Systematic screening for cardiovascular risk at pharmacies.

BACKGROUND: Early identification and treatment of cardiovascular risk factors (CVRFs) is essential to prevent excess morbidity, mortality and healthcare-related costs. We sought to investigate whether an active screening programme at pharmacies could identify a significant proportion of patients with previously undetected CVRFs. METHODS AND RESULTS: Between April and July 2013, 184 pharmacies in Lower Austria enrolled a total of 6800 participants, in whom body mass index (BMI), blood pressure (BP), total cholesterol and blood glucose were measured. Mean age was 58±17 years and 67.8% were women. 21% of men and 16% of women had a BMI≥30 kg/m2. The crude prevalence of diabetes mellitus (DM) was 7%, hypercholesterolaemia was identified in 57%, and 44% had elevated BP. Among fasting individuals (n=1814), DM was found in 18%. In total, 30% were confronted with a CVRF they were previously unaware of, and pharmacists recommended 45% of all participants to actively consult a physician. A first-time diagnosis of a CVRF was most frequent in the age groups between 25 and 64 (32% of participants). CONCLUSIONS: This pharmacy-based approach for cardiovascular risk screening found similar overall prevalences of CVRFs as reported by national surveys, but revealed underdiagnoses, particularly in lower age groups. A previously unknown CVRF was identified in every third individual, frequently prompting the pharmacists to recommend the consultation of a physician. An active screening approach at pharmacies might therefore serve as an effective alternative to the public preventive medical examination, particularly in younger age groups.

Passive cigarette smoking increases isoprostane formation.

Passive smoking has been demonstrated to exert a variety of deleterious effects eventually resulting in vascular damage. Isoprostanes, a reliable marker of in vivo oxidation injury, have been shown to increase in active cigarette smoking. Data for passive smoking are lacking. We were examining the isoprostane 8-epi-PGF2alpha in 12 smokers and non-smokers exposed daily to passive cigarette smoke for 12 days. Plasma samples stored at liquid nitrogen from people having been examined earlier were used. Prevalues of 8-epi-PGF2alpha are higher in cigarette smokers. Exposure to passive smoking causes a significant increase in 8-epi-PGF2alpha in non-smokers, while in smokers there is only a trendwise increase. After repeated passive smoke exposure, 8-epi-PGF2alpha in non-smokers approaches the respective values of smokers. There is a significant correlation of 8-epi-PGF2alpha to the thromboxane (plasma, serum, conversion from exogenous precursor, 11-dehydro-TXB2) parameters (MDA, HHT- conversion) examined in these patients before. The findings document a significant temporary increase in in vivo oxidation injury due to passive smoke favouring development and/or progression of vascular disease.

Atorvastatin reduces microalbuminuria in patients with familial hypercholesterolemia and normal glucose tolerance.

BACKGROUND: Anecdotal evidence indicates that significant lowering of LDL-cholesterol by means of LDL apheresis may reduce the level of microalbuminuria in heterozygous familial hypercholesterolemia. We therefore examined whether treatment with the most potent LDL-lowering drug available (atorvastatin) has a similar effect on the level of microalbuminuria. MATERIAL/METHODS: In a case series, 100 patients with familial heterozygous hypercholesterolemia were started on 10 mg atorvastatin. 62 patients were switched to 40 mg atorvastatin once in the evening when the LDL-cholesterol treatment goals were not reached within 1 month. RESULTS: Baseline serum creatinine clearance significantly improved after 1, 3 and 6 months, while serum urea and serum creatinine were unchanged. Blood pressure exhibited a lowering trend. After one month of treatment, the mean level of microalbuminuria was significantly improved in both dose regimens, showing further improvement after 3 months and stabilizing thereafter. CONCLUSIONS: These data indicate that significant lowering of LDL-cholesterol with atorvastatin may favorably affect kidney function, in particular microalbuminuria as a measure of endothelial function. It remains to be seen whether this effect can be attributed to lipid lowering alone.

Effect of prickly pear (Opuntia robusta) on glucose- and lipid-metabolism in non-diabetics with hyperlipidemia--a pilot study.

