Therapy and prevention of obesity: nutrition, physical activity and medical treatment / Az elhízás kezelése és megelozése: táplálkozás, testmozgás, orvosi lehetoségek.

Összefoglaló. Az elhízás és következményes megbetegedései fontos népegészségügyi problémát jelentenek hazánkban is. Kezelése komoly szakmai kihívás, ugyanakkor prevenciója eredményesebb lehet. Az elhízott betegekkel leggyakrabban találkozó háziorvosok, más szakorvosok és egészségügyi szakemberek részérol nagy igény van egy viszonylag rövid, áttekintheto, naprakész gyakorlatias útmutatóra. A különbözo orvosszakmai társaságokban tevékenykedo, évtizedes szakmai tapasztalatokkal rendelkezo szerzok összefoglalják tudományosan megalapozott, bizonyítékokon alapuló ismereteiket. Az elhízás kezelését lépcsozetesen célszeru megkezdeni, elotte felmérve a beteg motivációját, általános állapotát, lehetoségeit. A szerzok leírják az energiaszükséglet meghatározásával, az étrenddel és a fizikai aktivitás megtervezésével kapcsolatos alapveto szempontokat. Felsorolják a hazánkban elérheto gyógyszereket és metabolikus sebészeti beavatkozásokat, az életmódi támogatás igényét. Az elhízás megelozésében az élet elso 1000 napjának táplálkozása, a késobbiekben a szüloi minta a meghatározó. Sok kihasználatlan lehetosége van a háziorvosok, a lakóközösségek, az állami szervek koordinált együttmuködésének, helyi kezdeményezéseknek. Az elhízás betegségként való meghatározása egyaránt igényel egészségpolitikai és kormányzati támogatást, az elhízottak ellátására szakosodott multidiszciplináris centrumok számának és kompetenciájának növelését. Orv Hetil. 2021; 162(9): 323-335. Summary. Obesity and related morbidities have a high public health impact in Hungary. The treatment is a challenge, but prevention seems more effective. General practitioners, other specialists and health care professionals who are treating obese persons require short, summarized, updated and practical guideline. Hungarian medical professionals of different scientific societies, having decennial practices, are summarizing their evidence-based knowledge. Obesity management requires step by step approach, evaluating previously the general health condition, motivation and options of the patients. The measurement of energy requirement, planning of diet and physical activities, available surgical methods and medications are described in detail with life style and mental support needed. The most important period in the prevention of obesity is the first 1000 days from conception. Other significant factors are the life style habits of the parents. Proper obesity prevention requires better coordination of primary health care, community and governmental activities. Obesity should be defined as morbidity, therefore stronger governmental support and more health-policy initiatives are needed, beside increasing number and developing of multidisciplinary centres. Orv Hetil. 2021; 162(9): 323-335.

[One-year persistence of patients already treated with oral anticoagulants for atrial fibrillation]. / Orális antikoagulánssal már kezelt pitvarfibrilláló betegek egyéves terápiahusége.

INTRODUCTION: In the treatment of non-valvular atrial fibrillation (AF) with oral anticoagulants (OAC), medical adherence is a relevant factor for stroke prevention. AIM: To evaluate the one-year persistence of vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC) in patients suffering from AF and already treated with OACs. METHOD: Information from the National Health Insurance Fund of Hungary prescriptions database on pharmacy claims between June 1, 2015 and December 31, 2015 was analysed. Authors identified patients who filled prescriptions for OACs (VKAs or DOACs) prescribed for AF who have already received OACs therapy during one year before. Apparatus of survival analysis was used, where 'survival' was the time to abandon the medication. RESULTS: 196 016 patients met the inclusion criteria. 181 810 patients received VKA and 14 206 patients were treated with DOACs. The one-year persistence rate in patients taking VKA was 52.9% whereas it was 66.8% in those on the DOACs. The persistence rates after 360 days were 67.5% for rivaroxaban, 63.6% for apixaban and 63.4% for dabigatran. The mean duration of persistence was 311 days for rivaroxaban, 308 days for apixaban and 284 days for dabigatran. The actual rate of discontinuation was 14% (HR = 1.14 [95% CI 1.05-1.24]), p = 0.0015) for apixaban, 15% (HR = 1.15 [95% CI 1.08-1.23], p = 0.003) for dabigatran and 62% (HR = 1.62 [95% CI 1.56-1.69], p<0.0001) for VKA compared to rivaroxaban (reference). CONCLUSIONS: The authors have confirmed that the one-year persistence of DOAKs was significantly higher compared to KVA therapy in AF. The one-year persistence of rivaroxaban was more favoured than apixaban and dabigatran. Orv Hetil. 2019; 160(13): 509-515.

[One year persistence of atorvastatin and amlodipine fixed dose combination versus atorvastatin therapy]. / Az atorvastatin/amlodipin fix kombináció versus az atorvastatinterápia a terápiahuség tükrében.

