Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction.

BACKGROUND: In patients with type 2 diabetes, inhibitors of sodium-glucose cotransporter 2 (SGLT2) reduce the risk of a first hospitalization for heart failure, possibly through glucose-independent mechanisms. More data are needed regarding the effects of SGLT2 inhibitors in patients with established heart failure and a reduced ejection fraction, regardless of the presence or absence of type 2 diabetes. METHODS: In this phase 3, placebo-controlled trial, we randomly assigned 4744 patients with New York Heart Association class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either dapagliflozin (at a dose of 10 mg once daily) or placebo, in addition to recommended therapy. The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for heart failure) or cardiovascular death. RESULTS: Over a median of 18.2 months, the primary outcome occurred in 386 of 2373 patients (16.3%) in the dapagliflozin group and in 502 of 2371 patients (21.2%) in the placebo group (hazard ratio, 0.74; 95% confidence interval [CI], 0.65 to 0.85; P<0.001). A first worsening heart failure event occurred in 237 patients (10.0%) in the dapagliflozin group and in 326 patients (13.7%) in the placebo group (hazard ratio, 0.70; 95% CI, 0.59 to 0.83). Death from cardiovascular causes occurred in 227 patients (9.6%) in the dapagliflozin group and in 273 patients (11.5%) in the placebo group (hazard ratio, 0.82; 95% CI, 0.69 to 0.98); 276 patients (11.6%) and 329 patients (13.9%), respectively, died from any cause (hazard ratio, 0.83; 95% CI, 0.71 to 0.97). Findings in patients with diabetes were similar to those in patients without diabetes. The frequency of adverse events related to volume depletion, renal dysfunction, and hypoglycemia did not differ between treatment groups. CONCLUSIONS: Among patients with heart failure and a reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than among those who received placebo, regardless of the presence or absence of diabetes. (Funded by AstraZeneca; DAPA-HF ClinicalTrials.gov number, NCT03036124.).

Dapagliflozin and Diuretic Use in Patients With Heart Failure and Reduced Ejection Fraction in DAPA-HF.

BACKGROUND: In the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure), the sodium-glucose cotransporter 2 inhibitor dapagliflozin reduced the risk of worsening heart failure and death in patients with heart failure and reduced ejection fraction. We examined the efficacy and tolerability of dapagliflozin in relation to background diuretic treatment and change in diuretic therapy after randomization to dapagliflozin or placebo. METHODS: We examined the effects of study treatment in the following subgroups: no diuretic and diuretic dose equivalent to furosemide <40, 40, and >40 mg daily at baseline. We examined the primary composite end point of cardiovascular death or a worsening heart failure event and its components, all-cause death and symptoms. RESULTS: Of 4616 analyzable patients, 736 (15.9%) were on no diuretic, 1311 (28.4%) were on <40 mg, 1365 (29.6%) were on 40 mg, and 1204 (26.1%) were taking >40 mg. Compared with placebo, dapagliflozin reduced the risk of the primary end point across each of these subgroups: hazard ratios were 0.57 (95% CI, 0.36-0.92), 0.83 (95% CI, 0.63-1.10), 0.77 (95% CI, 0.60-0.99), and 0.78 (95% CI, 0.63-0.97), respectively (P for interaction=0.61). The hazard ratio in patients taking any diuretic was 0.78 (95% CI, 0.68-0.90). Improvements in symptoms and treatment toleration were consistent across the diuretic subgroups. Diuretic dose did not change in most patients during follow-up, and mean diuretic dose did not differ between the dapagliflozin and placebo groups after randomization. CONCLUSIONS: The efficacy and safety of dapagliflozin were consistent across the diuretic subgroups examined in DAPA-HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03036124.

Effect of dapagliflozin according to baseline systolic blood pressure in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial (DAPA-HF).