BACKGROUND: Besides others pectin, a soluble fibre, has been reported to be effective in lowering cholesterol levels in both animals and man with hyperlipidemia as well as being able to slow carbohydrate absorption and hence reduce the postprandial rise in blood glucose and serum insulin in patients with type-II diabetes. Aim of this pilot study was to assess the effect of prickly pear consumption on glucose- and lipid metabolism. DESIGN: In 24 non-diabetic, non-obese males (aged 37-55 years) suffering from primary isolated hypercholesterolemia (n = 12; group A) or combined hyperlipidemia (n = 12; group B) respectively, the influence of prickly pear pectin (Opuntia robusta)-intake on glucose- and lipid metabolism was examined. After an 8 week pre-running phase with a 7506 KJ step-I diet (phase I), 625 KJ were replaced by prickly pear edible pulp (250 g/day) for 8 further weeks (phase II). RESULTS: Prickly pear leads to a decrease of total cholesterol (12%), low-density lipoprotein-cholesterol (15%), apolipoprotein B (9%), triglycerides (12%), fibrinogen (11%), blood glucose (11%), insulin (11%) and uric acid (10%), while body weight, high-density lipoprotein-cholesterol, apolipoprotein A-I, and lipoprotein(a) remained unchanged. CONCLUSION: The hypocholesterolemic action of prickly pear may be partly explained by the fibre (pectin) content, but the hypoglycaemic actions (improvement of insulin sensitivity) in the non-obese, non-diabetic need further investigation to get more insights on the potential advantage of treating the metabolic syndrome.

Awareness of Austrian physicians of risk factors for the development of atherosclerosis.

OBJECTIVE: In industrialised countries, coronary heart- (CHD) and other atherosclerosis-associated diseases (AAD) are, with an increasing incidence, responsible for almost half of the deaths among their respective populations. There is unequivocal evidence that medicine should try to achieve a reduction in manifestations of atherosclerosis by efficient preventive strategies. A variety of guidelines have been published during the last decades; nevertheless there is a gap between established recommendations and its application in everyday practice by Austrian physicians. The aim of this survey was to investigate physicians' knowledge of and attitude towards risk factors, preventive strategies and therapy of CHD and other AAD. METHODS: The self-administered questionnaire was mailed to 1000 physicians. We obtained an answer from a total of 286 physicians (general practitioners, GP) and specialists in internal medicine, IMS), who were asked about selected items concerning CHD and other AAD and an eventual modification in attitude towards diagnosis and treatment according to their own, personal risk profile. RESULTS: Risk factors for developing AAD such as elevated CH was identified in 77% (74% GP vs. 84% IMS), hypertension in 77% (76% GP vs. 81% IMS), elevated TG in 37% (40% GP vs. 26% IMS), excess alcohol consumption in 14% of all interrogated physicians (16% GP vs. 9% IMS) respectively. 77% (75% GP vs. 81% IMS) of the physicians considered the CH/HDL-ratio to be important in primary prevention and 83% (81% GP vs. 87% IMS) in secondary prevention; Lipoprotein(a) was considered important in only 9% (8% GP vs. 14% IMS) and 24% (19% GP vs. 41% IMS), respectively. CONCLUSION: In summary, all mentioned risk factors were heavily underestimated by Austrian physicians, partly leading to insufficient evaluation and therapeutic interventions. Secondary prevention was managed quite satisfactorily by both GP and IMS according to the Austrian guidelines. The knowledge about primary prevention strategies was significantly worse in GP compared to IMS. There is still a great need for information and training-programs for Austrian physicians to make primary and secondary prevention strategies work more effectively.

Antiplatelet activity of semotiadil fumarate.

Calcium antagonists are known to exert antiplatelet activity. Semotiadil fumarate (SD-3211), a new benzothiazine, was therefore examined for its antiplatelet activity. The inhibitory activity on adenosine diphosphate (ADP)-, collagen-, arachidonic acid (AA)-, and platelet activating factor (PAF)-induced platelet aggregation after the 1-, 30-, 60- and 120-min incubation at concentrations ranging from 1 x 10(-3), 1 x 10(-4), 1 x 10(-5), 1 x 10(-6) and 1 x 10(-7) was examined. The data were compared with those using diltiazem, nifedipine and amlodipine under identical conditions in blood from eight healthy volunteers (four males, four females; aged 23-36 years) and eight hypertensive patients (four males, four females; aged 31-46 years). Semotiadil showed a dose-dependent inhibition of platelet aggregation in vitro with all the agents examined. Using the various aggregation-inducing agents, the dose-dependent inhibitory action was comparable for all the compounds tested. The antiaggregatory potency was in the order diltiazem, semotiadil, amlodipine and nifedipine. The incubation period did not significantly affect the antiaggregatory effect. No difference between platelets derived from healthy volunteers and hypertensive patients was noted. These findings indicate potent antiplatelet activity of the new calcium antagonist semotiadil.