[Hypolipidemic drugs and diabetes mellitus]. / Hypolipidemika a diabetes mellitus.

Diabetes mellitus associates with high cardiovascular risk. The absolute values of cardiovascular risk tend to be even higher than as calculated from the SCORE tables. Recent randomized clinical trials have shown evidence of benefit and safety of more intensive LDL-cholesterol lowering in patients with diabetes and established cardiovascular disease supporting guidelines for a more intensive LDL goal of therapy. A recent meta-analysis has confirmed benefit on major coronary events and ischaemic stroke in many diabetic patient subgroups, including those with type 1 disease. The pathological combination of several lipoprotein metabolism abnormalities and the need to reach lipoprotein goals need combination therapy of hypolipidemic drugs with different mechanisms of action. Despite statin treatment, cardiovascular disease residual risk remains high. After LDL the next lipoprotein goal is to increase HDL. Although there has been disappointment with the first cholesteryl-ester-transfer-protein-inhibitor, there is encouraging evidence that increasing HDL with the peroxisome-proliferator-activator-receptor (PPAR) gamma agonist, pioglitazone and nicotinic acid derivatives may contribute beyond statin therapy.

[Nutrition for the diabetic patient with kidney disease]. / Výziva diabetika s onemocnením ledvin.

Malnutrition is a major problem in chronically ill patients. The combination of diabetes and renal insufficiency increases the risk of malnutrition, also due to dietary interventions associated with the two diseases. Resulting malnutrition intensifies inflammatory activity and further compromises nutrition intake. This results in a vicious circle which significantly reduces the quality of life of the affected patients and increases their mortality. Proper nutritional care for such patients is an integral part of their treatment.

[The MIAC (malnutrition, inflammation, atherosclerosis, calcification) syndrome]. / Syndróm MIAC (malnutrition, inflammation, atherosclerosis, calcification).

The number of patients with chronic renal failure is on the rise; these patients have a 10 to 20 times higher risk of development and progression of cardiovascular diseases. Higher cardiovascular risk in such patients cannot be satisfactorily explained by traditional risk factors defined in the Framingham study. On the contrary, a concept of reverse epidemiology has been brought forward, designating a situation in which the incidence of obesity and hyperlipoproteinemia is associated with a higher survival rate of the patients concerned. Higher risk is today explained by the "MIAC (malnutrition, inflammation, atherosclerosis, calcification) syndrome", which is present in patients with chronic kidney disease. New evidence has been recently obtained of different circulating molecules associated with atherosclerosis, the plasmatic levels of which are decreased or increased in such patients and which are in a way linked with the MIAC syndrome and the progression of atherosclerosis. Clinical management of the syndrome could increase survival in the future, and reduce morbidity and the number of hospitalisations. Circulating molecules could serve as markers evidencing the presence of the syndrome and its severity, as well as the success of treatment.