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Cancer, type 2 diabetes, cardiovascular and neurological diseases are disorders commonly classified as diseases that have a significant impact on the length and quality of human life. Sirtuins play an important role in their pathogenesis and complications. Numerous studies indicate that modulation of the expression of these proteins can slow down the processes of aging and cell death, prevent inflammation, and regulate metabolic processes, and consequently modify the progression of the disease. One of the best-known sirtuins is sirtuin 1, whose strongest natural activator is resveratrol. The development of alternative therapies involving natural compounds such as resveratrol is highly desirable due to the significantly lower number of side effects compared to conventional therapies. Therefore, this review summarizes the possible benefits of resveratrol as a sirtuin 1 activator in the prevention and treatment of human diseases based on the results of the studies conducted so far.

Acetylsalicylic acid (ASA) is one of the most popular medicines in the world. ASA preparations have been used for over 100 years as anti-inflammatory, antipyretic and analgesic drugs. Since 1971, ASA has also been used as an antiplatelet drug. The main antiplatelet effect of aspirin is the irreversible inhibition of the key enzyme of arachidonic acid cascade, a prostaglandin H synthetase, also called cyclooxygenase (COX). ASA is a widely used drug in the prevention of cardiovascular diseases. In accordance with the current European guidelines, ASA is indicated in secondary prevention in all patients with established cardiovascular disease (coronary heart disease, previous myocardial infarction, previous stroke, peripheral atherosclerosis). Life therapy with low doses (75-150 mg daily) is recommended. ASA is also used to treat acute myocardial infarction, unstable coronary heart disease, coronary artery bypass surgery and angioplasty, as well as to treat acute stroke. Despite the proven benefits, approximately 10-20% of patients taking ASA are at risk for re-occurring cardiovascular events. In connection with the above, the phenomenon of the so-called resistance to ASA (or high on treatment platelet reactivity despite ASA). This phenomenon was reported in patients after stroke (up to 60% of subjects), in atherosclerosis of the lower limbs (up to 60%), in stable coronary disease (up to 70%) and in patients immediately after myocardial infarction (up to 80%). Despite studies conducted for several years, so far there are no clear guidelines for monitoring platelet function in patients taking ASA, both in primary and secondary stroke prevention.

The most common medical conditions after menopause are osteoporosis and atherosclerotic disease. Traditionally these two conditions were considered unrelated and their coexistence has been attributed to independent processess exclusively reated to age. The possible link between cardiovascular disease and osteoporosis stimulates today to analyse not only the evidence of a possible association, but also to identify mutual beneficial and adverse effects of drugs used in these two diseases. That's why, the focus on the interference between osteoporosis treatment and drugs used for atherosclerosis is made. Moreover side effects of cardiological drug considering bones are analysed. Additionally possible advantages of selected drugs used for cardiovascular diseases on osteoporosis prevention are evaluated. Drugs used for osteoporosis treatment may heave adverse effects on cardiovascular system. The article has detailed analyses of current drug classes, such as the bisphosphonates, strontium ranelate as well as a review of the controversy surrounding hormone replacement therapy (HRT) and the selective oestrogen receptor modulators (SERMs). Lastly discussion of adverse effects on the heart of calcium and drugs influencing calcium metabolism such as vitamin D, parathormone and calcitonin is performed.

The etiology of diet-related disorders is closely associated with dietary factors. A special role is attributed to intake of fat and fatty acid profile, both quantitative and qualitative. For prevention and treatment of the abovementioned diseases a proper supply of unsaturated fatty acids plays a significant role, because of their particular importance to health. γ-Linolenic acid (GLA), with three double bonds in the carbon chain, also known as all-cis 6,9,12-octadecatrienoic acid, belongs to the n-6 family of fatty acids. It plays biologically important functions in the human body, such as being a substrate for eicosanoids synthesis, involvement in the transport and oxidation of cholesterol, and being one of the components of lipid membrane. Its inadequate dietary intake or impaired formation is the cause of many inflammatory and degenerative diseases. A rich source of this fatty acid is vegetable oils, until recently used mainly in folk medicine. Nowadays, studies conducted both in animal models and in humans suggest its health-promoting properties in the prevention and treatment of atopic dermatitis, cardiovascular diseases, diabetes, cancers and rheumatoid arthritis.