AIMS: Concern about hypotension often leads to withholding of beneficial therapy in patients with heart failure and reduced ejection fraction (HFrEF). We evaluated the efficacy and safety of dapagliflozin, which lowers systolic blood pressure (SBP),according to baseline SBP in Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial (DAPA-HF). METHODS AND RESULTS: Key inclusion criteria were: New York Heart Association Class II-IV, left ventricular ejection fraction ≤ 40%, elevated N-terminal pro-B-type natriuretic peptide level, and SBP ≥95 mmHg. The primary outcome was a composite of worsening heart failure or cardiovascular death. The efficacy and safety of dapagliflozin were examined using SBP as both a categorical and continuous variable. A total of 1205 patients had a baseline SBP <110 mmHg; 981 ≥ 110 < 120; 1149 ≥ 120 < 130; and 1409 ≥ 130 mmHg. The placebo-corrected reduction in SBP from baseline to 2 weeks with dapagliflozin was -2.54 (-3.33 to -1.76) mmHg (P < 0.001), with a smaller between-treatment difference in patients in the lowest compared to highest SBP category. Patients in the lowest SBP category had a much higher rate (per 100 person-years) of the primary outcome [20.6, 95% confidence interval (95% CI) 17.6-24.2] than those in the highest SBP category (13.8, 11.7-16.4). The benefit and safety of dapagliflozin was consistent across the range of SBP; hazard ratio (95% CI) in each SBP group, lowest to highest: 0.76 (0.60-0.97), 0.76 (0.57-1.02), 0.81 (0.61-1.08), and 0.67 (0.51-0.87), P interaction = 0.78. Study drug discontinuation did not differ between dapagliflozin and placebo across the SBP categories examined. CONCLUSION: Dapagliflozin had a small effect on SBP in patients with HFrEF and was superior to placebo in improving outcomes, and well tolerated, across the range of SBP included in DAPA-HF. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03036124.

Management of diabetic patients with lower extremity peripheral arterial disease.

Extremitovascular arterial ischemic disease (lower extremity peripheral arterial disease - PAD) is an important manifestation of systemic atherosclerosis and other arterial diseases of vascular system. The lower the ankle-brachial pressure index, the greater the risk of serious acute instable organovascular events (e. g. acute myocardial infarction, stroke). Complex prevention and treatment of extremitovascular arterial disease is discussed in this article. Angiology/vascular medicine is the fastest growing field of internal medicine.

[Antiplatelet thromboprophylaxis of arterial vascular diseases and organovascular ischemic diseases]. / Antitrombocytová tromboprofylaxia artériových vaskulárnych chorôb a orgánovaskulárnych ischemických chorôb.

Antiplatelet therapy by acetylsalicylic acid (ASA, aspirin) provided pivotal advances in the prevention and treatment of organovascular (angiovascular, cardiovascular, cerebrovascular, extremitovascular, renovascular, genitovascular, mesenteriointestinokolonovascular, bronchopulmovascular, oculovascular, otovascular and other) arterial ischemic diseases. Currently available antiplatelet drugs have some limitations which might be overcomed by improved dosing regimens, use of combination of agents affecting different platelet functions and, in particular, by the new antiplatelet drugs (new arterial antithrombotics) with distinct pharmacodynamic properties offering new advantages, including faster onset of action, greater potency, and reversibility of effects.Key words: arteriothromboprophylaxis - arterial thrombosis - classic antiplatelet drugs - new antiplatelet agents - organovascular arterial diseases.

Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure.

