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The aim of this review was to summarize data regarding amaranth as a potential component of lifestyle modification to improve cardiovascular risk profiles by modifying cardiovascular risk factors such as cholesterol, diabetes, and hypertension. PubMed was searched for appropriate articles. The main inclusion criteria for articles were as follows: interventions with amaranth; conducted in humans or animals or in vitro; and reported serum lipids and lipoprotein levels, and antidiabetic, antihypertensive, and antioxidant abilities. The outcome measures were changes in serum lipids and the presence of antidiabetic, antihypertensive, and antioxidant activity. A total of 33 articles were included herein. Regarding hypolipidemic activity, most studies investigated the effect of intervention with amaranth in animals, and fewer studies were performed in humans. Most studies in animal models demonstrated the ability of amaranth to decrease total cholesterol and low-density lipoprotein cholesterol. Pilot studies in humans were not convincing regarding amaranth's lipid-lowering activity. Based on this search, it is not clear which constituents are potentially responsible for the hypocholesterolemic effect of amaranth. Some authors tend to think that squalene can play a role in this effect, whereas others suggest that different components of amaranth are of greater importance (eg, sterols, oil fractions rich in fatty acids, proteins, amino acids, or fiber) for its hypocholesterolemic effect. It is possible that several constituents are jointly responsible for this action. Regarding the antidiabetic, antihypertensive, and antioxidant activities, most studies were performed in vitro and showed good potential for all three biological effects. Future research should focus on clarifying the effect of amaranth on high-density lipoprotein cholesterol, identifying the constituents responsible for these beneficial effects, and providing more data regarding its use in humans, ideally using randomized controlled trials. The antidiabetic, antihypertensive, and antioxidant activities found in vitro should be confirmed further in animal or human models.

Introduction A retrospective/prospective observational study was conducted to explore the current management of hyperlipidaemia in high-risk (HR) and very high risk (VHR) patients in central/eastern Europe and Israel. Methods The study enrolled adult patients who were receiving lipid-lowering therapy and attending a specialist (cardiologist/diabetologist/lipidologist) or internist for a routine visit at 57 sites (including academic/specialist/internal medicine centres) across Bulgaria, Croatia, Czech Republic, Israel, Poland, Romania and Slovakia. Data were collected from medical records, for the 12 months before enrolment, with/without ≤ 6 months’ additional prospective follow-up. Results A total of 1244 patients, mean (SD) age 63.3 (11.3) years were included (307 with familial hypercholesterolaemia (FH), 943 secondary prevention patients). Almost all patients (98.1%) were receiving statins (76.7% monotherapy/21.4% combined therapy), with 53.1% receiving high-intensity statin therapy: 127 patients (10.2%) had adverse events attributed to statin intolerance. Mean (SD) low density lipoprotein cholesterol (LDL-C) levels were 3.3 (1.7) mmol/L at the first, and 2.7 (1.3) mmol/L at the last, visit of the retrospective phase of observation, with little change during the prospective phase. Less than one-quarter (23.8%; 95% CI 17.29–31.45%) of HR patients and less than half (42.0%; 39.05–44.98%) of VHR patients achieved their risk-based LDL-C targets of

In our pilot study, we aimed to determine how many patients with the statin intolerance history referred to the specialized center for the diagnostics and treatment of lipoprotein metabolism disorders really suffer from a complete statin intolerance. The purpose of the study was to prove that complete statin intolerance is overestimated and overdiagnosed, and with the detailed knowledge of the issue and patient approach, it is possible to find an appropriate statin treatment for the most of patients. With the increasing number of statin users worldwide, the issue of statin intolerance has been a frequently discussed topic in recent years. There are many factors that play a role in the manifestation of statin intolerance (predisposing factors as age, sex, and some diseases), genetic factors leading to a different metabolism, drug-drug interactions, psychological reasons, and the negative influence of the mass media. However, it is estimated that true complete statin intolerance, defined by an intolerance of at least three statins at their usual lowest daily doses, occurs in approximately 3–6% of all statin users. In our pilot study, we conducted a retrospective analysis of 300 patients who were referred to the Center of Preventive Cardiology with a history of statin intolerance. During the follow-up treatment, 222 patients (74%) were able to use some statin (rosu-, atorva-, simva-, fluvastatin), and in 21% of the cases (63 patient), the target values according their CV risk level were even achieved. Only 78 patients (26%) were confirmed as being complete statin intolerant following a thorough therapeutic effort. The most tolerated statin was rosuvastatin.

