[Show abstract][Hide abstract] ABSTRACT: In year 1995 the European Society of Cardiology started an epidemiological study EUROASPIRE to evaluate the results of secondary prevention in some European countries. The first study period was in 1995, the second in 1999-2000 and the third in 2007. From Hungary the same study centers participated in EUROASPIRE I-II-III investigation. Authors present the Hungarian data and changes occurring the last ten years. During the three studies, 1627 coronary patients- younger than 70 years - were evaluated, using standardized methods. In the two Hungarian study centers, the proportion of women and patients older than 60 years increased. The hospital documentation of risk factors improved, at the time of EUROASPIRE III necessary data were found in 89%-99% of patient's records. Mean systolic and diastolic blood pressure continuously decreased between the first and second study period, but at the time of the third study 44% of the patients had elevated blood pressure (>140/90 mmHg). Prevalence of smoking decreased by 8% between second and third study period, however, at the time of the last study, 18% of coronary patients were smokers. The mean of total cholesterol was lower in the last study period comparing to the first investigation (5.6 vs. 5.2 mmol/l). HDL cholesterol level was unchanged and increasing triglyceride values were observed. During the study period the prevalence of obesity continuously increased from 23% to 49%. Prevalence of patients with total cholesterol level 5.5 mmol/l or higher has decreased from 60% to 24%, however 57% of patients did not reach the target level (4.5 mmol/l) although 80% of patients were treated with lipid lowering drugs: 76% of them received statins. Authors say that some part of secondary prevention improved during the last ten years, but many patients did not reach the target blood pressure and cholesterol level and it is embarrassing the prevalence of obesity and diabetes. The published data are not representative for whole Hungary; most probably the general situation is worse. Authors emphasize the importance of secondary prevention in the graduate and postgraduate education. For improving the secondary prevention, better cooperation is needed between hospital staff and patients and general practitioners as well.
[Show abstract][Hide abstract] ABSTRACT: Risk factors' reduction decreases the number of vascular events. The therapy is successful, when target values of risk factors became realised.
3 modifiable risk factors - hyperlipidemia, hyperglycemia, hypertension - were checked in 350 high risk patients, comparing the target and the realised values of risk factors.
1. Medical history of risk factors' therapy. 2. serum lipids and fasting blood glucose parameters. 3. Physical and ultrasound examinations for cerebro-, cardio- and peripheral vascular diseases, measurement of abdominal circumference and blood pressure. 4. Risk stratification. 5. Statistical analysis.
1. Mean LDL-cholesterol was 3 +/- 0.94 and 3.3 +/- 0.87 in the group of patients with and without therapy, respectively (p < 0.01). Number of not treated patients is high (47.3%). 2. There were significantly (p = 0.053) more treated patients above blood sugar goals (6,7 mmol/l), than in the group of untreated patients. Mean fasting blood glucose were 8.11 +/- 3,036 and 7.25 +/- 1.925 mmol/l in treated and not treated group of patients, respectively (p = NS). 3. There were significantly (p < 0.00001) more hypertensive patients above therapeutic goal in the treated and less in the untreated group of patients. Mean tension (153,4 +/- 22.42 and 139.7 +/- 20.76) was significantly (p < 0,001) higher in the treated, and lower in the untreated group of patients. 4. Number of risk factors are more in high risk patients. Only 5.2% of patients became free of risk factors by recent clinical practice and in 72.3% remained 2 or 3 factors.
Most part of patients do not reach the therapeutic goals, and there are many persons without any therapy for hyperlipidaemia. To cure and to treat are different.
[Show abstract][Hide abstract] ABSTRACT: Endothelial dysfunction is caused by risk factors, which have basic, and initial role in atherogenesis. During further progression it is still not known, whether is and how is endothelial dysfunction influenced by risk factors in the late phase of atherosclerosis and/or what kind of other factors play role in endothelial dysfunction.
Brachial artery flow mediated vasodilation was examined in 293 high risk patients (vascular 2. type diabetes patients/persons with + 2 risk factors). Relationship between endothelial function and risk factors, and risk stratifications were statistically examined to define the principal predictors of endothelial dysfunction.
1. Examination of flow mediated vasodilation of brachial artery with ultrasound machine, 2. Risk factors evaluating, 3. Vascular examinations: physical, exercise test, Holter monitoring, CW Doppler, duplex scan 4. Risk stratification (10 year risk of fatal vascular events), 5. Statistical analysis (comparative and cohort).
1. Mean endothelial function of 293 high risk patients was reduced (105.1%). 2. Vascular disease plays principal role of the endothelial function in late phase atherosclerosis, because significantly decreases the brachial artery vasodilation (104.3% v. 108.3% p < 0.01) and significantly more (p < 0.0009) endothelial dysfunction can be found in patients with vascular disease than without. 3. Bad risk stratification plays principal role too, because there are significantly (p = 0.012) more endothelial dysfunction in high risk patients, than with better risk stratification. 4. Lipid-, glucose-metabolic alterations, hypertension, age and smoking (all: p = NS) have not already any role in endothelial dysfunction in late phase atherosclerosis.
Role of risk factors in initial atherogenesis is scientific evidence, but the role of these factors can not be proved later, when endothelial dysfunction already evolved. In this phase of atherosclerosis the vascular disease and the bed risk stratification have principal role, because they can cause significant more reduction of already reduced endothelial function. Further studies necessary to determine, whether this statistically proved relationship have, or have not any clinical relevance.