[Difference in efficacy of dyslipidaemia treatment in obese and not obese women. Analysis of date from 3ST-POL study].

Introduction: Cardiovascular diseases remain the first cause of premature death in polish society. In Poland mortality concerned with cardiovascular diseases is higher in women than in men. Dyslipidemia is one of the most important and one of the most common risk factor of cardiovascular diseases. The efficacy of treatment of dyslipidaemia in Poland remains poor however there is lack of date as far as influence of sex and coexistence obesity on efficacy of treatment of dyslipidaemia is concerned. Aim: Evaluation of difference in efficacy of treatment of dyslipidaemia in obese women and women with body mass index less than 30 kg/m2. Date from 3ST-POL Study. Methods: Post hoc analysis of date of 3ST-POL Study, conducted in 2007- 2008. The Study refers to efficacy of treatment of dyslipidaemia in ambulatory polish patients which remain under supervision of general practitioners, cardiologist or dialectologist. Results: Women comprise 53% (n=26099) of population of 3ST-POL Study. In 21769 of those it was possible to calculate body mass index (BMI). 16% of women ware obese. 70% of those in comparison of with 67.6% of women with BMI<30 kg/m2 were at high cardiovascular risk. (p<0.01). There was no difference in mean doses of statins between all groups (mean daily dose was 20 mg and 24 mg for atorvastatin and simvastatin respectively). LDL goal was reached in 9.67% vs, 15.8% of obese high risk and not at high risk women respectively (p<0.01). Total cholesterol goal was reached in 9.01% vs. 12.39% obese high risk and not at high risk women respectively (p<0.01). In group with BMI<30 kg/m2 LDL and total cholesterol goals in high risk and not at high risk women were reached in 10.02% vs. 14.46% and in 8.86% vs. 13.05% respectively (p<0.01 for both). Mean concentration of all lipids, except for triglycerides, was higher in non-obese women. Conclusions: The efficacy of treatment of dyslipidaemia in women from 3ST-POL study was higher in patients with lower global cardiovascular risk. Obesity or lack of it has no influence of that difference. Nevertheless global efficacy was very poor as far as both ­ LDL and total cholesterol goals were concerned. Moreover there were now difference in mean statins doses between groups. This may be due to therapeutic inertia of physicians.

Elastography of the Liver in Wilson's Disease.

Staging of liver fibrosis is of special significance in Wilson's disease as it determines the patient's prognosis and treatment. Histopathological examination is a standard method for fibrosis assessment; however, non-invasive methods like transient elastography and share wave elastography are believed to be reliable and repetitive and are expected to replace liver biopsy in Wilson's disease. This article presents a short description of available elastography techniques and the results of the most recent studies on elastography of the liver in patients with Wilson's disease.

Liver injury in Wilson's disease: An immunohistochemical study.

PURPOSE: Wilson's disease (WD) is an inherited disorder involving copper accumulation in the liver and brain. An important mechanism responsible for hepatocyte injury in WD is mitochondria destruction, although damage may also be caused by oxidative stress and lipid peroxidation. PATIENTS/METHODS: The study included 54 treated patients with WD without liver cirrhosis and 10 healthy controls. All patients had liver biopsy and immunohistochemical analysis of liver samples was performed using targeted staining for markers of mitochondrial injury (thioredoxin-2 [TRX2], cytochrome c oxidases subunit 2 [COX2], and cytochrome c oxidases complex IV subunit 4 isoform 1 [COX4-1]), of oxidative stress (peroxiredoxin-1 [PRDX1] and 8-hydroxyguanosine [8-OHdG]), and of lipid peroxidation (4-hydroxynonenal [4-HNE]). RESULTS: Expression, measured as mean strengths of intensity (SI) of immunohistochemical reactions per 5 fields of view, was significantly lower in patients with WD compared to controls for COX2 (2.9 vs 8.3), 8-OHdG (0.05 vs 3.8), TRX2 (4.9 vs 10.1), and PRDX1 (4.6 vs 10.1) (all P â€‹< â€‹10-5). COX4-1 expression was undetected in patients with WD but detected in control specimens (8.1) (P â€‹< â€‹10-5). 4-HNE was overexpressed in patients with WD compared to controls (10.1 vs 9.1; P â€‹< â€‹0.07). CONCLUSIONS: Negligible COX4-1 and low COX2 expression in liver specimens may serve as markers of inner mitochondrial membrane injury in treated patients with WD and early stages of liver fibrosis.

Evaluation of liver fibrosis in patients with Wilson's disease.

OBJECTIVES: Staging of fibrosis in chronic liver disease is important for prognosis and treatment planning. Liver biopsy is the gold standard in fibrosis assessment; however, new methods for fibrosis and stiffness measurement exist which have not been evaluated in patients with Wilson's disease. To evaluate the accuracy of collagen proportionate area (CPA), transient elastography and shear wave elastography (SWE) in the assessment of liver fibrosis in adult patients with Wilson's disease. METHODS: In this retrospective study of 60 patients with Wilson's disease, results of percutaneous cutting liver biopsy assessed using the Ishak fibrosis score and CPA were compared with liver stiffness measured with transient elastography and SWE. RESULTS: CPA correlated with the Ishak score (r = 0.45; P = 0.001) and transient elastography results correlated with SWE measurements (r = 0.80; P = 0.0001). In contrast, transient elastography or SWE did not significantly correlate with the Ishak score or CPA. CONCLUSION: Collagen content assessment may be useful for estimation of liver fibrosis in patients with Wilson's disease. However, single time-point elastographic liver stiffness measurements have a limited diagnostic value in Wilson's disease.