjects.

• Hemostatic effects of simvastatin in subjects with impaired fasting glucose.

  Authors: Robert Krysiak, Anna Gdula-Dymek, Bogusław Okopień

  Pharmacological reports : PR. 62(6):1090-8.

  The aim of our study was to compare the effect of simvastatin on a range of hemostatic variables in subjects with impaired fasting glucose (IFG) and isolated hypercholesterolemia. We enrolled 28The aim of our study was to compare the effect of simvastatin on a range of hemostatic variables in subjects with impaired fasting glucose (IFG) and isolated hypercholesterolemia. We enrolled 28 subjects with IFG, 25 primary hypercholesterolemic patients and 24 age-, sex- and weight-matched control subjects with normal lipid profile and glucose metabolism. The tested parameters (lipid profile, fasting and 2-h post-glucose load plasma glucose levels, the homeostasis model assessment (HOMA) ratio, glycated hemoglobin, the prothrombin and partial thromboplastin time, plasma fibrinogen, PAI-1 levels and factor VII coagulant activity) were determined at baseline and after 4 and 12 weeks of simvastatin treatment (20 mg/daily). Compared to the control subjects, hypercholesterolemic and IFG patients exhibited increased plasma levels of fibrinogen and PAI-1 and increased factor VII activity. PAI-1 was higher in hypercholesterolemic than in IFG patients. Simvastatin improved lipid profile in both groups of patients, but it did not influence glucose metabolism. In both IFG and hypercholesterolemic patients, simvastatin reduced fibrinogen and PAI-1 levels and factor VII activity, and it prolonged the prothrombin and partial thromboplastin time in a lipid- and glucose-independent manner. The main conclusion of our study is that early glucose metabolism abnormalities are associated with disturbed coagulation and fibrinolysis, which contribute to the development and progression of atherosclerosis. Treatment with a lipid lowering agent may bring multidirectional beneficial effects on hemostasis in IFG patients.

• Update on the management of polycystic ovary syndrome.

  Authors: Robert Krysiak, Bogusław Okopień, Anna Gdula-Dymek, Zbigniew Stanisław Herman

  Pharmacological reports : PR. 58(5):614-25.

  Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects 5% to 10% of women in reproductive age. It is the most simply defined as the association of hyperandrogenism (diagnosedPolycystic ovary syndrome (PCOS) is a common endocrine disorder that affects 5% to 10% of women in reproductive age. It is the most simply defined as the association of hyperandrogenism (diagnosed clinically and/or biochemically) with chronic anovulation in the absence of specific ovarian, adrenal and pituitary gland diseases. Recent studies have revealed that PCOS is associated with hyperinsulinemia and insulin resistance. Both of them have been shown to play a substantial role in the increased risk of the cardiovascular events. The new data concerning the pathogenesis and management of PCOS have changed its treatment strategy. The management of PCOS is complex and includes lifestyle modification combined with dietary-induced weight loss, oral contraceptives, clomiphene citrate, gonadotropins, antiandrogens and insulin-sensitizing agents. Women with PCOS, diagnosed and managed properly, can benefit from the reduction or even reversal of the reproductive and metabolic morbidities and from the reduction of the risk factors for cardiovascular disorders. In this article, we describe all these treatment options. Although both standard and novel therapies are discussed, this review focuses on the progress made in the recent years.