BACKGROUND: Clinical trials in heart failure have focused on the improvement in symptoms or decreases in the risk of death and other cardiovascular events. Little is known about the effect of drugs on the risk of clinical deterioration in surviving patients. METHODS AND RESULTS: We compared the angiotensin-neprilysin inhibitor LCZ696 (400 mg daily) with the angiotensin-converting enzyme inhibitor enalapril (20 mg daily) in 8399 patients with heart failure and reduced ejection fraction in a double-blind trial. The analyses focused on prespecified measures of nonfatal clinical deterioration. In comparison with the enalapril group, fewer LCZ696-treated patients required intensification of medical treatment for heart failure (520 versus 604; hazard ratio, 0.84; 95% confidence interval, 0.74-0.94; P=0.003) or an emergency department visit for worsening heart failure (hazard ratio, 0.66; 95% confidence interval, 0.52-0.85; P=0.001). The patients in the LCZ696 group had 23% fewer hospitalizations for worsening heart failure (851 versus 1079; P<0.001) and were less likely to require intensive care (768 versus 879; 18% rate reduction, P=0.005), to receive intravenous positive inotropic agents (31% risk reduction, P<0.001), and to have implantation of a heart failure device or cardiac transplantation (22% risk reduction, P=0.07). The reduction in heart failure hospitalization with LCZ696 was evident within the first 30 days after randomization. Worsening of symptom scores in surviving patients was consistently more common in the enalapril group. LCZ696 led to an early and sustained reduction in biomarkers of myocardial wall stress and injury (N-terminal pro-B-type natriuretic peptide and troponin) versus enalapril. CONCLUSIONS: Angiotensin-neprilysin inhibition prevents the clinical progression of surviving patients with heart failure more effectively than angiotensin-converting enzyme inhibition. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255.

Changes in vasomotion--effect of hyperbaric oxygen in patients with diabetes Type 2.

OBJECTIVES: To investigate vasomotion in diabetic patients who underwent sessions of hyperbaric oxygen (HBO2) therapy. MATERIALS AND METHODS: Seventy-one patients with diabetes Type 2 and lower-extremity neuropathy were enrolled in a prospective matched case-control study. A total of 39 patients underwent 15 sessions of HBO2 therapy consisting of 90 minutes of breathing 100% oxygen at 2.5 atmospheres; 32 were included in the control group without exposure to hyperbaric oxygen. We used laser Doppler flowmetry for measurement of flowmotion. Spectral analysis of laser Doppler flowmetry signals was performed using the Fast Fourier transform algorithm. The total spectral activity was divided into the subgroup of endothelium, adrenergic, intrinsic smooth muscle, respiratory and cardiac spectral activity. The lateral ankle and the dorsum of the foot were chosen for this study. Heating provocation test was performed on both sites. The measurement was performed 24 hours before the first HBO2 session and 24 hours after the last (15th) session of therapy. RESULTS: We observed a significant increase in respiratory, cardiac and total spectral activity of flowmotion on the ankle as well as a significant increase in cardiac and total spectral activity on the dorsum of the foot in patients without a foot ulcer. In the subgroup of patients with a diabetic ulcer, a decrease of total spectral activity of flowmotion on the dorsum of the foot was observed. CONCLUSION: Flowmotion (indirectly vasomotion) measured by laser Doppler flowmetry changed significantly after HBO2 therapy. Flowmotion dynamics may partly explain the positive effect of HBO2 on the healing process of a diabetic ulcer.

[Oral anticoagulants for primary and secondary prevention of venous thromboembolism]. / Perorálne antikoagulanciá v primárnej a sekundárnej prevencii vénovej tromboembólie.

Until recently, vitamin K antagonists (VKA; predominantly warfarin) were the only oral anticoagulants for primary and secondary prevention of venous thromboembolism. Prevention and therapy with novel, direct, non-VKA oral anticoagulant agents (NOACs; DOACs: dabigatran, rivaroxaban, apixaban, edoxaban), have recently become available as an alternative to VKA. NOACs have been shown to be non-inferior or superior to VKA in clinical trials. Available results suggest that real world safety of NOACs is mostly consistent with results observed in clinical trials. The most effective method is triple simultaneous prevention of venous thromboembolism (pharmaco kinezio mechano phlebothromboemboloprophylaxis).Key words: oral anticoagulants - NOAC/DOAC - thromboprophylaxis - venous thromboembolism - VKA.

Effect of short term aerobic exercise on fasting and postprandial lipoprotein subfractions in healthy sedentary men.