Angiogenesis is the formation of new blood vessels from existing vessels. This process occurs via budding endothelial cells in postnatal period, which is essential to many physiological phenomena (e.g. wound healing, formation of the placenta) and pathological ones such as cancer, ischemic diseases, and chronic inflammation. Various mechanisms of the formation of new blood vessels have been discovered and a number of pro-angiogenic and anti-angiogenic factors have been found. Understanding the function of these factors contributes to the creation of new tools and applications in the treatment of pathological processes. Article describes the regulation of angiogenesis and is a review of the most significant angiogenic factors and their inhibitors. It shows the selected mechanisms which underlie the action of currently used anti-angiogenic drugs and is a review of research which use these factors in anti-angiogenic therapy.

Endothelins are endothelial peptides, the properties of which have been investigated for over 25 years. They play a special role in the pathophysiology of many diseases of the cardiovascular system. Endothelin-1, which is the most explored one, is a potent vasoconstrictor. It increases renal water and sodium excretion, augments cell growth and proliferation and has proinflammatory activity, by intensifying the production of reactive oxygen and nitrogen species (ROS and RNS). ET-1 takes part in the progression of such diseases as hypertension, atherosclerosis, heart and renal failure. The physio- and pathological effects of endothelins are mediated through ETA and ETB receptors. Blocking these receptors, in particular the ETA receptor, can prevent negative effects of endothelins. Long-term efforts to create drugs which act like that have brought relevant results. Endothelin receptor antagonists (ERA) are a new class of medicines, which are indicated in the treatment of pulmonary arterial hypertension. There are also optimistic results of trials with ERA administered in other disorders. On the basis of these data we may conclude that there will be more indications for this group of drugs. This review discusses properties and new research directions of ERA registered in pharmacotherapy.

Anemia in chronic kidney disease (CKD) may affect up to 90% of the patients. It is one of the non typical risk factors of cardiovascular disease, specific for this population. The main reasons of the anemia in CKD are iron and erythropoietin deficiency. It is recognized in women with hemoglobin concentration < 11 g/dl and in men and postmenopausal women with hemoglobin concentration < 12 g/dl. Other potentially reversible reasons of anemia should be excluded in differential diagnosis. Iron and erythropoiesis stimulating agents (ESA) constitute the main treatment of anemia of CKD.

Chronic obstructive pulmonary disease (COPD) is one of the most frequent chronic diseases. Slightly reversable and progressive decrease in airflow through the airways is characteristic for the disease. It has been brought up last years that COPD course influences not only pulmonary system status but also many co-existing diseases in the eldery, especially cardio-vascular diseases, such as: ischaemic heart disease, hypertension, heart arrythmias, heart infarction. Wide usage and established position in the treatment of cardio-vascular diseases have the antagonists of beta-adrenergic receptors (beta-blockers). The aim of this work was the combination of the studies results quoted in the literature about the usage of beta-blockers in cardiovascular diseases co-existing with COPD. Conclusions. Nowadays there are no unambiguous recommendations for the usage of beta-blocker in patients with COPD and the decision about including them into treatment depends on the individually estimated risk of complications.

Flavonoids are plant components of the diet. Their daily intake is about 1 g. In Poland the main source of flavonoids is tea, apples and onions. These compounds are characterized by a variety of biological activities and pharmacological effects. Especially important for human health are their antioxidant properties. This paper presents the current state of knowledge on the role and importance of flavonoids in the prevention of the initiation and development of cardiovascular diseases. Epidemiological observations, clinical research, in vitro and in vivo experimental studies clearly show a protective effect of flavonoids on the cardiovascular system. Their beneficial effects on the cardiovascular system involve the inhibition of low density lipoprotein (LDL) oxidation, the reduction of blood vessels permeability, antiplatelet and anti-inflammatory activity, and hypotensive and direct vasodilator action. Biological potential of flavonoids (especially the antioxidant activity) indicates the possibility of their use in primary and secondary prevention of atherosclerosis and its clinical consequences (heart attack, stroke, and others) as a safe potential therapeutic agents.

Majority of patients with glaucoma, age-related maculopathy or diabetic macular edema is old. Therefore arterial hypertension, coronary arterial disease, diabetes and dyslipidemia are common finding in patients with sick eye. In this article some situations needing cooperation of cardiologist and ophthalmologist have been pointed. The influence of treatment of hypertension on glaucoma outcomes and the influence of intraocular injections of biological drugs on cardiovascular risk seems to be the most important issues.