Kardiovaskularni onemocněni (KVO) představuji stale zasadni problem pro vsechny země zapadni civilizace i pro země, ktere je svým ekonomickým rozvojem nasleduji. I když vlastni lecba KVO doznala v poslednich letech obrovských uspěchů, přeci jen nemensi (nebo dokonce jestě větsi) význam ma ovlivněni rizikových faktorů (RF). Mezi těmi pak hraje zasadni roli, jako primarni cil lecby, LDL-C. Zakladem lecby jsou samozřejmě nefarmakologicka opatřeni s důrazem na změnu životniho stylu. U vysokeho procenta nemocných vsak musime sahnout k farmakologicke lecbě. Jejim zakladnim piliřem jsou statiny, v kombinacni lecbě pak ke sniženi LDL-C přidavame ezetimib. PCSK9-inhibitory (PCSK9-i) představuji novou skupinu leků, ktere dramatickým způsobem pozitivně ovlivňuji lipidový profil (předevsim LDL-C, ale i apo B a Lp/a/). Tyto lipidove ucinky byly v poslednich několika letech velmi podrobně studovany v řadě studii. Dalsi studie pak sledovaly bezpecnostni profil. Vsechny tyto studie přinesly pouze pozitivni výsledky. V poslednim roce vsak byly publikovany velke studie (desetitisicove megatrialy), ktere sledovaly ucinky lecby PCSK9-i na KV morbiditu a mortalitu. Tyto studie, FOURIER a ODDYSEY outcomes, pak prokazaly nejen pokles KV rizika, KV přihod, ale dokonce i sniženi celkove mortality. Předložene sděleni je věnovano předevsim zkusenostem a výsledkům, ktere byly ziskany s evolocumabem, dostupným pod firemnim nazvem Repatha. Budou diskutovany výsledky studii, předevsim se zaměřenim na studii FOURIER a dale na analýzy bezpecnosti, ktere sledovaly mimo jine neurokognitivni funkce (studie Ebbinghaus) nebo vznik noveho diabetes mellitus (DM), který, na rozdil od statinů, nebyl pozorovan. Rovněž se zaměřime na vybrane podskupiny nemocných lecených PCSK9-i (vesměs s pozitivnim ucinkem), např. nemocne s familiarni hypercholesterolemii (FH) nebo nemocne s DM.

Kardiovaskularni onemocněni jsou stale nejcastějsi přicinou morbidity a mortality v rozvinutých zemich. Pouze komplexnim ovlivněnim vsech rizikových faktorů aterosklerozy jsme schopni významně redukovat kardiovaskularni riziko pacienta. Na zakladě výsledků klinických studii se stale zpřisňuji doporuceni odborných spolecnosti, soucasně narůsta pocet možných lekových kombinaci, pomoci kterých jsme schopni požadovaných cilových hodnot dosahnout. S narůstajici farmakoterapii bohužel klesa adherence pacienta k lecbě. Nejperspektivnějsim řesenim ke zlepseni adherence pacientů k farmakoterapii jsou fixni kombinace. Dnes jsou na trhu nejen fixni kombinace (zejmena) k ovlivněni jednoho rizikoveho faktoru, ale nově i leky, ktere obsahuji latky ovlivňujici několik rizikových faktorů aterosklerozy.

Erektilni dysfunkce je poměrně castým zdravotnim problemem, v Ceske republice trpi ve věku 35–65 let různým stupněm tohoto onemocněni vice než polovina mužů. Přiciny erektilni dysfunkce mohou být psychogenni a organicke, mezi organicke pak patři anatomicke, neurogenni, hormonalni a vaskularni. Erektilni dysfunkce může být prvnim varovanim zavažneho onemocněni, a proto bychom se neměli spokojit pouze se symptomatickou lecbou, ale měli bychom pacienta s erektilni dysfunkci vždy vysetřit komplexně. Můžeme mu tim zlepsit životni prognozu i dalsi kvalitu života.