BACKGROUND: Our goal was to investigate the effect of short term exercise on fasting and postprandial lipoprotein profile. METHODS: Healthy sedentary men exercised 20 min for four days. The intensity of exercise was modulated to maintain 75-80 % of a calculated HRmax. Before and after the exercise program, fasting and postprandial (4 h after standard meal) concentrations of lipoprotein subfractions were measured by an electrophoresis in polyacrylamide gel and total concentrations of TAG, LDL and HDL by enzymatic colorimetric method. After 2 days of rest, fasting and postprandial concentrations of lipoprotein fractions and subfractions were measured to determine a persistency of a changes in the lipoprotein profile. RESULTS: 4 days of physical exercise led to statistically significant decrease of concentration of triacylglycerol in fasting (76.29 ± 20.07, 53.92 ± 10.90, p < 0.05) and postprandial state (139.06 ± 23.72, 96.55 ± 25.21, p < 0.05) VLDL in fasting (21.88 ± 3.87, 18.00 ± 3.93, p < 0.05) and postprandial state (23.88 ± 3.52, 19.25 ± 3.62, p < 0.05), total cholesterol in fasting (162.26 ± 23.38, 148.91 ± 17.72, p < 0.05) and postprandial state (163.73 ± 23.02, 150.08 ± 18.11, p < 0.05). Atherogenic medium LDL decreased also in fasting (9.89 ± 3.27, 6.22 ± 2.55, p < 0.001) and postprandial state (8.88 ± 6.51, 6.88 ± 5.57, p < 0.001). However decrease of large IDL (25.38 ± 3.54, 23.88 ± 3.91, p < 0.05) and large LDL particles (42.89 ± 11.40, 38.67 ± 9.30) was observed only in postprandial state. Total HDL concentration remained unchanged but we observed statistically significant decrease of small HDL particles in fasting (6.11 ± 2.89, 4.22, p < 0.05) and postprandial state (6.44 ± 3.21, 4.56 ± 1.33, p < 0.05). Concentration of these particles are associated with progression of atherosclerosis. All changes of fasting and postprandial lipoprotein profile disappeared after 2 days of rest. CONCLUSION: Just 4 daily settings of 20 min of physical exercise can lead to significant positive changes of fasting and postprandial lipoprotein profile.

Prognostic significance of dipping in older hypertensive patients.

BACKGROUND AND AIMS: Arterial hypertension doubles the risk of coronary heart disease, heart and kidney failure, and peripheral arterial disease. Less variation in diurnal ambulatory blood pressure monitoring (ABPM) patterns may affect mortality outcome. Therefore, as hypertension occurs in over 95% of older subjects, the prognostic value of dipping status in older hypertensive patients will be assessed. METHOD: The retrospective study group consisted of 170 hypertensive patients, aged 75-84 years, enrolled in the years 2005 to 2007. Baseline measures included 24-h ABPM. Diurnal index and dipping status was calculated and stratified the group into dippers (40 patients, 23.5%), non-dippers (65 patients, 38.2%) and reverse-dippers (65 patients, 38.2%). RESULTS: During a 5-year observation, after baseline we have observed 69 deaths (40.9%) from the whole group of 170 patients with 23 (35.4%) being non-dippers and 36 (55.4%) reverse-dippers. There were significant differences between the groups divided according to diurnal dipping status in survival time, number of recorded deaths and night mean blood pressure. We have identified and confirmed risk factors for the all-cause mortality: age, mean systolic and diastolic blood pressure, diurnal index and dipping status (dipping, non-dipping or reverse-dipping). CONCLUSION: Reverse-dippers and non-dippers revealed worse prognosis compared with dippers.

Regional differences of vasodilatation and vasomotion response to local heating in human cutaneous microcirculation.