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, 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.

Endotelina (ET-1) is the polypeptide about wide spectrum of physiological effects, involved in pathophysiology of cardiovascular and neoplastic diseases. Thus, ET-1 blocking becomes modern therapeutic target. The endothelin receptor antagonists (ERA)--sentans are the intensely studied agents, already approved for an alternative pulmonary hypertension therapy and hormone-resistant prostate cancer treatment. The promising results of conducted clinical trials suggest the possible extension of ERA application in other clinical entities in the close future. The article shortly describes present studied endothelin receptor antagonists and rationale for their introduction to the general clinical practice.

Endothelin (ET-1) is the polypeptide about wide spectrum of physiological effects. The results of numerous experimental and clinical investigations showed its essential role also in the pathophysiology of various cardiovascular diseases (arteriosclerosis, heart failure, pulmonary hypertension, renal failure) and some neoplastic conditions. Thus, ET-1 blocking becomes an interesting tool of modern pharmacotherapy, targeted on neurohormonal mechanisms. The article briefly describes biochemical properties of ET-1 and ET and pathophysiological role of ET-1 in selected cardiovascular diseases.

In recent years in the Department of Neurotraumatology in Cracow it has been noticed the frequent connection between appearance of chronic subdural hematoma (CSDH) and treatment by anticoagulant medications. The aim of this study is to draw attention to the problem of insufficient control of anticoagulants consumption, especially by patients treated for cardiovascular system diseases that increases the risk of bleeding and CSDH development. The paper is based on data from questionnaires that was sent to patients with CSDH, cured in the Department of Neurotraumatology form 2004 to 2005. Analyzed was the group of 51 patients with chronic subdural hematoma; 37 individuals (72.5%) confirmed taking acetylsalicylic acid in the period of 3 months before admission to the Department, 9 (17.6%) patients answered that they were taking low-molecular weight heparin. One patient (1.9%) was taking chronically derivative of cumarin. The authors would inform that anticoagulant treatment might favour increase of chronic subdural hematoma incidence. It's especially important, because the average life expectancy has been prolonged in Poland and there are more people taking acetylsalicylic acid. This can be an epidemiological problem in future.

Regional anaesthesia can be associated with severe complications, which may be due to overdose or accidental intravascular injection of local anaesthetics. The clinical picture varies and depends on the pharmacodynamics of specific drugs, the total dose used, and the route of injection. Among the most common side effects are: excitation, seizures, loss of consciousness, cardiac dysrhythmias, severe shock and cardiac arrest. Cardiovascular resuscitation in such cases may be prolonged and very difficult, mostly because local anaesthetics are lipid soluble and require a long time for redistribution. The majority of cases with lidocaine-induced cardiovascular complications can be successfully resuscitated due to the relatively short duration of action of the drug. Bupivacaine-induced cardiac arrest is probably the most dangerous, with resuscitations in such cases being usually very long and frequently unsuccessful. Recently, intravenous fat emulsion (Intralipid) has been used during resuscitation. This review focuses on the role of intravenous fat emulsions in the treatment of toxicity due to local anaesthetics. The possible antidotal mechanisms are discussed.

Human urotensin II (U-II) is a cyclic peptide generated by proteolytic cleavage from a precursor prohormone. It was first isolated from the fish spinal cord and has been recognized as a hormone in the neurosecretory system of teleost fish. It is expressed in the human central nervous system as well as other tissues, such as kidney, spleen, small intestine, thymus, prostate, pituitary and adrenal gland and circulates in human plasma. The plasma U-II level is elevated in renal failure, congestive heart failure, diabetes mellitus, systemic hypertension and portal hypertension caused by liver cirrhosis. The effect of U-II on the vascular system is variable, depending on species, vascular bed and caliber of the vessel. The net effect on vascular tone is a balance between endothelium-independent vasoconstriction and endothelium-dependent vasodilatation. Urotensin II is also a neuropeptide and may play a role in tumor development. The development of U-II receptor antagonists may provide a useful research tool as well as a novel treatment not only for cardiovascular diseases.