INTRODUCTION: Hypertension and dyslipidemia are modifiable cardiovascular risk factors. In Hungary hypertension and dyslipidemia are quite frequent conditions. The patients' adherence is very important factor to reach the targets. AIM: The aim of the authors was to investigate the one-year persistence of the atorvastatin therapy and atorvastatin and amlodipine fixed dose combination. METHOD: National Health Insurance Found prescriptions database of Hungary on pharmacy claims between October 1, 2012 and September 30, 2013 was analyzed. The authors identified patients who filled prescriptions for atorvastatin and amlodipine fixed dose combination and atorvastatin prescribed for the first time. Patients did not receive similar drugs for one year before the study. To model the persistence, the apparatus of survival analysis was used, where "survival" was the time to abandon the medication. As it was available to month precision, discrete time survival analysis was applied: a generalized linear model was estimated with complementary log-log link function with the kind of drug being the only explanatory variable. RESULTS: During the trial period, atorvastatin and atorvastatin plus amlodipine fixed dose combination was started in 192,579 and 24,433 patients, respectively. One year persistence rate in patients with atorvastatin and amlodipine fixed dose combination was 43%, and 21% in patients with atorvastatin therapy. The 360-days-restricted study period, the mean duration of persistence was 221.4 (SE: 0.894) days in patients on atorvastatin and amlodipine fixed dose combination and 153.0 days (SE: 0.297) in those on atorvastatin regimen. The hazard of discontinuation was almost twofold higher during treatment with atorvastatin therapy compared with the use of the atorvastatin and amlodipine fixed dose combination (hazard ratio = 1.85, p<0.0001). CONCLUSIONS: There is a significant difference between the one-year persistence of atorvastatin therapy and atorvastatin plus amlodipine fixed dose combination. The result demonstrate that atorvastatin and amlodipine fixed dose combination is favourable to reach double goals on blood pressure and LDL-cholesterol.

[Ramipril plus amlodipine and lisinopril plus amlodipine fixed dose combinations and patient's adherence]. / A ramipril/amlodipin és a lisinopril/amlodipin fix kombinációk a terápiahuség tükrében.

INTRODUCTION: Patient's adherence has a great significance to reach target blood pressure values. The risk of cardiovascular adverse events decreases when patients are on target blood pressure. AIM: The aim of the authors was to investigate the one-year persistence of the ramipril/amlodipine and lisinopril/amlodipine fixed dose combination in hypertensive patients. METHOD: National Health Insurance Found prescriptions database of Hungary on pharmacy-claims between October 1, 2012 and September 30, 2013 was analyzed. The authors identified patients who filled prescriptions for fixed dose combinations of ramipril and amlodipine, and lisinopril and amlodipine prescribed for the first time, for the therapeutic indication of hypertension. Patients have not received antihypertensive therapy with similar active substances during one year before the study. To model the persistence, the apparatus of survival analysis was used, where "survival" was the time to abandon the medication. As it was available to month precision, discrete time survival analysis was applied: a generalized linear model was estimated with complementary log-log link function with the kind of drug being the only explanatory variable. RESULTS: During the study period, fixed dose combination antihypertensive therapy with ramipril plus amlodipine and lisinopril plus amlodipine was started in 10,449 and 20,276 patients, respectively. One-year persistence rate in patients taking ramipril and amlodipine as a fixed dose combination was 54%, whereas 36% in those on the fixed lisinopril and amlodipine combination. Considering only the 360-day study period, the mean duration of persistence was 271 days in patients on the ramipril based and 211 days on lisinopril based fixed dose combination. Analyzing persistence on treatment with these combinations showed that the actual rate of discontinuation was about twice higher during treatment with the lisinopril and amlodipine fixed dose combination compared with the use of the ramipril and amlodipine fixed dose combination (hazard ratio = 1.79, p<0.001). CONCLUSIONS: There is a significant difference between the one-year persistence of ramipril plus amlodipine and lisinopril plus amlodipine fixed dose combination in patients with hypertension. The result demonstrated that ramipril and amlodipine fixed dose combination has a favourable patients' adherence as compared to lisinopril and amlodipine fixed dose combination.

[Rivaroxaban in prevention of stroke in patients with atrial fibrillation]. / A rivaroxaban a stroke megelozésében pitvarfibrilláló betegekben.

Atrial fibrillation (AF) is well established risk factor for cardioembolic stroke. With thromboprophylatic treatment we can reduce the risk of stroke in patients with AF. Oral vitamin K antagonists (VKA) such as warfarin and acenocoumarol are effective for stroke prevention in patients with atrial fibrillation. VKAs are associated with several limitations including very narrow therapeutic range, several factors (diet, drugs, alcohol consumption) affecting the effect of VKA and excessive bleeding may occur if INR value not controlled successfully. New oral anticoagulant direct Xa factor inhibitor rivaroxaban has a good therapeutic efficacy in prevention (primary and secondary) of stroke in AF patients. Its advantages are including no need for monitoring, fixed oral dose, not affected by meal, age and body weight, all of them can improve patient adherence. In ROCKET AF trial in patients with AF, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism. There was no significant between-group difference in the risk of major bleeding, although intracranial and fatal bleeding occurred less frequently in the rivaroxaban group.