BACKGROUND: The aim of this study was to evaluate the vasodilatation and vasomotion response to local heating in the cutaneous microcirculation of the ankle, dorsum of foot and forearm. Recently, it has been suggested that this response differs between the forearm and the leg. PROBANDS AND METHODS: Twenty-nine young healthy adults were recruited. They underwent measurement by laser Doppler flowmetry (LDF) in three sites of the body (ankle, dorsum of foot, forearm). Percentage change of the median flow of the skin before and after provocation and normalised perfusion flow to maximal dilation (cutaneous vascular conductance--CVC % Max) during short provocation test were monitored. Spectral analysis of laser Doppler flowmetry signals was performed using the fast Fourier transform algorithm. RESULTS: Significant differences were found in CVC % Max between ankle/dorsum (45.18±6.38% Max vs. 51.24±6.87% Max, respectively; p<0.05) and between ankle/forearm (45.18±6.38% Max vs. 54.49±5.37% Max, respectively; p<0.05). Percentage change of flux after provocation has revealed significant differences between ankle/dorsum (394.1±204.5% vs. 577.4±273.5%, respectively; p<0.05) and ankle/forearm (394.1±204.5% vs. 637.1±324.7%, respectively; p<0.05). Total spectral activity of vasomotion has differed between ankle/dorsum and ankle/forearm: 69.59 [49.58-96.04] vs. 93.01 [73.15-121.8] (p<0.05) and 69.59 [49.58-96.04] vs. 107.5 [80.55-155.8] (p<0.05), respectively. CONCLUSIONS: Cutaneous microcirculation exhibits regional differences. Significant variability of function between ankle and dorsum of foot suggests that leg microcirculation is not uniform.

Effect of hyperbaric oxygen on lipoprotein subfractions in diabetic patients.

OBJECTIVES: Favorable metabolic changes have been observed in many in vitro and animal studies after application of hyperbaric oxygen (HBO2). Metabolic changes after hyperbaric oxygen therapy, especially focused on lipoprotein subfractions, have not been described in humans. Our aim was to investigate possible alteration in concentration of lipoprotein subfractions in diabetic patients after hyperbaric oxygen therapy. METHODS: 58 Type 2 diabetic patients were enrolled in a prospective matched case-control study. A total of 31 underwent hyperbaric oxygen therapy, and 27 were included in the control group without HBO2 exposure. Fasting concentrations of lipoprotein subfractions were measured by electrophoresis in polyacrylamide gel 24 hours before and 24 hours after hyperbaric sessions performed at 2.5 atmospheres absolute for 15 days. Homeostatic model assessment of insulin resistance, C-peptide and glycemic variability were assessed before and after therapy. RESULTS: We observed decreased subfractions of very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL 3), LDL 1, LDL 2 and LDL 3-7 after hyperbaric oxygen treatment. In addition, the IDL 1 subfraction, as well as the concentration of C-peptide, increased significantly in the treatment arm. Glycemic variability improved after therapy. No differences were observed in the control group. CONCLUSION: Hyperbaric oxygen therapy is connected with antiatherogenic metabolic changes. This study demonstrates that hyperbaric oxygen therapy may hold potential for inducing metabolic changes in diabetic patients that may decrease their cardiovascular risk.

[Acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult - 2014 AS SMC Guidelines on the classification and diagnosis of aortic diseases]. / Akútne a chronické aortové choroby hrudníkovej a brusnej aorty u dospelýchOdporúcania Angiologickej sekcie Slovenskej lekárskej komory pre klasifikáciu a diagnózu chorôb aorty (AS SLK, 2014).

In addition to organovascular arterial ischemic diseases (cardiovascular, vasculovascular, neurovascular, extre-mitovascular, renovascular, genitovascular, bronchopulmovascular, mesenteriovascular, osteoarthromusculovascular, dermovascular, oculovascular, otovascular, stomatovascular etc.), aortic diseases contribute to the wide spectrum of arterial diseases: aortic aneurysms (AA), acute aortic syndromes (AAS) including aortic dissection (AD), intramural haematoma (IMH), penetrating atherosclerotic ulcer (PAU) and traumatic aortic injury (TAI), pseudoaneurysm, aortic rupture, atherosclerosis, vasculitis as well as genetic diseases (e.g. Turner syndrome, Marfan syndrome, Ehlers-Danlos syndrome) and congenital abnormalities including the coarctation of the aorta (CoA). Similarly to other arterial diseases, aortic diseases may be diagnosed after a long period of subclinical development or they may have an acute presentation. Acute aortic syndrome is often the first sign of the disease, which needs rapid diagnosis and decisionmaking to reduce the extremely poor prognosis. Key clinical-etiology-anatomy-patophysiology (CEAP) diagnostic aspects of aortic diseases are discussed in this document (project Vessels).