Cardiac natriuretic peptide hormones, atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP), are synthesized and secreted by the heart, producing several biological effects, such as natriuresis, vasorelaxation and hypotension. During the last decade these peptides, especially BNP, have received increasing attention as potential markers of cardiovascular disease. Their measurements can be used to diagnose heart failure, including diastolic dysfunction, and using them has been shown to save money. BNP levels can enable the differentiation between dyspnoic patients secondary to ventricular dysfunction and subjects with primary respiratory disorders. Moreover, there is good evidence that natriuretic peptides may have a diagnostic role in arterial hypertension, acute coronary syndromes, pulmonary hypertension, some valvular heart disease and some disorders affecting other systems (diabetes or thyroid disorders). In this paper we discuss the clinical utility of assessment of natriuretic peptide hormones in the diagnosis of various clinical conditions and their use as pharmacological agents.

Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) posses multiple beneficial effects such as cardioprotection, cerebroprotection, nephroprotection which provide opportunity to select the most suitable drug for the target vascular bed (e.g. coronary, or cerebral circulation). In some clinical settings, combined therapy ACE-I with ARB (double blockage of the renin-angiotensin-aldosteron system) may appear the most effective. These drugs (especially ARB) may successfully prevent atrial fibrillation and play a protective role in metabolic syndrome. Recently, it has been demonstrated that losartan is able to inhibit vasodilatation of the aorta in Marfan syndrome, which might prevent sudden death due to aorta rupture. An increasing role of ARB is most beneficial in hipotensive therapy (inhibition/regression of hypertension-related organ damage). With particular interest, results of the ONTARGET study are being awaited. This study is focused on the effect of double blockage (ramipril and telmisartan) on reduction of the occurrence of myocardial infarction, stroke, and heart failure.

This article presents a review of the most important (from the cardiologic practice point of view) interactions among medicines administered to the patients suffering from cardiovascular diseases, in particular among medicines with cytochrome P450 (and its isoenzymes) dependent metabolism. Cardiovascular patients, often advanced in age, usually affected by concomitant diseases and compelled to take many different medicines are particularly exposed to side effects dependent on these interactions. The article describes both beneficial and unprofitable interactions among medicines administered in cardiology.

This review summarizes the data on biological activity and therapeutic potential of camosine. Camosine is a naturally occurring, water-soluble dipeptide. It has buffering activities in excitable animal and human tissues, exhibits metal ions binding properties, antioxidant and antiglycating properties, extends the life-span of cultured human diploid cells, regulates sarcoplasmic reticulum Ca-release channel activity. Carnosine may be a potential therapeutic agent (neurodegenerative, metabolic, cardiovascular diseases) mainly due to its antioxidant and antiglycating activities.

Moderate alcohol consumption decreases the risk of coronary heart disease (CHD). Epidemiological studies indicate that consumption of alcohol at the level 20-30 g per day can reduce risk of CHD by at least 20-25%. The mechanism of this protection has been associated with an increase in the level of HDL-cholesterol. Second of the proposed mechanisms of the protective effect of moderate alcohol intake is its beneficial effect on homeostasis.

Immunopharmacological studies show that medicines used in cardiovascular diseases (atherosclerosis, ischaemic heart disease, heart failure) can exert immunomodulatory effects on proinflammatory cytokines. In the paper the influence of statins, fibrates, angiotensin converting enzyme inhibitors (ACEI), beta-blockers, calcium channel blockers and phosphodiesterase inhibitors on the activity of cytokines was introduced.

In this paper we described the participation of beta-adrenoceptors in the regulation of the cardiovascular system. We characterized mainly the low-affinty state of beta1-adrenoceptors and beta3-adrenoceptors, which are insensitive to propranolol (the antagonist of beta1-/beta2-adrenoceptors). We also illustrated their function in the healthy and failing heart. In addition the vasodilatory effects of these receptors ligands were described.

Anthocyanins are common ingredients of human diet, and the rich source of them are: aronia fruits, black currant, raspberry, grapes and apples. Because of their chemical structure they are able to influence many active substances in human body having antioxidative, antiinflammatory and cardioprotective activity.

Recently, it has become clear that the action of aldosterone is far more complicated than it was previously thought. Beyond regulating sodium and volume homeostasis by its epithelial action, the hormone exhibits its effects in other organs, such as the heart, blood vessels and central nervous system. Some of these actions, so called non-genomic effects, are not related to the aldosterone-induced stimulation of classical mineralocorticoid receptors. In this paper we discuss the progress made in understanding the physiological function of aldosterone and the role of its excess in the etiology of cardiovascular disorders. In the second part of this article, we provide an overview of the clinically-proven benefits of a new selective aldosterone-receptor antagonist, eplerenone.