Aims: Despite the fact that statin treatment efficacy is very high, there are substantial differences in treatment effectiveness among individuals. It is supposed that genetic predisposition plays an important role in these differences, but the contribution of individual polymorphisms is poorly understood. So far, more than 30 genes have been examined with ambiguous results. Apolipoprotein A5 is an important determinant of plasma lipid concentrations and its genetic variation could account for some of the observed differences in the response to statin therapy. However, this has not been analyzed before. Materials and methods: We examined the putative association between APOA5 SNPs (c.-1131T>C, c.56C>G and c.457G>A) and efficacy during 3 months of statin treatment in 187 adult Caucasians. Patients were treated with low-dose (10 or 20 mg per day) simvastatin (46.3%), atorvastatin (40.5%) and lovastatin (13.2%). Results: The decrease in cholesterol was not significantly associated with the type or dose of statin. Carriers of the APOA5 genotype TT-1131 (n = 154) benefited more from statin treatment when compared with the C-1131 allele carriers (n = 33) (Δ low-density lipoprotein cholesterol: -36.3 ± 15.1% vs Δ low-density lipoprotein cholesterol: -29.9 ± 12.5%; p

There is a large body of evidence documenting the effects of long-chain polyunsaturated fatty acids with the first double bond at the third position from methyl-terminal (so called omega-3 fatty acids (FAs)) on different components of cardiovascular disease (CVD) risk. However, it may seem the more answers on the topic we learn, the more questions remain to be elucidated. There are three levels of evidence documenting the impact of fish omega-3 FAs on CVD risk. Epidemiological data have shown unequivocally the increased intake of fish is associated with lower CVD morbidity and mortality. Numerous experimental studies have shown (almost always) positive effects of omega-3 FAs on lipoprotein metabolism, coagulation and platelet function, endothelial function, arterial stiffness etc. Most importantly, there are a few prospective clinical endpoint trials (DART, JELIS, GISSI Prevenzione and GISSI-HF) that have examined the impact of omega-3 FAs supplementation on cardiovascular outcomes in different patient populations. Recent meta-analyses of these and other clinical studies have yielded somewhat conflicting results. In this review we will summarize current evidence of omega-3 FAs effects on cardiovascular risk focusing on new data from recent clinical trials as well as possible practical implications for clinical practice.

Diabetes mellitus and in particular type 2 diabetes mellitus is one of the most important risk factors of cardiovascular disease. To influence cardiovascular risk there is enormous important not only positive influence of glycemia, but also the treatment of diabetic dyslipidemia and hypertension. The present work provides an analysis of lipid-lowering and antihypertensive therapy for all diabetics registered with General Health Insurance Company in the period 2010-2013. In this time 866,570 patients with diabetes mellitus registered with General Health Insurance Company were treated, the majority of them were diabetics independent on insulin. Approximately half of the patients were observed by dialectologists and half of them by the doctors of other specialization. Out of antihypertensive medi-cation, patients were most often treated by drugs that affect the renin-angiotensin system, as well as beta-blockers and diuretics. Prescription of the lipid-lowering therapy, especially prescription of statins, in accordance with the guidelines, is increasing, but remains insufficient (at 2013 43.6% diabetics treated by dialectologists and 51.3% diabetics treated by GP´s didn´t have lipid lowering therapy). Inadequate use of combination lipid-lowering therapy was recorded too, still represented mainly by combination of statin and fibrate, but in coming years we expect (based on the positive results of the subanalysis IMPROVE-IT study), an increase of combination therapy statin and ezetimibe.

Prevention through evaluation and treatment of cardiovascular risk factors is an efficient approach to reduce the risk of cardiovascular events, however, the problem remains that the available treatment options are underused. Implementation of cardiovascular disease prevention guidelines into clinical practice is therefore important for decreasing the burden of cardiovascular disease in general population. However, there are many barriers to this process, including questionable relevance of scientific results for clinical practice, personal preferences and expertise of the doctors, patient attitudes, lack of time, and economical factors. All these factors need to be taken into account for any change in the clinical practice to be successful. With respect to cardiovascular disease prevention, insufficient screening for risk factors, inappropriate risk estimation and hesitation to keep to the guidelines-based treatment targets contribute most to inadequate control of risk factors, and this has been repeatedly demonstrated to be difficult to improve. In this context, our studies demonstrate that the emphasis on systematic application of the principles of cardiovascular prevention results in improved control of cardiovascular risk factors. Adequate support for transforming the guidelines-based knowledge into practicable habit appears therefore important for successful prevention of cardiovascular disease in clinical practice and may translate into substantial reduction of cardiovascular risk in general population.