[The importance of transcutaneous oxygen tension monitoring in diabetic patient with complications]. / Význam transkutánneho monitorovania tkanivového kyslíka u pacienta s diabetes mellitus s jeho komplikáciami.

Monitoring of transcutaneous perfusion pressure of tissue oxygen (tcpO2) is a simple, non-invasive method performed in diagnostic process of chronic diabetic complications. Primary, tcpO2is used as an indicator of microcirculatory function. Properly placed and fixed Clark electrode is able to detect with high accuracy partial oxygen pressure on the skin surface by polarographic system of dissolved oxygen from capillary bed through tissues to upper layers of the skin. The microcirculation function is influenced by macrocirculation, thus, tcpO2is a suitable parameter in diagnosis of peripheral arterial obliterative disease or other vascular pathologies. Combination of tcpO2monitoring and skin perfusion pressure by laser Doppler technique gives us information not only about nutritive capillary flow, but also about vessels which precede capillary bed. The article discusses current guidelines for measurement of tcpO2and evaluation of the results. Also reviews the results of recent studies which are interested in the use of tcpO2in diabetic patients.

[Present and future in the management of venous vascular diseases]. / Súcasnost a budúcnost v manazmente vénových vaskulárnych chorôb.

The prevalence and the incidence of chronic and acute venous vascular disease has been shown to be globally very high, in both industrialized and developing countries. Chronic venous diseases of lower extremities are being an integral part of the third millennium's deadly angiopandemy, at the present time. The rate of the most severe cases with advanced stage of venous failure is approximately twice as high in the population (2.1 %) as has been assumed so far. Among venoactive drugs (VAD), micronized purified flavonoid fraction (MPFF) of diosmin hesperidin remains the agent with the highest degree of recommendation and it also indicated to pharmacotherapeutical support of leg ulcer healing, along with sulodexide and pentoxifylline. Compressive sclerotherapy, liquid or foam, is a safe and effective invasive method to treat telangiectasias, reticular varicose veins and subcutaneous varicose veins. Direct oral anticoagulants (DOAC) represent one of the therapeutic and preventive options of deep venous thrombosis (DVT) and of venous thromboembolism (VTE) with a limitation in patients with malignant conditions and in pregnancy. The most effective is triple simultaneous pharmaco-kinezio-mechano-phlebothromboemboloprophylaxis. Superficial vein thromboses longer than 5 cm are indicated to anticoagulant therapy too.

[Erectile dysfunction as the first sign of systemic vascular diseases and of organovascular arterial ischemic diseases. Guidelines and Challenge of the Angiology section of Slovak Medical Chamber (AS SMC, 2015)]. / Erektilná dysfunkcia ako prvý znak systémových cievnych chorôb a orgánovovaskulárnych artériových ischemických chorôb Odporúcania a výzva Angiologickej sekcie Slovenskej lekárskej komory (2015).

Erectile dysfunction is a highly prevalent and progressive condition affecting the quality of life of man and his sexual partner. Evidence is accumulating in favour of erectile dysfunction as a sign of a genitovascular disease (GVD) in the majority of patients. Erectile dysfunction may be considered as the clinical manifestation of a organovascular disease affecting penis (male genitovascular disease - MGVD) as well as angina pectoris is the typical manifestation of a vascular disease affecting coronary arteries of a heart (cardiovascular disease - CVD). Several studies confirm the assumption that erectile dysfunction symptoms were found to come prior to cardiovascular disease symptoms in 60-95 % of CVD patients with mean interval of 2-3 years and likewise of all organovascular diseases (OVD). Four potent selective PDE5Is have been approved by the EMA for the treatment of erectile dysfunction. Physicians should systematically look for erectile dysfunction in any male with vascular risk factors.