Atypical endometrial hyperplasia has been associated with progression to endometrial cancer, the most common genital malignancy. There are multiple risk factors for endometrial cancer, such as early menarche, exogenous estrogen exposure, obesity and diabetes. Diabetics have a 3-4 fold relative risk of endometrial cancer. Also, several studies have demonstrated an association between insulin resistance and endometrial cancer. There is known the first description of atypical endometrial hyperplasia resistant to progestogen therapy, which was subsequently treated with an insulin-sensitizng agent, metformin. Metformin is a biguanide antihyperglycemic agent used in the treatment of adult-onset diabetes. Unlike the sulfonylureas, metformin does not act primarily by increasing insulin secretion. In contrast, metformin lowers the rate of gluconeogenesis in the presence of insulin. Therefore, it is considered an insulin-sensitizer. Increased insulin sensitivity may improve the metabolic effect of insulin and decrease its mitogenic effect by tissue-specific mechanisms. One explanation for tissue specific differences in insulin binding and action may be through the relative expression of the insulin receptor (IR) isoforms. The IR isoforms IR-A and IR-D differ by 12 amino acid residues, owing to the alternative splicing of exon. The IR-A is predominantly expressed in malignant tissues and may lead to mitogenic effects within the cell. The relative expressions of IR-A and IR-B in normal and malignant endometrial tissue is not known. Besides direct effects on the IR, several additional mechanisms have been proposed for the mitogenic effect of insulin in endometrial cancer. In addition to the possible direct mitogenic effects of insulin through the IR-A, insulin resistance may be associated with alterations in expression of insulin-like growth factors (IGFs) and the IGF binding proteins (IGFBPs) or may inhibit the protective effect of progestagens. Binding sites for IGF-1 and IGF-2 have been confirmed in both normal and malignant endometrium. Binding of IGF-1 is significantly higher in endometrial cancer compared to normal endometrium. In the Ishikawa human endometrial cancer cell line IGF-1 was a more potent mitogen than insulin or IGF-2. Insulin may increase mitogenicity by regulating the expression of IGFBPs. The IGFBPs are a family of proteins that have both proliferative and anti-proliferative effects. While all six high-affinity IGFBPs are expressed in the endometrium, IGFBP-1 is the best characterized. Hyperinsulinemia can decrease IGFBP-1 even in the presence of progesterone, perhaps inhibiting progesterone's protective effects. Interestingly, IGFBP-1 was undetectable or minimally expressed in endometrial cancers. Nestler discussed results of a 6-month treatment of 100 nonebese women with PCOS, which showed a somewhat greater effect of metformin than rosiglitazone and no benefit of administering both agents in combination. Long-term treatment with oral contraceptives decreases endometrial cancer, with a reduction in serum androgens and a decreases in hirsutism and acne, but may worsen insulin resistance and lead to deteriration in glucose tolerance. Insulin sensitizers, on the other hand, should decrease endometrial hyperplasia by inducing regular menses, but may not be as beneficial in improving androgen - related symptoms. Note that the Nurses Health Study (NHS) showed increased risk of diabetes in oral contraceptive users. These considerations may be related to the finding that women who used oral contraceptives have increased risk of myocardial infarction. Thus, in view of the particular increase in CVD risk among women with PCOS, one might be less likely to recommend oral contraceptives, while insulin sensitizers may be of particular benefit, decreasing androgens, improving ovulation and fertility, and reducing the risk of diabetes and CVD. Theoretically, metformin, a treatment which is now widely used to treat infertile women with PCOS, may have a role in preventing endometrial hyperstimulation by lowering insulin concentrations and restoring ovulation. However, the long-term effects of this drug in women with PCOS are not known and more studies are required before suggesting its use for preventing endometrial cancer.

The activation of adrenergic and renin-angiotensin-aldosterone (RAA) systems observed in patients with obstructive sleep apnoea syndrome (OSA) strongly affects functional status of the cardiovascular system. In this paper we discuss the link between obstructive sleep apnoea syndrome and common cardiovascular diseases such as systemic and pulmonary hypertension, ischaemic heart disease, stroke, arrhythmia and ventricular hypertrophy. We also present the importance of early pharmacologic treatment in preventing cardiac hypertrophy and ventricular dysfunction in patients with obstructive sleep apnoea syndrome.