[Pelvic venous congestion syndrome - diagnosis and management. Guidelines of the angiology section of slovak medical chamber (2015)]. / Syndróm vénovej panvovej kongescie - diagnóza a manazment Odporúcanie Angiologickej sekcie Slovenskej lekárskej komory (2015).

Pelvic congestion syndrome: chronic symptoms, which may include pelvic pain, perineal heaviness, urgency of micturition, and post-coital pain, caused by ovarian and/or pelvic vein reflux and/or obstruction, and which may be associated with vulvar, perineal, and/or lower extremity varices. The VEIN-TERM consensus document was developed by a transatlantic interdisciplinary faculty of experts under the auspices of the American Venous Forum (AVF), the European Venous Forum (EVF), the International Union of Phlebology (IUP), the American College of Phlebology (ACP), and the International Union of Angiology (IUA). It provides recommendations for fundamental venous terminology. Project Vessels of AS SMC.

[Epidemiologic data of hyperuricaemia prevalence in the conditions of primary care in Slovakia]. / Epidemiologické údaje o výskyte hyperurikémie u muzov a u zien v podmienkach primárnej liecebnej starostlivosti na Slovensku.

UNLABELLED: Hyperuricaemia represents nowaday the new risk factor for cardiovascular diseases. Prevalence data and its treatment in our patient´s population are still missing. Literature data shows, that its prevalence differs in various populations significantly from 4 % up to 40 % with race and geographical means. In the hospital population its prevalence is about 7 % and represents the important predictor of hospital mortality, e.i with heart failure. From the Framingham data relative risk was estimated of 25 % for cardiovascular diseases, coronary heart disease and all-course mortality. From the epidemiologic survey Mirror Slovakia hyperuricaemia was evaluated from the sample of 20 000 patients from the primare care physicians in order to see the picture on this newer risk factor. KEY WORDS: cardiovascular diseases - epidemiology - hyperuricaemia - therapy.

[Epidemiologic data of hyperuricaemia prevalence in the conditions of primary care in Slovakia]. / Epidemiologické údaje o výskyte hyperurikémie u muzov a u zien v podmienkach primárnej liecebnej starostlivosti na Slovensku.

Hyperuricaemia represents nowaday the new risk factor for cardiovascular diseases. Prevalence data and its treatment in our patient's population are still missing. Literature data shows, that its prevalence differs in various populations significantly from 4% up to 40% with race and geographical means. In the hospital population its prevalence is about 7% and represents the important predictor of hospital mortality, e.i with heart failure. From the Framingham data relative risk was estimated of 25% for cardiovascular diseases, coronary heart disease and all-course mortality. From the epidemiologic survey Mirror Slovakia hyperuricaemia was evaluated from the sample of 20 000 patients from the primare care physicians in order to see the picture on this newer risk factor.

[The effect of adding phytosterol to hypolipidemic therapy with statins on the size of lipoprotein particles in patients with very high cardiovascular risk]. / Vplyv pridania fytosterolu ku hypolipidemickej liecbe statínom na velkost lipoproteínových partikúl u pacientov s velmi vysokým kardiovaskulárnym rizikom.

Despite significant improvement in the diagnosis and therapy of cardiovascular diseases their global risk and proportion of their clinical forms remains very high. Still the large part of the patients cannot reach the estimated target lipid levels despite statin therapy. Low adherence to preventive programmes with physical training and diet leads to progression of the pathological process of atherothrombosis. One possible therapeutic approach could be the combined hypolipidemic treatment. In this context we followed-up the size of lipoprotein particles among very high risk patients on statin monotherapy, where phytosterole was added. Lipoprotein profile among very high risk patients during combined therapy lead to improvement and therefore may contribute to lowering of their residual risk.