Recombinant human erythropoietin (rHuEPO) is a hormone essential for normal erythropoiesis. The rHuEPO receptor is distributed in the cardiovascular system predominantly in endothelial cells and cardiomyocytes. RHuEPO has potentially beneficial effects on cardiovascular system, including anti-apoptic, mitogenic and angiogenic activity. On the other hand rHuEPO improves anemia observed in some patients with heart failure. Direct cardiac activity of rHuEPO and indirect influence on anemia suggest that rHuEPO therapy is safe and useful in chronic heart failure patients and other cardiovascular settings.

Vascular endothelial growth factor (VEGF) is a glycoprotein with a molecular weight of about 45,000 and it is an endothelial cell specific mitogen. The essential function of VEGF is induction of angiogenesis and stimulation of endothelial proliferation. Since few years there are some clinical trials using VEGF in the field of: stimulation of reendothelialization and prevention of restenosis after revascularization, therapy of peripheral vascular disorders leading to ischemic limb, therapy of ischemic heart disease through neoangiogenesis. First group of mentioned studies is making use of ability of VEGF to stimulate the endothelial proliferation and accelerate its regeneration. Second and third group of clinical trials is taking advantage of angiogenic activity of VEGF, which leads to collateral vessel development and enhancement of ischemic area perfusion. There are also studies in the field of VEGF gene therapy, which had a big advantage over treatment with VEGF-protein because it is stimulating VEGF production for even few weeks. Besides there are new ways of drug administration. The specialist of many different medicine disciplines (not only of cardiovascular diseases) are interested in VEGF. The results of their studies are pointing at purposefulness of continuing them and making that VEGF is having bigger and bigger importance in medicine.

Asacard is a microcapsulated, controlled-release form of acetylsalicylic acid, which delivers very low but constant amount of the drug directly into the intestine. The dose 162.5 mg Asacard, used in prevention of cardiovascular diseases, is thus sufficient to block platelets in the portal vein from synthesizing thromboxane but not high enough to enter the systemic circulation and block the formulation of prostacyclin and other prostaglandins. It is generally accepted that in aspirin-induced asthma (AIA) the bronchospasm is provoked by inhibition of prostaglandin synthesis with overproduction of cysteinyl leukotrienes. The aim of our study was to verify the hypothesis if Asacard, as a form of aspirin, which theoretically does not block prostacycline synthesis in systematic circulation, would be well tolerated by patients with AIA. We thus studied in an open study the tolerability of three single, increasing doses of Asacard in 10 patients with confirmed by oral challenge test aspirin intolerance (4 males, 6 females, mean age 40 years). Initially, the patients received 40 mg of Asacard and FEV1 and clinical symptoms were assessed every 30 minutes for 8 hours. A positive reaction was defined as a > or = 20% decline in FEV1 from baseline. Patients with negative reaction received 75 mg Asacard 7 days later. In absence of the reaction, the last dose 162.5 mg was administered a week later. In 5 out of 10 patients studied, Asacard given at single doses up to 162.5 mg was tolerated well. In the remaining 5, it provoked bronchospasm, a fall in FEV1 > or = 20% and other extrabronchial symptoms of aspirin intolerance. No correlation was found between the doses of regular aspirin, which provoked a fall in FEV1 > or = 20% during baseline oral provocation test and Asacard doses. In conclusion, any form of aspirin, even controlled-release, should not be prescribed for patients with AIA, because it may provoke symptoms of intolerance to this drug.

Arterial hypertension has an important functional and morphological influence on the arterial system. The evaluation of functional and morphological changes is based upon such terms as compliance, stiffness, distensibility in the former and intima-media thickness (IMT), number and kind of atheromatous plaques in the latter case. Functional changes in the large arteries can be modified by antihypertensive and hypolipemic agents. The IMT as a non-invasive marker of vascular wall injury is increasingly frequently used in the studies. It has been identified as a significant predictor of coronary and cerebral vascular complications. Most studies on hypolipemic therapy demonstrate that the progression of IMT is slowed down. Ca-antagonists, ACE inhibitors and beta blockers are the most frequently studied agents with respect to their influence on IMT in the following patient populations: hypertensives, patients with coronary artery disease, at high cardiovascular risk and asymptomatic subjects with carotid plaque. The present paper summarises the results of these studies. The findings of the ELSA trial, the largest study evaluating the effects of therapy on IMT are noteworthy. It has been demonstrated that lacidipine has a better antiatheromatous effect than atenolol, which is independent of its hypotensive properties. Non-invasive, relatively easy ultrasound measurement of IMT in the carotid artery is an important tool to detect atheromatous lesions and because of its prognostic value. It may also serve as a predictor of cardiovascular complications, which helps in the process of therapeutic decision-making.

The aim of our research was retrospective analysis of poisoning with cardiovascular drugs (T46 according to ICD 10 classification) in patients over 59 years old, hospitalized in Province Poisoning Centre in Lublin, in the period from 1995 to 2001. There were hospitalized 288 patients at this time age, over 59 years old. Among this 16 persons were poisoned with cardiovascular drugs (one accidental and 15 suicidal intoxications), and 3 of them died. Different kinds of cardiovascular medications were used e.g. digoxin, nitrates, hypotensive drugs (as single and multiplied drug poisonings). At 3 of the patients depression was diagnosed.

Endothelin-1 was first identified by Yanagisawa in 1988 and shown to be a potent and sustained vasoconstrictor and pressure peptide. Endothelial cells line all blood vessels and are capable of generating endothelin-1; receptors for the endothelins are widely expressed, particularly in tissues involved in cardiovascular regulation, including the heart, blood vessels, kidney and brain. Endothelin-1 has potent vasoconstrictor properties and the coronary, renal and cerebral blood vessels appear particularly sensitive. Moreover, endothelin-1 has activity as co-mitogen, interacts with the sympathetic nervous and renin-angiotensin system. These properties indicate a likelihood that the endothelin system is of functional importance in human cardiovascular physiology and may play a role in the pathophysiology of cardiovascular disease. It is possible that endothelin antagonists might be effective in the treatment of diseases associated with intermittent or sustained vasoconstriction.

Drugs classified as calcium channel blockers (CHBs) are now among the most frequently prescribed drugs for the treatment of cardiovascular disease. Although the currently available CCBs have major differences in their structural and cardiovascular effects, they share the common property of blocking the transmembrane flow calcium ions through voltage gated L-type channels. These drugs have been approved for the treatment of hypertensive heart disease: they reduce left ventricular hypertrophy and improve its sequelae, such as ventricular dysrhythmias, impaired filling and contractility, and myocardial ischemia. Long-acting CCBs have been shown to reduce mortality and morbidity in elderly patients with systolic hypertension, appear to be extremely useful in patients with cyclosporin-induced hypertension, and can be used as alternatives to ACE inhibitors in patients with hypertension and concomitant diabetes mellitus, renal disease, Raynaud's phenomenon or migraine. Long-acting dihydropyridine have been shown to be effective and safe in the treatment classic angina pectoris and vasospastic angina, supraventricular arrhythmias, particularly reentrant AV-nodal tachycardia, others to be beneficial in patients with congestive heart failure, and all of them have potential for decreasing atherogenesis.

According to contemporary views, the endothelium is not only a barrier separating blood from surrounding tissues, but a dynamic, heterogeneous organ, which possesses many secretory, metabolic and immunologic functions. Endothelial cells produce mediators, which regulate blood flow, influence platelet adhesion and aggregation, coagulation and fibrinolysis and also immunological response. Endothelial dysfunction is defined as an imbalance between vascular relaxing and contracting factors, between procoagulant and anticoagulant mediators or growth-inhibiting and growth-promoting substances. The definition is often confined to dysfunction of the vessel wall tonus control. The endothelial dysfunction frequently proceeds structural changes in vessels, as e.g. atherosclerotic plaque formation, neointima formation and vessel wall remodelling. This dysfunction has been confirmed in systemic hypertension, atherosclerosis, cardiac syndrome X, heart failure, using various invasive and non-invasive techniques. There are pharmacologic and non-pharmacologic methods to modify endothelial functions. It is obligatory to reduce risk factors of atherosclerosis, which lead to endothelial cell damage, i.e. hypertension, hyperlipidemia, cigarette smoking, estrogen deficiency and elevated levels of homocysteine. The role of physical exercise, low-cholesterol diet, discontinuation of smoking is emphasised. Among drugs statins, angiotensin-converting enzyme inhibitors and hormone replacement therapy are considered particularly beneficial. The importance of angiotensin receptor antagonists, endothelin receptor antagonists, L-arginine, growth factors and calcium-channel blockers for the improvement of endothelial function is studied.